Table Of ContentMapping the Social Consequences of Alcohol Consumption
Mapping the Social
Consequences of Alcohol
Consumption
Edited by
Harald Klingemann
Institute for Social Planning and Social Management,
University of Applied Sciences, Bern, Switzerland
and
Gerhard Gmel
Swiss Institute for the Prevention of
Alcohol and Other Drug Problems
Lausanne, Switzerland
Published on behalf of the World Health Organization Regional Office for Europe
by Kluwer Academic Publishers, Dordrecht, The Netherlands
SPRINGER-SCIENCE+BUSINESS MEDIA, B.Y.
Library of Congress Cataloging-in-Publication Data is available.
ISBN 978-90-481-5626-9 ISBN 978-94-015-9725-8 (eBook)
DOI 10.1007/978-94-015-9725-8
The views expressed in this publication are those of the author(s)/contributors and do not
necessarily represent the decisions or the stated policy of the World Health Organization.
Prillted OII acid-free paper
AII Rights Reserved
© 2001 Springer Science+Business Media Dordrecht
Originally published by WorId Health Organization in 2001
Softcover reprint ofthe hardcover 1st edition 2001
No part of this publication may be reproduced or
utilized in any form or by any means, electronic, mechanical,
including photocopying, recording or by any information storage and
retrieval system, without written permis sion from the copyright owner.
Contents
List of contributors IX
Introduction: Social consequences of alcohol - the
forgotten dimension?
H. Klingemann and G. Gmel
1. Concepts, dimensions and measures of alcohol-related
social consequences - A basic framework for alcohol-related
benefits and harm
J. Rehm 11
Measurement issues 15
References 18
2. What is meant by 'alcohol-related' consequences?
K. Pernanen 21
Alcohol-relatedness: coincidence, common etiology
and causality 21
Social-science and natural-science processes and consequences 22
Establishing a causal relationship 24
An alcohol-free society 25
Determining social consequences 27
Multiple causal determination 28
References 31
3. Alcohol consumption and social harm: quantitative
research methodology
G. Gmel and E. Gutjahr 33
Assessment of outcome 34
Assessment of exposure 40
Covariates: confounding and control variables 41
Study design 42
v
vi Contents
Some less-known designs for investigation of alcohol-
related social harm 44
Conclusions 47
References 48
4. Consequences of drinking to friends and the close social
environment
K. Pernanen 53
Friends, social environment 53
Concluding remarks 62
References 63
5. The impact of alcohol consumption on work and education
J. Rehm and I. Rossow 67
Work 67
Alcohol and absenteeism 68
Alcohol-related work problems other than absenteeism 70
Interaction of alcohol consumption with other factors 70
Drinking patterns associated with workplace problems 71
Education 71
References 74
6. Problem drinking and relatives
E.Mafflj 79
Introduction 79
Consequences for children 80
Consequences for the spouse/partner 84
Conclusion 86
References 88
7. Accidents, suicide and violence
I. Rossow, K. Pernanen and J. Rehm 93
Introduction 93
Alcohol and external trauma 94
Alcohol and accidents 95
Suicide and parasuicide 98
Alcohol and violence 100
Disability and mortality 104
Summary and implications 105
References 107
Contents vii
8. Public order and safety
H. Klingernann 113
The role of alcohol in crime: police and the criminal
justice system as guardians of 'the public order' 114
Compulsory treatment and 'danger to the public':
treatment and criminal justice cooperating in the
interests of the public order 115
The impact of alcohol consumption on the physical
and social environment, and communal/municipal
authorities as representatives of the public order 117
Alcohol consumption as part of deviant life-styles?
Skid rows and the homeless: welfare agencies, social work
and neighbourhoods with vested interests in public order 119
Drinking and occupational careers: conflicts at the
work-site and discrimination in the labour market 120
Public order and cultural aspects: social climate and
level of tolerance 121
Symbolic public display and potential offence to onlookers
of alcohol as a commodity: moral crusaders defending the
public order or controlling the poor? 124
Drinking and alcohol in youth subcultures: youth and
alcohol in conflict with the dominant culture (controlling youth) 125
Hooliganism - 'episodic' antisociaL delinquent behaviour:
social workers, politicians and the public as guardians of
'the public order' 126
Concluding remarks: implications for policy makers 127
References 129
9. The social costs of alcohol consumption
E. Gutjahr and G. Grnel 133
What constitutes social costs and how they are estimated 133
Recent European and non-European cost estimates 135
Policy implications 140
References 142
10. Harm minimization
M. Plant 145
Introduction: What is 'harm minimization'? 145
Education 147
Community action 148
Safer drinking places 151
Labelling to warn and inform 152
viii Contents
Treatment 154
Sustainability 154
Structural control policies 155
Conclusion 156
References 157
11. Community initiatives as strategies for implementation
of the European Alcohol Action Plan
M. Holmila 161
Introduction 161
Examples of reported European projects 164
The Lahti project 164
The Florence Community Alcohol Research project 165
The Kirseberg project 165
The Malczyce Community Action project in Poland 165
The Stad project in Stockholm, Sweden 165
Lessons learned 166
References 168
Contributors
Gmel. Gerhard
Swiss Institute for the Prevention of Alcohol and Other Drug Problems. Lausanne.
Switzerland
Gutjahr. Elisabeth
Swiss Institute for the Prevention of Alcohol and Other Drug Problems. Lausanne.
Switzerland
Holmila. Marja
Social Research Unit for Alcohol Studies. STAKES. Helsinki. Finland
Klingemann. Harald
Institute for Social Planning and Social Management. University of Applied Sciences.
Bern. Switzerland
Maffli. Etienne
Swiss Institute for the Prevention of Alcohol and Other Drug Problems. Lausanne.
Switzerland
Pemanen. Kai
National Institute for Alcohol and Drug Research, Oslo. Norway
Plant, Martin
Alcohol and Health Research Centre, City Hospital. Edinburgh, Scotland, United
Kingdom
Relzm, lurgen
Addiction Research Institute, Zurich. Switzerland
RossoII', Ingeborg
National Institute for Alcohol and Drug Research, Oslo. Norway
IX
Introduction:
Social consequences of alcohol
- the forgotten dimension?
H. Klingemann and G. Gmel
Health consequences of long-term drinking along with issues of drinking and
driving have dominated public discussion on alcohol-related problems. Such
social consequences as non-traffic injuries, spouse/family problems, stranger
violence, and suicide or attempted suicide have received much less public or
research attention. Recent instances of this selective perspective are the report
prepared for the Australian Commonwealth Department of Health and Aged
Care [1] and the lath Special Report to the United States Congress on 'Alcohol
and Health' [2]. Though the emphasis of the latter report is largely on aspects of
neuroscience and biology, including genetics, and on medical consequences, it
includes sections on 'Alcohol and Violence', 'Psychosocial Factors' and 'Alcohol
Impaired Driving', in recognition of the relevance of non-medical consequences
of alcohol consumption. This may be indicative of a growing interest in a
broader concept of alcohol-related consequences, including harm-reduction as
a concern of drug/alcohol policy and research [3]. An example of the increasing
recognition of alcohol as an agent of social problems is the release by the British
Home Office in August 2000 of an action plan entitled Tackling alcohol related
crime, disorder and nuisance [4]. The scientific community also has been devoting
increased attention to the relationship between patterns of consumption and
social consequences. Two combined factors are associated with harmful social
consequences of drinking: the volume of alcohol consumed, and the frequency
of heavy-drinking events. Conferences held in 1995 in Toronto (International
Conference on Social and Health Effects of Drinking Patterns) and a follow-up
meeting in 1998 in Perth, Australia, have shed more light on these hitherto
unexplored issues and highlighted the need to collect more data and improve
methods of assessing alcohol-related social outcomes (see a selection of articles
Harald Klingemann and Gerhard Gmel (eds.). Mapping the Social Consequences of Alcohol
Consumption. 1-9.
© 2001 Kluwer Academic Publishers.
2 Introduction
and summaries in Addiction II, 1996, the thematic issue of Contemporary
Drug Problems 3, 1996, and [5, 6]). This leads us to the focus of this book.
Clearly, alcohol has many consequences, harmful as well as beneficial, that
can be characterized as 'social' and not medical, or at least only indirectly
health-related. This is reflected in the Second European Alcohol Action Plan
2000-2005 of the Regional Office for Europe of the World Health Organization
(WHO) [7], designed to prevent or reduce the harm caused by alcohol to the
health and well-being of individuals, families and communities.
The present volume is the product of a first attempt to provide a comprehen
sive overview of the social consequences of alcohol consumption for individuals,
groups, organizations and society. It is the outcome of a two-year collaborative
project under the leadership of the WHO collaborating centre for substance
abuse, research, prevention and documentation (The Swiss Institute for the
Prevention of Alcohol and Drug Problems) with the participation of alcohol
researchers from Finland, Germany, Norway, Scotland and Switzerland. Its
scope, however, is not limited to a regional perspective.
A working meeting of the expert group concerned first took place on the
occasion of the annual meeting of the Kettil Bruun Society for Social and
Epidemiological Research on Alcohol, in Montreal, Canada in 1999, and a
closing workshop was held at Les Diablerets, Switzerland in 2000. At these
meetings the group discussed the joint framework and developed a working
definition of 'social consequences of alcohol consumption'.
At this point a disclaimer is necessary: The project has been concerned
specifically with the descriptive epidemiology of social harm attributable to
alcohol consumption. Because of the extensive coverage that this demanded,
only two chapters could be devoted to strategies for reducing social harm from
alcohol consumption: those on community programmes and harm-reduction
measures. Especially in relation to policy, therefore, the book should be seen as
complementary to other projects already carried out or under way. Most
prominent of these is an updating of the project 'Alcohol Policy and the Public
Good', co-sponsored by the WHO Regional Office for Europe, on alcohol
problems, including, for the first time, social consequences. A publication from
that project is expected in 2001 or 2002 (Oxford University Press). Already
appearing this autumn as a special issue of Addiction will be the results of the
'Supply Side Initiative', also sponsored by the Regional Office, covering, among
other subjects, those of 'alcohol policy and public health' and 'the role of
commercial interests in alcohol policies', both of which have implications,
positive and negative, for 'social consequences'. Two other activities are relevant
in this context: the topical comparative study on alcohol consumption and
alcohol problems among women in European countries [8]; ECAS (European
Comparative Alcohol Study), which addresses major elements of alcohol policy
in the European Union [9, 10]; and efforts to refine measurements (e.g. the
Conference in 2000 on 'Measuring Drinking Patterns, Alcohol Problems, and
their Connection', at Skarp6, Sweden).
