Sturla Nordlund

Episodic heavy drinking in four Nordic countries: a comparative survey.

AIMS The purpose of this study was to compare the phenomenon of episodic heavy drinking (binge drinking) and its different indicators in the Nordic countries. DESIGN A comparative survey of four Nordic countries. SETTING Telephone interviews in Denmark, 1997; Finland, 1996; Norway, 1996; and Sweden 1996-97. PARTICIPANTS Random samples of men and women aged 19-71 years. MEASUREMENTS Episodic heavy drinking was measured by the frequency of subjective intoxication, of drinking six or more drinks at a time (6+), and of negative consequences (mainly hangover symptoms). Additionally, annual consumption and measures of intake per occasion were used. FINDINGS Annual consumption, overall frequency of drinking and frequency of drinking 6+ were highest in Denmark and lowest in Norway. Frequency of subjectively defined intoxication was highest in Finland. There it was clearly higher than the frequency of drinking 6+, whereas in Denmark the contrary was observed. Finnish and Norwegian men and Danish women reported the largest quantities drunk per occasion. Results on 6+ frequency and the prevalence of negative consequences, with annual consumption held constant, suggest that Danes have the least concentrated drinking pattern. With annual consumption held constant, Norwegians report as high a frequency of intoxication, as do Finns. CONCLUSIONS The relations between subjective and more objective measures of episodic heavy drinking vary considerably between the Nordic countries. The results suggest that the definition, acceptability and experience of intoxication vary even when a set of relatively homogeneous countries are compared.

Contextual Determinants of Alcohol Consumption Changes and Preventive Alcohol Policies: A 12-Country European Study in Progress

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

What is alcohol abuse? Attitudes to drinking in seven European countries

Aims: To explore norms for alcohol consumption in different parts of Europe, by studying what people mean by “alcohol abuse.” Method: The participants were presented 18 standardized descriptions of different drinking patterns, obtained by systematically varying three levels of frequency of drinking, three levels of intoxication and two levels of context. Random samples of about 1000 persons aged 15 years and over were drawn from each of seven countries: Finland, Germany, Italy (Tuscany), Norway, Poland, Slovenia, and Spain. The participants were asked if they would call each of the descriptions “abuse” or not. As a measure of the “normative climate” in each country, the mean number of descriptions labeled “abuse” was calculated. We also estimated the conditional probabilities for using the different levels of the dimensions (frequency, intoxication, and context), given that the description was labeled “abuse.” This gave a quite easy comparison of the relative importance people in each country gave the different dimensions when they evaluated a drinking pattern as “abuse.” Results: Three distinct groups of countries appeared: The Nordic countries had the lowest number of descriptions labeled as “abuse,” and Tuscany and Slovenia the highest. The other countries came in the middle. Conclusion: It seems that norms for alcohol consumption vary geographically over Europe in a way that justifies the often used, but seldom defined, concept of “alcohol culture.” Southern European cultural settings suggest a normative system allowing for higher per capita consumption levels but also offering more restrictive informal norms on intoxication. Nordic countries, on the other hand, with their more restrictive alcohol policies, show a pattern of lower per capita consumption levels and less restrictive informal laws governing intoxication during drinking occasions.

What is alcohol abuse? Changes in Norwegians’ perceptions of drinking practices since the 1960s

The aims of this study is to demonstrate how perceptions of the concept of “alcohol abuse” have changed over time and to delineate variations among sub-groups of the Norwegian population. An initial survey was conducted in 1964 in 10 Norwegian cities. Follow-up surveys were conducted in 1989 and 2006 based on national, representative samples. From these samples presumably comparable sub-samples have been selected. The respondents characterised 18 different drinking situations as “abuse”, “not abuse” or “doubt”. The 18 drinking situations were constructed based on combinations of three degrees of drinking frequencies, three degrees of intoxication and two degrees of sociability. The different combinations were presented to the respondents on cards, and in a random order. Norwegians’ perceptions of alcohol consumption have undergone major changes, particularly with respect to perceptions of what constitutes “alcohol abuse”. In general, views have become more liberal and permissive. A shift in perceptions since 1964 was already manifest or: evident in 1989, but this has developed further in the same direction since then. The more people drink, the more liberal are their views on what is “alcohol abuse”? This applies both on individual and aggregated levels. Perceptions of drinking practices, especially of “alcohol abuse”, have shifted with the change in average alcohol consumption. The higher general consumption the more drinking is allow before it is perceived as abuse. This is probably a reciprocal process with no specific causal direction, but obviously influenced by external factors, such as economic and cultural globalisation, tourism and generally more liberal views on many other facets of society and social life.

An excellent book on gambling – with a rather modest title

The turnover of the gambling industry has exploded in most western countries during the last decades, so also in Britain. The first two chapters of this book describe the history of gambling in Britain since the Victorian times, and with emphasis on the latest part of the 20th century. This part presents a lot of details about the growth of the industry, on the regulation (or rather deregulation) and dynamics of the market, and on the policy making in this field. The presentation is confined to Britain, but it is interesting to see the parallels to the development in other countries, which could have been a subject for further comparative analysis. The next two chapters, which constitute more than one-third of the text, present a broad, thorough and critical review of the literature about gambling and problem gambling, starting with descriptions of the phenomenon, and proceeding to definitions, measuring instruments, prevalence estimations, correlations with other types of behaviour, theories of causality, both on an aggregate and individual level, and both social, psychological and biological ones. This part of the book is definitely not confined to British conditions and research. It is a comprehensive and critical international literature review, which can be ideal as an introduction to the field and as a book of reference. This is further accomplished by the impressive list of references and the very useful author index and subject index. Then the book turns to British conditions again, more precisely to a presentation of the first national survey of adult gambling and estimation of the prevalence of problem gambling in Britain. The presentation is largely a summary of the full report of the British Gambling Prevalence Survey that was done in 1999 by three of the authors of the book (Sproston, Erens and Orford). The results are nicely and clearly presented, but with a few exceptions they are not very surprising. The main features of gambling and problem gambling on different subgroups of society (e.g. sex, age, marital status, socio-economic variables, etc.) are quite similar to results from surveys in other countries. I think the generality of these features could have been stressed more in the text; the British are not that special!