Abstract: Objective. This
article describes the demographic characteristics and psychological
differences in a sample of female heavy and non-heavy drinkers who
attended three emergency services of the Mexican city of Pachuca, Hidalgo.
Material and Methods. A sample of patients seen at emergency services (ES)
over the age of 18 was selected using ES admission forms.
Twenty-five-minute, face-to-face interviews were conducted by a group of
trained interviewers. Patients answered various questionnaires and scales
to measure alcohol consumption and to provide information on variables
that have proved to be related to female drinking. Results. Thirty-six
women (5.2%) out of 717 of the number of women were found to be heavy
drinkers according to the TWEAK scale. This group of women had 2.3 times
the risk of becoming depressed, 2.87 times the risk of taking other drugs,
1.95 times the likelihood of having been sexually abused and 1.57 times
the risk of displaying suicidal ideation. Conclusions. Data from this
small analysis confirm international findings that problem drinking among
females throughout the life cycle is linked to depression. As regards the
screening instruments employed, it is necessary to conduct more in-depth
research to enrich their contents and increase their reliability and
validity when used among
female populations. In this study, the TWEAK proved to be extremely useful
for studies in emergency services. The English version of this paper is
available too at: http://www.insp.mx/salud/index.html
Received from Maaria Lindblad, Nordic
Council for Alcohol and Drug Research (NAD), November 20, 2002
New
NAD publication
Room, Robin (Ed.): The Effects of Nordic Alcohol Policies – what
happens to drinking and harm when alcohol controls change? NAD publication
No. 42. Helsinki: Nordic Council for Alcohol and Drug Research (NAD)
Alcohol
control policies have changed in big ways and small over the last 50 years
in the Nordic countries. Particularly in Finland, Norway and Sweden there
have been active traditions of studying the effects of these changes. In
this volume, the results of these studies are reviewed and a number of new
analyses are made. Among the questions addressed are:
*
Who started to drink more, and on which occasions, when alcohol became
much more available in Finland in 1969 and when beer became available in
Iceland in 1989?
*
Did the removal of medium-strength beer from Swedish grocery stores in
1977, or the introduction in 1998 of a minimum age limit of 15 for
off-sale purchases in Denmark, affect young people’s drinking?
*
Did the strike in Norwegian alcohol shops in 1982 diminish the level of
harms?
*
And what happened when round-the-clock opening of restaurants in Reykjavik
in 1999 was introduced?
The
main emphasis in these analyses is on the differential effects of changes
of alcohol control on different demographic groups, on heavier as against
lighter drinkers, and on different alcohol related harms. The results show
that heavier drinkers and alcohol-related problem rates are often more
strongly affected than the population’s overall level of consumption of
alcohol.
The publication can be ordered
from:
The Nordic Council for Alcohol and Drug Research (NAD)
Annankatu 29 A 23, FIN-00100 Helsinki, Finland
Telephone: +358-9-694 80 82 or 694 95 72; Fax: +358-9-694 90 81
E-mail: nads@kaapeli.fi, Http://www.kaapeli.fi/nad
Fee: 12 EUR (order within Europe) and 20 EUR/USD
(order outside Europe). To pay, use Eurogiro, to NAD:s giro account
number: 800015-1220009 with Sampo Bank plc, Unioninkatu 22, FIN-00075
Sampo, Finland; SWIFT address: PSPBFIHH.
Payment by credit card: please contact NAD.
Pekka
Sulkunen, Caroline Sutton, Christoffer Tigerstedt & Katarina Warpenius
(eds.), Broken Spirits [:] Power and Ideas in Nordic Alcohol Control,
NAD Publications No. 39, Helsinki: Nordic Council for Alcohol and Drug
Research, 2000.
Visit NAD's
web site (www.kaapeli.fi/nad) for
links to this book's table of contents and the text of its Preface and
Introduction. May be ordered via email to NADS, at nads@kaapeli.fi .
--posted by Pia Rosenqvist
.
The
"International guide for monitoring alcohol consumption and related
harm" has been published by WHO, Management of Substance Dependence.
Reference:
World Health Organization (2000) International Guide for monitoring
alcohol consumption and related harm. World Health Organization,
Geneva. (WHO/MSD/MSB/00.4)
The guide is
intended to give guidance to WHO Member States on epidemiological
monitoring of alcohol consumption and related harm and provides
general principles and practical guidance on the development of
realistic and effective sets of indicators of alcohol consumption and harm
for different countries with different level of resources.
Tim Stockwell
and Tanya Chikritzhs were largely responsible for the final draft.
Several other members of the Kettil Bruun Society were involved in the
drafting, or provided detailed feedback, and meetings on the project took
place in connection with KBS thematic meetings.
For a free
copy of the document please contact:
Mrs. Tess Narcisot
Management of Substance Dependence
Mental Health and Substance Dependence Department
World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland
Tel + 41 22 791 47 91
Fax + 41 22 791 48 51
email: narcisot@who.int
Other new
publications also available from the WHO Geneva office:
* Global
Status Report on Alcohol. Geneva: WHO, 1999. WHO/HSC/SAB/99.11
* Leanne
Riley & Mac Marshall, eds., Alcohol and Public Health in 8
Developing Countries. Geneva: WHO, 1999. WHO/HSC/SAB/99.9.
--posted by Robin
Room
Harold D.
Holder, ed., Sweden and the European Union: Changes in National Alcohol
Policy and Their Consequences, Stockholm: Almqvist & Wiksell
International, 2000. ISBN 91-22-01868-9. The book
includes chapters by a variety of Swedish contributors, including Björn
Trolldahl, Eckart Kühlhorn, Mats Ramstedt, Håkan Leifman, Anders
Romelsjö and Thor Norström. Among the issues discussed, focussing
particularly on the period since Sweden joined the EU in 1995, are
estimating the total consumption (including unrecorded); cross-border
buying in the south of Sweden (including an analysis by Norström
indicating how far people will travel for bargain alcohol), and changes in
the on-premise consumption market.
Roberta
Ferrence, John Slade, Robin Room and Marilyn Pope, eds., Nicotine and
Public Health. Washington: American Public Health Association, 2000.
ISBN 0-87553-249-7. This book is the result of an
international conference and Canada/U.S. working group exploring the
options for harm reduction approaches to nicotine use. Includes
perspectives from experiences in the alcohol and opiate arenas.
--posted by Robin
Room
An
almost-complete list of Kathryn Graham's publications and info on the
Safer Bars project may be found at http://publish.uwo.ca/~kgraham/
--posted by Kate
Graham
Recent scientific publications,
continually updated alcohol policy databases for the 50 U.S. states, model
local alcohol control ordinances, and numerous other products of the
Alcohol Epidemiology Program at the University of Minnesota may be
reviewed at our website: http://www.epi.umn.edu/alcohol
--posted by Alex Wagenaar
E. Single, J. Rehm, L.
Robson, M. Truong, "The relative risks and aetiologic fractions of
different causes of disease and death attributable to alcohol, tobacco and
illicit drug use in Canada," Canadian Medical Association Journal
162 (2000): 1669-1675.
Objective: This study
summarizes the relative risk of death and disease attributable to alcohol,
tobacco and illicit drugs, and estimates morbidity and mortality
attributable to substance abuse for Canada in 1996. Design: Using pooled
estimates of relative risk, aetiologic fractions are calculated by age,
gender and province for 90 causes of disease or death attributable to
alcohol, tobacco or illicit drugs, and then applied to national mortality
and morbidity data to estimate the number of deaths and hospitalizations
attributable to substance abuse. Results: There were 34,728 deaths and
197,755 hospitalizations attributed to tobacco, 6,503 deaths and 82,003
hospitalizations due to alcohol and 804 deaths and 6,925 hospitalizations
due to illicit drugs in 1995. Conclusions: The use and misuse of alcohol,
tobacco and illicit drugs account for 20% of deaths, 22% of years of
potential life lost and 10% of hospitalizations in Canada.
E. Single, P. Christie and
R. Ali, "The impact of cannabis decriminalisation in Australia and
the United States", Journal of Public Health Policy 21,2
(Summer, 2000): 157-186.
This paper summarises and
compares the impacts of cannabis decriminalisation measures in two
countries. In Australia, an expiation model of decriminalisation succeeded
in avoiding the imposition of criminal convictions for many offenders, but
substantial numbers of offenders received criminal convictions because of
a general “net-widening” in cannabis offence detections, and the
failure of many offenders to pay expiation fees and thus avoid criminal
prosecution. Despite these problems, the expiation approach has been
cost-effective, reducing enforcement costs without leading to increased
cannabis use. In the United States, cannabis decriminalisation similarly
reduced enforcement costs, with enforcement resources generally redirected
toward trafficking and other illicit drugs. There were no increases
in cannabis use or substantial problems that could be ascribed to
decriminalisation. The implications to other countries are discussed, with
particular attention to the importance of implementation issues,
monitoring and evaluation. Although decriminalisation has succeeded in
reducing enforcement and other costs without increasing the problems
associated with cannabis use, the same impacts would not necessarily
result from the legalisation of cannabis or the decriminalisation of other
illicit drugs.
E. Single, D. Collins, B.
Easton, R. Harwood, H. Lapsley and A. Maynard, International Guidelines on
Estimating the Costs of Substance Abuse, Ottawa: Canadian Centre on
Substance Abuse, 1996. Available on the CCSA website (www.ccsa.ca).
This document presents a
general framework for the development of cost estimates. Studies of the
economic costs of substance abuse are described as a type of
cost-of-illness study in which the impact of substance abuse on the
material welfare of a society is estimated by examining the social costs
of treatment, prevention, research, law enforcement and lost productivity
plus some measure of the quality of life years lost, relative to a
counterfactual scenario in which there is no substance abuse. A matrix of
the types of costs to be considered is presented, and there is a detailed
discussion of the theoretical issues involved, including: the definition
of abuse, determination of causality, comparison of the demographic and
human capital approaches to cost estimation, the treatment and measurement
of addictive consumption, the treatment of private costs, the measurement
of intangible costs, the treatment of non-workforce mortality and
morbidity, the treatment of research, education, law enforcement costs,
the estimation of avoidable costs and budgetary impact of substance abuse.
The guidelines conclude with a brief discussion of future directions, with
particular attention to the implications of these guidelines to research
agendas and data collection systems. (Author's note: The guidelines are
currently being updated in light of recent experience in their
application, with particular attention to special considerations in
developing economies and drug-producing countries.)
--posted by Eric Single
Boots, K. and Midford, R.
(2000) Mass Media Marketing and Advocacy to Prevent Harm. In Heather, N.,
Peters, T. and Stockwell, T.R. (Eds), International Handbook on Alcohol
Problems and Dependence. John Wiley and Sons, Chichester, UK. [In
Press]
Brinkman, S., Chikritzhs,
T., Stockwell, T.R. and Mathewson, P. (2000). An indicator approach to
the measurement of alcohol related violence. In Williams, P. (Ed)
Alcohol young people and Violence, Australian. Australian Institute of
Criminology, Research and Public Policy, Canberra.
Chikritzhs, T., Jonas, H.,
Heale, P., Stockwell, T.R., Dietze, P. and Hanlin, K. (2000). National
Alcohol Indicators Project Technical Report No. 1: Alcohol-caused deaths
and hospitalisations in Australia, 1990-1997. National Drug Research
Institute. Curtin University of Technology, Perth, Western Australia.
ISBN: 1 86342 907 7
This is the first report of
the National Alcohol Indicators Project (NAIP). The aim of NAIP is
to monitor and report on trends in alcohol-related and alcohol-caused harm
in Australia, at national, state and local levels. The NAIP is a
collaborative project between the National Drug Research Institute (Curtin
University of Technology) and Turning Point, Alcohol and Drug Centre Inc.
The NAIP is funded by the National Drug Strategy.
This report estimates the
burden of alcohol misuse (hazardous/harmful levels as defined by Pols
& Hawks in the 1992 NHMRC guidelines) in terms of morbidity and
mortality on the 1997 Australian population and documents the trend in
deaths and hospitalisations between 1990 and 1997. Patterns across
different geographic regions of the country were also examined. Major
variables under consideration included the age and sex of the persons
dying or being hospitalised as well as their Indigenous status.
Alcohol is a leading cause
of death, injury and illness in Australian society. For 1992, the annual
cost of alcohol-caused problems to the nation was conservatively estimated
at over $4.5 billion _ about 2.6 times the cost for illicit drugs (Collins
and Lapsley, 1996). Higgins et al. (2000) estimated that in 1997 the total
number of deaths due to illegal drug use in Australia was 832, while the
number of deaths due to tobacco use was 18,224.
This technical report
accompanies the NAIP Bulletin No. 1, detailing the methods employed and
providing additional results. Future bulletins and technical reports will
report on; alcohol-related road injury, violence, per capita alcohol
consumption and levels of high-risk alcohol consumption in the community.
Chikritzhs, T., Stockwell,
T.R., Heale, P., Dietze, P. and Webb, M. (2000). Trends in
alcohol-related road injury in Australia, 1990-1997. National Alcohol
Indicator Project, Bulletin No. 2. National Drug Research
Institute, Curtin University of Technology, Perth, Western Australia.
Chikritzhs, T., Stockwell,
T.R., Heale, P., Dietze, P. and Webb, M. (2000). National Alcohol
Indicators Project Technical Report No. 2: Trends in alcohol-related road
injury, 1990-1997. National Drug Research Institute. Curtin University
of Technology, Perth, Western Australia. ISBN: 1-86342-927-1
This is the second report
of the National Alcohol Indicators Project (NAIP). The aim of NAIP is to
monitor and report on trends in alcohol-related and alcohol-caused harm in
Australia, at national, state and local levels. The NAIP is a
collaborative project between the National Drug Research Institute (Curtin
University of Technology) and Turning Point Alcohol and Drug Centre Inc.
and is funded by the National Drug Strategy.
This report documents
trends in alcohol and non-alcohol related serious road injuries (SRIs),
including fatalities and hospitalisations, between 1990 and 1997 for all
Australian states and territories. It also provides estimates of the
proportions of all fatally injured drivers and pedestrians that were
alcohol-related and provides age and sex profiles for alcohol and
non-alcohol involved serious road injuries. Such estimates have not
previously been published for all Australian jurisdictions.
Alcohol is a major cause of
road injury in Australia. Using aetiologic fraction methodology, it was
estimated that in 1997, high-risk drinking caused 418 road deaths and
7,789 hospitalisations (Chikritzhs et al., 1999). The average cost of a
single road fatality or hospitalisation in Australia has been
estimated at about $750,000 and $132,000 respectively, resulting in a
total of over $1.3 billion for 1997.
Farringdon, F. (2000). Healthway
Research Starter Grant Final Report: SHAHRP 2000: An alcohol education
program for senior secondary school students. National Drug Research
Institute, Curtin University of Technology, Perth, Western Australia.
Farringdon, F., McBride,
N. and Midford, R. (2000). The fine line: Students perceptions of
drinking, having fun and losing control. Youth Studies Australia, 19,
(3), pp. 33-38.
The School Health and
Alcohol Harm Reduction Project (SHAHRP) 2000 is a quasi-experimental,
research intervention currently being conducted in 14 high schools in
Perth Western Australia, involving over 2000 intervention and control
students. The aim of the study is to provide senior high school students
with skills to enable them to minimise alcohol-related harms they have
identified as commonly encountered or of particular relevance, at a time
when alcohol use typically increases. To ensure that the SHAHRP 2000
intervention was sensitive to the concerns of the students it sought to
influence, a series of focus groups were conducted with Year twelve
Western Australian students. The aim was to identify young people's
alcohol use experiences, alcohol related harms that are of particular
concern to young people, harm reduction strategies used by young people
and educational approaches likely to be effective with young people.
The students were
remarkably consistent in many of the issues they identified as being of
concern to them. It is clear that drinking alcohol is commonplace and that
drinking in moderation is the desired behaviour. For these young people
however, drinking in moderation means not losing control, not necessarily
not getting drunk and they acknowledged that often it is difficult to find
the line between drinking and having fun and then losing control. As a
result they indicated that young people experience a range of harms and
although they are aware of commonly promoted harm reduction strategies
they believe these are not appropriate or realistic for young people.
Regarding alcohol education, the young people interviewed were quite
scathing in their views, indicating that it is boring, has abstinence as
its primary goal and focuses on the negative aspects of drinking. This was
viewed as inappropriate and inconsistent with young people experiences
with alcohol. One of the strongest messages from these focus groups is
that alcohol education programs that ignore young people's concerns are
likely to be viewed as irrelevant by young people. Consequently, the
insights gained from the focus groups have been used in the development of
the SHAHRP 2000 program, ensuring it has a basis in situations experienced
by young people.
Gray, D. (2000).
Indigenous Australians and liquor licensing restrictions. Invited and
refereed editorial. Addiction, 95, pp. 1469-1472.
Gray, D. and Chikritzhs,
T. (2000). Regional variation in alcohol consumption in the Northern
Territory. Australian and New Zealand Journal of Public Health, 24,
(1), pp. 35-38.
Objective: To identify any
regional variation in per capita consumption of pure alcohol, and the
types of beverages consumed in the NT; and, to estimate the relative
contributions to consumption by Aboriginal and non-Aboriginal people.
Method: Estimates of per
capita consumption were based on wholesale purchases of alcohol by
licensee and census population data. Mean levels of per capita
consumption, and the percentages of each beverage type consumed, were
compared between regions and through time. Estimates of per capita levels
of consumption between Aboriginal and non-Aboriginal segments of the
population were based upon reports of the proportion of frequent and
occasional drinkers in each group and the ratio of consumption among
Aboriginal and non-Aboriginal drinkers.
Results: Mean quarterly per
capita consumption was higher in both the Lower Top End (4.22 litres) and
the Central NT (4.04 litres), and less in the Barkly (3.44 litres) than in
the Top End (3.55 litres). Over the four year period there was a rise of
6.4 per cent in consumption in the Top End and a decline of 22.5 percent
in the Barkly. In the Lower Top End and the Central NT a larger percentage
of alcohol was consumed as cask wine than in the Top End. Prior to the
introduction of licensing restrictions, this was also the case in the
Barkly. In the NT, per capita consumption among Aboriginal people is
approximately 1.97 times, and among non-Aboriginal people about 1.43
times, the national average. Conclusions: In the NT, alcohol consumption
is greater than in Australia as a whole and there is significant regional
variation. The problem is not simply an Aboriginal problem, and a broad
range of strategies-which include a component to address regional
variation-is required to reduce it.
Gray, D., Saggers, S.,
Atkinson, D., Sputore, B. and Bourbon, D. (2000). Beating the grog: an
evaluation of the Tennant Creek liquor licensing restrictions. Australian
and New Zealand Journal of Public Health, 24, (1), pp. 39-44.
Objective: To identify any
regional variation in per capita consumption of pure alcohol, and the
types of beverages consumed in the NT; and, to estimate the relative
contributions to consumption by Aboriginal and non-Aboriginal people.
Method: Estimates of per
capita consumption were based on wholesale purchases of alcohol by
licensee and census population data. Mean levels of per capita
consumption, and the percentages of each beverage type consumed, were
compared between regions and through time. Estimates of per capita levels
of consumption between Aboriginal and non-Aboriginal segments of the
population were based upon reports of the proportion of frequent and
occasional drinkers in each group and the ratio of consumption among
Aboriginal and non-Aboriginal drinkers.
Results: Mean quarterly per
capita consumption was higher in both the Lower Top End (4.22 litres) and
the Central NT (4.04 litres), and less in the Barkly (3.44 litres) than in
the Top End (3.55 litres). Over the four year period there was a rise of
6.4 per cent in consumption in the Top End and a decline of 22.5 percent
in the Barkly. In the Lower Top End and the Central NT a larger percentage
of alcohol was consumed as cask wine than in the Top End. Prior to the
introduction of licensing restrictions, this was also the case in the
Barkly. In the NT, per capita consumption among Aboriginal people is
approximately 1.97 times, and among non-Aboriginal people about 1.43
times, the national average.
Conclusions: In the NT,
alcohol consumption is greater than in Australia as a whole and there is
significant regional variation. The problem is not simply an Aboriginal
problem, and a broad range of strategies-which include a component to
address regional variation-is required to reduce it.
Heale, P., Stockwell, T.R.,
Dietze, P., Chikritzhs, T. and Catalano, P. (2000). Patterns of alcohol
consumption in Australia, 1998. National Alcohol Indicators Project,
Bulletin No. 3. National Drug Research Institute, Curtin University of
Technology, Perth, Western Australia.
Heather, N., Peters, T.
and Stockwell, T.R. (Eds) (2000). International Handbook on Alcohol
Problems and Dependence. John Wiley and Sons, UK. [In Press]
Hulse, G.K., Saunders, R.,
Roydhouse, R.M., Stockwell, T.R. and Basso, M.R. (2000). Screening for
hazardous alcohol use and dependence in psychiatric inpatients using the
AUDIT questionnaire. Drug and Alcohol Review, 19, (4), pp. 291-298.
The Alcohol Use Disorders
Identification Test (AUDIT) has been used to screen for hazardous and
harmful alcohol consumption among general hospital populations but not in
psychiatric patients. Using the AUDIT, we assessed alcohol use in patients
with four major types of psychiatric disorder, namely mood, adjustment,
anxiety and psychotic disorders. Nine hundred and ninety consecutive
admissions to the psychiatric units of two hospitals during a 12-month
period underwent assessment. In each diagnostic group a high proportion of
patients was alcohol-dependent. Among those with mood disorders 25.4% of
men were alcohol-dependent, compared with 16.3% of women, while 34.5% of
men with anxiety disorder were alcohol-dependent, compared with 25.0% of
women. Both gender differences were statistically significant. The
differences were even greater for adjustment disorder (44.4% vs. 14.5%)
and psychosis (29.2% and 4.2%, respectively). More men than women with
anxiety disorder were classified as hazardous (24.1% vs. 11.7%) or harmful
drinkers (13.8% vs. 3.3%), but for the other diagnostic groupings the
percentages in these drinking categories were more nearly similar. Thus,
there is a high rate of excessive alcohol consumption in people with
psychiatric disorders, especially males. Such individuals may be
particularly vulnerable to complications of alcohol misuse such as suicide
and exacerbation of their disorder. The potential for decreased severity
of psychiatric symptoms and a reduction in the number of hospital
admissions following cessation or reduction in alcohol consumption is
considerable. The AUDIT is a simple screening device for investigating
alcohol use and dependence, and offers a means of initiating intervention
in this population.
McBride, N., Farringdon,
F. and Midford, R. (2000). What harms do young Australians experience in
alcohol use situations. Australian and New Zealand Journal of Public
Health, 21, (1), pp. 54-59.
Objective: This paper
provides an insight into the alcohol-related experiences of young students
in Perth, Western Australia with particular emphasis to alcohol-related
harm. Method: The study sample of 2329 students (female: n=1089, male:
n=1240) is a school-based group that was selected using cluster sampling,
with stratification by socio-economic area and represents young 11 to 12
year olds experiences with alcohol and alcohol-related harm. The fourteen
schools involved in the study represent approximately 23% of government,
secondary schools in the Perth metropolitan area. The SHAHRP survey
instrument was purposely developed and pre-tested to measure students'
knowledge, attitudes, patterns of use, context of use, harms associated
with the students own alcohol consumption and harms associated with other
people use of alcohol and incorporates the students perceptions of
alcohol-related harm. Results: The results indicate that: nearly two
thirds of all young people consumed alcohol under adult supervision;
nearly 40% of all young males and 34% of all young females also drink
alcohol in unsupervised situations; and a fifth of young males consumed
alcohol alone. Young males start drinking at a younger age than young
females, consumed alcohol more regularly than young females and consumed
more alcohol per occasion. In the last 12 months, young males experienced
over five alcohol-related harms associated with their own alcohol
consumption, young females experienced over three alcohol-related harms
associated with their own drinking. Young males and females experienced a
similar number of harms associated with other peoples use of alcohol.
Overall, young people experienced an average of seven alcohol-related
harms in the last 12 month. Unsupervised drinkers experienced 12
alcohol-related harms per month and were nearly 7 times more likely to
experience alcohol-related harm than supervised drinkers and nearly 13
times more likely to experience alcohol-related harm than non-drinkers.
Conclusion/Implications: The results of this study can assist in the
informing the development of alcohol education programs for young people.
McBride, N., Midford, R.
and Farringdon, F. (2000). Alcohol harm reduction education in schools:
Planning an efficacy study in Australia. Drug and Alcohol Review,
19, pp. 83-93.
The School Health and
Alcohol Harm Reduction Project (SHAHRP) is a four year,
quasi-experimental, evidence-based intervention research study designed to
explore the effects of a student focused, secondary school, alcohol
education intervention in reducing alcohol-related harm experienced by
school students. The SHAHRP study is unusual in that it has a primary aim
of harm minimisation rather than non-use or delayed use. The SHAHRP
intervention aims to reduce harm by enhancing students' abilities to
identify and deal with high risk drinking situations particularly likely
to be encountered by young people. The intervention involves eight lessons
in the first year with five booster lessons in the subsequent year. The
SHAHRP research will follow individual students exposed to both the
alcohol and health promotion interventions, over three successive years
taking measures in: knowledge; attitudes; patterns of use; context of use;
alcohol related harm associated with the students own use; alcohol related
harm associated with other peoples use of alcohol. This paper describes
the evidence-based conceptual components and design of the study by
providing a review of the health and drug education literature
particularly related to components that have the potential of influencing
behaviour.
McBride, N., Midford, R.,
Farringdon, F. and Phillips, M. (2000). Early results from a school
alcohol harm minimisation study. Addiction, 95, (7), pp. 1021-1042.
Aims: The School Health and
Alcohol Harm Reduction Project aims to reduce alcohol-related harm by
enhancing students' abilities to identify and deal with high risk drinking
situations particularly likely to be encountered by young people. Design:
The SHAHRP study has adopted a quasi-experimental research design,
incorporating intervention and control groups and measuring change over a
three year period. Setting: The study is set in metropolitan, government
secondary schools (13-17 year olds) in Perth, Western Australia. The
fourteen schools involved in the SHAHRP study represent approximately 23%
of government, secondary schools in the Perth metropolitan area.
Participants: The sample was selected using cluster sampling, with
stratification by socio-economic area and involves over 2300 intervention
and control students from junior secondary schools. Seventy three percent
(73.7%) of students completed surveys at both baseline and first
follow-up. Intervention: The intervention incorporated evidence-based
approaches to enhance potential for behaviour change in the target
population. The intervention is a curriculum based program, with an
explicit harm minimisation goal and will be conducted in two phases over a
two year period. Measures and Findings: The early results of the study
demonstrate initial knowledge and attitude change, predicted by the
students involvement in the intervention. A surprising impact of the first
phase of SHAHRP was the significant difference in alcohol consumption and
harms between control and intervention groups, with the SHAHRP group
demonstrating a significantly lower increase in alcohol consumption than
the control group. Students who were supervised drinkers at baseline and
who received the SHAHRP intervention, were overwhelmingly represented in
the change results. Conclusions: Results from phase one of the SHAHRP
study suggest that classroom based alcohol education programs can reduce
harm, particularly in students who are supervised drinkers prior to the
intervention.
McLeod, R., Stockwell, T.R.,
Stevens, M. and Phillips, M. (2000). The influence of alcohol and drug
use, setting and activity on the risk of injury - A case-control study.
National Drug Research Institute. Curtin University of Technology, Perth,
Western Australia. ISBN: 1-86342-904-2
There has been a tradition
of alcohol research concerned with investigating the harm associated with
chronic alcohol use. However in Australia during 1996, injury accounted
for the 5th highest number of life-years lost through disability, the 3rd
highest life-years lost through death and was included as a National
Health Priority Area by the Health Minister of Australia (Mathers, Vos and
Stevenson, 1999). Alcohol has been identified as one risk factor that
contributes to injury. However, aside from alcohol's well documented
contribution to road crashes, this issue has not been thoroughly
investigated in Australia. This study was designed to gather data from
injured patients at a major Emergency Department, regarding alcohol and
drug use prior to the occurrence of any injury. There were two specific
aims.
1) To quantify the role of
alcohol in the causation of acute injury by - estimating the relative risk
of injury associated with consumption of different amounts of alcohol, and
- calculating aetiologic fractions to quantify injuries that could be
prevented if alcohol consumption was reduced.
2) To identify the
contribution of contextual factors and drinking settings (e.g. location
and activity at time of injury, time and quantity of drinking, other drug
use) on the association between alcohol and injury.
Midford, R., and McBride,
N. (2000) Alcohol Education in Schools. In Heather, N., Peters, T. and
Stockwell, T.R. (Eds) International Handbook on Alcohol Problems and
Dependence. John Wiley and Sons, Chichester, UK. [In
Press]
Midford, R., McBride, N.
and Farringdon, F. (2000). The impact of a Youth Alcohol Forum: What
changes for the participants? International Journal of Health Promotion
& Education, 38, (2), pp. 65-70.
A Youth Alcohol Forum was
conducted in Perth, Western Australia to provide the opportunity for
students to learn about alcohol harm and to develop methods for reducing
such harm in their community. Seventy-five, Year 10 students, from
10 high schools in Perth, participated in the Forum. The event
consisted of a three day, peer-led, residential program where students
could talk about alcohol use and harm in a non judgmental setting and in
turn access information that was of immediate practical use in minimising
harms related to their own and others' use of alcohol. After the
Forum, project groups continued to work together to implement their
community action plans. The participating students were surveyed
immediately prior to the Forum on their consumption patterns, their
knowledge of alcohol and related harms and their attitude to alcohol
issues pertinent to their age group. They were surveyed again at the
conclusion of the Forum on knowledge and attitudes and once again
comprehensively, six months later. Their consumption patterns were
compared with the National Drug Household Survey sample of 14-19 year olds
(AGB McNair 1995; Commonwealth Department of Health and Family Services
1996). Participants' knowledge and attitudes changed significantly
during the course of the Forum and this change was substantially preserved
six months later. There was also some indication that participants
did not progress to more risky consumption patterns as would be expected
of young people their age. Participants knew more about alcohol and
held attitudes about alcohol related issues that were more knowledge
based, when followed up six months subsequent to their participation in
the Forum. In this regard the Forum seems to have been both useful
and influential for the participants. Achieving sustained change in
knowledge and attitude with a brief, intense intervention, albeit with
follow up, suggests that such Forums can be important components in school
drug education
Sputore, B., Gray, D. and
Sampi, C. (2000). Review of the services provided by Jungarni-Jutiya
Alcohol Action Council Aboriginal Corporation. National Drug Research
Institute, Curtin University of Technology, Perth.
Stockwell, T.R. (2000).
Responsible beverage service: lessons from server training and policy
initiatives around the world. In Elmeland, K. (Ed) Proceedings of the
Nordic Council for Drug Research (NAD) thematic meeting. Community
prevention of alcohol and drug problems in the Nordic countries. NAD
Publication No. 38. Nordic Council for Drug Research, Stockholm, Sweden.
pp. 113-125. ISBN: 951 53 2211 1
Responsible beverage
service programs have evolved in many countries alongside a general
increase in the availability of alcohol and a greater focus on the
prevention of alcohol related road crashes. They also recognise the
reality that a great deal of high risk drinking and preventable harm
occurs in and around licensed premises or as drinkers make their way home.
Early US efficacy studies of programs which trained managers and barstaff
to limit customers' levels of intoxication and prevent drink driving
showed promise. Studies of effectiveness of these programs in the wider
community and in the absence of the enforcement of liquor laws, found
little benefit. The data will be interpreted as suggesting that, in
reality, skills deficits in the serving of alcohol are not a significant
problem compared with the motivational issue for a commercial operation of
abiding by laws that are rarely enforced and which are perceived as
risking the goodwill of their best customers. Australian, UK and US
experiences with liquor law enforcement by police will be discussed along
with outcomes from the Australian invention of Alcohol Accords, informal
agreements between police, licensees and local councils to trade
responsibly. It will be concluded that the major task involved in lifting
standards of service and preventing harm is to institutionalise legal and
regulatory procedures which impact most on licensed premises. A number of
strategies are suggested also for creating a political and social climate
which supports the responsible service of alcohol and thereby supports the
enactment and enforcement of appropriate liquor laws.
Stockwell, T.R. (2000). A
bridge across the prevention/treatment divide. Comments on Smart &
Mann's "The impact of programs for high-risk drinkers on population
levels of alcohol problems". Addiction, 95, (1), pp. 57-58.
Smart and Mann (in press)
provide a brave and important analysis of some of the core issues and
assumptions influencing the field of alcohol interventions: do treatment
programs work? Which work best? Do they impact on alcohol problems at the
aggregate, population level? In general, is it better to spend money on
such programs targeted, as they are, towards the highest risk drinkers or
on strategies directed at the entire population of drinkers? They make a
strong case for taking seriously the argument that treatment programs
should be incorporated into a comprehensive set of public health
strategies to reduce population-level alcohol problems, while noting some
of the difficult methodological issues that remain to be fully resolved in
tackling the underlying research. While the evidence to date is reasonably
encouraging, a higher level of sophistication needs to be applied.
Stockwell, T.R. (2000). Acute
alcohol-related harm in Australia: what do we know and what do we need to
know? A discussion paper prepared for the National Workshop on Alcohol
Research Priorities. A report commissioned by the Commonwealth. [In Press]
This review is concerned
with (i) the prevalence of harms caused by the short-term or acute
consequences of excess alcohol consumption in Australia (ii) risk factors
for such harm (iii) national and local level indicators of these harms.
There is a strong tradition of epidemiological work on alcohol, which
attempts to identify and quantify the prevalence of acute (and chronic)
harms. Recent research identifies road crashes, violence, suicide,
drowning and alcohol overdose as major contributors to the estimated 1902
deaths, 41,998 years of life lost and 51, 468 hospital episodes to have
been caused by the acute effects of alcohol in 1997. While further work is
required to improve the evidence base and to develop standard
methodologies for these estimates, it is clear that acute consequences
comprise the bulk of alcohol-caused mortality and morbidity in Australia.
There are several,
overlapping ways of identifying increase of acute alcohol harm including
age (being young), gender (being male), being Aboriginal, amount consumed
per occasion, location (eg licensed premises) and time (usually night-time
and weekends). Risk of injury increases at low levels of intake and then
increases exponentially with further consumption. There has been
high quality Australian research identifying risk factors for violence on
licensed premises and for road injury. Total population consumption of
alcohol has been shown to be highly correlated with the net amount of
acute harm experienced. Consumption of higher strength and cheaper drinks
has been particularly linked to adverse acute outcomes. The bulk of
incidents of acute alcohol-related harm are contributed by occasional
excessive ("binge") drinkers, a pattern of drinking that is
highly prevalent in Australia.
There is an emerging
tradition of Australian research concerned with national and local
monitoring of acute harm, which promises to be a major resource for
national and local efforts to prevent and reduce such harm.
Recommendations for future
research are provided. Gaps in the research base include high quality
studies on prevalence and risk factors for alcohol overdose (with and
without heroin), workplace injuries and drowning. Further efforts to
develop and report harm indicators at the national and local level are
recommended.
Stockwell, T.R. (2000).
Alcohol and cardiovascular disease: still a research priority? Medical
Journal of Australia, 173, (3), pp. 116-117.
In today's issue yet
another study is published reporting a link between moderate alcohol
intake and a reduced risk of death from cardiovascular disease among older
people. The Simons et al study is an elegant example of the genre drawn
from a highly respected prospective study of risk factors for death and
illness in the population of Dubbo, New South Wales. The evidence that has
been amassed on this topic to date might be thought already sufficient to
bracket skeptics of alcohol's protective effect along with doubters of
manned lunar missions and members of the Flat Earth Society. Published
studies demonstrating this link can now be counted in the hundreds, no
fewer than six plausible underlying biological mechanisms have been
identified and alternative explanations relying on ever more tenuous
confounding effects have been discredited one by one. The apparently
protective effect of moderate alcohol consumption has to date survived the
use of controls for socio-demographic status, for the 'sick quitter
hypothesis' (ie the suggestion that many abstainers have quit due to
serious illness), for the extent of cholesterol in diet and even for
degree of social isolation . As evidenced in the Simons et al study1, the
protective effect is fairly specific to cardiovascular disease and does
not operate for other major causes of death in older people such as
cancer. While a handful of recent studies have failed to find a protective
effect for moderate drinking, these are still heavily outnumbered by those
with positive findings. In fact, the range of different countries and
cultures in which the phenomenon has been documented is also testimony to
its robustness, even if different levels of consumption appear to provide
the benefit in different drinking cultures.
Stockwell, T. and Lenton.
S. (2001) Demand Reduction: a glossary of terms. United National
Office for Drug Control and Crime Prevention, New York.
The 38th Session of the
Commission on Narcotic Drugs requested the United Nations International
Drug Control Program (UNDCP) to update the 'Resource Book on Measures to
Reduce Illicit Demand for Drugs' (UNDCP, 1979) and, to 'develop a glossary
of terms to ensure a common understanding of terms'.
It has long been recognised
by United Nations conventions that global efforts to prevent the supply of
illicit drugs should be complemented by measures which seek to
reduce demand for these drugs as well (e.g. United Nations, 1977). To
assist countries which are signatories to these conventions the above
Resource Book was prepared to identify a set of programs and policies
which would reduce the demand for illicit drugs by variously deterring
potential users from experimenting with drugs, by encouraging existing
users to stop using and by providing practical assistance to users to
achieve and maintain abstinence. The Resource Book also stressed the
significance of social conditions such as poverty and unemployment in the
genesis of problem drug use.
In 1996 an informal
international reference group was established under the auspices of UNDCP
to begin the important task of developing a new set of demand reduction
resource materials which would reflect new knowledge gained over the past
20 years. In early 1997, the Commonwealth Government of Australia offered
the services of three national research and training centres to facilitate
the development of these materials in conjunction with the informal
international reference group.
Stockwell, T.R. and
Gruenewald, P. (2000) Controls on the physical
availability of alcohol. In
Heather, N., Peters, T. and Stockwell, T.R. (Eds) International
Handbook on Alcohol Problems and Dependence. John Wiley and Sons,
Chichester, UK. [In Press]
Stockwell, T.R.,
Chikritzhs, T. and Brinkman, S. (2000). The role of social and health
statistics in measuring harm from alcohol. Journal of Substance Abuse.
[In Press]
Since excess use of alcohol
contributes to so many varieties of health and social harms, in most
countries there are many potential sources of data indicative of
alcohol-related harms. In a few instances, compilation and interpretation
of these data are straightforward but mostly they are open to various
sources of measurement error which need to be taken into account if they
are to be applied for research purposes. Police and health statistics are
the major source of such information but the underlying systems are not
usually set up with the purpose of monitoring alcohol-related events. In
both of these domains, types of events can be identified which are wholly
attributable to excess alcohol use i.e. drink-driving, alcoholic liver
cirrhosis. Specific alcohol-related events are particularly prone to
variations in, respectively, police enforcement practices, medical
diagnostic fashion and sensitivity to prejudices about alcohol-related
problems. A case will be made in this paper for the use of multiple
surrogate measures of alcohol-related harm drawn from several sources in
order to measure and track local, regional and national trends. For health
statistics on mortality and morbidity, the aetiologic fraction method will
be recommended for such monitoring purposes. It will also be recommended
that these data are categorised by the degree to which cases are
attributable to alcohol and also by whether the underlying hazardous
drinking pattern is a brief drinking bout or a sustained pattern of heavy
intake over a number of years. Night-time occurrences of road crashes,
public violence from both police and emergency room attendance data will
also be recommended. It will be argued that routine recording of
alcohol-relatedness of events is usually unreliable and the above
surrogate measures are preferable. Recommendations will also be made
for utilising national surveys of drinking behaviour to improve the
calculation of alcohol-related morbidity and mortality as well as refine
estimates of per capita alcohol consumption, another major
"surrogate" measure of alcohol-related harm. The arguments will
be illustrated with reference to Australia's National Alcohol Indicators
Project and related research projects.
Stockwell, T.R.,
Chikritzhs, T., Dawson, D., Holder, H., Jernigan, D., Medina-Mora, M. and
Single, E. (2000). International guide for monitoring alcohol-related
problems, consumption and harm. Prepared for the World Health
Organization, Geneva, Switzerland.
The purpose of this
document is (1) to provide guidance to WHO Member States on
epidemiological monitoring in order to inform and facilitate effective
policy formation and (2) to improve the global and regional comparability
of data on alcohol use and health consequences in order to improve
monitoring and to facilitate research and risk assessment. It is intended
to provide general principles and also practical guidance on the
development of realistic and effective sets of indicators of alcohol
consumption and harm for different countries with different levels of
resources.
The overall exercise is
placed into the context of other WHO initiatives on alcohol and drug
prevention and monitoring such as the "Global Burden of Disease"
report (Murray and Lopez, 1996), "Global Alcohol Report" (WHO,
2000) and the Alcohol Policy and Public Good Project for Developing
Countries.
The number and severity of
adverse consequences related to alcohol use constitute a major rationale
for international monitoring of alcohol's use and effects. Murray and
Lopez (1996) estimated that globally in 1990 alcohol contributed to
773,600 deaths, 19.3 million years of life lost and 47.7 million
disability adjusted life years. Some 82% of this burden of death, illness
and injury falls on regions of the world classified as
"developing". Estimates of the annual economic costs of alcohol
each year in developed economies range from 0.5% to 2.7% of GDP and
invariably greatly exceed the economic costs of illicit drug use.
The major uses to which
national alcohol monitoring systems can be put is summarised with
particular emphasis on raising awareness among the public and policy
makers of the contribution of alcohol to serious problems in the domains
of public health, safety and order. The different types of data that can
be used and their strengths and limitations for different purposes are
discussed in general terms.
The organisation of the
guidelines is introduced and some fundamental issues discussed such as:
the importance of measuring volume as well as pattern of drinking; the
usefulness of distinguishing between the long and short-term consequences
of alcohol use. The chapter concludes with a discussion of how alcohol
consumption and problems should be monitored and the results disseminated.
--posted by Susan Wilson
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