Is alcopop consumption in Switzerland associated with riskier drinking patterns and more alcohol‐related problems?

OBJECTIVES: To examine (a) whether consumers of alcopops compared to consumers of other alcoholic beverages but not alcopops have riskier drinking patterns and more alcohol-related consequences (e.g. truancy, scuffles, problems with parents) and (b) whether the amount of alcopops consumed is associated independently with risky drinking patterns and alcohol-related consequences over and above those associated with the amount of other alcoholic beverages consumed. SAMPLE: As part of the ESPAD international study, a cross-sectional national representative sample of 5,444 drinkers aged 13-16 years was interviewed by means of an anonymous, self-report questionnaire administered in a classroom setting. RESULTS: Earlier initiation of consumption, more frequent risky single occasion drinking (RSOD), and a higher likelihood of negative consequences for consumers than for non-consumers of alcopops were due mainly to higher overall consumption. Other alcoholic beverages had similar effects, and whether the same amount of alcohol was consumed as alcopops or as any conventional alcoholic beverage made no difference. CONCLUSIONS: Alcopops in Switzerland do not seem to be linked to specific riskier drinking patterns or consequences per se. Like all alcoholic beverages, they add to the problems caused by drinking and seem to be consumed in addition to conventional alcoholic beverages without replacing them. As the alcohol industry will continue to launch new beverages, prevention targeting alcohol consumption in general might be more effective than focusing on new beverages only.     

Socio‐economic status predicts drinking patterns but not alcohol‐related consequences independently

Aim To identify independent relationships between socio‐economic status and drinking patterns and related consequences and to identify socio‐economic groups at risk for heavier consumption. Design and setting Three comparable national telephone surveys were utilized: 1995, 2000 and 2004. The respondents were aged 18–65 years. Contextual information includes that a number of liberalized alcohol policy changes occurred over the time of the surveys. Results Educational qualification, income and occupation were associated independently with alcohol consumption. There were indications that the different dimensions of drinking (quantity and frequency) had different relationships with socio‐economic status (SES). For example, lower SES groups drank heavier quantities while higher SES groups drank more frequently. SES, however, did not play a major role predicting drinking consequences once drinking patterns were controlled for, although there were some exceptions. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population (as they had sustained increases in the quantities they consumed over time where other SES groups did not). Conclusion Socio‐economic status was related independently to drinking patterns and there were indications that SES interacted differently with the different dimensions of drinking (quantity and frequency). For the most part, socio‐economic status was not related independently to the experience of alcohol‐related consequences once drinking patterns were accounted for. It was the lower‐to‐average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population.     

Age,Alcohol Consumption and the Experiencing of Negative Consequences of Drinking in Four Scandinavian Countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), use of alcohol and negative consequences of drinking were studied in relation W age. Clear differences were found between age-groups as regards experiencing such negative consequences in respect of both men and women. These differences were to a large extent a reflection of similar differences between the age-groups in regard to alcohol consumption and intoxication frequency. However, it was also found that when both alcohol consumption and intoxication frequency were maintained at a constant level, age in itself seemed to influence the experiencing of negative consequences. The study also indicates that in all age-groups there are national differences in drinking patterns and thus in the experiencing of negative consequences of drinking which do not reflect the national differences in total alcohol consumption.     

Risk functions for frequency of alcohol-related negative consequences: New Zealand survey data

Aims. To examine the dose-response relationship between self-reported alcohol consumption and levels of self-reported negative consequences of drinking. Design. Data from 10 general population random sample surveys over the years 1990-1997 were combined and responses were plotted and subjected to regression analysis. Setting. Auckland, a city of approximately 1 million people in the North Island of New Zealand. Participants were interviewed in their homes using a computer-assisted telephone interviewing system. Participants. General population sample of 11 817 aged 14-65 years, representative of the Auckland population. Measurements. Frequency of experience of 14 negative consequences; annual volume of alcohol consumed; frequency of drinking larger quantities of alcohol. Results. Three different patterns of relationship between consequences and consumption were found for different consequences. These differed between the prevalence and the frequency of consequences but were similar for two different measures of consumption, annual volume and larger quantity drinking. Analysis of the frequency of experienced consequences found that the risk curves for the most common consequences approximated a straight line and the effects at low volume intake were due to those drinking larger quantities. Three less common consequences clearly showed a concave curve suggesting a threshold effect, with effects beginning at about 20 litres per annum of absolute alcohol. Conclusion. The different relationships between consumption and consequences imply that some consequences occur only once a very heavy volume of drinking is reached, while others show a direct relationship with consumption, reflecting that volume of alcohol consumed is closely related to the quantities consumed.     

Gender convergence in alcohol consumption and related problems: issues and outcomes from comparisons of New Zealand survey data

AIMS: This paper aims to compare women's and men's alcohol consumption patterns and alcohol-related problems in New Zealand in 1995 and 2000, by age groups. Secondary aims are to consider the findings in relation to debates on the gender convergence hypothesis regarding the link between gender convergence in alcohol consumption and possible explanations, such as social role convergence and policy changes. DESIGN: Data were collected in two general population surveys conducted in New Zealand in 1995 (n = 4232) and 2000 (n = 5113) using the same questionnaire. MEASUREMENTS: Quantity consumed on a typical drinking occasion, volume of absolute alcohol consumed per annum, proportions drinking 20+ litres per annum, proportion of total consumption consumed in heavy drinking occasions, frequency of consumption, proportion who drink enough to feel drunk at least once a week, proportions reporting three or more alcohol-related problems and attitudes to intoxication. FINDINGS: Evidence for gender convergence was found across a range of measures of alcohol consumption and alcohol-related problems. In the 20-39-year age group quantities of alcohol consumed on a typical occasion and the related measures of volume, drunkenness and problems all showed convergence. In the groups over 40 years of age convergence occurred in relation to frequency of drinking. In the groups below 20 years, which consumed relatively high quantities and where the differences in consumption between gender groups were relatively small, further convergence did not occur. CONCLUSIONS: Gender convergence took place in New Zealand from 1995 to 2000.     

The Relationship Between Alcohol Consumption,Alcohol Intoxication and Negative Consequences of Drinking in Four Scandinavian Countries★

In February 1979 identical questionnaires were mailed w representative samples totalling 3000 persons between 20 and 69 years of age in the populations of each of four Scandinavian countries, (Finland, Iceland, Norway and Sweden), in order to study-among other things-the relationship between alcohol consumption, alcohol intoxication and negative consequences of drinking in various cultural settings. The results indicate that it is not possible on the basis of the total consumption of a country to make a reliable prediction of the negative consequences of alcohol consumption that the study considers. In a country with a high total consumption, the scale of negative consequences could be much lower than in a country with a lota total consumption. However, the likelihood of having experienced the types of negative consequences inquired about in the questionnaire was approximately the same in all four countries, when intoxication frequency was maintained at a constant level. The national differences in the experience of negative consequences therefore mainly seems to correlate with differences between the countries in intoxication frequency.     

Cognitive motivations for drinking among alcoholics: factor structure and correlates.

The aims of this study were to: a) Identify factors reflecting reasons for drinking and expectancies regarding the effects of drinking among inpatient alcoholics; b) Examine the relationship between these cognitive "motivations" for drinking and both patterns of alcohol consumption and various personal and social consequences of consumption. The factors which emerged relate to negative mood reduction, positive mood enhancement, and social functioning. Although the factors identified in this investigation were not associated with quantity of alcohol consumed, small to moderate associations were found between scores on three of four factors and a variety of adverse physical and occupational consequences of alcohol abuse.     

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

Aims This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all‐cause mortality. Design, participants and measurement Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES‐D) scale and an eight‐item social isolation scale. Findings The J‐shaped risk curve for all‐cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life‐time abstainer. Conclusions The relationship of alcohol consumption to 11‐year all‐cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex‐drinkers.     

Alcohol and cardiovascular disease--more than one paradox to consider. Average volume of alcohol consumption,patterns of drinking and risk of coronary heart disease--a review

The effect of average volume of alcohol on coronary heart disease (CHD) is J-shaped in established market economies. Light to moderate drinkers have less risk than abstainers, with heavy drinkers displaying the highest level of risk. This relationship between average volume of alcohol consumption and CHD is modified by different patterns of drinking. Heavy drinking occasions as well as drinking outside meals are related to increased CHD risk, independently of volume of drinking. Beverage type does not seem to have much impact, even though there are some indications that wine is more protective than other forms of alcohol. Physiological mechanisms have been identified to explain this complex relationship between alcohol and CHD. Since patterns of drinking are important in determining CHD risk, they should be included in future epidemiologic studies, together with biomarkers further to test hypotheses about pathways.     

Relationships of drinking behaviour, gender and age with reported negative and positive experiences related to drinking

Abstract Aims. To assess associations between drinking behaviour, gender and age with reported experiences related to drinking. Design. Cross-sectional survey. Setting and participants. Interviews were performed in 1992 with a representative sample of the Finnish population between 15 and 69 years of age (N = 3446). Measurements. Annual intake of alcohol, frequency of drunkenness, and 14 negative and eight positive reported experiences related to drinking. Findings. Logistic regression models showed that overall intake and frequency of drunkenness were independently associated with almost all reported positive and negative consequences of drinking. Women more commonly reported that drinking had helped them to sort out interpersonal problems at home or in the work-place, to feel more optimistic about life, and to express their feelings. Men more commonly reported that drinking had helped them to be funnier and wittier and to get closer to the opposite sex. Drunken driving was markedly male behaviour, but women more commonly reported other types of reckless behaviour and adverse consequences of drinking. However, men more commonly said they were criticized by family for their drinking. With the exception of health problems, both positive and negative consequences of alcohol were more common among younger drinkers. Conclusions. Once overall intake and frequency of drunkenness were controlled for, significant differences between men's and women's perceptions of the costs and benefits of alcohol consumption emerged. Men tended to perceive more hedonic benefits while women perceived more functional benefits. Women reported behaving more recklessly in drinking situations. In light of the results, women were not under selective social control.     

The experiencing of positive consequences of drinking in four Scandinavian countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), the experiencing of positive consequences of drinking was studied in relation to alcohol consumption, intoxication frequency and the experiencing of negative consequences of drinking. In all four countries a substantial portion–both of the men and of the women–reported having experienced various positive effects of drinking during the last 12 months. The positive consequences clearly correlated with yearly alcohol consumption and even more with intoxication frequency. A strong link between the experiencing of positive and negative consequences of drinking was also found. The study also indicates that there are national differences in the experiencing of positive consequences of drinking which do not reflect the national differences in total alcohol consumption.     

Under-reporting of alcohol consumption in household surveys: a comparison of quantity-frequency, graduated-frequency and recent recall

AIM: To compare alternative survey methods for estimating (a) levels of at risk alcohol consumption and (b) total volume of alcohol consumed per capita in comparison with estimates from sales data and to investigate reasons for under-reporting. SETTING: The homes of respondents who were eligible and willing to participate. PARTICIPANTS: A total of 21,674 Australians aged 14 years and older. DESIGN: A 2001 national household survey of drug use, experiences and attitudes with weights applied for age, sex, geographic location and day of week of interview. MEASURES: Self-completion questionnaire using quantity-frequency (QF) and graduated-frequency (GF) methods plus two questions about consumption 'yesterday': one in standard drinks, another with empirically based estimates of drink size and strength. RESULTS: The highest estimate of age 14 + per capita consumption of 7.00 l of alcohol derived from recall of consumption 'yesterday' or 76.8% of the official estimate. The lowest was QF with 49.8%. When amount consumed 'yesterday' was recalled in standard drinks this estimate was 5.27 l. GF questions yielded higher estimates than did QF questions both for total volume (5.25 versus 4.54 l) and also for the proportion of the population at risk of long-term alcohol-related harm (10.6%versus 8.1%). With the detailed 'yesterday' method 61% of all consumption was on high risk drinking days. CONCLUSIONS: Questions about typical quantities of alcohol consumed can lead to underestimates, as do questions about drinking 'standard drinks' of alcohol. Recent recall methods encourage fuller reporting of volumes plus more accurate estimates of unrecorded consumption and the proportion of total alcohol consumption that places drinkers at risk of harm. However, they do not capture longer-term drinking patterns. It is recommended that both recent recall and measures of longer-term drinking patterns are included in national surveys.     

Average volume of alcohol consumption, drinking patterns and related burden of mortality in young people in established market economies of Europe

OBJECTIVE: To determine the burden of mortality in young people (age 15-29) in established market economies in Europe in 1999, which is attributable to alcohol consumption. Two dimensions of alcohol consumption were considered: average volume of consumption, and patterns of drinking. METHODS: Mortality data were obtained from the WHO EIP data bank, average volume data from the WHO global databank on alcohol, pattern of drinking data from a questionnaire sent out to experts, from the published literature and from the WHO global databank. Methods are explained and discussed in detail in two other contributions to this volume. RESULTS: More than 8,000 deaths of people aged 15-29 in Europe in 1999 were attributable to alcohol. Young males show a higher proportion of alcohol-attributable deaths (12.8%) than females (8.3%). Both average volume and patterns of drinking contribute to alcohol-related death. CONCLUSIONS: Alcohol-related deaths constitute a considerable burden in young people in Europe.     

On the emerging paradigm of drinking patterns and their social and health consequences

Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first “International Conference on Social and Health Effects of Different Drinking Patterns” held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and causalities as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for polity and programme development are discussed.     

Relation between average alcohol consumption and disease: an overview

OBJECTIVE: To conduct an overview of alcohol-related health consequences and to estimate relative risk for chronic consequences and attributable fractions for acute consequences. METHODS: Identification of alcohol-related consequences was performed by means of reviewing and evaluating large-scale epidemiological studies and reviews on alcohol and health, including epidemiological contributions to major social cost studies. Relative risks and alcohol-attributable fractions were drawn from the international literature and risk estimates were updated, whenever possible, by means of meta-analytical techniques. RESULTS: More than 60 health consequences were identified for which a causal link between alcohol consumption and outcome can be assumed. CONCLUSIONS: Future research on alcohol-related health consequences should focus on standardization of exposure measures and take into consideration both average volume of consumption and patterns of drinking.     

Adverse Drinking-Related Consequences Among Lower Income, Racial, and Ethnic Minority Drinkers: Cross-Sectional Results

Objective:  To examine factors associated with adverse consequences of alcohol consumption among a community sample of drinkers in a low-income, racial, and ethnic minority community.
Methods:  A sample of 329 drinkers was recruited from 17 randomly selected off-sell alcohol outlets in South Los Angeles. Respondents were interviewed by trained research personnel on their demographic characteristics, income, drinking patterns and preferences, and alcohol-related adverse consequences (using the Drinkers Inventory of Consequences—DrInC), among other items. We developed logistic regression models predicting high scores on DrInC total score and subscales (impulse control, interpersonal, intrapersonal, physical, and social responsibility).
Results:  In this sample, we found drinking patterns—bingeing, drinking outdoors, drinking in the morning—to be significantly associated with total DrInC scores and some subscales. Malt liquor beverage (MLB) use was significantly associated with total DrInC score and interpersonal and social responsibility subscales. Previous alcohol treatment predicted all but 1 DrInC subscale and total score.
Conclusions:  A diverse array of factors predicted high DrInC total and subscale scores. More research on the association between MLB use and consequences is required. In addition, studies with community samples are likely to further enrich our understanding of the interactions between drinking patterns and preferences, settings, and negative consequences.     

Revising the preventive paradox: the Swiss case

Aims. To examine Kreitman's preventive paradox of alcohol consumption and its revisions by Stockwell and colleagues and by Skog, with regard to alcohol‐related social harm in Switzerland, and to shed light on the reporting of alcohol‐related social harm in the low‐volume drinking, non‐bingeing subpopulation. The paper compares occurrence and severity of social harm in four subgroups defined by average consumption (volume) and binge drinking. Stage‐of‐change membership was used to further distinguish low‐risk drinkers who might have changed their drinking patterns from those who had not. Design, setting, and participants. Telephone interviews were conducted with 1256 current drinkers of a probabilistic two‐stage sample of the general population of Switzerland. Moderate and hazardous mean consumption (volume) was defined by means of a quantity‐frequency instrument. Daily average consumption of 20 g was set as the cut‐off point for women, and 30 g for men. Binge drinking was defined as taking four or more drinks on an occasion for women, and five or more for men. Structural equation modelling was used to construct a severity scale of six alcohol‐related consequences: work problems, accidents and problems with the police, with friends, with a partner or with the family. Explanatory factor analysis was used to assign drinkers to motivational stages of change. Findings. Moderate drinkers in terms of volume reported more problems than hazardous drinkers, which confirms Kreitman's view. Binge drinkers reported more problems than non‐binge drinkers, confirming the view of Stockwell and colleagues. Binge drinkers were more numerous in the moderate drinking group, which constituted the majority of drinkers, in accordance with Skog's view. Binge drinkers in the moderate‐volume and hazardous‐volume drinking groups did not differ significantly as to either severity or number of problems. Approximately 40% of moderate‐volume, non‐binge drinkers who reported alcohol‐related social harm had already changed their consumption pattern, which indicated that reported harm was related to an earlier drinking pattern. Conclusions. As Skog has pointed out, the second‐order preventive paradox of binge drinking reappeared, in that most binge drinkers were found to occur in the drinker group with low average consumption. Findings also indicate that, with respect to social harm, a preventive strategy aimed at the majority of the population, but on heavy‐drinking occasions rather than on mean consumption, may be valuable.     

Are Women at Greater Risk? An Examination of Alcohol‐Related Consequences and Gender

Men typically drink more than women; however, women achieve higher BACs (blood alcohol concentration) than men at equivalent consumption levels. This study investigated the unique effect of gender on individual alcohol problems by controlling both consumption and intoxication in a sample of 1,331 undergraduate drinkers. Gender independently influenced the risk of experiencing seven of nine negative consequences: (a) being female increased risk for tolerance, blacking out, passing out, drinking after promising not to, and getting injured; (b) being male increased risk for damaging property and going to school drunk. Gender patterns should be explored in a wider set of alcohol‐related problems.     

The importance of glucocorticoids in alcohol dependence and neurotoxicity

Alterations in hypothalamo-pituitary adrenal (HPA) function have been described in alcoholics and in rodents after chronic alcohol consumption but the role of glucocorticoids in alcohol consumption, and the mechanisms involved, has received little attention until recently. Both alcohol consumption and withdrawal from chronic alcohol intake raise circulating glucocorticoid levels, and prolonged high concentrations of glucocorticoids are known to have detrimental effects on neuronal function and cognition. This minireview covers the ways in which glucocorticoids may be involved in drinking behavior, from social drinking to dependence, and the negative consequences of alcohol consumption seen during withdrawal which may have a detrimental effect on treatment outcome. Research shows prolonged increases in brain glucocorticoid concentrations and decreased brain glucocorticoid receptor availability (consistent with increased levels of endogenous ligand) after withdrawal from chronic alcohol treatment. Evidence suggests that increased glucocorticoid levels in the brain after chronic alcohol treatment are associated with the cognitive deficits seen during abstinence which impact on treatment efficacy and quality of life. Studies on organotypic cultures also demonstrate the importance of glucocorticoids in the neuropathological consequences of alcohol dependence.     

Prague women's drinking before and after the 'velvet revolution' of 1989: a longitudinal study

Results are presented of a follow-up study in which a representative sample of 608 Prague women aged 20–49 years in 1987 at first interview was re-interviewed in 1992 3 years after the revolution that ended the 41 years of the Communist era in Czechoslovakia. The average yearly consumption of alcohol in the followed-up female sample increased between 1987–92 from a reported 3.6 litres to 4.8 litres. The percentage of heavier drinkers (with average daily consumption of over 20 g alcohol) increased from 7.2% to 14.0%. The women expressed increased tolerance of drunkenness in their attitudes to drinking. The consumption increase was mainly due to increased drinking frequency of spirits and to increased quantity of beer consumed per occasion. The consumption increase was largest in women working as free-lance and the newly emerging self-employed women; economically inactive women did not increase their consumption. Women who reported a positive impact of the socio-political changes on their personal lives and an expansion of social contacts also reported larger than average consumption increases. A coincidence of stressful, possibly self-inflicted, life events and increased alcohol use was observed and interpreted as probably a two-way influence.