Alcohol‐related mortality in Ukraine

Introduction and Aims. To substantiate public health policies aimed at diminishing alcohol‐related harm, the level of alcohol‐related deaths needs to be documented on a national level. The aim of this study was to explore the opportunities provided by the 1985–1988 anti‐alcohol campaign related data for estimation of alcohol‐related mortality in Ukraine. Design and Methods. Ecological study design based on the aggregate‐level data analysis regarding the natural experiment in Ukraine. All‐cause and cause‐specific observed mortality levels in 1986‐88 compared to the extrapolated 1980–84 trends. The number and proportion of ‘prevented’ deaths were calculated for those causes, for which were observed: (1) reduction of mortality levels during the campaign and (2) increase after 1988. Alcohol‐attributable fractions of mortality per one litre of per capita consumption were calculated for each death cause based on prevented deaths and consumption decrease estimates. The total number of alcohol‐related deaths for a specific year was also calculated. Results. Ukraine experienced a large mortality reduction during the campaign. The estimates of prevented deaths revealed that at least 76% of the mortality reduction was attributable to alcohol. Alcohol‐related mortality due to injuries is much higher for men, while coronary heart disease (CHD) alcohol‐attributable fractions were about 0.5 in middle age both for men and women. Discussion and Conclusions. While in Western countries alcohol is considered as a protective factor for CHD, in Ukraine alcohol‐related cardiovascular mortality is rather high. In 2004 in Ukraine total number of alcohol‐related deaths was about 119,000 or 251 per 100,000 of population.[Krasovsky K. Alcohol‐related mortality in Ukraine. Drug Alcohol Rev 2009;28:396–405]     

A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease

Issues. Alcohol has been implicated in both the popular press and scientific literature as having a protective effect for at least a dozen conditions including coronary heart disease (CHD). Approach. Epidemiological evidence for an apparent protective effect of alcohol on CHD is now being challenged on a number of fronts. This paper is a synopsis of those various challenges as they currently stand. Key Findings. The argument that systematic misclassification of ex‐drinkers and occasional drinkers to ‘abstainer’ categories among epidemiological studies might explain apparent protective effects of moderate alcohol consumption on CHD has recently been supported by new meta‐analyses and independent research. The influence of uncontrolled or unknown factors on the relationship between alcohol and disease cannot be ruled out. Exclusion of participants on the basis of ill‐health severely reduces study sample size and new analyses suggest that doing so might artificially create the appearance of protective effects. The ability of respondents to accurately recall their own alcohol consumption is in serious doubt and very few individuals maintain one single drinking level or style throughout life. The relationship between alcohol and some conditions might be a function of drinking patterns but few studies have addressed the issue. Implications. Popular perceptions regarding the strength of evidence for alcohol's protective effect on a growing number of conditions might be misguided. Conclusion. It is time for the wider research, health and medical community to seriously reflect on the quality of current evidence for apparent protective effects of alcohol on human disease.[Chikritzhs T, Fillmore K, Stockwell T. A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug Alcohol Rev 2009;28:441–444]     

Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policy

Issue. Scotland has experienced a substantial rise in alcohol‐related harm, which is now one of the biggest public health challenges it faces. Approach. Alcohol problems in Scotland are described along with national alcohol policy response in addressing them. The role of a program of Alcohol Brief Interventions is discussed therein. Key Findings. In Scotland, considerable proportions of the population are drinking hazardously or harmfully, common across different age and socioeconomic groups. Rising consumption has been set in wider environmental changes with alcohol becoming more available and affordable. Scotland has had one of the fastest growing chronic liver disease mortality rates in the world at a time when rates in most of Western Europe are falling. Scotland's alcohol policy has an explicit aim to reduce population consumption and includes legislative measures to tackle price and availability. A national program to deliver Alcohol Brief Interventions for hazardous drinkers is a key plank of this wider strategy. A portfolio of studies will monitor and evaluate national policy and, through contribution analysis, describe the role Alcohol Brief Interventions play in reducing alcohol misuse. Implications. Effective alcohol policy recognises that determinants of health not only lie at individual level, but include wider social, environmental and economic factors. Scotland's policy is addressing these determinants with both population‐based and population‐targeted interventions. Conclusion. Scotland has a serious problem with alcohol. A comprehensive, evidence‐based, resourced alcohol policy is being implemented, which will need continual review to ensure it remains anchored in evidence while maintaining its ambition.[Graham LJC, MacKinnon D. Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policy. Drug Alcohol Rev 2010;29;603–607]     

‘Off your Face(book)’: alcohol in online social identity construction and its relation to problem drinking in university students

Introduction and Aims. Alcohol is a key component of identity exploration for many young people, yet few studies have investigated identity construction in relation to problematic drinking. Increases in youth alcohol consumption have coincided with expanding use of communications technologies, particularly social networking sites (SNS), which have altered traditional conditions of identity construction. It has been found young people often engage with alcohol in the SNS environment by portraying themselves as binge drinkers. The current study applied an innovative approach to identity construction (the photographic essay) to provide insight into the portrayal of ‘alcohol‐identity’ on Facebook. Design and Methods. One hundred and fifty‐eight university students completed a range of alcohol measures before providing access for researchers to view their Facebook profiles to operationalise their alcohol‐identity according to autophotographic methodology. Results. Participants utilised a variety of photographic and textual material to present alcohol as a component of their identity on Facebook, with over half having selected an alcohol‐related profile image. Alcohol‐identity predicted alcohol consumption and problematic alcohol‐related behaviours as measured by questionnaires used to reliably identify alcohol‐related problems in university students. Almost 60% reported potentially problematic alcohol use according to the Alcohol Use Disorders Identification Test. Discussion and Conclusions. Findings suggest that portraying oneself as a drinker is considered by many young people to be a socially desirable component of identity in the SNS environment, perpetuating an online culture that normalises binge drinking. Ready‐made Facebook photo essays provide an alternate method of accessing problematic alcohol use, supplementing self‐report measures.[Ridout B, Campbell A, Ellis L. ‘Off your Face(book)’: Alcohol in online social identity construction and its relation to problem drinking in university students. Drug Alcohol Rev 2012;31:20–26]     

Alcohol as a risk factor for liver cirrhosis: A systematic review and meta‐analysis

Introduction and Aims. Alcohol is an established risk factor for liver cirrhosis. It remains unclear, however, whether this relationship follows a continuous dose–response pattern or has a threshold. Also, the influences of sex and end‐point (i.e. mortality vs. morbidity) on the association are not known. To address these questions and to provide a quantitative assessment of the association between alcohol intake and risk of liver cirrhosis, we conducted a systematic review and meta‐analysis of cohort and case–control studies. Design and Methods. Studies were identified by a literature search of Ovid MEDLINE, EMBASE, Web of Science, CINAHL, PsychINFO, ETOH and Google Scholar from January 1980 to January 2008 and by searching the references of retrieved articles. Studies were included if quantifiable information on risk and related confidence intervals with respect to at least three different levels of average alcohol intake were reported. Both categorical and continuous meta‐analytic techniques were used to model the dose–response relationship. Results. Seventeen studies met the inclusion criteria. We found some indications for threshold effects. Alcohol consumption had a significantly larger impact on mortality of liver cirrhosis compared with morbidity. Also, the same amount of average consumption was related to a higher risk of liver cirrhosis in women than in men. Discussion and Conclusions. Overall, end‐point was an important source of heterogeneity among study results. This result has important implications not only for studies in which the burden of disease attributable to alcohol consumption is estimated, but also for prevention. [Rehm J, Taylor B, Mohapatra S, Irving H, Baliunas D, Patra J, Roerecke M. Alcohol as a risk factor for liver cirrhosis: A systematic review and meta‐analysis. Drug Alcohol Rev 2010]     

Fluctuations in male ischaemic heart disease mortality in Russia 1959–1998: Assessing the importance of alcohol

Introduction and Aims. The decline in cardiovascular mortality in Russia following the Soviet anti‐alcohol campaign of 1985–1988 and the subsequent increase when these extreme alcohol controls were repealed suggested that alcohol consumption is responsible for a substantial number of ischaemic heart disease (IHD) deaths in Russia. To examine whether a similar conclusion can be drawn on the basis of a time‐series analysis covering a longer time period, namely 1959–1998. Design and Methods. Using ARIMA time‐series analysis, the male IHD mortality rates from 1959 to 1998 were analysed in relation to three indicators of alcohol consumption: estimated per capita consumption, mortality from liver cirrhosis and alcohol poisonings. Cigarette sales and lung cancer mortality were used as indicators of smoking. Results. Each indicator of alcohol consumption had positive and statistically significant relationships with male IHD mortality in bivariate autoregressive integrated moving average models. The association was stronger in models predicting changes in premature male IHD mortality (30–54 years). At least one alcohol indicator was significantly related to IHD mortality in multivariate models, and in the case of premature IHD mortality, both mortality indicators were significant. Discussion and Conclusions. The results provide additional empirical evidence supporting alcohol's conceivable negative effects on IHD in Russia and the idea that binge drinking could be the mechanism through which this effect is mediated. There were no signs of any protective effects from alcohol among Russian men.[Ramstedt M. Fluctuations in male ischaemic heart disease mortality in Russia 1959–1998: Assessing the importance of alcohol. Drug Alcohol Rev 2009;28:390–395]     

The National Alcohol Strategy 2018–2026 has to become a set of commitments

Alcohol consumption is behind only smoking and obesity among leading contributors to the burden of disease in Australia. For the first time in over a decade, Australian governments are developing a National Alcohol Strategy, and plan to finalise it in 2018. The draft contains evidence‐based recommendations but lacks a framework for accountability, and the Commonwealth Minister of Health recently suggested that the alcohol industry help devise the final version. We recommend that the Government rely on advice from health experts for health policy, pre‐specify outcome indicators, commit to modest activities initially, to develop momentum; and commission independent evaluation after 3 years.     

Alcohol consumption, ischemic heart disease and cerebrovascular disease. An epidemiological perspective

Epidemiological data on alcohol consumption, ischemic heart disease and cerebrovascular disease are examined. Alcohol consumption is positively associated with cerebrovascular disease. Data on the relationship between alcohol consumption and ischemic heart disease are conflicting and incomplete. The evidence suggests that over a range of consumption, the limits of which have not been established, the relationship is negative. However, consumption at the high levels usually associated with alcoholism carries an elevated risk.     

Alcohol consumption appears to protect against non-alcoholic fatty liver disease

Aliment Pharmacol Ther 2011; 33: 378–388

Summary

Background Moderate alcohol consumption may have certain beneficial effects against non‐alcoholic fatty liver disease, which is associated with metabolic syndrome. Aim To determine the association between drinking pattern and fatty liver in Japanese men and women. Methods A cross‐sectional study was performed with health checkup data including information concerning alcohol consumption and ultrasonographic assessment of fatty liver. Results We analysed 4957 men and 2155 women without reported liver diseases (median age, 49 years). In men, 40% of nondrinkers and 28% of drinkers had fatty liver. Alcohol consumption was inversely associated with fatty liver (adjusted odds ratio, 0.54; 95% confidence interval, 0.46–0.63). The prevalence of fatty liver in each category of drinking frequency was 38% (1–3 days/week), 29% (4–6 days/week), and 24% (daily drinking); there was a significant inverse correlation between drinking frequency and the prevalence of fatty liver (P < 0.001). In women, 16% of nondrinkers and 10% of drinkers had fatty liver. Drinking less than 20 g on 1–3 days/week was associated with low prevalence of fatty liver (adjusted odds ratio, 0.47; 95% confidence interval, 0.23–0.96). Conclusions Alcohol consumption appears to protect against non‐alcoholic fatty liver disease.     

Human carcinogenesis and alcohol in hepato-gastroenterology

Alcohol consumption is one of the top-10 risks for worldwide burden of disease. The International Agency for Research for Cancer affirmed that there was evidence for the carcinogenicity of ethanol in animals and classified alcohol consumption as carcinogenic for humans. Alcohol consumption causes cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver, pancreas and female breast. Most alcohol-induced diseases increases in a linear fashion as intake increases: oral, oesophagus and colon cancer fall into this pattern: very little is known about safe margins of alcohol consumption. Given the linear dose-response relation between alcohol intake and risk of cancer, control of heavy drinking remains the main target for cancer control. European Code Against Cancer recommends keeping daily consumption within two drinks (20 g [corrected] of alcohol/day) for man and one drink for women and US Department of Health and Human Services suggest as a low risk, a maximum of 10 g [corrected] of alcohol a day in man and half of this in women.     

Maternal alcohol consumption and altered miRNAs in the developing fetus: Context and future perspectives

Alcohol is a teratogenic agent that can cause a wide range of developmental disorders, and sometimes, the effects persist throughout an individual's lifetime. Researchers have shown the involvement of epigenetic mechanisms in alcohol‐mediated disorders. Non‐coding RNAs are one of the major sources of epigenetic modifications, especially microRNAs. The association of microRNAs with alcohol consumption leads to a new focus on finding the molecular mechanisms of alcohol toxicity. It has been suggested that alcohol alters the relative expression of microRNAs and regulates target mRNA expression in both in vitro and in vivo models. Currently, we lack information regarding the relationship between altered microRNA expression and disease phenotypes in alcohol‐mediated disorders. In this review, we tried to gather all of the available information about the alcohol‐mediated dysregulation of microRNA expression in utero. We hope that our efforts will help future researchers identify major microRNAs in the field of prenatal alcohol toxicity and related therapeutics.     

Neighbourhood matters: perceptions of neighbourhood cohesiveness and associations with alcohol, cannabis and tobacco use

Introduction and Aims. To examine relationships between perceived neighbourhood cohesion and alcohol, tobacco and cannabis consumption in New Zealand. Design and Methods. A two‐level random intercept regression model was used to examine the extent to which perception of neighbourhood cohesion (at the individual and area level) was associated with the frequency of substance (alcohol, tobacco and cannabis) consumption, after controlling for demographics and deprivation. This study is based on data from two national Health Behaviours Surveys (Drugs and Alcohol) conducted in 2003 and 2004 in New Zealand. Data were collected by computer‐assisted telephone interviewing with two complementary computer‐assisted cellphone interviewing samples. The combined sample consists of 6346 men and 8411 women (n = 14 757) distributed across 1572 census area units. Results. Perception of neighbourhood cohesion was significantly associated with the level of alcohol, tobacco and cannabis consumption. Individuals who perceived their neighbourhood as more cohesive had higher annual frequency of alcohol consumption but lower consumption on a typical drinking occasion. Higher perceived neighbourhood cohesion was also associated with a decrease in the probability of tobacco and cannabis use and of the amounts consumed. Area‐level analysis suggested that aggregate census area unit‐level neighbourhood cohesion exerted a significant additional contextual effect on the frequency of tobacco and cannabis consumption over and above individual perceptions of neighbourhood cohesiveness. Discussion and Conclusions. This study provides empirical evidence that perceptions of the neighbourhood social environment are associated with people's substance consumption patterns. Increasing residents' sense of neighbourhood cohesion might prove a promising way to decrease health‐damaging consumption behaviours. [Lin E‐Y, Witten K, Casswell S, You RQ. Neighbourhood matters: Perceptions of neighbourhood cohesiveness and associations with alcohol, cannabis and tobacco use. Drug Alcohol Rev 2012;31:402–412]     

饮酒与乙肝病毒感染对肝脏损伤的协同作用及机制的研究进展

饮酒和乙肝病毒感染是造成肝脏损伤的两大病因。流行病学调查显示,在慢性肝病患者中,饮酒及HBV感染两种损伤因素多并存。饮酒与HBV感染促进肝脏损伤的发生和进展,促进肝细胞癌的发生。饮酒可促进体内HBV的病毒复制和基因突变,而HBV感染亦可增加肝细胞对乙醇损伤的易感性。这些研究为临床肝病患者的保健和治疗提供了依据。本文从临床表现、临床研究和实验机制研究等方面综述了饮酒与HBV感染对肝脏损伤的协同作用及其机制。     

When risk factors combine: the interaction between alcohol and smoking for aerodigestive cancer, coronary heart disease, and traffic and fire injury

BACKGROUND: Alcohol and tobacco are responsible for a significant amount of burden of disease, but some diseases may be a result of the interaction between these two risk factors. METHODS: Systematic literature review identified articles on the interaction of alcohol and smoking on a number of outcomes related to both risk behaviours. RESULTS: The interaction of smoking and alcohol significantly increases risk for aerodigestive cancers, and may increase risk for traffic injury and fire injury, but there were very few quality studies on injury. The indication that the cardioprotective effect of alcohol on coronary heart disease is only valid for smokers, but this result is inconclusive because of small evidence base. CONCLUSIONS: The interaction between smoking and alcohol consumption seems to be responsible for a significant amount of disease. Unfortunately, little is known on the mechanisms and details of this interaction on disease outcomes. Future studies, especially for coronary heart disease and injury outcomes, are warranted.     

Cost of privatisation versus government alcohol retailing systems: Canadian example

Introduction and Aims. Alcohol retail monopolies have been established in many countries to restrict alcohol availability and thus, minimise alcohol‐related harm. The aim of this study was to estimate the impact of the privatisation of alcohol sales on the burden and direct health‐care, law enforcement costs and indirect costs (lost productivity due to disability or premature mortality) in Canada. Design and Methods. Simulation modelling. International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse were used. All burden and costs were compared with the baseline taken from the aggregate Cost Study on Substance Abuse in Canada 2002. Results. If all Canadian provinces and territories were to privatise alcohol sales we assume that consumption would increase from 10% to 20% based on available Canadian literature. Under the 10% scenario the costs would increase from 6% ($828 million) and under the 20% scenario costs would increase 12% ($1.6 billion). This increase is substantially greater than the tax and mark‐up revenue gained from increased sales, and represents a net loss. Discussion and Conclusions. Alcohol‐attributable burden and associated costs will increase markedly if all Canadian provinces and territories gave up the government alcohol retailing systems. For public health and economic reasons, governments should continue to have a strong role in alcohol retailing. [Popova S, Patra J, Sarnocinska‐Hart A, Gnam WH, Giesbrecht N, Rehm J. Cost of privatisation versus government alcohol retailing systems: Canadian example. Drug Alcohol Rev 2012;31:4–12]     

Alcohol misuse is rare among Hong Kong medical students

Introduction and Aims. High rates of hazardous alcohol consumption have been reported among medical students in several countries. This study aimed to determine the degree of self‐reported alcohol use among medical students in Hong Kong, and to compare this with published data from medical students elsewhere. Design and Methods. 111/137 (81%) final year medical students from the Chinese University of Hong Kong were recruited and anonymously completed the World Health Organization's Alcohol Use Disorders Identification Test, a screening tool which assesses alcohol consumption, dependence and alcohol‐related problems. Results are graded as low risk (score 1–7) or harmful and hazardous (8 or more). Results. The rate of ever drinking among this group of Hong Kong medical students is relatively high (74%) but few students reported at‐risk drinking patterns (1.8%). Most students who drank did so less than once per month and most reported typically drinking only one to two drinks when they did drink alcohol. Discussion and Conclusions. While rates of alcohol drinking among this group of Hong Kong medical students are comparable to those reported in Europe and North America, rates of problem drinking are much lower.[Rotheray KR, Cattermole GN, Liow ECH, Machin P, Graham CA, Rainer TH. Alcohol misuse is rare among Hong Kong medical students. Drug Alcohol Rev 2011;30:685–688]     

The direct and indirect relationships between alcohol prevention measures and alcoholic liver cirrhosis mortality

OBJECTIVE: The objective of this article is to investigate direct and indirect relationships between prevention measures and alcoholic liver cirrhosis mortality in Canadian provinces from 1968 to 1986. METHOD: The data base that was assembled included alcoholic cirrhosis mortality rates, alcohol availability measures (rate of licensed premises, year in which the legal drinking age was reduced), per capita consumption of alcohol, rates of AA members and groups, and economic and demographic measures. This article develops a two-equation analytic model based on the availability theory of alcohol problems and prevention (Single, 1988). The distinction between direct and indirect effects of prevention measures can be made explicitly with this model. RESULTS: Alcohol availability measures, but not AA measures, had a significant direct potential impact on alcohol consumption. AA measures had a significant direct relationship to cirrhosis mortality rates. Alcohol consumption also had a significant direct relationship to cirrhosis mortality, and alcohol availability measures had an important indirect relationship through their influence on per capita alcohol consumption. CONCLUSIONS: While these observations need to be interpreted cautiously, the two-equation model shows promise as an approach to understanding direct and indirect influences on alcohol problems. As expected, AA measures and per capita alcohol consumption demonstrated significant direct relationship to cirrhosis mortality. In addition, important indirect influences of drinking-age changes and rates of licensed premises on cirrhosis mortality were observed through their relationships to per capita alcohol consumption.     

Pills and pints: risky drinking and alcohol-related harms among regular ecstasy users in Australia

Introduction and Aims. A significant proportion of young Australians engage in risky alcohol consumption, and an increasing minority are regular ecstasy (3,4‐methylenedioxymethamphetamine) users. Risky alcohol use, alone or in combination with ecstasy, is associated with a range of acute and chronic health risks. The aim of this study was to document the incidence and some health‐related correlates of alcohol use, and concurrent alcohol and ecstasy use, among a large, national sample of regular ecstasy users (REU) in Australia. Design and Methods. National, cross‐sectional surveys of REU in Australia 2003–2008. Among REU in 2008 (n = 678) usual alcohol use, psychological distress and health‐related quality of life were measured using the Alcohol Use Disorders Identification Test, Kessler Psychological Distress Scale and Short Form‐8 Survey respectively. Results. Among REU in 2008, 36% reported high‐risk patterns of usual alcohol consumption, 62% reported usually consuming more than five standard drinks with ecstasy, and 24% reported currently experiencing high or very high levels of psychological distress. Controlling for age and education, high‐risk drinking among REU was associated with higher levels of psychological distress and poorer health‐related functioning; however, the associations between concurrent alcohol and ecstasy use, and health outcomes, were not significant (P > 0.05). Discussion and Conclusions. A large and increasing proportion of REU in Australia engage in high‐risk patterns of alcohol consumption, including in combination with ecstasy. High‐risk alcohol consumption among this group is associated with adverse health‐related outcomes. Prevention and harm reduction interventions for REU should incorporate messages about the risks associated with alcohol use. There is an ongoing need for youth‐specific, coordinated alcohol and other drug and mental health services.[Kinner SA, George J, Johnston J, Dunn M, Degenhardt L. Pills and pints: Risky drinking and alcohol‐related harms among regular ecstasy users in Australia. Drug Alcohol Rev 2012;31:273–280]     

Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers

Considerable research with animals indicates that the GABA-benzodiazepine (BZ) system plays a key role in alcohol reinforcement. However, only limited research appears to have assessed this issue directly in humans. The present study investigated whether low-dose diazepam would cross-prime motivation for alcohol in problem drinkers. Twelve male problem drinkers (Alcohol Dependence Scale; ADS score > or =9) received oral diazepam (5 mg) and placebo, in a counterbalanced manner on separate sessions. There were three measures of primed motivation for alcohol: self-reported desire for alcohol, consumption of placebo beer in an ostensible taste test procedure, and automatically executed vocal reading responses to Alcohol versus Neutral words on a computer-based task. Diazepam significantly increased beer consumption, and produced a marginally significant increase in reported desire for alcohol. On the reading task, diazepam significantly decreased response latency to Alcohol words relative to Neutral words. Latency to Alcohol words correlated significantly with beer consumption under the drug. Moreover, response latency to Alcohol words under the drug also predicted ADS scores. Thus, severity of dependence was directly linked with vulnerability to a BZ priming effect on motivation for alcohol. These findings provide direct evidence that the GABA-BZ system plays an important role in alcohol reinforcement in problem drinkers.     

The importance of alcoholic beverage type for suicide in Japan: a time-series analysis, 1963-2007

Background. Japan has one of the highest suicide rates in the world. Cohort analysis has suggested that alcohol consumption is a risk factor for suicide in Japan. However, this relationship has not been observed at the population level when a measure of per capita total alcohol consumption has been analysed. The present study employed a time‐series analysis to examine whether these contradictory findings may be due to the existence of beverage‐specific effects on suicide. Methods. An autoregressive integrated moving average model was used to assess the relationship between the consumption of different types of alcohol and suicide rates from 1963 to 2007. The data comprised age‐adjusted suicide rates for the ages 15–69, and information on beverage‐specific alcohol consumption per capita (15+). The unemployment rate was included as a control variable. Results. During 1963–2007, male suicide rates increased substantially whereas female rates decreased slightly. Consumption of distilled spirits was significantly related to male suicide rates (but not in women) with a 1 L increase in consumption associated with a 21.4% (95% confidence interval: 3.2–42.9) increase in male suicide rates. There was no statistically significant relationship between suicide and any other form of alcohol consumption (beer, wine, other alcohol). Conclusion. This is the first study that has shown an association between spirits consumption and male suicide in Japan. Potentially beneficial policy changes include increasing spirits prices through taxation, reducing the physical availability of alcohol and discouraging the practice of heavy drinking.[Norström T, Stickley A, Shibuya K. The importance of alcoholic beverage type for suicide in Japan: A time‐series analysis, 1963–2007. Drug Alcohol Rev 2012;31:251–256]