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  • 101.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Smashing the liquor machine: A global history of prohibition2022In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 41, no 4, p. 1003-1003Article, book review (Other academic)
  • 102.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    A Framework Convention on Alcohol Control: Getting Concrete about Its Contents2021In: European Journal of Risk Regulation, ISSN 1867-299X, E-ISSN 2190-8249, Vol. 12, no 2, p. 433-443Article in journal (Refereed)
    Abstract [en]

    This article proposes and discusses the text of a Framework Convention on Alcohol Control, which would serve public health and welfare interests. The history of alcohol's omission from current drug treaties is briefly discussed. The paper spells out what should be covered in the treaty, using text adapted primarily from the Framework Convention on Tobacco Control, but for the control of trade from the 1961 narcotic drugs treaty. While the draft provides for the treaty to be negotiated under the auspices of the World Health Organization, other auspices are possible. Excluding alcohol industry interests from the negotiation of the treaty is noted as an important precondition. The articles in the draft treaty and their purposes are briefly described, and the divergences from the tobacco treaty are described and justified. The text of the draft treaty is provided as Supplementary Material. Specification of concrete provisions in a draft convention points the way towards more effective global actions and agreements on alcohol control, whatever form they take.

  • 103.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. La Trobe University, Australia.
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Government monopoly as an instrument for public health and welfare: Lessons for cannabis from experience with alcohol monopolies2019In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 74, p. 223-228Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Government monopolies of markets in hazardous but attractive substances and activities have a long history, though prior to the late 19th century often motivated more by revenue needs than by public health and welfare.

    METHODS: A narrative review considering lessons from alcohol for monopolization of all or part of legal markets in cannabis as a strategy for public health and welfare.

    RESULTS: A monopoly can constrain levels of use and harm from use through such mechanisms as price, limits on times and places of availability, and effective implementation of restrictions on who can purchase, and less directly by replacing private interests who would promote sales and press for greater availability, and as a potential test-bed for new policies. But such monopolies can also push in the opposite direction, particularly if revenue becomes the prime consideration. Drawing on the alcohol experience in recent decades, the paper discusses issues relevant to cannabis legalization in monopolization of different market levels and segments - production, wholesale, import, retail for off-site and for on-site use - and choices about the structuring and governance of monopolies and their organizational location in government, from the perspective of maximizing public health and welfare interests.

    CONCLUSION: While the historical record is mixed for government monopolies of attractive but hazardous commodities, experience with alcohol in recent decades shows that for public health and welfare public monopolization is generally a preferable option.

  • 104.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Greenfield, Thomas K.
    Holmes, John
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Livingston, Michael
    Pennay, Amy
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Supranational changes in drinking patterns: factors in explanatory models of substantial and parallel social change2020In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 28, no 6, p. 467-473Article in journal (Refereed)
    Abstract [en]

    Background: That there have been 'long waves' of consumption in parallel in different societies has previously been noted. Now there is a sustained drop in drinking among youth in most of Europe, Australia and North America. Can such changes be understood in a common frame? In terms of inexorable historical phenomena or forces, like Kondratieff waves? In terms of generational shifts, with a younger generation reacting against the habits of an older? Method: Such conceptual models for understanding the dynamics of social change are examined in terms of their potential contribution in explaining when and how substantial changes in levels of consumption occur roughly in concert in different societies, with particular reference to the decline in drinking and heavy drinking in current youth cohorts. Results and Conclusion: Timing tends to rule out economic change as a factor in the current widespread decline in youth drinking. The technological revolution of the electronic web and the smart phone seems a primary explanation, with the widespread change in social presentation and interaction - in habitus - between parents and children also involved. Directions for further research are suggested.

  • 105.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    MacLean, Sarah
    Pennay, Amy
    Dwyer, Robyn
    Turner, Karen
    Saleeba, Emma
    Changing risky drinking practices in different types of social worlds: concepts and experiences2022In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 29, no 1, p. 32-42Article in journal (Refereed)
    Abstract [en]

    The 'social worlds' concept has been underutilized in alcohol research. This is surprising given that drinking is primarily a social activity, often a secondary part of a sociable occasion in a social world whose members come together around something they have in common, such as an occupation, a hobby, or an identity. Social worlds which include drinking in their practices often entail encouragements or pressures to drink more, though they may also try to impose some limits on drinking or related behavior. Heavy drinking social worlds may be a useful target for public health interventions aimed at supporting less harmful drinking practices, and this paper moves beyond a theoretical discussion of social worlds and their utility to suggest how the concept might be applied in practical terms. We discuss the various influences and actors that potentially impact on heavy drinking social worlds, and suggest a pragmatic typology of social worlds in terms of five features: activity-based, identification-based, settings-based, worldview-based and social position-based. Most social worlds will be characterized by more than one feature, although it is likely that one will predominate in a given social world. Examples are discussed of changes in drinking norms in heavy-drinking social worlds primarily characterised in terms of each of the five features. Implications are considered for public health programming to reduce risky drinking in such social worlds.

  • 106.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Miller, Mia
    Waleewong, Orratai
    Assanangkornchai, Sawitri
    Beccaria, Franca
    Benegal, Vivek
    Borges, Guilherme
    Gmel, Gerhard
    Graham, Kathryn
    Hao, Wei
    Mäkelä, Pia
    Morojele, Neo
    Hanh, Hoang Thi My
    Obot, Isidore
    O'Brien, Paula
    Pinsky, Ilana
    Sornpaisarn, Bundit
    Stockwell, Tim
    Laslett, Anne-Marie
    Research agendas for alcohol policymaking in the wider world2022In: The international journal of alcohol and drug research, ISSN 1925-7066, Vol. 10, no 1, p. 34-44Article in journal (Refereed)
    Abstract [en]

    From comparisons of World Health Organization statistics, it is clear that people in lower-income countries experience more harms per litre of alcohol and different types of harms compared to those from higher-income countries. Yet studies in higher-income countries dominate research on policies to prevent alcohol problems. The paper reports on results of collaborative work to map priority areas for research relevant to low- and middle-income countries. Research focus areas were identified and discussed among potential coauthors from diverse fields with relevant knowledge, with agreement reached on an initial list of seven research priority areas.  Areas identified include: (1) the effects of choices (e.g., national vs. local, monopoly vs. licensing system) in organising the alcohol market; (2)  involvement/separation of alcohol industry interests in decisions on public health regulation; (3) options and effectiveness of global agreements on alcohol governance; (4) choices and experience in controlling unrecorded alcohol; (5) means of decreasing harm from men’s drinking to family members; (6) strategies for reducing the effects of poverty on drinking’s role in harms; and (7) measuring and addressing key alcohol-induced low-and middle-income country (LMIC) health harms: infectious diseases, injuries, digestive diseases. Paths ahead for such research are briefly outlined. 

  • 107.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Rehm, Jürgen
    “Harm per litre” as a concept and a measure in studying determinants of relations between alcohol consumption and harm2023In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 115, article id 104006Article in journal (Refereed)
    Abstract [en]

    The term “harm per litre” has been increasingly used in alcohol research in recent years as a concept and a comparative measure of alcohol-attributable harm in comparisons between environments, circumstances, and patterns of drinking. This essay discusses the origins of the term in connection with analyses in terms of patterns as well as levels of drinking and with concerns about differential harms from drinking different beverage types. Also discussed is the term's current primary usage, in the context of epidemiological concerns about differentially severe harms for poorer persons who drink. It is noted that these same concerns have been discussed, particularly in Britain, using the phrase “alcohol harm paradox”.

    “Harm per litre” was initially most often used in comparisons between rates of alcohol-attributable harm by beverage type. After 2010, the expression was applied more broadly, particularly after its use in various World Health Organization-related discussions and documents. In addition, and especially from 2018 onwards when most of the papers using this term were published, it has been used in comparisons by socioeconomic status at the individual level, and by level of socioeconomic development at the country level. Almost all the findings indicate that people with lower socioeconomic status, and countries with lower average income, e.g., low income and lower-middle income countries, incur considerably higher harm per litre (with harm being expressed in disease burden and mortality) than upper middle-income and high-income countries.

    “Harm per litre” is a practicable and easy-to-understand concept to compare groups of individuals or countries, and to quantify health inequalities. The next important step will need to be elucidating a better causal understanding of the processes underlying these inequalities, with an emphasis on factors which can be most easily changed by interventions.

  • 108.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Lockelsen och skammen – berättelser om spelproblem i Japan2020In: Orientaliska Studier, ISSN 0345-8997, Vol. 164, p. 38-77Article in journal (Other academic)
    Abstract [sv]

    Syftet med den här studien är att belysa spelproblem i en japansk kontext och att undersöka hur lockelsen och skammen med ett överdrivet pachinkospelande kan te sig för personer som sökt hjälp inom självhjälpsgrupper eller i vårdsystemet. Mer specifikt undersöks hur personer med spelproblem beskriver utvecklingen av sitt problem, hjälpsökandeprocessen och hur de förhåller sig till skam, skuld och stigma. Avslutningsvis diskuteras olika åtgärder för att minska skadeverkningarna av spel om pengar i Japan.

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  • 109.
    Samuelsson, Eva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kristina, Sundqvist
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Det svårfångade problemspelandet – spelares subjektiva tolkningar av Swelogs bedömningsinstrument2019Other (Other (popular science, discussion, etc.))
    Abstract [sv]

    Överdrivet spelande om pengar kan få ekonomiska, känslomässiga och sociala konsekvenser i olika grad. Hur spelare själva upplever bekymren är centralt för huruvida de kommer att försöka förändra sina spelvanor. Men vad är det egentligen vi fångar när vi mäter problemspelande i befolkningen? Vi har undersökt hur spelare som tidigare bedömts ha ett problemspelande tolkar frågorna som användes vid just denna bedömning.

  • 110.
    Samuelsson, Eva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Månsson, Josefin
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Becoming Safe, Legal, Mature, Moderate, and Self-Reflexive: Trajectories of Drinking and Abstinence among Young People2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 6, article id 3591Article in journal (Refereed)
    Abstract [en]

    In recent years, a vast body of research has investigated trends of declining alcohol consumption among youths. However, the extent to which restrictive-youth approaches towards drinking are maintained into adulthood is unclear. The aim of this study is to explore how young people’s relation to alcohol changes over time. Our data are based on longitudinal qualitative in-depth interviews with 28 participants aged 15 to 23 conducted over the course of three years (2017–2019). The study draws on assemblage thinking by analysing to what kinds of heterogeneous elements young people’s drinking and abstinence are related and what kinds of transformations they undergo when they get older. Five trajectories were identified as influential. Alcohol was transformed from unsafe to safe assemblages, from illegal to legal drinking assemblages, from performance-orientated to enjoyment-orientated assemblages, and from immature to mature assemblages. These trajectories moved alcohol consumption towards moderate drinking. Moreover, abstinence was transformed from authoritarian assemblages into self-reflexive assemblages. Self-control, responsibility, and performance orientation were important mediators in all five trajectories. As the sober generation grows older, they will likely start to drink at more moderate levels than previous generations.

  • 111.
    Samuelsson, Eva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Gamblers’ (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish Longitudinal Gambling Study2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, no 2, p. 140-160Article in journal (Refereed)
    Abstract [en]

    The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications. Aims: To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers’ answers to the PGSI items, in relation to their own current and past gambling behaviours. Methods: Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis. Results: Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account. Conclusions: Answers to the PGSI can contain a variety of meanings based on the respondents’ subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers’ perceptions of the gambling behaviour and its negative consequences.

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  • 112. Schulte, Bernd
    et al.
    Jacobsen, Britta
    Kuban, Maria
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Sweden; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Schmidt, Christiane Sybille
    Schaeffer, Dirk
    Umsetzung von Testung, Diagnostik und Behandlung der Hepatitis C in Einrichtungen der niedrigschwelligen Drogenhilfe in Deutschland – eine Querschnittsbefragung: [Implementation of testing, diagnostic and treatment of hepatitis C in low-threshold drug help facilities in Germany - a cross-sectional survey]2022In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 23, no 03, p. 121-129Article in journal (Refereed)
    Abstract [en]

    Background AIDS and drug aid facilities offer a low-threshold access for people with injecting and other forms of drug use and thus play a central role in reducing hepatitis C virus (HCV) infections in this high-risk group. The aim of this study is to describe the provision and barriers of HCV-specific measures in facilities with low-threshold services for drug users in Germany.

    Method The cross-sectional survey addressed facility structures, availability of HCV-specific measures (prevention, testing, diagnostics, therapy), structural, facility-related and patient-related barriers. The allocation of consumer paraphernalia was used as a criterion for the selection of facilities with low-threshold access for people with injecting and other forms of drug use. The data analysis was carried out descriptively by summarizing and analyzing facilities based on their characteristics.

    Results Of the 380 facilities contacted, responses from 135 facilities with low-threshold access for people with injecting and other forms of drug use were included in the analysis. Most of the facilities offer information on safer use (98.5%) and HCV-counselling (87.4 %). Around 28% of the facilities have HCV antibody or rapid tests available. 40% and 64.4% of all facilities stated that clients with a positive antibody test result or with a corresponding diagnosis (e.g. chronic HCV infection) can be referred to medical care. Insufficient funding and client-related barriers (e.g. lack of reliability) were mentioned as the main barriers to improving the implementation of HCV-specific measures.

    Conclusions While general HCV-prevention measures are an integral part of low-threshold services for drug users in Germany, the availability and uptake of HCV testing and HCV care services for people with injecting and other forms of drug use is not sufficient to significantly reduce HCV infections in this high-risk group. In addition to adequate funding, client-centered interventions are needed to improve the uptake of such offers.

  • 113. Schwarz, Tanja
    et al.
    Anzenberger, Judith
    Busch, Martin
    Gmel, Gerhard
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary; University Medical Centre Hamburg-Eppendorf, Germany.
    Krausz, Michael
    Labhart, Florian
    Meyer, Maximilian
    Schaub, Michael P.
    Westenberg, Jean N.
    Uhl, Alfred
    Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland2024In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 254, article id 111036Article in journal (Refereed)
    Abstract [en]

    Background and Aims: OAT is a well developed and successful treatment strategy for opioid dependent patients in Europe. It has significantly contributed to the fight against the HIV and HCV pandemics, leading to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany, and Switzerland and their models of care, the objective of this study is to analyse experiences and changes in patient structures to identify necessary adaptations for the system of care.

    Methods: We analysed national register-based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents.

    Results: Across these three countries, the life expectancy of OAT patients increased substantially. The mean age increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases), and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020.

    Conclusions: Integrated support models, reliable care structures, internationally comparable high treatment coverage, flexible prescribing practices, and a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy of OAT patients.

  • 114. Schwarzkopf, Larissa
    et al.
    Dorscht, Lisa
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Luttenberger, Katharina
    Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy - results from a randomized controlled trial2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 1162Article in journal (Refereed)
    Abstract [en]

    Background: Bouldering-Psychotherapy (BPT) has proven to effectively reduce depressive symptoms, but evidence on its cost-effectiveness is lacking. Corresponding information is paramount to support health policy decision making on a potential implementation of BPT in routine care.

    Methods: Using data from the German KuS trial BPT was compared with group Cognitive Behavioral Therapy (CBT). Severity of depression symptoms at end of the intervention was operationalized via Montgomery-Asberg Depression Rating Scale (MADRS) and Patient Health Questionnaire (PHQ-9). Adopting a societal perspective, direct medical costs and productivity loss were calculated based on standardized unit costs. To determine incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves (CEAC), adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) were obtained from 1000 simultaneous bootstrap replications.

    Results: BPT was related to improved effects (AMDs: MADRS -2.58; PHQ-9: - 1.35) at higher costs (AMD: +euro 754). No AMD was significant. ICERs amounted to euro288 per MADRS-point and euro550 per PHQ-9-point. For both effect parameters about 20% of bootstrap replications indicated dominance of BPT, and about 75% larger effects at higher costs. At hypothetical willingness to pay (WTP) thresholds of euro241 (MADRS) and euro615 (PHQ-9) per unit of change BPT had a 50% probability of being cost-effective.

    Conclusion: BPT is a promising alternate treatment strategy which - in absence of established WTP thresholds for improving symptoms of depression - cannot unambiguously be claimed cost-effective. Further studies defining subgroups that particularly benefit from BPT appear paramount to delineate recommendations for an efficient prospective roll-out to routine care.

  • 115. Sepanlou, Sadaf G.
    et al.
    Safiri, Saeid
    Bisignano, Catherine
    Ikuta, Kevin S.
    Merat, Shahin
    Saberifiroozi, Mehdi
    Poustchi, Hossein
    Tsoi, Derrick
    Colombara, Danny V.
    Abdoli, Amir
    Adedoyin, Rufus Adesoji
    Afarideh, Mohsen
    Agrawal, Sutapa
    Ahmad, Sohail
    Ahmadian, Elham
    Ahmadpour, Ehsan
    Akinyemiju, Tomi
    Akunna, Chisom Joyqueenet
    Alipour, Vahid
    Almasi-Hashiani, Amir
    Almulhim, Abdulaziz M.
    Al-Raddadi, Rajaa M.
    Alvis-Guzman, Nelson
    Anber, Nahla Hamed
    Angus, Colin
    Anoushiravani, Amir
    Arabloo, Jalal
    Araya, Ephrem Mebrahtu
    Asmelash, Daniel
    Ataeinia, Bahar
    Ataro, Zerihun
    Atout, Maha Moh'd Wahbi
    Ausloos, Floriane
    Awasthi, Ashish
    Badawi, Alaa
    Banach, Maciej
    Bejarano Ramirez, Diana Fernanda
    Bhagavathula, Akshaya Srikanth
    Bhala, Neeraj
    Bhattacharyya, Krittika
    Biondi, Antonio
    Bolla, Srinivasa Rao
    Boloor, Archith
    Borzi, Antonio M.
    Butt, Zahid A.
    Alberto Camera, Luis L. A.
    Campos-Nonato, Ismael R.
    Carvalho, Felix
    Dinh-Toi, Chu
    Chung, Sheng-Chia
    Cortesi, Paolo Angelo
    Costa, Vera M.
    Cowie, Benjamin C.
    Daryani, Ahmad
    de Courten, Barbora
    Demoz, Gebre Teklemariam
    Desai, Rupak
    Dharmaratne, Samath Dhamminda
    Djalalinia, Shirin
    Hoa, Thi
    Dorostkar, Fariba
    Drake, Thomas M.
    Dubey, Manisha
    Duncan, Bruce B.
    Effiong, Andem
    Eftekhari, Aziz
    Elsharkawy, Aisha
    Etemadi, Arash
    Farahmand, Mohammad
    Farzadfar, Farshad
    Fernandes, Eduarda
    Filip, Irina
    Fischer, Florian
    Gebremedhin, Ketema Bizuwork Bizuwork
    Geta, Birhanu
    Gilani, Syed Amir
    Gill, Paramjit Singh
    Alma Gutierrez, Reyna
    Haile, Michael Tamene
    Haj-Mirzaian, Arvin
    Hamid, Saeed S.
    Hasankhani, Milad
    Hasanzadeh, Amir
    Hashemian, Maryam
    Hassen, Hamid Yimam
    Hay, Simon I.
    Hayat, Khezar
    Heidari, Behnam
    Henok, Andualem
    Chi, Linh
    Hostiuc, Mihaela
    Hostiuc, Sorin
    Hsieh, Vivian Chia-rong
    Igumbor, Ehimario U.
    Ilesanmi, Olayinka Stephen
    Irvani, Seyed Sina Naghibi
    Balalami, Nader Jafari
    James, Spencer L.
    Jeemon, Panniyammakal
    Jha, Ravi Prakash
    Jonas, Jost B.
    Jozwiak, Jacek Jerzy
    Kabir, Ali
    Kasaeian, Amir
    Kassaye, Hagazi Gebremedhin
    Kefale, Adane Teshome
    Khan, Rovshan Khalilov Muhammad Ali
    Khan, Ejaz Ahmad
    Khater, Amir
    Kim, Yun Jin
    Koyanagi, Ai
    La Vecchia, Carlo
    Lim, Lee-Ling
    Lopez, Alan D.
    Lorkowski, Stefan
    Lotufo, Paulo A.
    Lozano, Rafael
    Abd El Razek, Muhammed Magdy
    Hue, Thi
    Manafi, Navid
    Manafi, Amir
    Mansournia, Mohammad Ali
    Mantovani, Lorenzo Giovanni
    Mazzaglia, Giampiero
    Mehta, Dhruv
    Mendoza, Walter
    Menezes, Ritesh G.
    Mengesha, Melkamu Merid
    Meretoja, Tuomo J.
    Mestrovic, Tomislav
    Miazgowski, Bartosz
    Miller, Ted R.
    Mirrakhimov, Erkin M.
    Mithra, Prasanna
    Moazen, Babak
    Moghadaszadeh, Masoud
    Mohammadian-Hafshejani, Abdollah
    Mohammed, Shafiu
    Mokdad, Ali H.
    Montero-Zamora, Pablo A.
    Moradi, Ghobad
    Naimzada, Mukhammad David
    Nayak, Vinod
    Negoi, Ionut
    Trang, Huyen
    Ofori-Asenso, Richard
    Oh, In-Hwan
    Olagunju, Tinuke O.
    Padubidri, Jagadish Rao
    Pakshir, Keyvan
    Pana, Adrian
    Pathak, Mona
    Pourshams, Akram
    Rabiee, Navid
    Radfar, Amir
    Rafiei, Alireza
    Ramezanzadeh, Kiana
    Rana, Saleem Muhammad M.
    Rawaf, Salman
    Rawaf, David Laith
    Reiner, Robert C.
    Roever, Leonardo
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Roshandel, Gholamreza
    Safari, Saeed
    Samy, Abdallah M.
    Sanabria, Juan
    Sartorius, Benn
    Schmidt, Maria Ines
    Senthilkumaran, Subramanian
    Shaikh, Masood Ali
    Sharif, Mehdi
    Sharifi, Amrollah
    Shigematsu, Mika
    Singh, Jasvinder A.
    Soheili, Amin
    Suleria, Hafiz Ansar Rasul
    Teklehaimanot, Berhane Fseha
    Tesfay, Berhe Etsay
    Vacante, Marco
    Vahedian-Azimi, Amir
    Valdez, Pascual R.
    Vasankari, Tommi Juhani
    Giang, Thu
    Waheed, Yasir
    Weldegwergs, Kidu Gidey
    Werdecker, Andrea
    Westerman, Ronny
    Wondafrash, Dawit Zewdu
    Wondmieneh, Adam Belay
    Yeshitila, Yordanos Gizachew
    Yonemoto, Naohiro
    Yu, Chuanhua
    Zaidi, Zoubida
    Zarghi, Afshin
    Zelber-Sagi, Shira
    Zewdie, Kaleab Alemayehu
    Zhang, Zhi-Jiang
    Zhao, Xiu-Ju
    Naghavi, Mohsen
    Malekzadeh, Reza
    The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 20172020In: The Lancet Gastroenterology & Hepatology, ISSN 2468-1253, Vol. 5, no 3, p. 245-266Article in journal (Refereed)
    Abstract [en]

    Background Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings In 2017, cirrhosis caused more than 1.32 million (95% UI 1.27-1.45) deaths (440000 [416 000-518 000; 33.3%] in females and 883 000 [838 000-967 000; 66.7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2.4% (2.3-2.6) of total deaths globally in 2017 compared with 1.9% (1.8-2.0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21.0 (19.2-22.3) per 100 000 population in 1990 to 16.5 (15.8-18-1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32.2 [25.8-38.6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10.1 [9.8-10-5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3.7 [3.3-4.0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103.3 [64.4-133.4] per 100 000 in 2017). There were 10.6 million (10.3-10.9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33.2% for compensated cirrhosis and 54.8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases snore than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. Interpretation Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH.

  • 116. Sleczka, Pawel
    et al.
    Braun-Michl, Barbara
    Schwarzkopf, Larissa
    Spörrle, Matthias
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Munich, Germany; ELTE Eötvös Loránd University, Budapest, Hungary.
    Why do they gamble and what does it mean? Latent class analysis of gambling motives among young male gamblers2022In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 30, no 6, p. 431-440Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Motives to gamble are important in the functional analysis of problematic gambling. This study examines the possibility of classifying young male gamblers based on their motives to gamble and compares the identified groups to validate the obtained classification.

    METHOD Based on a screening survey among 2,681 young men from Bavaria, n=170 frequent or problem gamblers (Mage = 22.3 years, SD = 2.5) were recruited to participate in a survey with a 2-year follow-up. Latent class analyses (LCA) were conducted based on baseline answers to 10 items measuring five domains of gambling motives: enhancement, coping, self-gratification, and social and financial motives. The identified classes were compared regarding baseline gambling attitudes and impulsiveness as well as gambling behavior and gambling disorder (GD) criteria at baseline and follow-up.

    RESULTS Analyses revealed a four-class solution based on reported motives: ‘primarily fun-motivated gamblers’ (n=100, 58.8%), who gambled mostly for fun; ‘asset and self-gratification seekers’ (n=19, 11.2%) with a high risk of GD at baseline; ‘thrill seekers’ (n=42, 24.7%) with high impulsiveness; and ‘polymotivated coping gamblers’ (n=9, 5.3%) with a higher risk of GD than the ‘primarily fun-motivated gamblers’ in cross-sectional and longitudinal analyses.

    CONCLUSIONS The identified group differences support the validity of the classification. ‘Thrill seekers’ and ‘polymotivated coping gamblers’ correspond to the impulsive and emotionally vulnerable pathways described by Blaszczynski and Nower (2002) respectively. The two other groups appear to be subtypes of the behaviorally conditioned type. Motivation-based classification offers a promising approach to identifying individuals with an elevated risk of GD.

  • 117. Smit, Koen
    et al.
    Dowling, Rowan
    Livingston, Michael
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Melbourne, Australia.
    Laslett, Anne-Marie
    Ferrier, Adamm
    Livingstone, Charles
    Borland, Ron
    Jiang, Heng
    Trends in alcohol expenditure in Australia from 1984 to 2015-2016: An exploratory study2023In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 42, no 5, p. 1235-1245Article in journal (Refereed)
    Abstract [en]

    Introduction: Excessive alcohol use is associated with non-communicable diseases and social problems, such as work absence, financial problems and family violence. Expenditure and expenditure shares on alcohol are valuable measures to monitor financial activities on this risk behaviour. The aim of this paper is to report trends in alcohol expenditure in Australia over the last two decades.

    Methods: Data are from six waves of Australian Household Expenditure Surveys from 1984 to 2015–2016. We explored trends of alcohol expenditure among Australians and in different socio-demographic groups in the last 30 years. We further examined changes of expenditure on different on- and off-premises beverages over time.

    Results: Absolute alcohol expenditure has remained the same between the 1980s and 2016, after accounting for inflation. However, a declining trend in relative alcohol expenditure as a proportion of total household expenditure was found across nearly all demographic groups (e.g., sex, age, employment, household income), except for women aged 45–54, who showed an increasing trend of alcohol expenditure after 1998–1999.

    Discussion and Conclusions: The current study shows declines in relative alcohol expenditure, which may reflect declines in alcohol's relative importance within the elements of the person's lifestyle they need to pay for and/or increased awareness of alcohol's health and social harms. Further longitudinal analysis should explore additional predictors of household expenditure on alcohol. Results suggest that current bi-annual indexation increases in alcohol tax should account for increases in income to ensure the effectiveness of pricing. Moreover, attention is needed to address drinking among middle-aged females.

  • 118. Smit, Koen
    et al.
    Jiang, Heng
    Rockloff, Matthew
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Melbourne, Australia.
    MacLean, Sarah
    Laslett, Anne-Marie
    Associations Between Heavy Episodic Drinking, Drinking While Gambling, and Risky Gambling2023In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, no 39, p. 1597-1610Article in journal (Refereed)
    Abstract [en]

    Introduction: Understanding how patterns of drinking are associated with risky gambling in Australia is needed to inform an effective approach to minimise harm. Methods: This cross-sectional questionnaire study reports on 2,704 subsampled participants who completed survey questions about their patterns of drinking. With logistic regressions, we examined whether frequency of heavy episodic drinking (HED) and alcohol use while gambling were associated with risky gambling while controlling for sociodemographic variables. Results: Occasional HED and monthly HED were associated with any gambling (versus no gambling), but frequent HED was not significantly associated with gambling. The opposite pattern was found when predicting risky gambling. Occasional HED (i.e. less than monthly) was not significantly associated, but a higher frequency of HED (at least weekly) was associated with a higher likelihood of risky gambling. Drinking alcohol while gambling was associated with risky gambling, over and above HED. The combination of HED and use of alcohol while gambling appeared to significantly increase the likelihood of risky gambling. Conclusions: The association of HED and alcohol use while gambling with risky gambling highlights the importance of preventing heavy alcohol use among gamblers. The links between these forms of drinking and risky gambling further suggests that individuals who engage in both activities are specifically prone to gambling harm. Policies should therefore discourage alcohol use while gambling for example by prohibiting serving alcohol at reduced prices or to gamblers who show signs of being affected by alcohol and informing individuals of the risks associated with alcohol use while gambling.

  • 119. Specht, Sara
    et al.
    Schwarzkopf, Larissa
    Braun-Michl, Barbara
    Seitz, Nicki-Nils
    Wildner, Manfred
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut Für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 20162022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 320Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to decompose independent effects of age, period, and cohort on trends in outpatient addiction care utilization resulting from alcohol (AUD) and illicit substances use disorders (ISUD). Decomposing trends in addiction care utilization into their independent effects by age, period, and cohort may lead to a better understanding of utilization patterns.

    Methods: Individuals seeking help in Berlin outpatient addiction care facilities between 2008 and 2016 with an age range of 18–81 years for AUD (n = 46,706) and 18–70 years for ISUD (n = 51,113) were standardized to the general Berlin population using data from the German Federal Statistical Office. Classification of utilization as AUD- (F10) or ISUD-related (F11, F12, F14, F15, F16, F18, F19) help-seeking was based on primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. Age was measured in years and period as year of data collection. Cohort was defined as the mathematical difference between period and age. Age, period, and cohort analyses were conducted using the intrinsic estimator model on AUD- and ISUD-related outpatient addiction care utilization.

    Results: Age effects on AUD-related utilization were highest in 18- to 19-year-old and in 39- to 59-year-old individuals. ISUD-related utilization declined almost continuously with increasing age. Period effects on AUD- and ISUD-related utilization were small. AUD-related utilization was highest in cohorts born from 1951 to 1986. ISUD-related utilization increased in cohorts born between 1954 and 1973 where utilization peaked, followed by a decline of the same order.

    Conclusions: Age and cohort effects were the strongest drivers of trends in AUD- and ISUD-related outpatient addiction care utilization. Onset of help-seeking in earlier phases of AUD development should be enhanced as well as help-seeking for AUD and ISUD in general. The highest cohort-related rates in the baby boomer and following cohorts for AUD and ISUD underline an increased demand for addiction care.

  • 120. Stelemekas, Štelemėkas
    et al.
    Manthey, Jakob
    Badaras, Robertas
    Casswell, Sally
    Ferreira-Borges, Carina
    Kalėdienė, Ramunė
    Lange, Shannon
    Neufeld, Maria
    Petkevičienė, Janina
    Radišauskas, Ričardas
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Telksnys, Tadas
    Zurlytė, Ingrida
    Rehm, Jürgen
    Alcohol control policy measures and all-cause mortality in Lithuania: an interrupted time-series analysis2021In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 116, no 10, p. 2673-2684Article in journal (Refereed)
    Abstract [en]

    Background and aims Alcohol use has been identified as a major risk factor for burden of mortality and disease, particularly for countries in eastern Europe. During the past two decades, several countries in this region have implemented effective alcohol policy measures to combat this burden. The aim of the current study was to measure the association between Lithuania's alcohol control policies and adult all-cause mortality.

    Design Interrupted time-series methodology by means of general additive models.

    Setting Lithuania.

    Participants Adult population of Lithuania, aged 20 years and older.

    Measurements Alcohol control policies were ascertained via a document review of relevant legislation materials. Policy effects were evaluated as follows: (1) slope changes in periods of legislative (non-)activity with regard to alcohol control policy (analysis 1); (2) level changes of three interventions following recommendations of the World Health Organization (analysis 2); and (3) level changes of seven interventions judged a priori by an international panel of experts (analysis 3). Mortality was measured by sex-stratified and total monthly age-standardized rates of all-cause mortality for the adult population.

    Findings During the period 2001-18, effective alcohol control policy measures were implemented on several occasions, and in those years the all-cause mortality rate declined by approximately 3.2% more than in years without such policies. In particular, the implementation of increased taxation in 2017 was associated with reduced mortality over and above the general trend for men and in total for all analyses, which amounted to 1452 deaths avoided (95% confidence interval = -166 to -2739) in the year following the implementation of the policy.

    Conclusions Alcohol control policies in Lithuania appear to have reduced the overall adult all-cause mortality over and above secular trends.

  • 121.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Balancing welfare and market logics: Procurement regulations for social and health services in four Nordic welfare states2020In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 37, no 1, p. 6-31Article in journal (Refereed)
    Abstract [en]

    Aim: In increasingly market-oriented welfare regimes, public procurement is one of the most important instruments of influencing who produces which services. This article analyses recent procurement regulations in four Nordic countries from the point of view of addiction treatment. The implementation of public procurement in this field can be viewed as a domain struggle between the market logic and the welfare logic. By comparing the revision of the regulations after the 2014 EU directives in Denmark, Finland, Norway, and Sweden, we identify factors affecting the protection of a welfare logic in procurement. We discuss the possible effects of different procurement regulations for population welfare and health.

    Data and theoretical perspective: The study is based on the recently revised procurement laws in the four countries, and adherent guidelines. The analysis is inspired by institutional logics, looking at patterns of practices, interests, actors, and procurement as rules for practices.

    Results: Procurement regulations are today markedly different in the four countries. The protection of welfare and public health aspects in procurement – strongest in Norway – is not solely dependent on party political support. Existing service providers and established steering practices play a crucial role. 

    Conclusion: In a situation where market steering has become an established practice and private providers are strongly present, it can be difficult to introduce strong requirements for protection of welfare and population health in procurement of social services.

  • 122.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). National Institute for Health and Welfare (THL), Helsinki, Finland.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    When the organization is a problem: An empirical study of social work with substance use problems in more or less NPM-influenced Swedish municipalities2023In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, Vol. 13, no 1, p. 36-49Article in journal (Refereed)
    Abstract [en]

    New Public Management (NPM) has added new aspects to the conflict between political-bureaucratic steering and professional autonomy in the search for a substance use treatment system (SUT) that is economic and characterized by high quality, accessibility, and professional discretion. This article analyses if and how organizational aspects of NPM imply additional challenges for professionals and SUT. The experiences of 29 social workers, in different positions in the services and administration of SUT, in six municipalities with different degrees of NPM and post-NPM, form the empirical data. Many quality problems were common across municipalities: frequent unevaluated reforms, lack of resources for SUT, and cooperation issues. Several problems were especially pronounced in statutory social work. NPM added challenges. Competition with private providers was viewed as initially (in the 1990s) having improved treatment, but the present market was regarded as creating quality problems without savings. Cooperation between providers was a special quality challenge in NPM municipalities, and NPM added to treatment continuity challenges. While accessibility for resourceful clients was linked to NPM models, treatment for less resourced users was obstructed by NPM. Workplace climate and trust issues were more problematic in the most NPM-permeated municipalities. Professional discretion was difficult to link to local NPM degree. Increased standardization and documentation were often accepted as improving quality. While a system based on competition ideology appeared destructive for treatment quality, post-NPM reforms with cooperation between needs-assessment, treatment, and economic support, conformed better with professionals’ perceptions of good treatment.

  • 123.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    How Substance Use Treatment Professionals Manage Organisational Tensions: A Web Survey and an Interview Study2020In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 66, no 2, p. 93-103Article in journal (Refereed)
    Abstract [en]

    Aims: The study examined how substance use treatment professionals managed problems and tensions in their work, and explored if the strategies varied by organisational features related to New Public Management (NPM). Methods: A total of 69 semi-structured interviews(2017–2018) with treatment staff in nine sampled local/regional areas formed the basis for constructing a web survey administered to staff across Sweden in 2019 (n=606). The means showed how often the different strategies were used. Regression analyses examined organisationaldifferences, and central strategies were illustrated by the interview study. Results: Treatment professionals in general reported satisfactory freedom in their work. Staff in more NPM-like organisations were less likely to report autonomy and more inclined to report conflicting demands.When conflicts emerged, the staff used both passive strategies indicating adaptation or resignation, and active strategies including boundary spanning, protest, and liberty-taking. Some challenging strategies such as looking for other jobs or reporting one thing but doing anotherwere more common in more NPM-like organisations. The opposite was found for customer orientation. Conclusions: While NPM features on customer orientation and steering methods appeared to create fewer problems, more NPM-like organisations appeared to be less favourableoverall and should be applied with caution.

  • 124.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    One model to rule them all? Governing images in the shadow of the disease model of addiction2018In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 37, no 6, p. 726-728Article in journal (Other academic)
    Abstract [en]

    Treatment providers demonstrate a quite strong support for a disease model of addiction, particularly so in the United States. However, conceptions vary and the problems may be perceived as primarily a disease, moral or social problems, or a combination of these (Barnett et al. in press). This commentary discusses the ongoing and dynamic process of defining addiction problems and notes that non-medical perspectives often appear in the shadow of and tend to oppose the disease model that stands quite inviolable – i.e., like the One Ring to rule them all by citing The Lord of the Rings. Recent changes in the Swedish Addiction treatment system, well known for its social perspective on the nature and handling of addiction problems, are highlighted to demonstrate that the world may be changing, or not. It is argued that there cannot be just one model. 

  • 125.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Antonsson, Erik
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The Swedish Addiction Treatment System: Government, Steering and Organisation. Technical Report2019Report (Other academic)
    Abstract [en]

    Welfare systems in Sweden and internationally have gone through major changes regarding modes of operation and means of government in New Public Management (NPM) reforms, which have sought to balance autonomy and control. There is a lively debate about NPM, but research is scarce. NPM indicates improved performances but also unintended consequences and inconsistencies concerning ideas, demands on the services and performance incentives – such as tensions between medical and social professional autonomy and knowledge on the one hand and administrative control, auditing and a growing bureaucracy (e.g., procurement, inspections, documentation) on the other. The research project used addiction treatment with different organisations and professions as a case for studying the impact of NPM on the daily work in regional health care and municipal social services organisations.

    We charted the broad steering and organisation of addiction treatment. We analysed the extent to which tendencies of NPM have conveyed advantages or created conflicting logics by comparing addiction treatment in three regions and six municipalities with varying degrees of NPM. The study used official statistics, documents, interviews and a web survey. A total of 85 interviews were made with 93 individual state, regional and local policy-makers and officials (including the previously unstudied procurers) and public and private care providers (managers and treatment professionals) in 2017–2018. The interviews formed the basis for a web survey among professionals in Sweden in 2019. Purchasing addiction services was further examined by observing a large procurement process, by organising a workshop with Nordic procurement experts, and by interviewing civil servants in Finland, Denmark and Norway.

    The study shows how addiction treatment is governed and organised, highlighting developments over time with special emphasis on various NPM features. The interviews addressed advantages and tensions in the daily work and if and how professionals seek to adapt to new, perhaps inconsistent, demands. The web survey allows for comparisons across organisations and professional groups. This technical report presents the background and aims of the study and describes in detail the Swedish study setting, and the study design, methods and data sources used.

  • 126.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    The new suit of the Centre for Social Research on Alcohol and Drugs (SoRAD): A well-tailored costume for tackling research and challenges ahead2020In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 37, no 6, p. 592-608Article in journal (Refereed)
    Abstract [en]

    This overview reviews the establishment and evolution of the Centre for Social Research on Alcohol and Drugs (SoRAD). It outlines its current organization and updated research direction, and discusses SoRAD’s future challenges and opportunities. SoRAD was established at Stockholm University to strengthen and support Swedish social science research on alcohol and drugs. It became active in 1999, and quickly grew in research efforts and reputation, while experiencing setbacks around 2006 and 2017. In 2018 SoRAD merged with the Centre for Health Equity Studies (CHESS), to form a new Department of Public Health Sciences. In its new suit, SoRAD acts as a research centre within the teaching department. The research activities on alcohol and other drugs and gambling behaviour and problems may be categorized into four main areas: Social epidemiology; Subcultures and social worlds of use and heavy use; Policy formation, implementation and societal responses; and Societal and other collective definitions of problems and solutions. The new arrangements, with an increased staff pool and close interplay with higher education, provides a more stable and long-term platform for achieving the main mission of promoting and developing social science research on addictive substances and behaviours and related problems.

  • 127.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Lerkkanen, Tuulia
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Winerdal, Ulrika
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    A conference on Nordic comparisons of addictive substances and behaviors – Time for the revival of the tradition of Nordic research exchange!2023Other (Other (popular science, discussion, etc.))
    Abstract [en]

    The Department of Public Health Sciences at Stockholm University and its Center for Social Research on Alcohol and Drugs (SoRAD) are announcing a conference on Nordic Comparative Research on Addictive Substances and Behaviors – Advancing by Comparing. It takes place in Stockholm, in April 2024. The three-day conference aims to revive the tradition of Nordic research collaboration by presenting the latest Nordic comparisons and sharing a platform for inspiring researchers to discuss possible comparisons in the future.

  • 128.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?2019In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 53, no 5, p. 776-792Article in journal (Refereed)
    Abstract [en]

    Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi-market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across publicand private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “new normal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.

  • 129.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). National Institute for Health and Welfare, Finland.
    Why Research Should Pay Attention to Effects of Marketization of Addiction Treatment Systems2019In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, no Supplement 18, p. 31-39Article in journal (Refereed)
    Abstract [en]

    Objective:

    Researchers generally assume that addiction treatment systems can be viewed as entities and planned with the citizens’ best interests in mind. We argue that another steering principle, the market logic, has permeated many Western World treatment systems but is neglected in research. We demonstrate how it may affect system-level planning, service provision, and the service users.

    Method:

    We draw on an ongoing Swedish study, with some Nordic references, using several data sources: (1) public statistics on treatment expenditures and purchases; (2) interviews with service users (n = 36) and their service providers (n = 23) on different market features; (3) an observation of a large public procurement process concluding framework agreements based on competitive tendering; (4) interviews with officials involved with steering of the system and procurement (n = 16); (5) a workshop on procurement in the Nordic countries (n = 11 participants); and (6)77 interviews with professionals, managers, and elected representatives.

    Results:

    We outline seven propositions that call for further research attention: public procurement, as regulated in the European Union, is not suitable for addiction treatment; marketization challenges democracy, equity, needs assessment, and treatment planning; marketization causes new accountability problems and idle monitoring; marketization causes fragmentation and obstructs coordination and continuity of care; marketization causes unification of services and favors big bureaucratically sophisticated providers; treatment professionals’ values are downplayed when a mistrust-based market logic replaces a trust- and needs-based logic; and marketization marginalizes treatment professionals and service users by limiting discretion.

    Conclusions:

    Findings point toward the importance of acknowledging and mitigating market principles in treatment systems to safeguard needs assessments and planning that serve the interests of the service users and the public.

  • 130. Strothmann, Benjamin
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Kriston, Levente
    Röhrig, Jeanette
    Scherbaum, Norbert
    Buchholz, Angela
    Factorial, Construct, and Predictive Validity of the Motivation for Treatment Scale in Alcohol-Use Disorder Withdrawal Treatment2023In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 29, no 6, p. 375-384Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of the present study was to examine for the first time the factorial, construct, and predictive validity of the motivation for treatment (MfT) scale in a cohort of patients undergoing inpatient-qualified alcohol withdrawal treatment with the goal of referring patients to further treatment. The MfT scale has previously been evaluated in different settings of substance abuse treatment, revealing factorial ambiguity. To the best of our knowledge, the present study is the first study that conducted comprehensive factor analyses versus separate analyses of the factors conducted in prior studies in order to clarify the aforementioned factorial ambiguity. Methods: A total of 249 patients (mean age 45.2 years (SD = 10.3); 34.4% females) with alcohol dependence were assessed. Data were obtained from four inpatient clinics specialized in qualified alcohol withdrawal treatment in Germany. First, confirmatory factor analyses were carried out to examine the fit of the four models discussed in the literature. Second, an exploratory factor analysis was conducted. Correlations of the new factors with other motivational constructs and referral to a subsequent treatment were investigated as measures of construct and predictive validity. Results: None of the four models showed an acceptable fit to the data in confirmatory analyses. The exploratory analysis suggested to eliminate seven items because of inappropriate factor loadings and resulted in a shortened MfT scale, which consists of three factors based on 17 items. For the latent variables “problem recognition,” “desire for help,” and “treatment readiness,” satisfactory composite reliability was found with 0.82, 0.80, and 0.78, respectively. Evidence for predictive validity was found in the correlation between “treatment readiness” and referral to a subsequent treatment. Discussion/Conclusion: The new shortened MfT scale exhibited remarkable parsimony, which is desirable in settings such as withdrawal treatment, where patients frequently are cognitively or physically impaired. Despite its briefness, construct and predictive validity were better than in the original version of the MfT scale. The factorial validity of the suggested scale needs to be corroborated in further research. 

  • 131. Sundin, Erica
    et al.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Galanti, Maria Rosaria
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Ramstedt, Mats
    Country-Level Heavy Episodic Drinking and Individual-Level Experiences of Harm from Others' Drinking-Related Aggression in 19 European Countries2022In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 28, no 2, p. 134-142Article in journal (Refereed)
    Abstract [en]

    Introduction: There is limited knowledge about how individual experiences of harm from others’ drinking are influenced by heavy episodic drinking (HED) at the country level. The present study aimed to assess (1) the association between the country-level prevalence of HED and the risk of experiencing harm from others’ drinking-related aggression and (2) if HED at the country level modifies the association between consumption of alcohol per capita (APC) and such harm. Methods: Outcome data from 32,576 participants from 19 European countries stem from the RARHA SEAS study. Self-reported harm from others’ drinking included having been verbally abused, harmed physically, or having serious arguments. Data on country-level drinking patterns were derived from the World Health Organization. Associations between country-level prevalence of monthly HED and experiences of aggression (at least 1 of 3 studied harms) were derived through multilevel models – adjusted for country-level age structure and by including the respondent’s own HED patterns as a mediator. Results: A 1% increase in the prevalence of monthly HED was associated with 5% higher odds (odds ratio [OR] 1.05) of experiencing others’ alcohol-related aggression among men, and 6% (OR 1.06) among women. The results suggest that the association between APC and harm was stronger in countries with high prevalences of HED, but the modifying effect could not be confirmed. Discussion/Conclusion: Harm from others’ drinking-related aggression depends not only on individual factors but is also influenced by the drinking patterns of the population. However, the country-level prevalence of HED only explains a small part of the variance of this type of harm.

  • 132. Thor, Siri
    et al.
    Karlsson, Patrik
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; The Swedish Council for Information on Alcohol and Other Drugs, Sweden.
    Social Inequalities in Harmful Drinking and Alcohol-Related Problems Among Swedish Adolescents2019In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 54, no 5, p. 532-539Article in journal (Refereed)
    Abstract [en]

    Aims

    The study aims to examine how socio-economic status (SES) among youth is related to binge-drinking and alcohol-related problems using three SES indicators: (i) SES of origin (parental education level), (ii) SES of the school environment (average parental education level at student’s school) and (iii) SES of destination (academic orientation).

    Methods

    Cross-sectional data on upper secondary students (n= 4448) in Sweden. Multilevel logistic and negative binomial regression were used to estimate the relationship between each SES indicator and binge-drinking and alcohol-related problems, respectively.

    Results

    Only SES of destination was significantly associated with binge-drinking, with higher odds for students in vocational programmes (OR= 1.42, 95% CI= 1.13–1.80). For the second outcome, SES of destination (rr=1.25; 95%CI=1.08–1.45) and SES of the school environment (rr=1.19, 95% CI=1.02–1.39) indicated more alcohol-related problems in vocational programmes and in schools with lower-educated parents. After adjustment for drinking patterns, the relationship remained for SES of the school environment, but became non-significant for SES of destination.

    Conclusion

    Our results suggest that the SES gradient among youth is stronger for alcohol-related problems than for harmful drinking. By only focusing on SES differences in harmful alcohol use, researchers may underestimate the social inequalities in adverse alcohol-related outcomes among young people. Our findings also support the notion that the environment young people find themselves in matters for social inequalities in alcohol-related harm.

  • 133. Torney, Alexandra
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Melbourne, Australia.
    Callinan, Sarah
    Cask wine: Describing drinking patterns associated with Australia's cheapest alcohol2023In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 42, no 6, p. 1322-1331Article in journal (Refereed)
    Abstract [en]

    Introduction: In Australia, cask wine is the cheapest alcoholic beverage available, offering the lowest price per standard drink. Despite this, there is little research on the contextual correlates of cask wine consumption. Therefore, the current study aims to describe how cask wine consumption has changed over the last decade. Then, through comparisons between cask and bottled wine, how prices, typical drinking locations, and patterns of consumption differ between the beverages.

    Methods: Cross-sectional data was drawn from two sources. Four waves of the National Drug Strategy Household Survey were used (2010, 2013, 2016 and 2019) in order to examine consumption trends over time. The International Alcohol Control study (2013) in Australia was additionally used to explore pricing and consumption trends in greater detail.

    Results: Cask wine was considerably cheaper than other forms of wine at $0.54 per standard drink (95% confidence interval [CI] 0.45–0.62, p < 0.05). Consumption trends associated with cask wine differed from that of bottled wine, being consumed almost entirely at home and in significantly greater quantity (standard drinks per day 7.8, 95% CI 6.25–9.26, p < 0.05). Among the heaviest drinkers, 13% (95% CI 7.2–18.8, p < 0.05) consumed cask wine as their main drink, compared to 5% (95% CI 3.76–6.24, p < 0.05) consuming bottled wine.

    Conclusions: Cask wine drinkers are disproportionately more likely to consume higher amounts of alcohol, paying less per drink doing so compared to bottled wine drinkers. As all cask wine purchases were under $1.30, a minimum unit price may largely affect cask wine purchases, applying to a far smaller proportion of bottled wine.

  • 134. Torney, Alexandra
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Huckle, Taisia
    Casswell, Sally
    Callinan, Sarah
    Beverage-specific consumption trends: A cross-country, cross-sectional comparison2023In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 117, article id 104047Article in journal (Refereed)
    Abstract [en]

    Introduction: The price of alcoholic beverages can vary for a range of reasons, including tax. Risky drinkers purchase more low-cost alcoholic drinks than moderate drinkers, contributing to beverage-specific risks for that category. The study aimed to examine the proportion of total alcohol consumption comprised by each beverage type and their correlates. Australian and New Zealand populations were compared, where drinking cultures are similar, but taxation of alcohol differs.

    Method: Data was taken from the International Alcohol Control study in Australia (N=1580) and New Zealand (N =1979), a cross national survey that asks questions on beverage specific alcohol consumption at a range of different locations. Tax rates were obtained from previous analyses run on the dataset.

    Results: Ready to Drink (pre-mixed) beverages are more popular in New Zealand and the proportion of these drinks consumed out of total alcohol consumption by risky drinkers was correspondingly higher there. Conversely, the proportion of wine consumed by risky drinkers was higher in Australia. The consumption of spirits and beer by risky drinkers was similar in both countries.

    Discussion: Differences found for the proportion of beverages consumed by risky drinkers between the countries are fairly well aligned with differences in the taxation of each drink type. Future adaptations in taxation systems should consider the impact of taxes on preferential beverage choice and associated harms.

  • 135. Torney, Alexandra
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Jiang, Heng
    Huckle, Taisia
    Holmes, John
    Callinan, Sarah
    Where do high-risk drinking occasions occur more often? A cross-sectional, cross-country study2024In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362Article in journal (Refereed)
    Abstract [en]

    Introduction: The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk.

    Methods: Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country.

    Results: The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers.

    Discussion and Conclusions: As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise.

  • 136. Torney, Alexandra
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Jiang, Heng
    Livingston, Michael
    Callinan, Sarah
    Shifts in the Australian public's opinions towards alcohol policies: 2004-20192023In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 42, no 7, p. 1785-1795Article in journal (Refereed)
    Abstract [en]

    Introduction: After a period of stagnation, alcohol policy in Australia has received increased attention in the past decade, with Sydney's lockout laws and Queensland's restrictions on trading hours garnering media attention. This study will investigate any changing trends in support towards alcohol policy and identify any demographic-specific shifts.

    Methods: Respondents from the National Drug Strategy Household Survey (conducted every 3 years from 2004 to 2019) were asked to gauge their level of support for 16 alcohol policy items proposed to reduce the problems associated with excessive alcohol use. Mean levels of support for various policy options, as well as demographic predictors of support, were assessed.

    Results: After an increase from 2004 to 2013, support for more evidence-based policies on alcohol (e.g., restricting the availability of alcohol) has decreased since 2013. Support for policy items that focus less on the restriction of the availability of alcohol and more on education remained relatively stable in comparison. While demographic groups continue to vary in their extent of support, shifts appear to be occurring fairly uniformly across sex, age, states and drinking groups.

    Discussion and Conclusions: Support for public health-oriented alcohol policies has been decreasing since 2013. The introduction of high-profile policies and less of a media focus on alcohol may be contributing to decreases in support.

  • 137. Tran, Alexander
    et al.
    Jiang, Huan
    Kim, Kawon Victoria
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Štelemėkas, Mindaugas
    Lange, Shannon
    Rovira, Pol
    Rehm, Jürgen
    Predicting the Impact of Alcohol Taxation Increases on Mortality-A Comparison of Different Estimation Techniques2022In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 57, no 4, p. 500-507Article in journal (Refereed)
    Abstract [en]

    Aims: To examine how standard analytical approaches to model mortality outcomes of alcohol use compare to the true results using the impact of the March 2017 alcohol taxation increase in Lithuania on all-cause mortality as an example.

    Methods: Four methodologies were used: two direct methodologies: (a) interrupted time-series on mortality and (b) comparing predictions based on time-series modeling with the real number of deaths for the year following the implementation of the tax increase; and two indirect methodologies: (c) combining a regression-based estimate for the impact of taxation on alcohol consumption with attributable-fraction methodology and (d) using price elasticities from meta-analyses to estimate the impact on alcohol consumption before applying attributable-fraction methodology.

    Results and Conclusions: While all methodologies estimated reductions in all-cause mortality, especially for men, there was substantial variability in the level of mortality reductions predicted. The indirect methodologies had lower predictions as the meta-analyses on elasticities and risk relations seem to underestimate the true values for Lithuania. Directly estimated effects of taxation based on the actual mortalities seem to best represent the true reductions in alcohol-attributable mortality. A significant increase in alcohol excise taxation had a marked impact on all-cause mortality in Lithuania. 

  • 138. Tran, Alexander
    et al.
    Jiang, Huan
    Lange, Shannon
    Livingston, Michael
    Manthey, Jakob
    Neufeld, Maria
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stelemekas, Mindaugas
    Telksnys, Tadas
    Petkeviciene, Janina
    Radisauskas, Ricardas
    Rehm, Juergen
    The Impact of Increasing the Minimum Legal Drinking Age from 18 to 20 Years in Lithuania on All-Cause Mortality in Young Adults - An Interrupted Time-Series Analysis2021In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 57, no 4, p. 513-519Article in journal (Refereed)
    Abstract [en]

    Short Summary: We investigated the effect of an increase in minimum legal drinking age (MLDA) on all-cause mortality in young adults (aged 18-19). MLDA had a negative effect on all-cause mortality (even when controlling for general trends using other age groups), however when confounding factors were included, these effects were attenuated.

    Aims: To determine the effect of an alcohol policy change, which increased the minimum legal drinking age (MLDA) from 18 years of age to 20 years of age on all-cause mortality rates in young adults (18-19 years old) in Lithuania.

    Methods: An interrupted time series analysis was conducted on a dataset from 2001 to 2019 (n = 228 months). The model tested the effects of the MLDA on all-cause mortality rates (deaths per 100,000 individuals) in three age categories (15-17 years old, 18-19 years old, 20-22 years old) in order to control for general mortality trends in young adults, and to isolate the effects of the MLDA from other alcohol control policies. Additional models that included GDP as a covariate and a taxation policy were tested as well. Results There was a significant effect of the MLDA on all-cause mortality rates in those 18-19 years old, when modelled alone. Additional analyses controlling for the mortality rate of other age groups showed similar findings. Inclusion of confounding factors (policies on alcohol taxation, GDP) eliminated the effects of MLDA.

    Conclusions: Although there was a notable decline in all-cause mortality rates among young adults in Lithuania, a direct causal impact of MLDA on all-cause mortality rates in young adults was not definitively found.

  • 139. Tran, Alexander
    et al.
    Jiang, Huan
    Lange, Shannon
    Manthey, Jakob
    Štelemėkas, Mindaugas
    Badaras, Robertas
    Petkevičienė, Janina
    Radišauskas, Ričardas
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Rehm, Jürgen
    Can alcohol control policies reduce cirrhosis mortality? An interrupted time-series analysis in Lithuania2022In: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231, Vol. 42, no 4, p. 765-774Article in journal (Refereed)
    Abstract [en]

    Background and Aims: The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population-level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population-level alcohol control policies on cirrhosis mortality rates in Lithuania - a high-income European Union country with high levels of alcohol consumption.

    Methods: Age-standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time-series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted.

    Results: There was a significant effect of the 2008 (P < .0001) and 2017 (P = .0003) alcohol control policies but a null effect of the 2018 policy (P = .40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02-3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50-2.52) deaths per 100,000 adults, corresponding to 245 deaths averted.

    Conclusions: Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost-effective and aid in reducing the burden of liver disease.

  • 140.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Analyzing agency and identity navigation in addiction stories by drawing on actor-network theory and narrative positioning analysis2023In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 30, no 1, p. 95-104Article in journal (Refereed)
    Abstract [en]

    In addiction stories in which dependence is experienced as an antagonistic force, agency manifests as enigmatic. As narrators in these stories usually describe how they lost their agency to a substance, we may ask who then acts. By drawing on the actor-network theory, I propose that addiction stories should be approached with an ontology that allows agency also to non-human actors and conceptualizes both human and non-human agencies as relational. Moreover, I argue that addiction stories perform complex identity navigation that can be captured by analysing them from the dimensions of ‘story,’ ‘interaction,’ and ‘identity claim’. As addiction stories describe what kinds of unique human and non-human elements and assemblages have contributed to the development of addiction, they provide expressive material to analyze how their narrators reassemble their addictive past (story), justify it to their audience (interaction) and articulate who they are (identity claim). By approaching addiction stories through these dimensions, we can produce knowledge on what kinds of identity alignments with particular human and non-human actors promote or hinder addiction as part of specific assemblages. This knowledge can help health practitioners focus their treatment interventions on the relational identities that act as barriers or facilitators of recovery. 

  • 141.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Covid-19 as a Generator of Pending Narratives: Developing an Empirical Tool to Analyze Narrative Practices in Constructing Futures2021In: International Journal of Qualitative Methods, E-ISSN 1609-4069, Vol. 20, article id 1609406921996855Article in journal (Refereed)
    Abstract [en]

    The article describes the basic elements of the pending narrative and develops them into a tool of qualitative analysis by taking examples from Covid-19-related reports, opinions and editorials in the news. The pending narrative is a powerful story form, persuading the responsible actors in public to take action by stirring up compelling passion for a specific goal. It has a cogency that comes from the threat that if we do not act in the right way now, the continuity of life will be jeopardized. Crises are fertile breeding grounds for pending narratives, and the arrival of the Covid-19 virus is an expressive example of a situation threatening the continuity of human life around the globe. These circumstances feed on the emergence of pending narratives, which translate the unknown, uncertain and frightening future from open, multiple and unpredictable trajectories into more closed, predictable and controllable pathways. In the development of the pending narrative into a tool of qualitative analysis, the article takes influences from narratology, Bamberg's theory on positioning analysis, Greimas' narrative semiotics and critical discourse analysis. It proposes that in the analysis of pending narratives we benefit from the separation of three levels. On the first level, pending narratives highlight disorder and the menacing trajectory of the anti-subject, and outline a qualifying trajectory for the subject to overcome the threat. On the second level they persuade the responsible actors and the audience to identify with the qualifying trajectory and to take action or support it. And on the third level they articulate the kind of values, identities and moral order in aid of which the required action is taken.

  • 142.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Relational Agency and Identity Navigation in Life Stories on Addiction: Developing Narrative Tools to Analyze the Interplay Between Multiple Selves2022In: International Journal of Qualitative Methods, E-ISSN 1609-4069, Vol. 21, article id 16094069221078378Article in journal (Refereed)
    Abstract [en]

    In life stories on addiction, in which dependence is experienced as an antagonistic force, agency manifests as enigmatic. As narrators in these stories usually describe how they lost their agency to a substance, we may ask who then takes over the agency and is the actor. Can material things act with agency? By taking influences from actor–network theory, Bambergs’ narrative positioning theory, Greimas’ narrative semiotics, symbolic interactionism, and critical discourse studies, I propose that addiction stories can be productively approached with an ontology that conceptualizes actors’ agency as relational. According to this ontology, individuals develop addiction in relation to heterogeneous attachments that form an enabling assemblage. Moreover, I propose that life stories on addiction are narratives in which narrators navigate their addiction by negotiating with multiple selves. These selves can be productively identified and analyzed from the perspectives of “story,” “interaction,” and “identity claim.” As a story, in which actors are positioned vis-à-vis one another, life stories on addiction can be approached as narratives that describe the confrontation between the trajectory of the self that is driven by addiction and the trajectory of the self that seeks mastery over one’s life. As an interaction between narrators and interlocutors, life stories on addiction can be examined as performances of interactive selves who do positive face-work to neutralize, rationalize, and justify their “deviant” behavior. And as identity claims, life stories on addiction can be considered embodiments of ideal or normative selves that are articulated in relation to the dominant discourses and master narratives of surrounding culture. By using examples from life stories on addiction, the article aims to clarify with what kinds of concepts and narrative tools we can analyze the interplay between multiple selves in addiction stories. 

  • 143.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Safe, funny and frightening drinking situations from children’s viewpoint: Comparing recalled childhood stories about others’ drinking in Scandinavia2019In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 67, p. 34-42Article in journal (Refereed)
    Abstract [en]

    The article analyzes retrospective childhood stories related to others’ drinking (N = 336). The stories have been told in a focus group context in Finland and Sweden. Hence, they are stories about the past that have been constructed in the present. The retrospective childhood stories are analyzed from the perspective of emotions, seen as relational and situational sociocultural constructions, by paying attention to what kind of contact and emotional responses children develop to others’ drinking in specific situations. The analysis demonstrates how in an intoxicated-oriented drinking culture the presence of alcohol may signify something outside the bounds of everyday life, in the case of which children develop an ambiguous contact with drinking in which many kinds of positive or negative emotions can emerge, such as love, fun, fear, shame or curiosity. In the Finnish narratives, children’s emotional socialization to drinking is regulated by situations of heavy domestic drinking, festive drinking and moderate routine drinking at home. In the Swedish narratives, children’s emotional socialization to drinking is governed by festive situations, moderate routine drinking at home and meal drinking. Fear dominates the Finnish participants’ recalled childhood stories, whereas fun is the most common emotion in the stories from Sweden. The differences between Finnish and Swedish emotions recalled from childhood in relation to drinking may reflect differences in these culture’s drinking practices and/or social interaction norms. The article demonstrates how adults’ childhood memories on drinking provide an important ‘indirect’ source to get knowledge on children’s ways of experiencing and responding to others’ drinking in various situations.

  • 144.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT, Institut für Therapieforschung, Germany.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Why are young people drinking less than earlier? Identifying and specifying social mechanisms with a pragmatist approach2019In: International Journal of Drug Policy, ISSN 0955-3959, Vol. 64, p. 13-20Article in journal (Refereed)
    Abstract [en]

    Recent surveys have found a strong decrease in alcohol consumption among young people and this trend has been identified in European countries, Australia and North America. Previous research suggests that the decline in alcohol consumption may be explained by changes in parenting style, increased use of social media, changes in gender identities or a health and fitness trend. We use qualitative interviews with drinking and non-drinking young people from Sweden (N = 49) to explore in what way and in what kinds of contexts these explanations may hold true and how they alone or together may explain declining alcohol consumption among young people. By using the pragmatist approach, we pay attention to what kinds of concerns, habits, practices, situations and meanings our interviewees relate to adolescents' low alcohol consumption or decline in drinking. By analyzing these matters, we aim to specify the social mechanisms that have reduced adolescents' drinking. Our paper discovers social mechanisms similar to previous studies but also a few that have previously been overlooked. We propose that the cultural position of drinking may have changed among young people so that drinking has lost its unquestioned symbolic power as a rite of passage into adulthood. There is less peer pressure to drink and more room for competing activities. This opening of a homogeneous drinking culture to the acceptance of differences may function as a social mechanism that increases the success of other social mechanisms to reduce adolescents' drinking. Furthermore, the results of the paper suggest a hypothesis of the early maturation of young people as more individualized, responsible, reflective, and adult-like actors than in earlier generations. Overall, the paper provides hypotheses for future quantitative studies to examine the prevalence and distribution of the identified social mechanisms, as well as recommends directions for developing effective interventions to support young people's healthy lifestyle choices.

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  • 145.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Criminology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung München, Germany; ELTE Eötvös Loránd University Budapest, Hungary.
    How do social media-related attachments and assemblages encourage or reduce drinking among young people?2021In: Journal of Youth Studies, ISSN 1367-6261, E-ISSN 1469-9680, Vol. 24, no 4, p. 515-530Article in journal (Refereed)
    Abstract [en]

    Research shows that young people’s online practices have become a continuous, seamless and routine part of their physical and social worlds. Studies report contradictory findings on whether social media promotes intoxication-driven drinking cultures among young people or diminishes their alcohol consumption. By applying actor-network theory, our starting point is that the effects of social media depend on what kinds of concerns mediate its use. Social media alone cannot make young people drink more or less but influences their drinking in relation to specific attachments that we call here ‘assemblages’. The data consist of individual interviews among girls (n = 32) and boys (n = 24) between 15 and 19 years old from Sweden, covering topics such as alcohol use, social media habits and leisure time activities. The paper maps the variety of assemblages that mediate young people’s online practices and analyzes how young people’s drinking-related social media assemblages increase, decrease or exclude their alcohol consumption. The analysis shows that social media-related attachments seem to reduce our interviewees’ use of alcohol by providing competing activities, by transforming their drinking under the public eye, by reorganizing their party rituals to be less oriented towards drinking and by facilitating parents’ monitoring of their drinking situations.

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  • 146.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Gunnarsson, Malin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Online gambling venues as relational actors in addiction: Applying the actor-network approach to life stories of online gamblers2020In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 85, article id 102928Article in journal (Refereed)
    Abstract [en]

    Background With the emerging technologies of the Internet and smartphones during the last decades, the gambling environment has undergone a massive transformation. In Sweden, and Europe in general, online gambling has more than doubled since 2007.

    Method The paper studies online gambling venues (OGVs) as relational actors of addiction. By drawing on the actor-network theory (ANT) and assemblage thinking, we examine how OGVs, as actors in specific networks of attachment, enable the development of gambling addiction and facilitate its continuation. The data consists of life story interviews with 34 online gamblers.

    Results Online gambling venues extend the scope of gambling opportunities through space, providing an easy portable 24-hours-a-day access to gambling online and on smartphones. This increases the spatial mobility of gambling to diverse contexts. By linking gambling to more unpredictably evolving patterns of relations, online gambling venues also increase gambling's temporal mobility to intrude in the habitual trajectories of everyday life. By enhancing the gambling mobility through space and time, OGVs simultaneously extend the scope of situations in which gambling may transform from a controlled activity into an addiction. It is then that the actor-networks of gambling infiltrate in the actor-networks of work, domestic life and leisure, and start to feed processes where they are translated to serve the interests of gambling.

    Conclusion By giving us tools to challenge simplistic and taken-for-granted explanations of gambling addiction and by allowing us to grasp the flux and changing nature of addiction as a relational pattern of heterogeneous contextual attachments, the actor-network theory can help us to understand the complexity and multiplicity of gambling problems. The knowledge on what kinds of contextual attachments in diverse actor-networks enable harmful gambling and sustain unhealthy relations helps practitioners to focus treatment interventions especially on these contextual linkages and their configurations.

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  • 147.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Health, risk-taking and well-being: doing gender in relation to discourses and practices of heavy drinking and health among young people2020In: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 22, no 5-6, p. 305-323Article in journal (Refereed)
    Abstract [en]

    In the last 20 years, adolescents’ heavy drinking in many western countries has declined. Simultaneously, researchers have identified an increased interest in health among young people. The paper compares adolescents’ gendered discourses and practices on intoxication and health in order to clarify the role gender plays in their current low alcohol consumption. The data consists of semi-structured interviews about alcohol, health and leisure activities among adolescents aged between 15 and 19 (N = 56). In the coding of the material, we have singled out two approaches to health and well-being among the participants, which we name the ‘social’ and ‘physical health’ approaches. By drawing on Butler’s work on ‘gender as performativity’, Connell’s understanding of gendered identities as ‘multidimensional’ and Bourdieu’s concept of ‘habitus’, we analyse how the participants align with, negotiate or oppose the hegemonic masculinities and femininities in these approaches, and examine the everyday practices that the two approaches are embedded in. Our analysis shows that the participants’ gendered performances in the ‘physical health’ approach are more variable, reflective and critical than those in the ‘social health’ approach. Moreover, the physical health approach modifies young people’s risk-taking practices of heavy drinking and helps to reinforce practices that favour young people’s low alcohol consumption. We propose that the move from doing gender in relation to risk-taking by heavy drinking towards doing it more through health- and physical appearance-related activities may generate processes that narrow the gender gap between masculinities and femininities and encourage new kinds of interaction and gender blending between them.

  • 148.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Månsson, Josefin
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Negotiating Emerging Adulthood With Master and Counter Narratives: Alcohol-Related Identity Trajectories Among Emerging Adults in Performance-Oriented Neoliberal Society2021In: Journal of Adolescent Research, ISSN 0743-5584, E-ISSN 1552-6895Article in journal (Refereed)
    Abstract [en]

    This study analyzes how emerging adults negotiate their relation to alcohol in the context of declining youth drinking and how this relationship changes over time. The sample consists of longitudinal qualitative interview data (N = 28) with 9 boys and 19 girls aged 15 to 21. The participants were recruited through schools, social media and non-governmental organizations from mainly the Stockholm region and smaller towns in central Sweden to reach a heterogeneous sample in terms of sociodemographic factors and drinking practices. We interviewed the participants in-depth three times between 2017 and 2019. Thematic coding of the whole data with NVivo helped us select four cases for more detailed analysis, as they represented the typical trajectories and showed the variation in the material. We used the master narrative framework and Bamberg’s narrative positioning analysis to examine the data. The analysis demonstrates what kinds of narrative alignments in identity development encourage heavy drinking, moderate alcohol consumption, and fuel abstinence. The results suggest that the decline in youth drinking is produced by a co-effect of multiple master narratives that intersect and guide the identity development away from heavy drinking.

  • 149.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    ‘Social health’, ‘physical health’, and well-being: Analysing with bourdieusian concepts the interplay between the practices of heavy drinking and exercise among young people2021In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 91, article id 102825Article in journal (Refereed)
    Abstract [en]

    Background: The article examines the interplay between the practices of heavy drinking and exercise among young people. The comparison helps to clarify why young people are currently drinking less than earlier and how the health-related discourses and activities are modifying young people's heavy drinking practices.

    Methods: The data is based on interviews (n = 56) in Sweden among 15–17-year-olds and 18–19-year-olds. By drawing on Pierre Bourdieu's concepts of habitus, field, and capital, we examine what kinds of resources young people accumulate in the fields of heavy drinking and exercise, how these resources carry symbolic value for distinction, and what kind of health-related habitus they imply.

    Results: The analysis shows that young people's practices in the social spaces of intoxication and exercise are patterned around the ‘social health’ and ‘physical health’ approaches and shaped by gendered binaries of masculine dominance. The ‘physical health’ approach values capable, high-performative, and attractive bodies, whereas the ‘social health’ approach is oriented towards accumulating social capital. The analysis demonstrates that these approaches affect the interviewees’ everyday life practices so that the ‘physical health’ approach has more power over the ‘social health’ approach in transforming them.

    Conclusion: As the ‘physical health’ approach appears to modify young people's practices of drinking to be less oriented to intoxication or away from drinking, this may partly explain why young people are drinking less today than earlier. Compared to drinking, the physical health-related social spaces also seem to provide more powerful arenas within which to bolster one's masculine and feminine habitus. This further suggests that intoxication may have lost its symbolic power among young people as a cool activity signalling autonomy, maturity, and transgression of norms.

  • 150. Van der Kruk, Shannen
    et al.
    Harrison, Nathan J.
    Bartram, Ashlea
    Newton, Skye
    Miller, Caroline
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Olver, Ian
    Bowden, Jacqueline
    Prevalence of parental supply of alcohol to minors: a systematic review2023In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 38, no 5, article id daad111Article, review/survey (Refereed)
    Abstract [en]

    Parental supply of alcohol to minors (i.e. those under the legal drinking age) is often perceived by parents as protective against harms from drinking, despite evidence linking it with adverse alcohol-related outcomes. This systematic review describes the prevalence of parental supply of alcohol, as reported in the international literature. The review was registered with PROSPERO (CRD42020218754). We searched seven online databases (Medline, Embase, PsycINFO, CINAHL, Scopus, Web of Science and Public Health Database) and grey literature from January 2011 to December 2022 and assessed the risk of bias with the JBI Critical Appraisal Checklist. Among 58 articles included in narrative synthesis from 29 unique datasets, there was substantial variation in the definition and measurement of parental supply of alcohol. Overall prevalence rates ranged from 7.0 to 60.0% for minor-report samples, and from 24.0 to 48.0% for parent-report samples. Data indicate that parental supply prevalence is generally proportionately higher for older minors or later-stage students, for girls, and has increased over time among minors who report drinking. Literature on the prevalence of parental supply of alcohol is robust in quantity but inconsistent in quality and reported prevalence. Greater consistency in defining and measuring parental supply is needed to better inform health promotion initiatives aimed at increasing parents’ awareness. 

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