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  • 51.
    Landberg, Jonas
    et al.
    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.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sydén, Lovisa
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The Contribution of Alcohol Use, Other Lifestyle Factors and Working Conditions to Socioeconomic Differences in Sickness Absence2020In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 26, no 1, p. 40-51Article in journal (Refereed)
    Abstract [en]

    Introduction: This study investigates how alcohol use contributes to the social gradient in sickness absence. Other factors assessed include lifestyle factors (smoking, physical activity and body mass index), physical and psychosocial working conditions. Methods: The study used baseline data from the Stockholm public health cohort 2006, with an analytical sample of 17,008 respondents aged 25-64 years. Outcome variables included self-reported short-term (<14 days) and register-based long-term (>14 days) sickness absence. Socioeconomic position (SEP) was measured by occupational class. Alcohol use was measured by average weekly volume and frequency of heavy episodic drinking. Negative binominal regression was used to estimate sex-specific SEP differences in sickness absence, before and after adjusting for alcohol use and the additional explanatory factors. Results: Adjusting for alcohol use attenuated the SEP differences in long-term sickness absence by 20% for men and 14% for women. Alcohol use explained a smaller proportion of the differences in short-term sickness absence. Alcohol use in combination with other lifestyle factors attenuated the SEP differences (20-35%) for both outcomes. Physical working conditions explained more than half of the gradient in long-term sickness absence, whereas psychosocial conditions had greater impact on short-term sickness absence among men. Discussion/Conclusion: Alcohol use explains a substantial proportion of the SEP disparities in long-term sickness absence among men. The effect is smaller among women and for short-term sickness absence. Our findings support the notion that physical working conditions constitute the key explanatory variable for SEP differences in long-term sickness absence, but add that psychosocial working conditions have greater impact on the gradient in short-term sickness absence among men.

  • 52. Laslett, Anne-Marie
    et al.
    Anderson-Luxford, Dan
    Willoughby, Bree
    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.
    Doran, Chris
    Egerton-Warburton, Diana
    Jenkinson, Rebecca
    Smit, Koen
    Jiang, Heng
    Harm from the drinking of people you know: A range of effects from different relationships2024In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443Article in journal (Refereed)
    Abstract [en]

    Aims: To describe the range of effects experienced due to the drinking of people respondents know and analyze risk and protective factors for harm from the drinking of partners and household members, other relatives and friends and co-workers.

    Design, setting and participants: Surveys of 2574 participants' experiences were obtained from two samples: 1000 people responded to random digitally dialled Australian mobile calls and 1574 participants responded from the Life in AustraliaTM panel survey.

    Measurements: Respondents were asked whether they had been negatively affected in the previous 12 months by the drinking of persons they knew who were ‘a heavy drinker or drank a lot sometimes’ and the nature of these harms. Weighted logistic regressions were used to analyze differences in rates of key negative outcomes from known others' drinking by gender, age and socio-economic status.

    Findings: Almost two thirds [60.2%; 95% confidence interval (CI) = 57.7%–62.7%] of participants reported having heavy drinkers in their lives and 21.8% (95% CI = 19.8%–23.9%) reported being negatively affected by the drinking of people they knew well in some way. Participants reported a gamut of effects, including, most commonly, adverse social effects: having to transport relatives and friends who had been drinking, role failure and faults, being emotionally hurt or neglected, serious arguments, family problems, having to care for drinkers and verbal abuse. Less commonly, respondents reported physical or sexual harm, property damage, financial stress and threats from others' drinking. Women (odds ratio = 1.49; 95% CI = 1.13–1.95), younger people, rural, Australian-born (vs. respondents born overseas in non-English speaking countries) and more frequent drinkers were more likely to report harm from a drinker they knew than their counterparts after adjusting for other variables in the model.

    Conclusions: Australians appear to be commonly adversely affected by the drinking of people they know. Harms from known drinkers are more likely to be experienced by women than men, particularly from the people they live with and other relatives.

  • 53. Laslett, Anne-Marie
    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.
    Kuntsche, Sandra
    Anderson-Luxford, Dan
    Willoughby, Bree
    Doran, Christopher
    Jenkinson, Rebecca
    Smit, Koen
    Egerton-Warburton, Diana
    Jiang, Heng
    Alcohol's harm to others in 2021: Who bears the burden?2023In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 118, no 9, p. 1726-1738Article in journal (Refereed)
    Abstract [en]

    Background and aims: Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia.

    Design, setting, participants and measurements: Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross-sectional survey modes: a random-digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co-workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment.

    Findings: In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian-born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English-speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age).

    Conclusions: More than one-third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking.

  • 54. Laslett, Anne-Marie
    et al.
    Stanesby, Oliver
    Graham, Kathryn
    Callinan, Sarah
    Karriker-Jaffe, Katherine J.
    Wilsnack, Sharon
    Kuntsche, Sandra
    Waleewong, Orratai
    Greenfield, Thomas K.
    Gmel, Gerhard
    Florenzano, Ramon
    Hettige, Siri
    Siengsounthone, Latsamy
    Wilson, Ingrid M.
    Taft, Angela
    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.
    Children's experience of physical harms and exposure to family violence from others' drinking in nine societies2020In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 28, no 4, p. 354-364Article in journal (Refereed)
    Abstract [en]

    Aim: To study caregiver reports of children's experience of physical harm and exposure to family violence due to others' drinking in nine societies, assess the relationship of harm with household drinking pattern and evaluate whether gender and education of caregiver affect these relationships. Method: Using data on adult caregivers from the Gender and Alcohol's Harm to Others (GENAHTO) project, child alcohol-related injuries and exposure of children to alcohol-related violence (CAIV) rates are estimated by country and pooled using meta-analysis and stratified by gender of the caregiver. Households with and without heavy or harmful drinker(s) (HHDs) are compared to assess the interaction of caregiver gender on the relationship between reporting HHD and CAIV, adjusting for caregiver education and age. Additionally, the relationship between caregiver education and CAIV is analyzed with meta-regression. Results: The prevalence of CAIV varied across societies, with an overall pooled mean of 4% reported by caregivers. HHD was a consistent correlate of CAIV in all countries. Men and women in the sample reported similar levels of CAIV overall, but the relationship between HHD and CAIV was greater for women than for men, especially if the HHD was the most harmful drinker (MHD). Education was not significantly associated with CAIV. Conclusions: One in 25 caregivers with children report physical or family violence harms to children because of others' drinking. The adjusted odds of harm are significantly greater (more than four-fold) in households with an HHD, with men most likely to be defined as this drinker in the household.

  • 55. Laslett, Anne-Marie
    et al.
    Stanesby, Oliver
    Wilsnack, Sharon
    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; University of Melbourne, Australia.
    Greenfield, Thomas K.
    Cross-National Comparisons and Correlates of Harms From the Drinking of People With Whom You Work2020In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 44, no 1, p. 141-151Article in journal (Refereed)
    Abstract [en]

    Background: While research in high-income countries (HICs) has established high costs associated with alcohol's harm to others (AHTO) in the workplace, scant attention has been paid to AHTO in the workplace in lower- or middle-income countries (LMICs).

    Aim: To compare estimates and predictors of alcohol's impacts upon coworkers among workers in 12 countries.

    Methods: Cross-sectional surveys from 9,693 men and 8,606 women employed in Switzerland, Australia, the United States, Ireland, New Zealand, Chile, Nigeria, Lao PDR, Thailand, Vietnam, India, and Sri Lanka. Five questions were asked about harms in the past year because of coworkers' drinking: Had they (i) covered for another worker; (ii) worked extra hours; (iii) been involved in an accident or close call; or had their (iv) own productivity been reduced; or (v) ability to do their job been affected? Logistic regression and meta-analyses were estimated with 1 or more harms (vs. none) as the dependent variable, adjusting for age, sex, rurality of location, and the respondent worker's own drinking.

    Results: Between 1% (New Zealand) and 16% (Thailand) of workers reported that they had been adversely affected by a coworker's drinking in the previous year (with most countries in the 6 to 13% range). Smaller percentages (<1% to 12%) reported being in an accident or close call due to others' drinking. Employed men were more likely to report harm from coworkers' drinking than employed women in all countries apart from the United States, New Zealand, and Vietnam, and own drinking pattern was associated with increased harm in 5 countries. Harms were distributed fairly equally across age and geographic regions. Harm from coworkers' drinking was less prevalent among men in HICs compared with LMICs.

    Conclusions: Workforce impairment because of drinking extends beyond the drinker in a range of countries and impacts productivity and economic development, particularly affecting men in LMICs.

  • 56. Livingston, Michael
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Centre for Alcohol Policy Research, La Trobe University, Australia.
    Chikritzhs, Tanya
    Taylor, Nicholas
    Yuen, Wing See
    Dietze, Paul
    Trends in alcohol-related liver disease mortality in Australia: An age-period-cohort perspective2023In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 118, no 11, p. 2156-2163Article in journal (Refereed)
    Abstract [en]

    Background and Aims

    There have been few systematic attempts to examine how alcohol-related mortality has changed in Australia, and no studies that have explored cohort effects in alcohol-related mortality. This study uses more than 50 years of data to measure age, period and cohort trends in alcohol-related liver disease (ALD) mortality.

    Design, Setting and Cases

    This was a retrospective age-period-cohort analysis of total Australian ALD mortality data from 1968 to 2020 in Australia. There was a total of 35 822 deaths-27 208 men (76%) and 8614 women (24%).

    Measurements

    Deaths from ALD were grouped into 5-year age groups and periods (e.g. deaths for 20-24-year-olds between 1968 and 1972 were combined).

    Findings

    ALD mortality peaked in the late 1970s and early 1980s for both men and women. In age-period-cohort models, mortality was highest for cohorts born 1915-30. For example, men born between 1923 and 1927 had a relative risk of 1.58 [95% confidence interval (CI) = 1.52, 1.64] compared with men born between 1948 and 1952. For women, there was an increase in risk for cohorts born in the 1960s [e.g. the 1963-67 cohort had a relative risk (RR) of 1.16 (95% CI = 1.07, 1.25) compared with women born in 1948-52]. For men, there was a broad decline in mortality over time [e.g. in 2020, the RR was 0.87 (95% CI = 0.82, 0.92) compared with the reference year of 2000]. For women, mortality declined until 2000 and has been stable since.

    Conclusions

    Alcohol-related liver disease mortality has declined across the Australian population since the 1970s and 1980s partly due to cohort-specific shifts as the highest-risk birth cohorts age. For women, this decline had stalled by the year 2000, and cohorts of women born during the 1960s were at higher risk than earlier cohorts, suggesting the need for thoughtful interventions as this population enters its highest-risk years for ALD mortality.

  • 57. Lochbuehler, Kirsten
    et al.
    Rossa, Monika
    Ebert, Christopher
    Morgenstern, Matthis
    Arnaud, Nicolas
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). ELTE Eötvös Loránd University, Hungary ; Hamburg University, Germany.
    Substance use and the usage of social media, computer games, and gambling among apprentices at vocational schools: [Substanzkonsum und nutzung von sozialen medien, computerspielen und glücksspielen unter auszubildenden an beruflichen schulen]2024In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, E-ISSN 1437-1588, Vol. 67, no 4, p. 465-474Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the current study was to assess the prevalence of the (problematic) consumption of alcohol, tobacco, and cannabis as well as the (problematic) use of social media, e‑products, computer games, and gambling among apprentices. Method: Cross-sectional survey of 4591 apprentices at 17 vocational schools from Bavaria, Schleswig-Holstein, and Hamburg. Data was collected using questionnaires between March 2021 and April 2022. The primary endpoints were the 30-day prevalence and the problematic consumption and usage behavior of the mentioned substances/behaviors using screening instruments. Results: Among the assessed substances/behaviors, social media were used most frequently by the apprentices with a 30-day prevalence of 97.7%, followed by alcohol (64.3%) and computer games (55.8%). Cigarettes were consumed by 35.1%, e‑products by 17.9%, and cannabis by 15.4% of the apprentices. Of the apprentices, 12.2% reported having gambled in the past 30 days. Rates of problematic use were 47.4% for alcohol, 18.0% for tobacco, 6.2% for e‑products, and 1.6% for cannabis. Problematic use of social media was indicated by 45.0% of the apprentices, of gambling by 2.2%, and of computer games by 0.7%. Discussion: These results suggest that apprentices constitute a risk group for problematic substance use, indicating increased need for intervention. In particular, secondary prevention efforts in the areas of alcohol and social media should be taken into consideration due to their widespread prevalence in the vocational school setting.

  • 58. Loy, Johanna K.
    et al.
    Seitz, Nicki-Nils
    Bye, Elin K.
    Dietze, Paul
    Kilian, Carolin
    Manthey, Jakob
    Raitasalo, Kirsimarja
    Soellner, Renate
    Trolldal, Björn
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    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.
    Changes in Alcoholic Beverage Choice and Risky Drinking among Adolescents in Europe 1999-20192021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 20, article id 10933Article in journal (Refereed)
    Abstract [en]

    This paper explores trends in beverage preference in adolescents, identifies related regional differences, and examines cluster differences in key drinking measures. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), covering 24 European countries between 1999 and 2019. Trends in the distribution of alcoholic beverages on the participants’ most recent drinking occasion were analysed by sex and country using fractional multinomial logit regression. Clusters of countries based on trends and predicted beverage proportions were compared regarding the prevalence of drinkers, mean alcohol volume and prevalence of heavy drinking. Four distinct clusters each among girls and boys emerged. Among girls, there was not one type of beverage that was preferred across clusters, but the proportion of cider/alcopops strongly increased over time in most clusters. Among boys, the proportion of beer decreased, but was dominant across time in all clusters. Only northern European countries formed a geographically defined region with the highest prevalence of heavy drinking and average alcohol volume in both genders. Adolescent beverage preferences are associated with mean alcohol volume and heavy drinking at a country-level. Future approaches to drinking cultures need to take subpopulations such as adolescents into account.

  • 59. Loy, Johanna K.
    et al.
    Seitz, Nicki-Nils
    Bye, Elin K.
    Raitasalo, Kirsimarja
    Soellner, Renate
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    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.
    Trends in alcohol consumption among adolescents in Europe: Do changes occur in concert?2021In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 228, article id 109020Article in journal (Refereed)
    Abstract [en]

    Objective: The present paper extends the scope of testing Skog's theory on the 'collectivity of drinking culture' to adolescent alcohol use in 26 European countries. The aim was to 1) examine whether changes in adolescent alcohol use are consistent across different consumption levels, and 2) explore whether trends in heavy and light drinkers diverged or converged.

    Method: Data came from six waves of the cross-sectional European School Survey Project on Alcohol and other Drugs (ESPAD) between 1999 and 2019. The sample consisted of n = 452,935 students aged 15-16 years. Trends in alcohol volume across consumption levels including abstainers were estimated by quantile regression models (50th, 80th, 90th and 95th percentile). Countries were classified according to trends showing (soft/hard) collectivity or (soft/hard) polarisation. Trends in heavy drinkers were compared with the population trend.

    Results: Trends in alcohol consumption at different levels across 26 European countries in the period 1999-2019 were not homogeneous. Collective changes were found in 15 (14 soft/1 hard), and polarised trends in 11 countries (5 soft/6 hard). Collectivity was generally associated with a declining trend. In 18 countries, trends in heavy and light drinkers diverged.

    Conclusion: Accepting some variation in the strength of changes across consumption levels, changes in many European countries occurred in the same direction. Yet, diverging trends at different consumption levels in most countries indicate a less beneficial change in heavy compared with light drinkers, implying that in addition to universal population-level strategies, intervention strategies targeting specific risk groups are needed to prevent alcohol-related harm.

  • 60. MacLean, Sarah
    et al.
    Caluzzi, Gabriel
    Cook, Megan
    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.
    Callinan, Sarah
    Drinking alcohol at home feels different from drinking in public places: a qualitative study of midlife Australians2024In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 86, p. 103179-, article id 103179Article in journal (Refereed)
    Abstract [en]

    This paper shows how drinking in one's own home affords different affective experiences to drinking in public settings such as bars, pubs and restaurants. A thematic analysis of interviews with 40 Australians aged 30-65 identified three main variations in alcohol-associated feelings, sensations and urges. Alcohol was used at home to decelerate, but in contrast, people were enlivened when drinking in public venues. Drinking in public generated a sense of vigilance and greater requirement to self-monitor than usually felt necessary at home. For some, drinking at home seemed more habitual; governed by urges rather than intentionality, than drinking outside it did. Policy and interventions that target drinking in the home should be prioritised, such as those focussed on off-premise pricing and availability.

  • 61. MacLean, Sarah
    et al.
    Demant, Jakob
    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.
    Who or what do young adults hold responsible for men's drunken violence?2020In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 81, article id 102520Article in journal (Refereed)
    Abstract [en]

    Background: Men are more likely than women to perpetrate serious violence when they have consumed alcohol, but alcohol does not affect all men in the same way. This paper considers young adults' attribution about agency (the capacity to act) in men's drunken violence.

    Methods: Interviews about alcohol use in night-time venues, streets or private parties were conducted with 60 young adults aged 18-24 in Melbourne, Australia, and analysed thematically. Participants included seven men who identified as having initiated violence when drunk.

    Results: Some interviewees stated that men chose to be violent, or that men's violence when they were drunk was purposeful and therefore involved some component of choice. However, much alcohol-related violence enacted by young men was understood (both by men who reported violence and by other young adults) as impelled by forces outside their control. These forces were: diffusely defined effects of drinking alcohol; proclivities of men and masculinity, and the interaction of alcohol and men's bodies to override capacity for judgement and produce an irresistible urge to fight. The latter was at times explained as caused by the mutually reinforcing actions of alcohol and testosterone, providing a particularly persuasive account of men's violence as biologically-determined.

    Conclusion: These categories encapsulate a set of discursive resources that contribute to the rationalisation, naturalisation and production of men's violence. Participants tended to regard alcohol, masculinities and testosterone as inciting violence predictably and consistently, suggesting that men themselves had relatively little agency over its occurrence. In contrast, research evidence indicates that these actors do not cause violence in any uniform way and that their effects are contingent on changing configurations of factors. Highlighting discrepancies between young adults' understandings of responsibility for men's drunken violence, and those expressed in research, presents additional opportunities for intervention.

  • 62. MacLean, Sarah
    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.
    Cook, Megan
    Mugavin, Janette
    Callinan, Sarah
    Affordances of home drinking in accounts from light and heavy drinkers2022In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 296, article id 114712Article in journal (Refereed)
    Abstract [en]

    Home drinking contributes substantially to health harms associated with alcohol consumption. Drawing on practice theory and new materialism, we argue that drinking is a social practice that allows particular sets of effects, or affordances, when it takes place in a person's home. Qualitative interviews were conducted by telephone with 40 Australian adult home drinkers, of whom 20 drank at a level designated as low risk and 20 at a level which exposed them to a higher likelihood of harm. Our analyses identified four substantive affordances of home drinking practice. The first two concern transformations of home life. Home drinking allowed both celebration and smoothing of dissatisfaction with domestic relationships. Through producing subtly different affective states at home compared to in other locations, drinking practice rendered domestic settings home-like: as places of comfort and respite. The second two affordances of home drinking concern how home as a place acts in the co-constitution of drinking patterns. This entailed routinising alcohol consumption alongside other home-based practices and loosening constraints on intoxication. Importantly for our argument, each of these operated with greater intensity for participants who drank at a heavier level than for those who drank more moderately. For example, heavy drinkers expressed a greater imperative to alter relationships and affective states at home and emphasised how being at home produced opportunities for, and removed obstacles to, heavy drinking. We show that home drinking is patterned with other activities and entwined in domestic wellbeing and the emergence of home as a space of privacy, autonomy and relaxation for Australians in our study sample. Understanding home drinking as deeply embedded in the constitution of contemporary western domestic life helps to explain heavy alcohol consumption in these settings. It also supports the need for targeted public health responses such as restrictions on home delivery of alcohol.

  • 63. Manning, Victoria
    et al.
    Garfield, Joshua B. B.
    Lam, Tina
    Allsop, Steve
    Berends, Lynda
    Best, David
    Buykx, Penny
    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.
    Lubman, Dan
    Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use2019In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 8, no 9, article id 1407Article in journal (Refereed)
    Abstract [en]

    People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study (Patient Pathways'), we recruited 796 clients within one month of intake from 21 publicly funded addiction treatment services in two Australian states, 555 (70%) of whom were followed-up 12 months later. We measured QOL at baseline and follow-up using the WHOQOL-BREF (physical, psychological, social and environmental domains) and determined rates of SUD treatment success (past-month abstinence or a statistically reliable reduction in substance use) at follow-up. Mixed effects linear regression analyses indicated that people who achieved SUD treatment success also achieved significantly greater improvements in QOL, relative to treatment non-responders (all four domains p < 0.001). Paired t-tests indicated that non-responders significantly improved their social (p = 0.007) and environmental (p = 0.033) QOL; however, their psychological (p = 0.088) and physical (p = 0.841) QOL did not significantly improve. The findings indicate that following treatment, QOL improved in at least some domains, but that reduced substance use was associated with both stronger and broader improvements in QOL. Addressing physical and psychological co-morbidities during treatment may facilitate reductions in substance use.

  • 64. Manthey, Jakob
    et al.
    Kilian, Carolin
    Schomerus, Georg
    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.
    Rehm, Jürgen
    Schulte, Bernd
    Alcohol Use in Germany and Europe during the SARS-CoV-2 Pandemic2020In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 66, no 5, p. 247-258Article in journal (Refereed)
    Abstract [de]

    Aims: The aim of this study was to examine changes in alcohol consumption during the Sars-CoV-2 pandemic in Germany in comparison to changes in other European countries. Method: Analyses of sociodemographic and socio-economic data, as well as reports on alcohol use changes since the pandemic collected through a European online survey (N=40,064) in 21 countries. Weights based on gender, age and education were applied to account for sample bias. Results: Since the beginning of the pandemic, alcohol consumption has decreased on average. The decline is primarily due to a reduction in heavy episodic drinking occasions. As compared to other European countries, alcohol consumption in Germany has declined less sharply. This is mainly due to an increase in alcohol consumption among women as well as among people who report negative impacts on jobs and finances and among people with risky consumption patterns. Conclusion: In order to counter negative consequences of increased alcohol consumption in sub-groups during the pandemic, cutting the availability of alcohol through reasonable taxation and fostering alcohol screening activities in primary health care settings is needed.

  • 65. Maron, Julian
    et al.
    Gomes de Matos, Elena
    Piontek, Daniela
    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.
    Pogarell, Oliver
    Exploring socio-economic inequalities in the use of medicines: is the relation mediated by health status?2019In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 169, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Objectives: This study evaluated mediating effects of the health status on the association between socio-economic status (SES) and medicine use. It was hypothesized that more privileged people show a reduced use of medicines, as compared with the underprivileged, because of their superior health status. It was further hypothesized that people may apply medication based on their type of health complaint (ill physical versus mental status).

    Study design: Data were taken from the 2012 German Epidemiological Survey of Substance Abuse, a nationally representative cross-sectional study of n = 9084 individuals of the German general population aged 18-64 years.

    Methods: Direct and indirect effects of SES on weekly use of analgesics and sedatives/hypnotics were examined by applying generalized structural equation modeling. Self-rated physical and mental health statuses were considered as potential mediators. SES was measured by using educational level as a proxy. All analyses were gender-stratified.

    Results: Among men, both physical and mental health mediated the path from SES to the use of analgesics and sedatives/hypnotics, respectively, with a stronger effect of physical health on analgesic use and mental health on sedative/hypnotic use. These effects were only partially found among women.

    Conclusions: Social inequalities in health seem to have substantial impact on the prevalence of medicine use. Identification and elimination of the reasons for poor health among people of low SES may, therefore, not only help to reduce health inequalities directly. A decline in the use of medicines would also result in less side-effects and a reduced number of people with medicine-related misuse and addiction.

  • 66. Maspero, Simona
    et al.
    Delle, Simone
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University Medical Center Hamburg-Eppendorf, Germany.
    Pogarell, Oliver
    Hoch, Eva
    Bachner, Joachim
    Lochbühler, Kirsten
    Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 588Article in journal (Refereed)
    Abstract [en]

    Background

    The objective of the present study was to examine the short-term effectiveness of the national German quitline for smoking cessation.

    Methods

    A parallel-group, two-arm, superiority, randomized controlled trial with data collection at baseline and post-intervention (three months from baseline) was conducted. Individuals were randomized to either the intervention group, receiving up to six telephone counselling calls, or the control group, receiving an active control intervention (self-help brochure). The primary outcome was the seven-day point prevalence abstinence at post-assessment. Secondary outcomes included changes in smoking-related cognitions and coping strategies from pre- to post-assessment, the perceived effectiveness of intervention components, and the satisfaction with the intervention.

    Results

    A total of n = 905 adult daily smokers were assigned to either the intervention group (n = 477) or the control group (n = 428). Intention-to-treat analyses demonstrated that individuals allocated to the telephone counselling condition were more likely to achieve seven-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI [1.7, 3.1]). Participants who received the allocated intervention in both study groups displayed significant improvements in smoking-related cognitions and coping strategies with the intervention group showing greater enhancements than the control group. This pattern was also found regarding the perceived effectiveness of intervention components and the satisfaction with the intervention.

    Conclusion

    The present study provides first empirical evidence on the short-term effectiveness of the national German quitline for smoking cessation, highlighting its potential as an effective public health intervention to reduce the burden of disease associated with smoking.

    Trial registration

    This study is registered in the German Clinical Trials Register (DRKS00025343). Date of registration: 2021/06/07.

  • 67. McCambridge, Jim
    et al.
    Garry, Jack
    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 Origins and Purposes of Alcohol Industry Social Aspects Organizations: Insights From the Tobacco Industry Documents2021In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, Vol. 82, no 6, p. 740-751Article in journal (Refereed)
    Abstract [en]

    Objective: This article describes the origins and purposes of alcohol industry “social aspects organizations” as portrayed in internal tobacco industry documents. Method: We systematically searched the Truth Tobacco Documents Library for information regarding alcohol industry social aspects organizations. Using content provided by industry actors themselves, we identified a series of episodes in their evolution from the early 1950s to the early 1990s. Results: Hill and Knowlton, a public relations company, developed and managed the tobacco industry's scientific programs from the early 1950s onward. At the same time, the company performed a similar function for the U.S. distilled spirits industry, with research funding central to advancing what were conceived as public relations goals. They sought to persuade the public and policy makers that the cause of alcohol problems was the people who drank distilled spirits, rather than the product itself. Facing the existential threat posed by the developing population-level understanding of alcohol problems in the 1980s, national and international trade associations collaborated with the tobacco industry in various ways. The largest companies sought to bring together the different sectors of the alcohol industry to support a global network of national-level social aspects organizations. Conclusions: Alcohol industry social aspects organizations were developed to advance long-term public relations goals to manage both policy and science.

  • 68. Miller, Mia
    et al.
    Anderson-Luxford, Dan
    Mojica-Perez, Yvette
    Sjödin, Lars
    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
    A time-series analysis of the association between alcohol and suicide in Australia2022In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 231, article id 109203Article in journal (Refereed)
    Abstract [en]

    Introduction: 800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017.

    Materials and methods: Age and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined.

    Results: A 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality.

    Discussion: Contemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.

  • 69. Miller, Mia
    et al.
    Wilkinson, Claire
    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.
    O'Brien, Paula
    Townsend, Belinda
    Schram, Ashley
    Gleeson, Deborah
    Industry submissions on alcohol in the context of Australia's trade and investment agreements: A content and thematic analysis of publicly available documents2021In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 40, no 1, p. 22-30Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims: Alcohol use is a leading risk factor for death and disability, responsible for 3 million deaths in 2016. The alcohol industry is a powerful player in shaping trade and investment rules in ways that can constrain the ability of governments to regulate alcoholic beverages to reduce harm. This paper analyses publicly available submissions about alcohol in the context of Australia's free trade agreements to determine the key themes put forward by industry. Design and Methods: We searched for submissions made to the Department of Foreign Affairs and Trade by alcohol industry trade associations, alcohol manufacturers, distributors and retailers, general industry association, and government agencies with responsibilities for alcohol trade, about specific free trade agreements involving Australia. Thirty-one submissions in relation to eight trade agreements were included for analysis. The analysis involved both descriptive content analysis and thematic analysis. Results: Findings suggest that industry is actively seeking to shape trade negotiations around alcohol. Priority issues for the industry include improving market access, harmonising regulation, improving clarity and transparency, reducing the burden of regulation and preventing monopolies on product names. Discussion and Conclusion: The alcohol industry and associated business and government organisations are actively working to influence trade agreement negotiations for industry economic gain, arguing for rules which may undermine public health goals. The analysis suggests that public health experts should pay attention to trade and investment agreements and develop counter frames to ensure agreements do not create barriers for coherent health policies.

  • 70. Molander, Olof
    et al.
    Volberg, Rachel
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden .
    Månsson, Viktor
    Berman, Anne H.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Stockholm County Council, Sweden; Stockholm Center for Dependency Disorders, Sweden.
    Development of the Gambling Disorder Identification Test (G-DIT): Protocol for a Delphi Method Study2019In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 8, no 1, article id e12006Article in journal (Refereed)
    Abstract [en]

    Background: Research on the identification and treatment of problem gambling has been characterized by a wide range of outcome measures and instruments. However, a single instrument measuring gambling behavior, severity, and specific deleterious effects is lacking. Objective: This protocol describes the development of the Gambling Disorder Identification Test (G-DIT), which is a 9-to 12-item multiple-choice scale with three domains: gambling consumption, symptom severity, and negative consequences. The scale is analogous to the widely used Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Methods: The G-DIT is developed in four steps: (1) identification of items eligible for the G-DIT from a pool of existing gambling measures; (2) presentation of items proposed for evaluation by invited expert researchers through an online Delphi process and subsequent consensus meetings; (3) pilot testing of a draft of the 9- to 12-item version in a small group of participants with problem gambling behavior (n= 12); and (4) evaluation of the psychometric properties of the final G-DIT measure in relation to the existing instruments and self-reported criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), among individuals with problem gambling and nonproblematic recreational gambling behaviors (n= 600). This protocol article summarizes step 1 and describes steps 2 and 3 in detail. Results: As of October 2018, steps 1-3 are complete, and step 4 is underway. Conclusions: Implementation of this online Delphi study early in the psychometric development process will contribute to the face and construct validity of the G-DIT. We believe the G-DIT will be useful as a standard outcome measure in the field of problem gambling research and serve as a problem-identification tool in clinical settings.

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  • 71. Molander, Olof
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Berman, Anne H.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Stockholm, Sweden; Stockholm Center for Dependency Disorders, Stockholm, Sweden.
    The Gambling Disorders Identification Test (GDIT): Psychometric Evaluation of a New Comprehensive Measure for Gambling Disorder and Problem Gambling2023In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 30, no 1, p. 225-237Article in journal (Refereed)
    Abstract [en]

    The novel gambling disorder identification test (GDIT) was recently developed in an international Delphi and consensus process. In this first psychometric evaluation, gamblers (N = 603) were recruited from treatment- and support-seeking contexts (n = 79 and n = 185), self-help groups (n = 47), and a population sample (n = 292). Participants completed self-report measures, a GDIT retest (n = 499), as well as diagnostic semistructured interviews assessing gambling disorder (GD; n = 203). The GDIT showed excellent internal consistency reliability (α = .94) and test-retest reliability (6-16 days, intraclass correlation coefficient = 0.93). Confirmatory factor analysis yielded factor loadings supporting the three proposed GDIT domains of gambling behavior, gambling symptoms, and negative consequences. Receiver operator curves and clinical significance indicators were used to estimate GDIT cut-off scores in relation to recreational (<15) and problem gambling (15-19), any GD (≥20), mild GD (20-24), moderate GD (25-29), and severe GD (≥30). The GDIT can be considered a valid and reliable measure to identify and predict GD severity, as well as problem gambling. In addition, the GDIT improves content validity in relation to an international research agreement concerning features of gambling outcome measures, known as the Banff Consensus Agreement.

  • 72. Moskalewicz, Jacek
    et al.
    Garretsen, Henk
    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.
    A half-century of the Kettil Bruun Society: a history against a backdrop of global developments2022In: Alcoholism and Drug Addiction/Alkoholizm i Narkomania, ISSN 0867-4361, Vol. 35, no 4, p. 293-306Article in journal (Refereed)
    Abstract [en]

    The Kettil Bruun Society (KBS) has developed from a small, almost informal group of social researchers to a relatively large organisation that has sustained itself over the decades, organising regularly its annual symposia and less regular thematic meetings which offer a platform for comparative social and epidemiological alcohol research.

    Unlike the few previous papers on KBS, which focused on internal development, the aim of this one is to put its history in a wider global political, social and economic context.

    Several global developments were identified that may have affected the KBS and its history: emergence of the new left generation in the 60s; growth and decline of the welfare state, in particular the Nordic welfare state with its health-oriented alcohol monopolies; globalisation and internationalisation of research; emergence and expansion of neoliberal ideologies; globalisation of the alcohol industry and social aspects organisations; technological and methodological advances in research.

    The Society’s original organisational culture, with a focus on the comparative perspective, openness, transparency and supportive relationships among members, has been sustained but is likely to evolve under a pressure of recent global developments.

  • 73. Motka, Franziska
    et al.
    Grüne, Bettina
    Sleczka, Pawel
    Braun, Barbara
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Who uses self-exclusion to regulate problem gambling? A systematic literature review2018In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 7, no 4, p. 903-916Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Self-exclusion programs offer an intervention for individuals with problem gambling behavior. However, these programs are insufficiently used. This review describes sociodemographic features and gambling behavior of self-excluders as well as goals and motives for initiating self-exclusion from terrestrial and online gambling. In addition, use of further professional help and barriers to self-exclusion are examined.METHODS: Based on systematic literature search and quality assessment, n = 16 original studies (13 quantitative, 2 qualitative, and 1 mixed method) published between 1997 and 2017 in English or German language were analyzed. Results are presented for online and terrestrial gambling separately.RESULTS: Online self-excluders were on average 10 years younger than terrestrial self-excluders. Self-exclusion was mainly motivated by financial problems, followed by feelings of losing control and problems with significant others. Financial problems and significant others were less important for online than for terrestrial gamblers. Main barriers for self-exclusion were complicated enrollment processes, lack of complete exclusion from all venues, little support from venue staff, and lack of adequate information on self-exclusion programs. Both self-excluders from terrestrial and online gambling had negative attitudes toward the need of professional addiction care.CONCLUSION: To exploit the full potential of self-exclusion as a measure of gambler protection, its acceptance and its utilization need to be increased by target-group-specific information addressing financial issues and the role of significant others, simplifying the administrative processes, facilitating self-exclusion at an early stage of the gambling career, offering self-determined exclusion durations, and promoting additional use of professional addiction care.

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  • 74. Mugavin, Janette
    et al.
    MacLean, Sarah
    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.
    Callinan, Sarah
    Adult low-risk drinkers and abstainers are not the same2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1Article in journal (Refereed)
    Abstract [en]

    BackgroundAlcohol consumption, even at low-levels, can not be guaranteed as safe or risk free. Specifically, the 2009 Australian National Health and Medical Research Council drinking guidelines recommend that adults should not drink more than two standard drinks on any day on average, and no more than four drinks on a single occasion. Nearly 40% of Australians aged 12years and older drink alcohol but don't exceed these recommended limits, yet adult low-risk drinkers have been largely overlooked in Australian alcohol survey research, where they are usually grouped with abstainers. This paper examines the socio-demographic profile of low-risk drinking adults (18+ years old), compared to those who abstain.MethodsData from the 2013 National Drug Strategy Household Survey were used. In the past 12months, 4796 Australians had not consumed alcohol and 8734 had consumed alcohol at low-risk levels, accounting for both average volume and episodic drinking (hereafter low-risk).ResultsMultivariate logistic regression results indicated that low-risk drinkers were more likely to be older, married, Australian-born, and reside in a less disadvantaged neighbourhood compared with abstainers. There was no significant difference by sex between low-risk drinkers and abstainers.ConclusionsThe socio-demographic profile of low-risk drinkers differed from that of abstainers. Combining low-risk drinkers and abstainers into a single group, which is often the practice in survey research, may mask important differences. The study may support improved targeting of health promotion initiatives that encourage low-risk drinkers not to increase consumption or, in view of increasing evidence that low-risk drinking is not risk free, to move towards abstinence.

  • 75. Mugavin, Janette
    et al.
    MacLean, Sarah
    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.
    Callinan, Sarah
    Subgroups of adults who drink alcohol at low-risk levels: Diverse drinking patterns and demography2020In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 39, no 7, p. 975-983Article in journal (Refereed)
    Abstract [en]

    Introduction. A significant minority of Australians drink within the 2009 national guidelines. Despite encouragement of low-risk drinking as opposed to consumption patterns associated with greater harm, little is known about the drinking patterns of this group. This paper identifies subgroups of low-risk drinkers and their distinguishable characteristics. Methods. Data were sourced from the 2016 National Drug Strategy Household Survey, specifically 8492 adults (18+) who consumed 1-730 Australian standard drinks (ASD; 10 g ethanol) in the past year, and never 5+ ASD on a single occasion. Cluster analysis enabled identification of subgroups from drinking variables. Drinking patterns, socio-demographic characteristics, drinking context and alcohol-related perceptions of subgroups were examined. Results. Three subgroups were identified.Special occasion drinkers(64.6%) drank low to moderate amounts very infrequently.Regular moderates(19.6%) andRegular sippers(15.8%) drank 5-6 days a week on average, with the average number of ASD per day 1.2 and 0.5, respectively.Special occasion drinkerstended to be younger than members of more regular drinking subgroups. Perceptions of regular alcohol use also differed betweenSpecial occasion drinkersand members of the other subgroups. Discussion. Alcohol consumption patterns among low-risk drinkers are not homogeneous. Younger drinkers who consume at low-risk levels are more likely to report infrequent consumption than moderate regular consumption. A better understanding of low-risk drinkers may help increase the prominence and acceptability of this type of drinking, challenge the normativity of heavier drinking norms and help target campaigns as new information emerges on health risks associated with low-level drinking.

  • 76. Mugavin, Janette
    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.
    Callinan, Sarah
    MacLean, Sarah
    How do people drink alcohol at a low-risk level?2023In: Health Sociology Review, ISSN 1446-1242, E-ISSN 1839-3551, Vol. 32, no 3, p. 311-326Article in journal (Refereed)
    Abstract [en]

    Reducing the risks associated with drinking is an ongoing public health goal. Approximately two-fifths of Australian adults consume alcohol within low-risk guidelines, yet little is known about their drinking patterns or practices. In this paper, we use social practice theory to consider low-risk drinking at home as a routinised social practice with material, meaning and competence dimensions. We analysed open-text survey responses from 252 Australian adults (30–65, 89% female) who were considered low-risk drinkers. A low-risk drinking occasion was typically closely linked to other practices such as eating dinner or connecting with family or friends. Drinking alcohol, even in small amounts, was associated with enjoyment. Being attuned to bodily sensations and applying some self-imposed rules were competencies that allowed low-risk drinkers to avoid intoxication. Low-risk drinking practices entail some elements that can inform health promotion, including encouraging efforts to limit drinking to times of the day (e.g. during meals) and to attend to bodily feelings of sufficiency. The study also shows how low-risk drinking is entangled with gendered and age-related norms about drinking, and facilitated by rarely being in ‘intoxigenic’ environments. These factors are imbricated with individual decisions in our respondents’ capacity to consume alcohol moderately. 

  • 77.
    Månsson, Josefin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Samuelsson, Eva
    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).
    Doing adulthood—doing alcohol: what happens when the ‘sober generation’ grows up?2022In: Journal of Youth Studies, ISSN 1367-6261, E-ISSN 1469-9680, no 1, p. 84-99Article in journal (Refereed)
    Abstract [en]

    Since the 2000s, there has been a worldwide trend of decreased alcohol consumption among young people. Although recent studies have given multiple explanations for this, we know little about the meaning of alcohol for this generation as they enter adulthood. The aim of this article is therefore to describe and analyze the age-related views toward alcohol among this group as they transition from adolescents to adults. The study was based on 39 qualitative interviews with people aged 17–21. Theoretical concepts such as doing age and symbolic boundaries were used to analyze the material and investigate how age can structure alcohol use, and how alcohol consumption can be narrated to produce maturity and adulthood. The analysis showed that participants presented their relation to alcohol in nuanced and responsible ways, signaling maturity. The participants’ navigation of acceptable alcohol consumption differs in terms of agency and control in different life phases. ‘Doing adulthood’ in relation to alcohol for abstainers and drinkers seems to center on the same understandings of legitimate behavior: being moderate, nuanced, and in control. This focus linked alcohol to the position these emerging adults hold in wider society, given that participants incorporated societal demands for a neoliberal lifestyle.

  • 78. Möckl, Justin
    et al.
    Lindemann, Christina
    Manthey, Jakob
    Schulte, Bernd
    Reimer, Jens
    Pogarell, Oliver
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Centre for Mental Health and Addiction Research, Germany; Eötvös Loránd University (ELTE), Hungary.
    Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage2023In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, article id 1002526Article in journal (Refereed)
    Abstract [en]

    Background: In Germany, most individuals with alcohol dependence are recognized by the health care system and about 16% per year receive addiction-specific care. This paper aimed to analyze the prevalence and treatment utilization rate of people with alcohol dependence by type of addiction-specific care in the federal state of Bremen using routine and survey data.

    Methods: The number of individuals with alcohol dependence was estimated using data from the 2018 Epidemiological Survey of Substance Abuse (ESA). Furthermore, linked routine data of two statutory health insurances (SHIs), the German pension insurance (GPI), and the communal hospital group Gesundheit Nord – Bremen Hospital Group (GeNo), from 2016/2017, were analyzed. Based on SHI data, the administrative prevalence of various alcohol-related diagnoses according to the International Classification of Diseases (ICD-10), in various treatment settings, was extrapolated to the total population of Bremen. Based on all routine data sources, treatment and care services for individuals with alcohol dependence were also extrapolated to Bremen’s total population. Care services included outpatient addiction care visits and addiction-specific treatments, [i.e., qualified withdrawal treatment (QWT), outpatient pharmacotherapy as relapse prevention, and rehabilitation treatment].

    Results: Of the survey-estimated 15,792 individuals with alcohol dependence in Bremen, 72.4% (n = 11,427) had a diagnosis documented with an ICD-10 code for alcohol dependence (F10.2) or withdrawal state (F10.3–4). One in 10 individuals with alcohol dependence (n = 1,577) used one or more addiction-specific care services during the observation period. Specifically, 3.7% (n = 675) received outpatient addiction care, 3.9% (n = 736) initiated QWT, 0.8% (n = 133) received pharmacotherapy, and 2.6% (n = 405) underwent rehabilitation treatment. The share of seeking addiction-specific treatment after diagnosis was highest among younger and male patients.

    Conclusion: Although more than half of the individuals with alcohol dependence are documented in the health system, utilization rates of addiction-specific treatments are low. These low utilization rates suggest that there are existing barriers to transferring patients with alcohol dependence into addiction-specific care. Strengthening primary medical care provision in dealing with alcohol-related disorders and improving networking within the addiction support system appear to be particularly appropriate.

  • 79. Norman, Thomas
    et al.
    Anderson-Luxford, Dan
    O'Brien, Paula
    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.
    Regulating alcohol advertising for public health and welfare in the age of digital marketing: challenges and options2024In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 31, no 1, p. 70-81Article in journal (Refereed)
    Abstract [en]

    Aims: This narrative review considers traditional strategies for regulating alcohol marketing and their applicability to digital media.

    Method: Drawing on international research, case studies, and reports, we examine the applicability of (1) comprehensive or partial bans; (2) placement restrictions; (3) content restrictions; and (4) counter-advertising.

    Results: Comprehensive bans on advertising are generally the most effective option. A partial ban applying to digital media would make some lesser contribution to reducing exposure, but will usually simply result in the promotional budget being shifted to whichever media remain less strictly regulated. Limits on the placement of marketing have more salience for traditional media than for most digital media, which can be individualized and targeted. Content restrictions play a limited role in reducing exposure as they are not concerned with marketing volume, but with the way in which alcohol is represented.

    Conclusions: Although these traditional strategies have a role in regulating digital media and are applied in certain international jurisdictions, new regulatory approaches are needed. These may include the use of artificial intelligence for monitoring, transparency requirements, and privacy law rights and duties. Opportunities to regulate alcohol marketing online will need to be addressed and seized as they arise in the current volatile policy environment concerning the governance of social media.

  • 80.
    Norström, Thor
    et al.
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Trolldal, Björn
    Drinking and acquisition of unrecorded alcohol across educational groups in Sweden2022In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 41, no 1, p. 160-170Article in journal (Refereed)
    Abstract [en]

    Introduction: It is estimated that 18.5% of total alcohol consumption in Sweden in 2018 was unrecorded. However, little is known about the socio-economic profile of consumers of unrecorded alcohol. The aim of this study was to elucidate this issue by analysing data from a unique Swedish national repeated cross-sectional alcohol use survey.

    Methods: Individual-level information on alcohol consumption and socio-economic status (SES) for the years 2013–2018 was retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample comprised 64 375 respondents aged 25–74 years. SES was measured by educational level. We used three educational groups: (i) low (<10 years); (ii) intermediate (10–12 years); and (iii) high (13+ years). We included indicators of the following sources of unrecorded alcohol consumption: travellers' import, smuggled alcohol, home production, internet and illicit home-distilling. We estimated adjusted SES-specific means of the various forms of unrecorded consumption. The means were adjusted for the effects of age, sex and region.

    Results: There were no significant educational differences in the total of unrecorded alcohol consumption; the same holds true for home-production and internet. However, with respect to smuggled and home-distilling, a statistically significant educational gradient was observed with the lowest educational group scoring approximately four times higher than the highest.

    Discussion and Conclusions: Our findings suggest that there are no differences across educational groups in the consumption of unrecorded alcohol as a whole. However, consumption of smuggled alcohol and illicitly distilled spirits is elevated in the low educational group.

  • 81. O'Brien, Paula
    et al.
    Dwyer, Robyn
    Gleeson, Deborah
    Cook, Megan
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-20302023In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 119, article id 104115Article in journal (Refereed)
    Abstract [en]

    Background

    In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to strengthen implementation of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol.

    Methods

    48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments.

    Results

    In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated normal drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co regulation rather than cost-effective public health measures to prevent harms from alcohol.

    Conclusion

    The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

  • 82. O'Donnell, Renee
    et al.
    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, Australia.
    Mojica-Perez, Yvette
    Callinan, Sarah
    Disparities in definitions of drinker type and related harms: self-identified and researcher-defined drinker type and alcohol-related consequences2022In: Journal of Substance Use, ISSN 1465-9891, E-ISSN 1475-9942, Vol. 27, no 5, p. 475-481Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES This study aimed to measure the extent to which risky drinkers identify themselves as a heavy/binge drinker and to examine if risky drinkers who identify themselves as a heavy/binge drinker experience less negative drinking-related consequences than those who do not classify themselves as a heavy/binge drinker.

    METHODS Participants, who met our criterion for heavy and/or binge drinking, were asked about their drinking patterns and to describe themselves as a non-, ex-, occasional, light, social, heavy or binge drinker. Self-identified and researcher-defined (based on participants' past 12 months consumption) drinker types were compared among 4,562 participants (74% males, mean age of 43.4).

    RESULTS Over half of the researcher-defined binge and heavy drinkers classified themselves as social drinkers. Researcher-defined binge and heavy drinkers who classified themselves accurately experienced more drinking-related harms than those who classified themselves as a social drinker.

    CONCLUSIONS This study found that rather than using consumption-based definitions, drinkers may classify their drinking based on harms experienced, rather than their risk of harm. Health promotion campaigns aiming to prevent harms in risky drinkers should be aware that drinkers who would be considered at risk may not see themselves that way until they have experienced harm from their drinking.

  • 83. Olderbak, Sally
    et al.
    Möckl, Justin
    Manthey, Jakob
    Lee, Sara
    Rehm, Jürgen
    Hoch, Eva
    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.
    Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 20212024In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 119, no 2, p. 311-321Article in journal (Refereed)
    Abstract [en]

    Aims: To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.

    Design: Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.

    Setting: Germany.

    Participants/cases: German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative.

    Measurements: Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.

    Findings: The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.

    Conclusions: Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).

  • 84. Patsouras, Maree
    et al.
    Riordan, Benjamin C.
    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.
    Kuntsche, Emmanuel
    Support for policies restricting alcohol exposure in films: Does feeding back the amount of alcohol in films increase support?2024In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 43, no 1, p. 132-140Article in journal (Refereed)
    Abstract [en]

    Introduction: Alcohol exposure is common in popular films, and research has demonstrated a link between alcohol exposure and use. The likelihood of implementing specific policies to reduce the amount of film exposure is dependent on the level of public support; however, evidence is currently lacking. This study investigated how supportive people are of film-related alcohol policies and whether providing information about the amount of film exposure increased support.

    Methods: Australian adults (N = 252) first provided estimates of how much alcohol they thought were in popular films and then were randomised to either see an infographic about the amount of alcohol in films or not. All participants rated how supportive they were of eight policies.

    Results: The items ‘alcoholic beverages and consumption should not be shown in G or PG rated films’ (M = 3.54) and ‘alcohol should not be glorified in films’ (M = 3.49) were rated significantly higher than the scale's midpoint of 3 (p < 0.001). Participants who were older, female or reported lower alcohol use were more supportive of the policies. Only one policy item, ‘information about alcohol sponsorship should be provided’ received higher support from those who received the infographic compared to those who did not (M = 3.53 vs. M = 3.05; t(250) = −3.09, p = 0.002).

    Discussion and Conclusion: Participants were relatively supportive of film alcohol policies. However, providing information about the amount of alcohol in films did not make a difference on the level of support for most film alcohol policies.

  • 85. Pfeiffer-Gerschel, Tim
    et al.
    Schneider, Franziska
    Dammer, Esther
    Braun, Barbara
    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; Eötvös-Loránd-Universität, Hungary.
    Methamphetaminkonsum in Deutschland: Verbreitung und Problemlage2019In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 65, no 4, p. 241-249Article, review/survey (Refereed)
    Abstract [de]

    Zusammenfassung. Zielsetzung: Um ein möglichst umfassendes und differenziertes Bild der Verbreitung von Methamphetamin (MA) in Deutschland zu zeichnen, wird im vorliegenden Beitrag mittels verschiedener Datenquellen ein überblick zur Verbreitung des Konsums von MA sowie einschlägiger Straftaten in Deutschland und Europa gegeben. Ergänzend werden Angaben zur Beratungs-/Behandlungsnachfrage in Deutschland gemacht. Methodik: Es werden verfügbare aktuelle Daten zur Konsumverbreitung, Beschlagnahmungen und Straftaten sowie von repräsentativen nationalen und regionalen Bevölkerungsstudien, Abwasseranalysen, Strafverfolgung sowie Suchtberatung und -behandlung berichtet. Ergebnisse: Insgesamt zeigt sich mit Prävalenzraten von 0,6 % (Lebenszeit) und 0,2 % (letzte 12 Monate), dass der Konsum von MA in der erwachsenen Allgemeinbevölkerung eine eher untergeordnete Rolle spielt. Es finden sich in mehreren Datenquellen regionale Unterschiede, die darauf schließen lassen, dass die Verbreitung von MA in Sachsen, Thüringen und Bayern deutlich höher ist als in anderen Regionen Deutschlands. Schlussfolgerungen: Konsum und Problemlage von MA weisen regionale Schwerpunkte insbesondere in den Grenzregionen zur Tschechischen Republik auf. Aufgrund der hohen Belastung in den betroffenen Regionen wurden in den letzten Jahren zahlreiche Interventionen initiiert, die von spezifischen Programmen zur Frühintervention bis zu strukturierten Behandlungsprogrammen reichen. Die Verbesserung der Situation in betroffenen Regionen bedarf weiterer aktiver Unterstützung durch politische und soziale Maßnahmen.

  • 86.
    Ramstedt, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Lindell, Annette
    Raninen, Jonas
    Tal om alkohol 2012: en statistisk årsrapport från Monitorprojektet2013Report (Other academic)
    Download full text (pdf)
    Tal om alkohol 2012: en statistisk årsrapport från Monitorprojektet
  • 87. Rauschert, Christian
    et al.
    Seitz, Nicki-Nils
    Olderbak, Sally
    Pogarell, Oliver
    Dreischulte, Tobias
    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.
    Abuse of Non-opioid Analgesics in Germany: Prevalence and Associations Among Self-Medicated Users2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 864389Article in journal (Refereed)
    Abstract [en]

    Background: Abuse of non-opioid analgesics (NOA) is associated with serious health consequences. However, due to inconsistent definitions of NOA abuse, prevalence estimates for the German population are unclear.

    Objectives: This study aimed to estimate the 12-month prevalence of NOA abuse among self-medicated users of these drugs in the general German population and to identify risk factors.

    Methods: Data are from the 2015 Epidemiological Survey of Substance Abuse, a nationally representative sample with 9,204 individuals aged 18–64 years. Classification of NOA abuse was based on self-reported information according to the definition of the ICD-10-GM diagnosis F55.2 abuse of non-dependence producing substances. Multiple logistic regression was performed to examine associations between NOA abuse and sociodemographic, behavioral, and health-related variables.

    Results: The weighted 12-month prevalence of NOA abuse was 14.6% (95%-CI [13.2- 16.0]) among self-medicated users of these drugs. Extrapolation of the proportion of individuals abusing NOA to the German population aged 18 to 64 is 3,243,396 individuals or 6.4% (95%-CI [5.7- 7.1]). Inexplicable physical pain, being underweight, depression, hazardous alcohol use, daily smoking, illegal drug use, and frequent use of NOA (one or more times per week and daily use) were associated with an increased probability of NOA abuse. The use of cannabis was associated with a lower probability of NOA abuse.

    Conclusion: Abuse of NOA is highly prevalent in the German population. Against the background of increasing self-medication of NOA, healthcare providers need to be aware of potential risk factors of abuse to better identify and prevent this problem. 

  • 88. Rauschert, Christian
    et al.
    Seitz, Nicki-Nils
    Olderbak, Sally
    Pogarell, Oliver
    Dreischulte, Tobias
    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.
    Subtypes in Patients Taking Prescribed Opioid Analgesics and Their Characteristics: A Latent Class Analysis2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 918371Article in journal (Refereed)
    Abstract [en]

    Background: Owing to their pharmacological properties the use of opioid analgesics carries a risk of abuse and dependence, which are associated with a wide range of personal, social, and medical problems. Data-based approaches for identifying distinct patient subtypes at risk for prescription opioid use disorder in Germany are lacking.

    Objective: This study aimed to identify distinct subgroups of patients using prescribed opioid analgesics at risk for prescription opioid use disorder.

    Methods: Latent class analysis was applied to pooled data from the 2015 and 2021 Epidemiological Survey of Substance Abuse. Participants were aged 18–64 years and self-reported the use of prescribed opioid analgesics in the last year (n = 503). Seven class-defining variables based on behavioral, mental, and physical health characteristics commonly associated with problematic opioid use were used to identify participant subtypes. Statistical tests were performed to examine differences between the participant subtypes on sociodemographic variables and prescription opioid use disorder.

    Results: Three classes were extracted, which were labeled as poor mental health group (43.0%, n = 203), polysubstance group (10.4%, n = 50), and relatively healthy group (46.6%, n = 250). Individuals within the poor mental health group (23.2%, n = 43) and the polysubstance group (31.1%, n = 13) showed a higher prevalence of prescription opioid use disorder compared to those of the relatively healthy group.

    Conclusion: The results add further evidence to the knowledge that patients using prescribed opioid analgesics are not a homogeneous group of individuals whose needs lie in pain management alone. Rather, it becomes clear that these patients differ in their individual risk of a prescription opioid use disorder, and therefore identification of specific risks plays an important role in early prevention.

  • 89. Rehm, Juergen
    et al.
    Neufeld, Maria
    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.
    Sornpaisarn, Bundit
    Štelemėkas, Mindaugas
    Swahn, Monica H.
    Lachenmeier, Dirk W.
    The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations2022In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 99, article id 103420Article, review/survey (Refereed)
    Abstract [en]

    Background: The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use.

    Methods: Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide.

    Results: Unrecorded alcohol consumption did not automatically increase with increases in taxation and subse-quent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined.

    Conclusions: Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.

  • 90. Rehm, Jürgen
    et al.
    Badaras, Robertas
    Ferreira-Borges, Carina
    Galkus, Lukas
    Midttun, Nijole Gostautaite
    Gobina, Inese
    Janik-Koncewicz, Kinga
    Jasilionis, Domantas
    Jiang, Huan
    Kim, Kawon Victoria
    Lange, Shannon
    Liutkute-Gumarov, Vaida
    Manthey, Jakob
    Miščikienė, Laura
    Neufeld, Maria
    Petkevičienė, Janina
    Radišauskas, Ričardas
    Reile, Rainer
    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; .
    Stoppel, Relika
    Tamutiene, Ilona
    Tran, Alexander
    Trišauskė, Justina
    Zatoński, Mateusz
    Zatoński, Witold A.
    Zurlyte, Ingrida
    Štelemėkas, Mindaugas
    Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000-20202023In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 33, article id 100704Article in journal (Refereed)
    Abstract [en]

    Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time -series analyses suggest improved health, measured as reductions in all -cause and alcohol -attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol -attributable deaths. The natural experiment in this region of high -income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.

  • 91. Rehm, Jürgen
    et al.
    Casswell, Sally
    Manthey, Jakob
    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.
    Shield, Kevin
    Reducing the Harmful Use of Alcohol: Have International Targets Been Met?2021In: European Journal of Risk Regulation, ISSN 1867-299X, E-ISSN 2190-8249, Vol. 12, no 2, p. 530-541Article in journal (Refereed)
    Abstract [en]

    Alcohol use has been identified in major United Nations (UN) initiatives, such as the Sustainable Development Goals and the Non-Communicable Disease Action Plan, as a major contributor to the global burden of disease. As a result, levels of alcohol use serve as an official indicator of progress towards these UN-set goals. Given current trends, UN targets for reduced alcohol consumption are unlikely to be met. Moreover, in many countries, especially in low- and middle-income countries, the alcohol-attributable burden of disease continues to increase. Pressure will need to be exerted on national and international decision-makers to arrive at more powerful and normatively persuasive instruments, such as a treaty.

  • 92. Rehm, Jürgen
    et al.
    Crepault, Jean-Francois
    Hasan, Omer S. M.
    Lachenmeier, Dirk W.
    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.
    Sornpaisarn, Bundit
    Regulatory Policies for Alcohol, other Psychoactive Substances and Addictive Behaviours: The Role of Level of Use and Potency. A Systematic Review2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 19, article id 3749Article, review/survey (Refereed)
    Abstract [en]

    The object of this contribution based on a systematic review of the literature is to examine to what degree the level of use and potency play a role in regulatory policies for alcohol, other psychoactive substances and gambling, and whether there is an evidence base for this role. Level of use is usually defined around a behavioural pattern of the user (for example, cigarettes smoked per day, or average ethanol use in grams per day), while potency is defined as a property or characteristic of the substance. For all substances examined (alcohol, tobacco, opioids, cannabis) and gambling, both dimensions were taken into consideration in the formulation of most regulatory policies. However, the associations between both dimensions and regulatory policies were not systematic, and not always based on evidence. Future improvements are suggested.

  • 93. Rehm, Jürgen
    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, Bundoora, Australia.
    Rovira, Pol
    Shield, Kevin David
    Tran, Alexander
    Lange, Shannon
    Štelemėkas, Mindaugas
    Using Direct and Indirect Estimates for Alcohol-Attributable Mortality: A Modelling Study Using the Example of Lithuania2023In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 29, no 2, p. 119-126Article in journal (Refereed)
    Abstract [en]

    Introduction: Comparative risk assessments (CRAs) for alcohol use are based on indirect estimates of attributable harm, and usually combine country-specific exposure estimates and global risk relations derived from meta-analyses. CRAs for Eastern European countries, such as Lithuania, base their risk relations not on global risk relations, but on a large Russian cohort study. The availability of a direct estimate of alcohol-attributable mortality following the 2017 implementation of a large increase in alcohol excise taxes in Lithuania has allowed a comparison of these indirect estimates with a country-specific gold standard. Methods: A statistical modelling study compared direct (predictions based on a time-series methodology) and indirect (predictions based on an attributable-fraction methodology) estimates of alcohol-attributable mortality before and after a large increase in alcohol excise taxes in Lithuania. Specifically, Russia-specific versus global relative risks were compared against the gold standard of time-series based predictions. Results: Compared to direct estimates, indirect estimates markedly underestimated the reduction of alcohol-attributable mortality 12 months post intervention by at least 63%. While both of the indirect estimates differed markedly from the direct estimates, the Russia-specific estimates were closer to the direct estimates, primarily due to higher estimates for alcohol-attributable cardiovascular mortality. Discussion: As all indirect estimates were markedly lower than direct estimates, current overall relative risks and price elasticities should be re-evaluated. In particular, global estimates should be replaced by new regional estimates based on cohort studies.

  • 94. Rehm, Jürgen
    et al.
    Lange, Shannon
    Gobiņa, Inese
    Janik-Koncewicz, Kinga
    Miščikienė, Laura
    Reile, Rainer
    Stoppel, Relika
    Tran, Alexander
    Ferreira-Borges, Carina
    Jasilionis, Domantas
    Jiang, Huan
    Kim, Kawon Victoria
    Manthey, Jakob
    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.
    Liutkutė-Gumarov, Vaida
    Zatoński, Witold A.
    Štelemėkas, Mindaugas
    Classifying alcohol control policies enacted between 2000 and 2020 in Poland and the Baltic countries to model potential impact2023In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 118, no 3, p. 449-458Article in journal (Refereed)
    Abstract [en]

    Aims: The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020.

    Methods: Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all-cause mortality and alcohol-attributable hospitalizations was discussed.

    Results: All Baltic countries implemented stringent availability restrictions on off-premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans.

    Conclusions: This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland).

  • 95. Rehm, Jürgen
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Centre for Alcohol Policy Research, Turning Point, Australia; University of Melbourne, Australia.
    Cultural specificity in alcohol use disorders2022In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 399, no 10327, p. e7-e8Article in journal (Other academic)
  • 96. Rehm, Jürgen
    et al.
    Tran, Alexander
    Gobiņa, Inese
    Janik-Koncewicz, Kinga
    Jiang, Huan
    Kim, Kawon Victoria
    Liutkutė-Gumarov, Vaida
    Miščikienė, Laura
    Reile, Rainer
    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
    Stoppel, Relika
    Zatoński, Witold A.
    Lange, Shannon
    Do alcohol control policies have the predicted effects on consumption? An analysis of the Baltic countries and Poland 2000–20202022In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 241, article id 109682Article in journal (Refereed)
    Abstract [en]

    Background: Many population-based alcohol control policies are postulated to work via changes in adult alcohol per capita consumption (APC). However, since APC is usually assessed on a yearly basis, often there are not enough data to conduct interrupted time-series or other controlled analyses. The current dataset, with 21 years of observation from four countries (Estonia, Latvia, Lithuania, and Poland), had sufficient power to test for average effects and potential interactions of the World Health Organization’s (WHO) three “best buys” for alcohol control: taxation increases leading to a decrease in affordability; reduced availability (via a decrease in opening hours of at least 20 %); and advertising and marketing restrictions. We postulated that the former two would have immediate effects, while the latter would have mid- to long-term effects.

    Methods: Linear regression analysis.

    Results: Taxation increases and availability reductions in all countries were associated with an average reduction in APC of 0.83 litres (ℓ) of pure alcohol per year (95 % confidence interval: −1.21 ℓ, −0.41 ℓ) in the same year, with no significant differences between countries. Restrictions on advertising and/or marketing had no significant immediate associations with APC (average effect 0.04 ℓ per year; 95 % confidence interval: −0.65 ℓ, 0.73 ℓ). Several sensitivity analyses corroborated these main results.

    Conclusions: The WHO “best buy” alcohol control policies of taxation increases and availability restrictions worked as postulated in these four northeastern European Union countries.

  • 97.
    Reitan, Therese
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Negotiating Space in Confined Places: Co-Production of Public Services with Unwilling Users2019In: Scandinavian Journal of Public Administration, ISSN 2001-7405, E-ISSN 2001-7413, Vol. 23, no 3-4, p. 61-81Article in journal (Refereed)
    Abstract [en]

    An expanding body of research on co-production, participation, co-creation and other forms of user involvement in public services has not sufficiently reflected their coercive nature. Coercion, like persuasion, is a central dimension of public administration and a defining element of, for example, compulsory care. It is, however, seldom properly addressed in the literature on co-production. The aim of this study is twofold; to propose a broadened definition of co-production which more adequately reflects the complexities of human services by distinguishing between users (clients) and consumers (social services), and to investigate the relevance and practice of co-production in a non-voluntary setting. Examples of enhanced, participative, consumer, and user co-production were identified based on organizational and individual data from the Swedish government agency responsible for compulsory care for substance abusers. Forms of user co-production at the operational level were highlighted through client records and administrative data concerning transfers to community care – so called Care in Other Forms (COF). COF placements are intricate processes involving many different stakeholders and the analysis revealed how clients actively partake in negotiations on the terms and content of service delivery. The idiosyncrasies of involuntary human services should be considered in future research on co-production.

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  • 98. Rintala, Jade
    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.
    Smit, Koen
    Jiang, Heng
    Laslett, Anne-Marie
    The 2021 Alcohol’s Harm to Others Survey: Methodological Approach2023In: The international journal of alcohol and drug research, ISSN 1925-7066, Vol. 11, no 2, p. 48-56Article in journal (Refereed)
    Abstract [en]

    Background: The 2021 Alcohol's Harm to Others (AHTO) is a comprehensive survey measuring the prevalence of different harms due to another’s drinking in the Australian population. First implemented in 2008, the AHTO survey has since been adapted to reflect changes in modern survey research and to be comparable with international AHTO surveys.

    Aims: The current paper aims to provide a detailed account of the 2021 Australian Alcohol's Harm to Others (AHTO) survey, including the procedures for sampling, data collection, weighting, response rate calculation and results from a mode analysis.

    Methodology: The 2021 AHTO survey was conducted by the Social Research Centre (SRC), whereby 1,000 participants were recruited through Random Digit Dial (RDD) and 1,574 through the Life in Australia Panel™ (LinA). Weights applied to the data to match key respondent demographics to the Australian population and between the two samples. Multivariable logistic regression models were conducted to probe the extent sample source (RDD; LinA) was associated with various survey outcomes.

    Results: Multiple regression analyses found sample source had a statistically significant association with responses on three out of eight outcomes, with sample source contributing 1 – 8% of the overall variance in these models.

    Discussion: The current paper highlighted the 2021 AHTO survey’s comprehensiveness and adaptability to a modern research context as its strengths. Yet some limitations were identified relating to the use of bi-modal survey methods. The methodological critiques from the current paper are vital to inform future AHTO surveys used in both a national and international context.

  • 99.
    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.
    Global Intergovernmental Initiatives to Minimise Alcohol Problems: Some Good Intentions, but Little Action2021In: European Journal of Risk Regulation, ISSN 1867-299X, E-ISSN 2190-8249, Vol. 12, no 2, p. 419-432Article in journal (Refereed)
    Abstract [en]

    While, historically, alcohol production and sale were local matters, commercialised and industrialised alcohol has supervened, globalised initially through European empires, transforming alcohol's place in everyday life. But alcohol was not included in the current international drug control system, initiated in 1912. In the current UN system of 35 intergovernmental agencies, alcohol has been a recurrent concern in the work only of the World Health Organization (WHO). Examples are given of the sporadic involvement in alcohol issues of other agencies, and the history of WHO's involvement between 1950 and early 2020 is briefly described. At WHO, the place of alcohol programming in its structure and which other topics it is linked with have been recurrent issues. Civil society support for alcohol initiatives has been comparatively weak, and alcohol industry counter-pressure has been strong. Alcohol issues have thus received less attention at the intergovernmental level than the harm would justify. Constraining factors have included not only lobbying by industry interests, but also the multi-sectoral nature of alcohol problems and the international cultural position of alcohol as a luxury good served at gatherings of political and media elites.

  • 100.
    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)
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