Drinking in Context – A Collective Responsibility
http://www.addictioninfo.org/articles/3192/1/Drinking-in-Context--A-Collective-Responsibility/Page1.html
Misc Author
Miscellaneous authors not listed elsewhere.
By Misc Author
Published on 02/6/2009
Patterns of drinking shape both benefit and harm: Where people drink,
what, how, when, how often, and with whom are all important influences. At the same time, drinking— like many other behaviors—is learned, it
can be accompanied by responsible choices, and the potential for harm
is preventable.
INTRODUCTION
Alcohol can benefit as well as harm those who consume it.
The duality of its nature makes alcohol unlike many other commodities and plays an important role in why people drink and in the outcomes they are likely to experience.
Patterns of drinking shape both benefit and harm: Where people drink, what, how, when, how often, and with whom are all important influences.
At the same time, drinking— like many other behaviors—is learned, it can be accompanied by responsible choices, and the potential for harm is preventable.
In selecting alcohol policies, societies must decide how to encourage some behaviors and discourage others, while maintaining what they perceive as an appropriate balance between state and individual responsibility.
This ICAP Review proposes a fresh approach to tackling this process in a way that respects the multiplicity of drinking cultures existing around the world and is responsive to the varying needs and resources in different communities, countries, and regions.
This Review sets the stage for the upcoming publication, Drinking in Context: Patterns, Interventions, and Partnerships,1 by outlining the volume’s three key themes.
Namely, it is argued that patterns of drinking are the best way to describe drinking behavior and predict both positive and negative outcomes in a given society; that targeted interventions are key in maximizing the benefits and minimizing the harms related to drinking; and that multistakeholder partnerships offer an excellent opportunity to promote the complex mix of measures required by each society.
In the broadest terms, the purpose of alcohol policies in countries where alcohol beverages are permitted is to establish appropriate, realistic, and sustainable approaches that will help reduce alcohol-related harms, promote safer drinking behaviors, and enhance the positive function of alcohol consumption for individuals and society.
PATTERNS OF DRINKING
Understanding drinking patterns: Populations, behaviors, and contexts The relationship between drinking and outcomes is complex.
Traditionally, the extent of drinking in population has been measured by the average amount of alcohol consumed per person in a country—or per capita alcohol consumption—commonly derived from sales, production, and taxation statistics.
This has formed the basis for epidemiological research in the alcohol field, dating back to the work of Ledermann in the 1950s,2 and, more recently, for the most ambitious attempts to quantify the contribution of alcohol to deaths and disease states globally, the World Health Organization’s (WHO) Global Burden of Disease project.3
-----------
(i) The opinions expressed in this review are those of the individual author and do not necessarily reflect the views of the International Center for Alcohol Policies, its sponsors, or the International Harm Reduction Association.
-----------
Per capita consumption measures are a convenient way of collecting relevant data and are useful gross indicators of drinking in population. However, they do not capture the myriad ways in which individuals drink.
To get a better understanding of drinking among individuals and groups, the harms and benefits that may accompany their drinking, and interventions likely to minimize harm, it is necessary to understand patterns of drinking.
These comprise a number of facets: the quantity of alcohol consumed per occasion; types of beverages being consumed; the duration and frequency of drinking; the characteristics of individual drinkers; the settings in which drinking takes place and activities that accompany drinking; and the cultural role of alcohol and the social mores that surround it.
At a general level, drinking patterns describe three important aspects of alcohol consumption: populations, individuals or groups sharing common traits or drinking practices; contexts within which drinking takes place; and behaviors that may accompany drinking.
These three broad aspects— individually and in interaction—have a bearing on outcomes. For example, there is great variation across countries and cultures in who drinks alcohol and who does not, and why.
Gender, age and how drinking evolves across the life span (also known as drinking trajectories), socioeconomic factors and educational level, as well as factors related to health and genetic predisposition to problems define populations of drinkers and have an impact on how they drink and the consequences they are likely to experience.
In addition, contexts within which an individual finds him or herself with regard to drinking—namely, the prevailing culture around alcohol in a given society, its acceptability and the general social mores surrounding it, as well as what types of beverages are consumed and where—are reflected in the drinking behavior (including the rhythm of heavy drinking, the extent to which heavy drinking episodes are isolated or spread out and how frequently they occur) and other activities that may accompany drinking.
The diversity of drinking patterns translates into the wide range of health and social effects that have been related to alcohol consumption.4
It is well known that certain inappropriate drinking patterns may lead to a range of physical and social harms, affecting both the drinker and the wider community.(ii)
These can be chronic health consequences (such as toxic effects on liver, heart, and other organs)5 and acute outcomes (such as traffic crashes, injuries, and alcohol poisoning).6
On the other hand, it is established that moderate or low alcohol consumption may have a protective role for certain diseases, such as cardiovascular disease, ischemic stroke, and diabetes.7
Also known but less noted is the broader benefit of drinking—its positive contribution to individual and social wellbeing. To that end, three general areas of benefit have been identified: psychosocial benefits (such as subjective health, mood enhancement, stress reduction, and mental health), social benefits (such as sociability and social cohesion), and cognitive and performance benefits (such as long-term cognitive functioning, creativity, and income earned).8
To date, no means exist for assessing the value of these important outcomes in a quantitative fashion. The inability to include the broader positive contribution of alcohol to health and wellbeing in calculations of net benefit and harm represents a significant confounder in the available analyses and is an obstacle to balanced decision-making.
-------
(ii) A caveat to relating drinking patterns to their possible outcomes should be noted: An association does not necessarily imply a causal link. Where such associations are made, other confounding influences that may modify the effects of drinking on a particular individual should also be taken into consideration—for instance, age and general health or other lifestyle factors, such as smoking, stress, diet, exercise, or obesity.
------
From patterns to policy
Drinking behaviors are diverse and vary not only from country to country, but also between areas within countries, between social groups, and across different time periods.
Measures required to affect these practices are likely to vary as well. The choice of policies and interventions to reduce alcohol-related harms and the resources available for their implementation are influenced by social, cultural, political, religious, and economic factors.
Views on public health and social issues also vary. Some countries have invested substantially in developing a public health framework for analyzing and responding to health problems; in others, it is rare or absent.
New interventions must therefore be designed in the context of the available resources and cultural climate—but they certainly cannot be implemented without knowing the drinking behavior in some detail. Selecting the interventions that are right for particular populations, contexts, or behaviors requires getting beneath the data on overall population consumption and calls for prior assessment of drinking practices and the individual and social function of drinking, as well as identification of specific issues to be addressed.
Linking evidence and action may meet with considerable obstacles. Planners at local and national levels (particularly in developing countries) often find themselves in a “data desert,” lacking the information necessary to make decisions.
The growing interest in “evidence-based policy-making” and “evidence-based practice” has highlighted the gaps between information providers and decisionmakers and led to various suggestions about how to get better evidence9 and better utilization of evidence.10
Clearly, it is important to improve routine national data systems and surveys to collect information on alcohol consumption and problems. However, the financial implications are considerable.
For example, resource-poor countries may face a difficult choice between, on the one hand, developing systems that contribute to global and national monitoring and, on the other hand, collecting local intelligence information that is directly linked to policy-making and developing local interventions.
Importantly, the absence of data does not put a hold on the need to develop policy measures. International agencies have become increasingly interested in rapid methods of assessing health and social problems, specifically in order to design interventions.
Collectively known as rapid assessments, these methods have been developed as a practical tool for gauging health and social problems.
Although rapid assessment in the alcohol field remains remarkably underused, this approach offers promise in areas where policy-makers, health and social planners, and practitioners need to gather information quickly; where there may be limited resources and capacity to collect information; and where conventional epidemiological, social science, and public health assessment methods (such as population surveys) may be difficult to undertake.11
The process involves a range of stakeholders and uses a variety of sources and research methods, often in combination. Table 1 provides a sample of issues that could be exploited in an alcohol assessment, the first step toward developing appropriate and acceptable interventions.
Importantly, the choice of interventions needs to consider the feasibility of their implementation, including obstacles to be overcome and the procedures and resources needed to get them into place.
[Continued]
This article is an excerpt from the PDF document ICAP Review 2: Drinking in Context – A Collective Responsibility [see summary page], an overview by Gerry V. Stimson of the key themes of the book Drinking in Context: Patterns, Interventions, and Partnerships.
Patterns of drinking shape both benefit and harm: Where people drink,
what, how, when, how often, and with whom are all important influences. At the same time, drinking— like many other behaviors—is learned, it
can be accompanied by responsible choices, and the potential for harm
is preventable.patterns of drinking, alcohol policies, alcohol prevention strategies, dealing with alcoholism
By Gerry V. Stimson, International Harm Reduction Association and Imperial College London, U.K.(i)INTRODUCTION
Alcohol can benefit as well as harm those who consume it.
The duality of its nature makes alcohol unlike many other commodities and plays an important role in why people drink and in the outcomes they are likely to experience.
Patterns of drinking shape both benefit and harm: Where people drink, what, how, when, how often, and with whom are all important influences.
At the same time, drinking— like many other behaviors—is learned, it can be accompanied by responsible choices, and the potential for harm is preventable.
In selecting alcohol policies, societies must decide how to encourage some behaviors and discourage others, while maintaining what they perceive as an appropriate balance between state and individual responsibility.
This ICAP Review proposes a fresh approach to tackling this process in a way that respects the multiplicity of drinking cultures existing around the world and is responsive to the varying needs and resources in different communities, countries, and regions.
This Review sets the stage for the upcoming publication, Drinking in Context: Patterns, Interventions, and Partnerships,1 by outlining the volume’s three key themes. Namely, it is argued that patterns of drinking are the best way to describe drinking behavior and predict both positive and negative outcomes in a given society; that targeted interventions are key in maximizing the benefits and minimizing the harms related to drinking; and that multistakeholder partnerships offer an excellent opportunity to promote the complex mix of measures required by each society.
In the broadest terms, the purpose of alcohol policies in countries where alcohol beverages are permitted is to establish appropriate, realistic, and sustainable approaches that will help reduce alcohol-related harms, promote safer drinking behaviors, and enhance the positive function of alcohol consumption for individuals and society.
PATTERNS OF DRINKING
Understanding drinking patterns: Populations, behaviors, and contexts The relationship between drinking and outcomes is complex.
Traditionally, the extent of drinking in population has been measured by the average amount of alcohol consumed per person in a country—or per capita alcohol consumption—commonly derived from sales, production, and taxation statistics.
This has formed the basis for epidemiological research in the alcohol field, dating back to the work of Ledermann in the 1950s,2 and, more recently, for the most ambitious attempts to quantify the contribution of alcohol to deaths and disease states globally, the World Health Organization’s (WHO) Global Burden of Disease project.3
-----------
(i) The opinions expressed in this review are those of the individual author and do not necessarily reflect the views of the International Center for Alcohol Policies, its sponsors, or the International Harm Reduction Association.
-----------
Per capita consumption measures are a convenient way of collecting relevant data and are useful gross indicators of drinking in population. However, they do not capture the myriad ways in which individuals drink.
To get a better understanding of drinking among individuals and groups, the harms and benefits that may accompany their drinking, and interventions likely to minimize harm, it is necessary to understand patterns of drinking.
These comprise a number of facets: the quantity of alcohol consumed per occasion; types of beverages being consumed; the duration and frequency of drinking; the characteristics of individual drinkers; the settings in which drinking takes place and activities that accompany drinking; and the cultural role of alcohol and the social mores that surround it.
At a general level, drinking patterns describe three important aspects of alcohol consumption: populations, individuals or groups sharing common traits or drinking practices; contexts within which drinking takes place; and behaviors that may accompany drinking.
These three broad aspects— individually and in interaction—have a bearing on outcomes. For example, there is great variation across countries and cultures in who drinks alcohol and who does not, and why.
Gender, age and how drinking evolves across the life span (also known as drinking trajectories), socioeconomic factors and educational level, as well as factors related to health and genetic predisposition to problems define populations of drinkers and have an impact on how they drink and the consequences they are likely to experience.
In addition, contexts within which an individual finds him or herself with regard to drinking—namely, the prevailing culture around alcohol in a given society, its acceptability and the general social mores surrounding it, as well as what types of beverages are consumed and where—are reflected in the drinking behavior (including the rhythm of heavy drinking, the extent to which heavy drinking episodes are isolated or spread out and how frequently they occur) and other activities that may accompany drinking.
The diversity of drinking patterns translates into the wide range of health and social effects that have been related to alcohol consumption.4
It is well known that certain inappropriate drinking patterns may lead to a range of physical and social harms, affecting both the drinker and the wider community.(ii)
These can be chronic health consequences (such as toxic effects on liver, heart, and other organs)5 and acute outcomes (such as traffic crashes, injuries, and alcohol poisoning).6
On the other hand, it is established that moderate or low alcohol consumption may have a protective role for certain diseases, such as cardiovascular disease, ischemic stroke, and diabetes.7
Also known but less noted is the broader benefit of drinking—its positive contribution to individual and social wellbeing. To that end, three general areas of benefit have been identified: psychosocial benefits (such as subjective health, mood enhancement, stress reduction, and mental health), social benefits (such as sociability and social cohesion), and cognitive and performance benefits (such as long-term cognitive functioning, creativity, and income earned).8
To date, no means exist for assessing the value of these important outcomes in a quantitative fashion. The inability to include the broader positive contribution of alcohol to health and wellbeing in calculations of net benefit and harm represents a significant confounder in the available analyses and is an obstacle to balanced decision-making.
-------
(ii) A caveat to relating drinking patterns to their possible outcomes should be noted: An association does not necessarily imply a causal link. Where such associations are made, other confounding influences that may modify the effects of drinking on a particular individual should also be taken into consideration—for instance, age and general health or other lifestyle factors, such as smoking, stress, diet, exercise, or obesity.
------
From patterns to policy
Drinking behaviors are diverse and vary not only from country to country, but also between areas within countries, between social groups, and across different time periods.
Measures required to affect these practices are likely to vary as well. The choice of policies and interventions to reduce alcohol-related harms and the resources available for their implementation are influenced by social, cultural, political, religious, and economic factors.
Views on public health and social issues also vary. Some countries have invested substantially in developing a public health framework for analyzing and responding to health problems; in others, it is rare or absent.
New interventions must therefore be designed in the context of the available resources and cultural climate—but they certainly cannot be implemented without knowing the drinking behavior in some detail. Selecting the interventions that are right for particular populations, contexts, or behaviors requires getting beneath the data on overall population consumption and calls for prior assessment of drinking practices and the individual and social function of drinking, as well as identification of specific issues to be addressed.
Linking evidence and action may meet with considerable obstacles. Planners at local and national levels (particularly in developing countries) often find themselves in a “data desert,” lacking the information necessary to make decisions.
The growing interest in “evidence-based policy-making” and “evidence-based practice” has highlighted the gaps between information providers and decisionmakers and led to various suggestions about how to get better evidence9 and better utilization of evidence.10
Clearly, it is important to improve routine national data systems and surveys to collect information on alcohol consumption and problems. However, the financial implications are considerable.
For example, resource-poor countries may face a difficult choice between, on the one hand, developing systems that contribute to global and national monitoring and, on the other hand, collecting local intelligence information that is directly linked to policy-making and developing local interventions.
Importantly, the absence of data does not put a hold on the need to develop policy measures. International agencies have become increasingly interested in rapid methods of assessing health and social problems, specifically in order to design interventions.
Collectively known as rapid assessments, these methods have been developed as a practical tool for gauging health and social problems.
Although rapid assessment in the alcohol field remains remarkably underused, this approach offers promise in areas where policy-makers, health and social planners, and practitioners need to gather information quickly; where there may be limited resources and capacity to collect information; and where conventional epidemiological, social science, and public health assessment methods (such as population surveys) may be difficult to undertake.11
The process involves a range of stakeholders and uses a variety of sources and research methods, often in combination. Table 1 provides a sample of issues that could be exploited in an alcohol assessment, the first step toward developing appropriate and acceptable interventions.
Importantly, the choice of interventions needs to consider the feasibility of their implementation, including obstacles to be overcome and the procedures and resources needed to get them into place.
[Continued]
This article is an excerpt from the PDF document ICAP Review 2: Drinking in Context – A Collective Responsibility [see summary page], an overview by Gerry V. Stimson of the key themes of the book Drinking in Context: Patterns, Interventions, and Partnerships.