What Are Appropriate Prevention Strategies, When Risky Single Occasion Drinking Is the Norm in the Young?
Comment on Gmel et al. "Who drinks most of the total alcohol in young men: risky single occasion drinking as normative behaviour," this issue, pages 692--697
Former Director the Swiss Institute for Alcohol and Drug Problems, Lausanne Préverenges, Switzerland
E-mail: mueller_richard{at}bluewin.ch
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Alcohol consumption in Switzerland has long been monitored by the Swiss Institute of Prevention of Alcohol and other Drug Problems, the National Office for Public Health, and the Swiss Alcohol Board has published consumption data since the 18th century. The results of the subsequent analyses, published in various reports, revealed basically that Switzerland displays the pattern of a wine-consuming country with high mean alcohol consumption and a low frequency of ‘binge’ drinking. There are, however, clear differences between the cultural regions, so wine is consumed more in the Latin than in the German regions; beer is consumed equally in all three cultural regions and is the preferred drink among young people. There is growing evidence of a trend towards risky single occasion drinking (RSOD) among youngsters in Switzerland, as has also been demonstrated for other countries (Annaheim and Gmel, 2004
).
Gmel and his co-authors (2008) reveal the magnitude of the current problem of RSOD in Switzerland. Their finding is that three quarters (75.5%) of the sample report RSOD days at least once a month. This is indeed noteworthy, in particular, against the background that such drinkers report more problems than other drinkers, and that there is a high proportion of RSOD drinkers who, if categorized according to their total, or average, consumption could be termed ‘moderate’ rather than ‘hazardous’. It may, however, be argued that in the course of life most such young drinkers tend to decrease their risky occasions because they are maturing out of their unhealthy drinking habits while they get settled, married and raise children. So should prevention just wait up until young wild men get wiser? Certainly not.
A stated aim of the alcohol beverage industry in Switzerland is to reduce harmful drinking and to promote moderate and sensible drinking, in particular, among youth by endorsing the same goals as those of alcohol policy makers: promoting sensible drinking through education, mass media campaigning, even though it is well documented that these means of prevention are not very efficient. Additionally, the Swiss drinks industry has stressed several times that it has no interest in profiting from adolescent or young adult problem drinking and that since in its view the majority drink in responsible ways it supports selective actions targeting high-risk groups. Gmel et al. (2008) demonstrate that the assertion that ‘the majority drink in responsible ways’ is not longer true. Prevention efforts should indeed be targeted towards lowering heavier drinking occasions, but given the fact that the majority of young men drink unwisely, these efforts do not have to be selective and concentrated on high-risk groups but should aim to decrease overall consumption among young people. The drinks industry might not favour such a view, as its revenue from alcohol in this age group stems predominantly from that majority of drinkers who drink in risky single occasions.
In the recent past, the drinks industry has been strongly opposed to increases in the price of alcoholic beverages. It opposed a price increase on alcopops and lobbied successfully against low taxation of spirits in Switzerland. Attempts to increase beer taxes were also opposed. Low off-premise alcohol and high on-premise alcohol prices are one of the reasons why the ‘botellones’ are no longer a phenomenon that occurs not only in Spain but also in Switzerland. Spontaneous gatherings in public places are organized by young people through the internet as a low-cost alternative to night clubs and public bars. The alcohol consumed is bought in the local grocery stores and drunk from the bottle or mixed with Coke etc. It is clear that these drinking habits are not easy to quantify by epidemiologists.
The mass inebriation of youngsters by means of cheap alcohol has scandalized Switzerland's ‘moral entrepreneurs’ and they aim to prohibit these spontaneous gatherings. And indeed, officials in Lausanne, Bern and Zurich are banning these events on a rather shaky legal base, not taking into account that these gatherings also serve for socialization among youngsters. Effective means would probably consist of increasing overall alcohol taxes and not selling alcoholic drinks in late opening shops. These measures, however, are not apparently being considered by the authorities and the drink industry.
The recent UK report (Department of Health, 2007) follows the same line; the influence of the industry and its signal to collaborate has led to the formulation of a joint alcohol prevention strategy representing both public health policy makers and the industry: ‘This strategy has the objective of reducing the harm caused by alcohol misuse in England. It recognises that there are both benefits and costs to alcohol use and, therefore, does not aim to cut alcohol consumption by the whole population. Instead it focuses on the prevention, minimisation and management of the harm caused by alcohol’. The report also encourages collaboration with the drinks industry because ‘messages encouraging responsible drinking disseminated by the industry will reach most people who drink’ (p. 27).
One argument against focussing on overall consumption suggests that a ‘smoothing out’ of drinking episodes might ultimately disguise problematic patterns, leading to greater probability of problems (Midanik, 2001, p. 511). If, however, the large majority of a given age group displays a problematic drinking pattern, this argument is no longer true.
In conclusion, as risky single occasion drinking is predominant among young men in Switzerland, prevention efforts will need to touch the majority of them to be effective. The study casts doubt upon preventive activities targeted only at the highest consumers in that group. Strategies for young people, set up in collaboration with the alcohol industry, will be effective at the point when those high-risk drinking occasions are substantially reduced, but that will reduce greatly the industry's revenues from sales in that age group.
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Annaheim B, Gmel G. Alkoholkonsum in der Schweiz: Ein Synthesebericht zu Alkoholkonsum und dessen Entwicklung auf der Basis der Schweizerischen Gesundheitsbefragung 1997 und 2002 (2004) Lausanne: Schweizerische Fachstelle für Alkohol- und andere Drogenprobleme (SFA).
Department of Health, Home Office, Department for Education and Skills and Department for Culture, Media and Sport. Safe, Sensible, Social: Next Steps for the Government's National Alcohol Strategy (2007) London: Department of Health, Alcohol Policy Team & The Home Office, Alcohol Harm Reduction Programme Office, Anti-Social Behaviour and Alcohol Unit.
Gmel G, Gaume J, Faouzi M, et al. Who drinks most of the total alcohol in young men: risky single occasion drinking as normative behaviour. Alcohol Alcohol (2008) 43:692–97.
Midanik LT. Where should alcohol problems prevention be targeted? Comments on Gmel et al. Addiction (2001) 96:511.[Web of Science][Medline]
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