Alcohol consumption as a risk factor for suicidal behavior: A systematic review of associations at the individual and at the population level

-To provide an updated review of the magnitude of the relationship between alcohol use and suicidal behaviour at the individual and the population level. Systematic literature searches retrieved 14 reviews of individual level studies and 16 primary population level studies. Results: Alcohol abuse and alcohol intoxication are often present in suicidal behaviour; risk of suicide is elevated in alcohol abusers and increasing population drinking tends to be associated with increase in suicide rates. Estimated magnitude of the relationship differs for men and women and it varies at the population level across cultures with different drinking pattern. These variations probably reflect gender differences and cultural variation in drinking behaviour generally. Empirical evidence for a causal relationship is still urgently needed

Nære pårørende av alkoholmisbrukere - hvor mange er de og hvordan berøres de?

Alkohol står for det største omfanget av rusmiddelproblemer i Norge, både med hensyn til hvor mange personer som har et rusmiddelproblem og omfanget av de helsemessige og sosiale konsekvensene av rusmiddelbruken. Denne rapporten omhandler de negative konsekvensene av alkoholbruk for nære pårørende som barn og ektefelle/partner. Både spørsmålet om hvor mange nære pårørende det er til alkoholmisbrukere og hva slags negative konsekvenser de erfarer, blir for første gang ved hjelp av norske data belyst her. Vi har tatt utgangspunkt i to tilgjengelige datasett; en intervjuundersøkelse blant vel 2000 voksne personer og en spørreskjemaundersøkelse blant vel 20 000 ungdommer. Et viktig anliggende i rapporten har vært å vise at det ikke er noen distinkte skiller mellom alkoholmisbrukere eller personer med et risikofylt alkoholkonsum og andre alkoholbrukere. Vi må derfor anta at de negative konsekvensene som nære pårørende opplever både varierer betydelig i type, varighet og alvorlighetsgrad og kan tilskrives en større gruppe av alkoholbrukere enn den lille gruppen som drikker mest. Våre beregninger viste at vi kan anta at det i Norge er i størrelsesorden 50 000 – 150 000 barn og 50 000 – 100 000 ektefeller/partnere som bor sammen med personer med et risikofylt alkoholkonsum. Det er trolig mer enn 130 000 personer som i løpet av sitt voksne liv har opplevd visse typer negative konsekvenser (sjikane/utskjelling, trusler om vold og vold, uønsket seksuell tilnærming, hærverk og seksuelt overgrep) av foreldres eller partners alkoholproblemer. Blant ungdom ser vi at forekomst av ulike typer psykososiale problemer som voldsutsatthet, dårlig mental helse og dårlige foreldrerelasjoner øker med hvor ofte de opplever å se foreldrene beruset. Likevel er det, selv blant dem som ofte opplever foreldrene beruset, et flertall som ikke rapporterer noen av disse problemene. Gjennomgang av forskningslitteraturen har vist at dette er et forsømt forskningsområde. Det er ikke bare et åpenbart behov for mer forskning om norske forhold på dette feltet, men også viktig å bidra til den internasjonale forskningsbaserte kunnskapen på området

Om sentrale deler av norsk alkoholpolitikk

Denne rapporten tar opp de endringer som for tiden skjer i norsk a lkoholpolitikk og de ulike krefter som påvirker utviklingen, særlig i bruken av prisinstrumentet og restriksjoner på tilgjengeligheten. Den prøver også å beskrive noen mulige fremtids - scenarier basert på beregninger av effektene av ulike endringer i avgift snivået på alkohol. Kapittel 1 beskriver dagens alkoholpolitikk og hvordan denne oppfattes av befolkningen. Særlig er det lagt vekt på utviklingen det seneste 10 - året. Grensehandelens betydning for norsk alkoholpolitikk er viet en del oppmerksomhet, fordi omfanget av grensehandelen påvirker utviklingen av avgiftsnivået i Norge. Her kan det forventes betydelige endringer i tiden framover, dels ved at Systembolagets butikker vil bli lørdagsåpne fra 1. juli 2001, og dels ved at Sverige har måttet akseptere EU s innførselskvoter fra 1.1.2004, noe som antas å føre til reduserte alkoholpriser i Sverige og dermed økt press på prisene i Norge. Kapittel 2 gir en beskrivelse av de norske alkoholavgiftene sett i internasjonal sammenheng. Den viser at Norge og Island h ar de klart høyeste avgiftene blant EU/EØS - landene. Ser vi imidlertid på prisene fratrukket avgiftene, dvs. det som går til produsent, grossist, distributør og detaljist, blir bildet noe annerledes. Det viser seg da at, med unntak av øl, er denne delen av alkoholprisene lavere i mange av de landene som selger alkoholdrikker gjennom et detaljmonopol, enn i Danmark. I kapittel 2 har en også beskrevet avgiftsreduksjonen på mellom - produkter (sterkviner og lignende) fra 1.1.2000, og effektene av den. I kapitt el 3 tas det sikte på å vise hvordan prisene påvirker forbruket av alkohol, og hvordan ulike pris - scenarier kan komme til å slå ut på forbruksnivået. Først beskrives utviklingen i alkoholforbruket i Norge gjennom de siste 20 år. Sammenlignet med nivået i 1 980 er det registrerte alkoholforbruket ved inngangen til år 2000 litt lavere, men tar man også med det uregistrerte forbruket synes nedgangen ubetydelig, og meget langt fra målsettingen om 25 prosent reduksjon. Den uregistrerte alkoholen stammer dels fr a lovlige kilder - ta

Does parental drinking influence children's drinking? A systematic review of prospective cohort studies.

AIMS: To evaluate evidence of the capacity for causal inference in studies of associations between parental and offspring alcohol consumption in the general population. METHODS: A systematic search for, and narrative analysis of, prospective cohort studies of the consequences of drinking, except where assessed prenatally only, or with clinically derived instruments. Primary outcome measures were alcohol use or related problems in offspring, which were collected at least 3 years after exposure measures of parental drinking. The systematic review included 21 studies comprising 26,354 families or parent-child dyads with quantitative effect measures available for each study. Criteria for capacity of causal inference included (1) theory-driven approach and analysis; (2) analytical rigour; and (3) minimization of sources of bias. RESULTS: Four of the 21 included studies filled several, but not all, criteria and were assessed to have some capacity for causal inference. These four studies found some evidence that parental drinking predicted drinking behaviour in adolescent offspring. The remaining 17 studies had little or no such capacity. CONCLUSIONS: There is a fairly large and consistent literature demonstrating that more parental drinking is associated with more drinking in offspring. Despite this, existing evidence is insufficient to warrant causal inferences at this stage

The handling of evidence in national and local policy making : a case study of alcohol industry actor strategies regarding data on on-premise trading hours and violence in Norway

BACKGROUND: Effective alcohol policy measures conflict with the interests of the alcohol industry. In this study we addressed how various alcohol industry actors in Norway have responded to research findings and police data relating to the possible impacts of changes in on-premise trading hours on violent offending. METHODS: A content analysis of documents was undertaken. The documents comprised i) hearing statements from policy processes on on-premise trading hours at the national level, and in 15 Norwegian cities, and ii) newspaper articles and other media coverage of this topic in Norway. RESULTS: Alcohol industry actors employed a range of strategies to shape the use of evidence regarding on-premise trading hours and violence. Nationally, the relevance of the international research literature was questioned before the publication of an unfavourable national study which was criticized directly. This led to commissioned attacks on the findings, constructing what were claimed to be disagreements between experts, emphasis on the complexity of violence and the role of confounding variables, and deflecting attention to alternative interventions. The handling of evidence at the local level was importantly different, where different industry actors and forms of evidence, notably police data, were involved in debates. CONCLUSION: Alcohol industry actors employed various strategies to shape perceptions and use of evidence to advance their interests. The particular strategies and arguments changed over time as new data and research became available, and also varied between the national and the local levels, and by categories of industry actors

Collaboration between general hospitals and community health services in the care of suicide attempters in Norway: a longitudinal study

<p>Abstract</p> <p>Background</p> <p>The aim of this paper was to study the collaboration between emergency departments (EDs) in general hospitals and community health services (CHS) in Norway when providing psychosocial care and aftercare to patients treated in EDs following a suicide attempt. We wanted to explore the extent to which quality indicators at the hospital level measured in 1999 and 2006 could predict the presence or absence of a chain of care structure in the CHS in 2006.</p> <p>Methods</p> <p>Data were collected through structured interviews with informants from 95% of all general hospitals in Norway in 1999 and 2006, and informants from CHS, in a stratified sample of Norwegian municipalities in 2006 (n = 47).</p> <p>Results</p> <p>In 15 of the 47 municipalities (32%), the CHS reported having a chain of care structure in 2006. A discriminant function analysis revealed that the hospitals that in 1999 had: (a) a collaboration agreement with aftercare providers, and (b) written guidelines, including a quality assurance system, were significantly more likely to have municipalities with a chain of care structure in their catchment area in 2006.</p> <p>Conclusions</p> <p>Hospitals' and municipalities' self-reported provision of aftercare services for patients treated after a suicide attempt was markedly below the recommendations given in national standards. Systems at the hospital level for the management and care of patients admitted after a suicide attempt and systematic collaboration between hospitals and aftercare providers seem to be important elements in the long-term maintenance of continuity of care for suicide attempters.</p

Gambling consumption and harm: a systematic review of the evidence

The total consumption model (TCM) postulates a close link between total consumption and levels of harm within the population, which has important implications for prevention. This review aimed to explore evidence relating to the application of the TCM and theoretical elements associated with it (i.e. the distribution of harms; the concentration of consumption) to gambling by reviewing evidence pertaining to the distribution of harms across the population; the concentration of gambling consumption; and evidence of the validity of the TCM in gambling. Systematic literature searches were performed using MEDLINE, PsycINFO, and Web of Science databases, restricted to publications between January 1, 2010, and March 29, 2023. The search identified seven studies examining risk curves for gambling harm, of which only two employed continuous consumption measures. This nascent literature suggests mixed evidence for the relationship between gambling consumption (e.g. losses, frequency, expenditure, and expenditure as a percentage of income) and risk of harm. Five publications found that the concentration of gambling consumption was high among those experiencing gambling harms, with some evidence that spending is more concentrated for certain games (e.g. online casinos) than for others (e.g. lotteries). Finally, four studies assessed the TCM, suggesting close association between gambling consumption and problem gambling, lending empirical support to the validity of the TCM. However, robust evidence is nascent and further research is required to assess these relationships

Mortality and alcohol-related morbidity in patients with delirium tremens, alcohol withdrawal state or alcohol dependence in Norway: A register-based prospective cohort study

Background and Aims: Little is known about long-term consequences of delirium tremens (DT). This study aimed to compare all-cause and cause-specific mortality and alcohol-related morbidity between patients with: (i) DT, (ii) alcohol withdrawal state (AWS) and (iii) alcohol dependence (AD). Design: A national longitudinal health registry study with linked data from the Norwegian Patient Registry and the Norwegian Cause of Death Registry. Setting: Norway. Participants: All patients registered in the Norwegian Patient Registry between 2009 and 2015 with a diagnosis of AD (ICD-10 code F10.2), AWS (F10.3) or DT (F10.4) and aged 20–79 years were included (n = 36 287). Measurements: Patients were categorized into three mutually exclusive groups; those with DT diagnosis were categorized as DT patients regardless of whether or not they had received another alcohol use disorder diagnosis during the observation period or not. Outcome measures were: annual mortality rate, standardized mortality ratios (SMR) for all-cause and cause-specific mortality and proportion of alcohol-related morbidities which were registered in the period from 2 years before to 1 year after the index diagnosis. Findings: DT patients had higher annual mortality rate (8.0%) than AWS (5.0%) and AD (3.6%) patients, respectively. DT patients had higher mortality [SMR = 9.8, 95% confidence interval (CI) = 8.9–10.7] than AD patients (SMR = 7.0, 95% CI = 6.8–7.2) and AWS patients (SMR = 7.8, 95% CI = 7.2–8.4). SMR was particularly elevated for unnatural causes of death, and more so for DT patients (SMR = 26.9, 95% CI = 21.7–33.4) than for AD patients (SMR = 15.2, 95% CI = 14.2–16.3) or AWS patients (SMR = 20.1, 95% CI = 16.9–23.9). For all comorbidities, we observed a higher proportion among DT patients than among AWS or AD patients (P < 0.001). Conclusions: People treated for delirium tremens appear to have higher rates of mortality and comorbidity than people with other alcohol use disorders

Concentration of gambling spending by product type: analysis of gambling accounts records in Norway

Background Most previous studies on the distribution of gambling losses were based on self-reported data. In this study, we employed tracking data (i.e. electronic betting records) to examine the concentration of gambling losses and whether concentration varies by product type. Method Tracking data were provided by the Norwegian gambling monopolist, Norsk Tipping (NT). Data comprised of 14 different games for a random draw of 2% (N = 39 995) of all NT’s customers in 2019. We applied three measures of concentration of gambling losses: the mean to median ratio, the Gini coefficient, and the proportion of total losses accounted for by the upper 1%, 5% or 10% of those who gamble. Results Across the 14 games, the mean/median ratio was 2.22, ranging from 1.37 to 17.48 for the different games, whereas the overall Gini coefficient was 0.65, ranging from 0.55 to 0.90. The upper 1%, 5% and 10% of those who gamble accounted for 17.9% (range = 5.6 − 3 8.3%), 39.5% (range = 23.6 − 74.3%), and 52.2% (range = 37.9 − 86.9%) of the losses, respectively. High concentration of losses was especially pronounced for one type of lottery (Keno), two online casino games (KongKasino and Bingoria), and for two sports betting games (Oddsen and Tipping). These findings were consistent across measures. Conclusion Overall, the results lend strong support to the notion that a disproportionately large fraction of gambling losses are accounted for by a relatively small minority of people and that concentration of losses varies by product type