STAD –

Stockholm Prevents Alcohol and Drug Problems

Stockholm County Council and Karolinska Institutet

(Stockholm förebygger alkohol- och drogproblem)

Alcohol sales in Sweden 1861-2009(litres of pure alcohol per inh. 15+)

0

1

2

3

4

5

6

7

8

9

10

11

12

Sprit Starköl Öl, klass IIA

Öl, klass IIB Summa Öl Vin

Totalt registrerad Skattning av total alkoholanskaffning

Alcohol consumption (sales) divided by type of beverage 1996 - 2010

Alcohol consumption (sales) divided by ’purchase source’1996 - 2010

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

1996 1998 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

liter

alk

oh

ol (

100%

) p

er in

vån

are

15 å

r +

Systembolaget

Resandeinförsel

Restauranger

Livsmedelsbutiker

Hemtillverkning

Smuggling

Distribution of alcohol consumption in different percentiles 2004, 2007, 2008 och 2009 among men.

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

2,2

2,4

2,6

2,8

3

1 8 15 22 29 36 43 50 57 64 71 78 85 92 99

Lite

r re

n (1

00 %

) al

koho

l per

mån

ad (

förs

ta 9

mån

.)

Alcohol-2004 Alcohol-2007 Alcohol-2008 Alcohol-2009

Gräns för riskkonsumtion (> 14 standardglas i veckan = 92 cl ren alk i mån)

Distribution of alcohol consumption in different percentiles 2004, 2007, 2008 och 2009 among men

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

1

1,1

1,2

1,3

1,4

1,5

1 8 15 22 29 36 43 50 57 64 71 78 85 92 99

Alcohol-2004 Alcohol-2009 Alcohol-2007 Alcohol-2008

Gräns för riskkonsumtion (> 9 standardglas i veckan = 58 cl ren alk i mån)

Self-reported alcohol consumption in different age groups in the years 2004/05, 2006/07 and 2008/09,

among men

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

16-1

7

18-1

9

20-2

1

22-2

3

24-2

5

26-2

7

28-2

9

30-3

1

32-3

3

34-3

5

36-3

7

38-3

9

40-4

1

42-4

3

44-4

5

46-4

7

48-4

9

50-5

1

52-5

3

54-5

5

56-5

7

58-5

9

60-6

1

62-6

3

64-6

5

66-6

7

68-6

9

70-7

1

72-7

3

74-7

5

76-7

7

78-7

9

80-8

1

Lit

er r

en a

lko

ho

l per

mån

ad (

jan

-sep

t 20

04-j

an-s

ept

2005

Alkoholkonsumtion 2004-05 Alkoholkonsumtion 2008-09 Mediankonsumtion 2004-05

Mediankonsumtion 2008-09 Mediankonsumtion 2006-07 Alkoholkonsumtion 2006-07

Self-reported alcohol consumption in different age groups in the years 2004/05, 2006/07 and

2008/09, among women

0

0,05

0,1

0,15

0,2

0,25

0,3

0,35

0,4

0,45

1617

1819

2021

2223

2425

2627

2829

3031

3233

3435

3637

3839

4041

4243

4445

4647

4849

5051

5253

5455

5657

5859

6061

6263

6465

6667

6869

7071

7273

7475

7677

7879

8081

Lit

er r

en a

lko

ho

l per

mån

ad (

jan

-sep

t 20

04-j

an-s

ept

2005

Alkoholkonsumtion 2004-05 Alkoholkonsumtion 2008-09 Alkoholkonsumtion 2006-07

Mediankonsumtion 2004-05 Mediankonsumtion 2008-09 Mediankonsumtion 2006-07

Self-reported consumption among boys and girls grade nine (age 15-16) 1987-2009

27

3133 33

31 32

2830

32

39

42

53

48

41

38

41

35 36

3032 32

15

1816 15

17 18 1917

20

26 26

29 28

3129 30

32

28

22

25

21

0

10

20

30

40

50

60

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

Gen

omsn

ittlig

sjä

lvra

ppor

tera

d to

tal å

rslk

onsu

mtio

n av

alk

ohol

(i d

ecili

ter r

en

alko

hol)

Pojkar Flickor Källa: CAN, 2006

Binge drinking among women, based on monthly survey data (Monitor project)

Binge drinking frequency

2002

2003

2004

2005

2006

2007

2008

2009

2010

All ages16-80 of age More than once a week 1,4 1,3 1,2 1,1 1,3 0,9 0,9 0,8 1,0 Once a week 2,4 2,5 2,5 2,4 2,2 2,0 1,8 1,5 1,7 2-3 times a month 17,7 16,6 14,8 15,1 15,7 13,7 13,0 14,0 13,8 Never 78,5 79,6 81,5 81,4 80,9 83,5 84,3 83,6 83,5

16-29 years of age

More than once a week 3,5 3,2 3,6 2,9 3,6 2,2 2,1 1,3 2,0 Once a week 5,2 6,1 6,2 6,4 4,9 4,6 4,5 3,7 3,7 2-3 times a month 34,0 31,6 26,3 28,0 28,1 25,9 23,3 24,7 22,2 Never 57,2 59,2 63,9 62,7 63,4 67,4 70,17 70,3 72,1

Binge drinking among men, based on monthly survey data (Monitor project)

Binge drinking frequency

2002

2003

2004

2005

2006

2007

2008

2009

2010

All ages16-80 of age More than once a week 4,5 5,0 5,0 4,3 4,8 4,5 4,3 4,0 3,4 Once a week 7,7 7,9 7,7 8,0 7,5 7,2 6,0 5,3 5,3 2-3 times a month 33,5 30,4 29,5 28,3 28,4 28,4 26,9 25,5 26,6 Never 54,3 56,7 57,8 59,3 59,4 59,9 62,8 65,2 64,7

16-29 years of age

More than once a week 7,8 9,2 8,9 8,3 8,1 8,0 5,7 6,0 5,8 Once a week 12,6 13,6 13,1 13,7 12,3 11,5 8,6 8,7 8,2 2-3 times a month 46,9 38,8 38,3 35,9 36,3 35,8 34,7 30,5 31,9 Never 32,7 38,5 39,7 42,2 43,3 44,7 51,0 54,7 54,1

Used cannabis among 15-24-year olds (Source: Eurobarometer, Young people and drugs, 2004)

Ever used Past month

EU-15 Sweden EU-15 Sweden

2002 29 % 17 % 11 % 4 %

2004 33 % 14 % 11 % 3 %

Culture acceptance

More culturally accepted -- Yes and no

More integrated in everyday life - wine, beer

Still restrictive attitudes – more positive towards high taxation and keeping the retail monopoly

More people abstain altogether from alcohol

Prop (%) women and men who agree completely or largely that wine should be sold in grocery stores, year

2002 and 2005-2010. 2002 2003 2004 2005* 2006* 2007 2008 2009 2010**

n=18018 n=9052 n=9007 n=18005 n=18012 n=18014 n=13474

Women 16-29 50.9 . . 41.1 39.0 33.0 31.2 29.7 20.4 30-49 59.0 . . 47.2 49.0 45.0 42.1 40.7 36.5 50-64 60.1 . . 47.4 44.0 46.4 41.3 38.1 32.6 65-80 48.9 . . 45.2 40.0 39.6 37.4 36.0 31.3 All 55.6 . . 45.6 43.6 41.3 39.4 36.7 31.0 Men 16-29 64.1 . . 48.8 46.0 45.0 40.5 39.6 31.3 30-49 73.5 . . 56.8 60.0 57.0 54.6 53.0 47.4 50-64 71.4 . . 57.2 55.0 54.0 49.5 47.0 42.2 65-80 60.9 . . 55.7 46.0 50.0 48.0 46.4 43.9

All 68.8 . . 54.8 53.4 52.5 49.7 47.3 41.7

Alcohol policyOn many levels, and today more than before

on local level

Have a written national alcohol policy – strategy, so also most municipalities

Still – low physical and econ. availability – corner pillars in the alc. policy – number of outlets, age limits, taxation, opening hours,

One major reason – affecting young people

Alcohol policy

Recent years – focus more on local level and on other ’new’ methods to compensate for the weakening of most important national alc. policy measures (i.a. due to closer European integration – cross border shopping, abolishment of all monopolies except on the retail side)

Local – regional organisation and coordination built up and resources spent on strengthening and developing methods, especially young people

Alcohol policyLocal level:- Limit availability incl. social availability constraints

(drinking context) - surveillance, enforcement, RBS- Illegal alcohol – ‘Kronoberg method’- Parental/family programs – strengthening parenthood

– some prg. focusing on alcohol – clear rules, caring parents etc.

- Students at high school and particularly univ. – RBS, brief intervention (Student health care org.)

- Some focus on schools and prg (but not explicit alc.)

During the intervention period (July 1998-July 2000), reported violent crimes during night time (between 22-06 hours) were reduced by 29 per cent in the intervention area compared to the trends in the control area

(Wallin, et al., 2003)

Alcohol policy

Local level:- More focus on mothers (parents) to be – in

prenatal care – AUDIT, brief intervention- In new strategy as from 2011 – much focus on

new born and children brought up in dysfunctional families, incl. alcohol and drug abuse: how to reach these children , cooperation between different actors – school, social services, health care, police etc.

Eval. alcohol policy- Main pillars in the alcohol policy – strong

scientific support, but the emphasise on local level

– no ‘real’ evaluation, but follow-ups.

We don’t know why young people drink less – does the local prevention and the increase in prev. matters? We must know better.

Therefore in the new strategy on alcohol, drugs, doping and tobacco (ANDT):

Swedish national strategy for alcohol, narcotics, doping and tobacco (ANDT) from 2011-2015.

- Overall goal – a drug and doping free society, less harm from alc. and tobacco

- Seven long-term goals (L-T G) targets – (1) lower availability, (2) protecting children (incl. unborn, new born child), (3) lower levels among young people (age on onset etc), (4) reduced risk cons., harmful use, dependence, (5) increased avail. to treatment, (6) reduced harm rates - morbidity and mortality, (7) Sweden – active work internationally

- Within each LT, several prioritised (policy) goals (PG)

– If possible, develop measurable indicators ( but difficult, e.g. indicator/s on ‘more effective crime prevention concerning illegal alcohol’, ‘more coordinated and effective

supervision of on-premise sales and sales at grocery stores’

For each level and goal – indicators should be suggested.

Structure for the ANDT-strategy

L-T G 1

L-T G 2

L-T G 3

L-T G 4

L-T G 5

L-T G 6

L-T G 7

Overall goal: a drug and doping free society and reduced medical and social harm from alcohol and tobacco use

P G 1P G2P G 3P G 3P G 4

etc

P G 1P G2P G 3P G 3P G 4

etc

P G 1P G2P G 3P G 3P G 4

etc

P G 1P G2P G 3P G 3P G 4

etc

P G 1P G2P G 3P G 3P G 4

etc

P G 1P G2P G 3P G 3P G 4

etc

P G 1P G2P G 3P G 3P G 4

etc

• Suggest measurable indicators – long term (goals) (outcomes: behaviour change – risk cons., heavy use, harm reduce etc.) and prioritised goals (policy, activities, processes)

• Not only give definition – but the whole chain from def. to concrete analyses: what data, which scale, how to analyse

• Core indicators: most important to follow – some should also be plugged into local studies (surveys) – bridge between national main surveys and local surveys

• Expanded indicators – complementing core indicators – focus on more detailed diff. aspects of the core indicators

• Additional/developmental indicators: open up new areas, need development before ready as indicators – cannot be used today

• Also – suggest a follow-up system, including who should and what should be collected and how the new “guidelines” of indicators and monitoring should be disseminated on national and to the local level

Indicators – what should be doneIndicators – what should be done

Indicators – Indicators – Why this? (1) Increases the possibilities to understand/explain

changes and (2) a driving force for more systematic work. Since local level important – also indicators on local level, when applicable

Policy/activitiesConsumption/

harmNational level:

Regional/local level:

Policy/activitiesConsumption/

harm