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NADRA 2014: Focus on Nordic substance use and trends

  • Folkhälsa

Alcohol consumption and habits among the Swedish population as well as measurements of illegal drugs in waste water were key-themes of the session “Substance use and trends” at the Nordic Alcohol and Drug Researchers’ Assembly. The assembly, organized by the Nordic Welfare Centre, was held in August 2014 in Stockholm.

Alcohol consumption among Swedish adolescents has decreased during the last decade. Thor Norström from the Swedish Institute for Social Research and Jonas Raninen from The Swedish Council for Information on Alcohol and Other Drugs (CAN) have studied youth drinking trajectories across at-risk groups.

Thor Norström, NADRA 2014

The background is that alcohol-related harm and consumption trends do not seem to correlate in the predicted manner, and it is therefore relevant to study whether or not some groups may have actually increased their drinking despite the declining trend among the vast majority of the population, often referred to as polarization in drinking.

The data were obtained from CAN´s yearly nation-wide school survey on alcohol and other drugs, conducted among 9th grade students. The data used for this study originates from the years 2000 to 2012.

Norström and Raninen divided the research material into 5 at-risk groups ranging from low to high based on their relative ranking on a risk scale for substance use.

The findings showed that drinking decreased in all 5 at-risk groups, that is, there were no indications of a polarization in drinking between 2000 and 2012.

The steady decline of drinking among youth has however raised questions among the research community: Why are the young people drinking less than before? The declining trend is consistent on all areas of society and has taken place despite a liberalising trend in alcohol legislation and policy on the national level.

No major changes in alcohol consumption among Swedes

Håkan Källmén from Centre for Psychiatry Research at Karolinska Institutet, division STAD, presented a study about Swedish alcohol habits as assessed using the AUDIT (Alcohol Use Disorders Identification Test) test. The study gives particular attention to test results from the years 2009 and 2014.

Björn Källmén, NADRA 2014A random sample of 1459 persons aged 17 to 80 and living in Sweden was drawn from an official Swedish addresses-register. Comparable data have been collected in 1997, 2001, 2005 and 2009. The long-term intention of the project is to link changes in alcohol habits to changes in alcohol legislation and national-level policy.

A conclusion based on the latest findings is that there have been no major changes in the alcohol consumption among the Swedish population since 2009. However, young men have decreased their consumption to some extent whilst there has been a slight increase in alcohol consumption among young women. These changes were not significant. 

How can social scientist find new ways to conduct research?

Declining response-rates in population survey-studies give increasing cause for concern. In the last survey sample of Swedish alcohol habits the final response rate was 60 percent. Is the research material valid to get a comprehensive picture of the drinking habits of Swedes?

Many social scientists are nowadays particularly concerned about exclusion of population groups that are in general less willing to answer surveys and questions. Questions have been raised whether or not studies using traditional research methods give us a realistic picture of the overall alcohol consumption. 

Combining register-data on treatment and services or register-data on driving under the influence with alcohol sales figures is a useful way of supplementing knowledge on the substance use epidemiology as well as comparing self-reported data with injury-data.

Analysing drugs through waste water

Ellen Amundsen from the Norwegian Institute for Alcohol and Drug Research gave a presentation on how measurements of illegal drugs in waste water can improve and supplement knowledge about the substance-use epidemiology.

The drugs that can be analysed through waste water are amphetamine, methamphetamine, cannabis, ecstasy, and some opioids (for instance heroin, morphine, Codeine, methadone). In addition alcohol and nicotine levels in waste water can also be measured.

National wastewater analysis enables international data comparison and up-to-date information on the use of both traditional illicit drugs and new psychoactive substances (Kankaanpää et al. 2013). Comparison on a national and an international level makes it possible to acquire information about the amount of illegal drugs used at a certain time at a specific region. This information can be enriched by combining the data with population-data on the residents in the area tested.

Advantages and disadvantages

The advantage of using this method is that results can be obtained on a daily basis. Examining waste water is thus especially suitable for studying drug-use patterns, for instance which days of the week drug use is most frequent. Waste water analysis can also be employed for comparison of which drugs are used mainly during weekends and which drugs are used more frequently, possibly indicating a difference between so called recreational use and severe drug use. 

- For instance in the Oslo area, there is a clear peak in alcohol consumption on Fridays and Saturdays, Amundsen pointed out.

The advantage of waste water studies is that it provides an inexpensive method of measuring consumption as well as an easy method for monitoring the introduction of new drugs.

However, waste water analysis provides no personal information about consumers. Obtaining information that covers an entire country is prevented by ethical considerations. Waste water studies must for instance take into consideration the effect of publishing analysis in closed or small communities in order to prevent stigmatization.

Kankaanpää, Aino & Ariniemi, Kari & Heinonen, Mari & Kuoppasalmi, Kimmo & Gunnar, Teemu (2013): Use of illicit stimulant drugs in Finland: A wastewater study in ten major cities. Science of the Total Environment, December 2013

Related topics:
Avfallsvattnet visar trender för drogvanor (PopNAD, april 2014)

About AUDIT:
The AUDIT (Alcohol Use Disorders Identification Test) Questionnaire is used internationally to screen for problem drinking among the general population. It was constructed as a screening instrument for hazardous and harmful habits in primary care, it has been shown that it screens for alcohol-related social problems, alcohol-related health problems and dependency.

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