Commentary on Laslett et al. (2011): alcohol-related collateral damage and the broader issue of alcohol's social costs

Work-Related Alcohol Use and Harm to Others

Drinking alcohol with coworkers is a common practice in many occupational cultures. This practice may produce negative consequences for some employees. Objectives: We estimate the prevalence of a set of negative consequences of work-related alcohol use and identify risk factors associated with experience of harm from coworkers' drinking. Methods: In an online survey, Norwegian employees (n = 3596) aged 20-69 reported whether they had experienced the following due to coworkers' drinking the past 12 months: (a) felt excluded, (b) experienced unwanted sexual attention, (c) been physically harmed, and (d) been verbally abused. Each outcome was regressed on socio-demographics (age, gender, education, and income), job characteristics (flexibility and autonomy), respondents' alcohol use, and perceived intoxication frequency in work contexts for a typical coworker (perceived coworker intoxication frequency). Results: The 12-month prevalence of experiencing any of the negative consequences was 18%. Having felt excluded (10.7%) and experienced unwanted sexual attention (7.0%) were more common than being verbally abused (4.8%) or physically harmed (1.9%). Perceived coworker intoxication frequency was strongly associated with all outcomes. Respondents' own drinking frequency predicted being verbally abused, being physically harmed, and experiencing unwanted sexual attention. Women experienced less physical harm and more unwanted sexual attention than men. Prevalence also varied by age, education, income, and job characteristics. Conclusions: Each year, approximately one-sixth of Norwegian employees experience harm from their coworkers' drinking. The frequency of intoxication in work contexts is strongly associated with harm to others.

Positioning Alcohol's Harm to others (AHTO) within Alcohol Research: A Reinvented Perspective with Mixed Policy Implications

Aims & Design

This overview analyses the recent emergence of the concept of alcohols harm to others (AHTO) and the potential policy implications embedded in this research perspective. The overview is an account of ways in which recent alcohol research has grasped the kind of harm that goes beyond the drinker. It positions the dimensions of alcohol's harm to others as a research perspective in relation to other established research approaches to alcohol-related problems.

Findings

Several concepts presented within different disciplines have focused on how adverse consequences of drinking go beyond the individual drinker. However, the scientific discussion is still characterised by an obvious conceptual instability. Alongside the growing research interest in alcohol's harm to others there is a political discourse stressing the urgency of alcohol policy measures protecting innocent victims against damage from others' alcohol use.

Conclusions

In drawing attention to the interactional nature of alcohol-related harm, the AHTO perspective brings a novel syntagmatic and cross-cutting aspect to established traditions in alcohol research and forms a unique scientific approach. The AHTO perspective has the potential for creating a political will to move the alcohol policy agenda forward, but the question of a suitable and credible term is unresolved. Conceptually, the AHTO perspective is still in a state of flux, while politically it is loaded with considerable ambitions and interests related to causal attributions and ethical conclusions embedded in the research perspective.

A Cross-National Examination of Differences in Classification of Lifetime Alcohol Use Disorder Between DSM-IV and DSM-5: Findings from the World Mental Health Survey

BACKGROUND

The current study sought to examine the diagnostic overlap in DSM-IV and DSM-5 alcohol use disorder (AUD) and determine the clinical correlates of changing diagnostic status across the 2 classification systems.

METHODS

DSM-IV and DSM-5 definitions of AUD were compared using cross-national community survey data in 9 low-, middle-, and high-income countries. Participants were 31,367 respondents to surveys in the World Health Organization's World Mental Health Survey Initiative. The Composite International Diagnostic Interview, version 3.0, was used to derive DSM-IV and DSM-5 lifetime diagnoses of AUD. Clinical characteristics, also assessed in the surveys, included lifetime DSM-IV anxiety; mood and drug use disorders; lifetime suicidal ideation, plan, and attempt; general functional impairment; and psychological distress.

RESULTS

Compared with DSM-IV AUD (12.3%, SE = 0.3%), the DSM-5 definition yielded slightly lower prevalence estimates (10.8%, SE = 0.2%). Almost one-third (n = 802) of all DSM-IV abuse cases switched to subthreshold according to DSM-5 and one-quarter (n = 467) of all DSM-IV diagnostic orphans switched to mild AUD according to DSM-5. New cases of DSM-5 AUD were largely similar to those who maintained their AUD across both classifications. Similarly, new DSM-5 noncases were similar to those who were subthreshold across both classifications. The exception to this was with regard to the prevalence of any lifetime drug use disorder.

CONCLUSIONS

In this large cross-national community sample, the prevalence of DSM-5 lifetime AUD was only slightly lower than the prevalence of DSM-IV lifetime AUD. Nonetheless, there was considerable diagnostic switching, with a large number of people inconsistently identified across the 2 DSM classifications.

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.

How Well Do Survey Studies Capture Alcohol's Harm to Others?

Empirical studies assessing alcohol’s harm to others very often rely on population survey data. This study addresses some of the problems and challenges in using survey data for this purpose. Such problems include the limited capacity of population surveys in identifying infrequent harm and long-term consequences of drinking. Moreover, the drinker may report the alcohol-related harm or the person being harmed may report the damage. However, irrespective of who reports the harm, causal attribution to drinking is problematic. Challenges for future population surveys to address alcohol’s harm to others include the need for improved models and understanding of complex mechanisms to guide empirical studies within the broad range of harm. Study designs other than cross-sectional surveys, such as longitudinal study designs and combinations of population surveys and other data sources, are likely to overcome some of the identified problems in current population surveys of alcohol’s harm to others.

Parental drinking and adverse outcomes in children: A scoping review of cohort studies

Introduction and Aims

There is a growing interest in measuring alcohol's harms to people other than the drinker themselves. ‘Children of alcoholics’ and foetal alcohol spectrum disorder have received widespread attention. Less is known about how children are affected by post‐natal exposure to parental drinking other than alcohol abuse/dependence. In this scoping review, we aim to assemble and map existing evidence from cohort studies on the consequences of parental alcohol use for children, and to identify limitations and gaps in this literature.

Design and Methods

Systematic review methods were used. Electronic databases were searched (1980 to October 2013) and a total of 3215 abstracts were screened, 326 full text papers examined and 99 eligible for inclusion according to selection criteria including separation of exposure and outcome measurement in time and report of a quantitative effect size.

Results

The main finding is the large literature available. Adolescent drinking behaviour was the most common outcome measure and outcomes other than substance use were rarely analysed. In almost two of every three published associations, parental drinking was found to be statistically significantly associated with a child harm outcome measure. Several limitations in the literature are noted regarding its potential to address a possible causal role of parental drinking in children's adverse outcomes.

Discussion and Conclusions

This study identifies targets for further study and provides a platform for more targeted analytic investigations which ascertain risk of bias, and which are capable of considering the appropriateness of causal inferences for the observed associations. [Rossow I, Felix L, Keating P, McCambridge J. Parental drinking and adverse outcomes in children: A scoping review of cohort studies. Drug Alcohol Rev 2016;35:397–405]

Harms to 'others' from alcohol consumption in the minimum unit pricing policy debate: a qualitative content analysis of U.K. newspapers (2005-12)

BACKGROUND AND AIMS

Minimum unit pricing is a fiscal intervention intended to tackle the social and health harms from alcohol to individual drinkers and wider society. This paper presents the first large-scale qualitative examination of how newsprint media framed the debate around the harms of alcohol consumption to 'others' during the development and passing of minimum unit pricing legislation in Scotland.

METHODS

Qualitative content analysis was conducted on seven U.K. and three Scottish national newspapers between 1 January 2005 and 30 June 2012. Relevant articles were identified using the electronic databases Nexis U.K. and Newsbank. A total of 403 articles focused on the harms of alcohol consumption to 'others' and were eligible for detailed coding and analysis.

RESULTS

Alcohol harms to wider society and communities were identified as being a worsening issue increasingly affecting everyone through shared economic costs, social disorder, crime and violence. The availability of cheap alcohol was blamed, alongside a minority of 'problem' youth binge drinkers. The harm caused to families was less widely reported.

CONCLUSIONS

If news reporting encourages the public to perceive the harms caused by alcohol to wider society as having reached crisis point, a population-based intervention may be deemed necessary and acceptable. However, the current focus in news reports on youth binge drinkers may be masking the wider issue of overconsumption across the broader population.