Russia's National Concept to Reduce Alcohol Abuse and Alcohol-Dependence in the Population 2010-2020: Which Policy Targets Have Been Achieved?

Alcohol, No Ordinary Commodity: policy implications for Canada

Alcohol is a favorite psychoactive substance of Canadians. It is also a leading risk factor for death and disability, playing a causal role in a broad spectrum of health and social issues. Alcohol: No Ordinary Commodity is a collaborative, integrative review of the scientific literature. This paper describes the epidemiology of alcohol use and current state of alcohol policy in Canada, best practices in policy identified by the third edition of Alcohol: No Ordinary Commodity, and the implications for the development of effective alcohol policy in Canada. Best practices - strongly supported by the evidence, highly effective in reducing harm, and relatively low-cost to implement - have been identified. Measures that control affordability, limit availability, and restrict marketing would reduce population levels of alcohol consumption and the burden of disease attributable to it.

A thematic analysis of alcohol and alcohol-related harm across health and social policy in Aotearoa New Zealand

OBJECTIVE

This study aims to: 1) explore how alcohol and alcohol harm are framed in New Zealand national policy, strategy, and action plan documents; and 2) examine how these documents align with the WHO SAFER framework.

METHODS

Keyword searches across government websites and Google were conducted in January 2021. Inclusion and exclusion criteria were applied to all identified documents, resulting in 22 being included for analysis in this study. An inductive and deductive thematic analysis of those documents was performed.

RESULTS

Our inductive thematic analysis identified three themes, of which one is detailed in this study: 'Location of responsibility for addressing alcohol harms' with a focus on individuals and non-specific government agencies. Thematic results from the deductive analysis found that the most consistently referenced SAFER policies included brief interventions (68% of documents), followed by drink driving measures (45%), alcohol marketing (36%), alcohol availability (27%), and alcohol price (23%). The conversion rate from a document mentioning a SAFER framework policy area to making specific policy recommendations was usually less than or around 50%.

CONCLUSIONS

The lack of alignment between New Zealand alcohol policy and the SAFER framework can be partially attributable to the absence of an updated national alcohol strategy (NAS). An updated NAS should identify responsible agencies, create a systematic monitoring and evaluation mechanism, and be consistent with the WHO SAFER framework.

IMPLICATIONS FOR PUBLIC HEALTH

The analysis supports the need to update a national alcohol strategy to guide alcohol policy development.

The impact of alcohol minimum unit pricing on people with experience of homelessness: Qualitative study

BACKGROUND

Alcohol Minimum Unit Pricing (MUP) was introduced in Scotland in May 2018. Existing evidence suggests MUP can reduce alcohol consumption in the general population, but there is little research about its impact on vulnerable groups. This qualitative study explored experiences of MUP among people with experience of homelessness.

METHODS

We conducted qualitative semi-structured interviews with a purposive sample of 46 people with current or recent experience of homelessness who were current drinkers when MUP was introduced. Participants (30 men and 16 women) were aged 21 to 73 years. Interviews focused on views and experiences of MUP. Data were analysed using thematic analysis.

RESULTS

People with experience of homelessness were aware of MUP but it was accorded low priority in their hierarchy of concerns. Reported impacts varied. Some participants reduced their drinking, or moved away from drinking strong white cider, in line with policy intentions. Others were unaffected because the cost of their preferred drink (usually wine, vodka or beer) did not change substantially. A minority reported increased involvement in begging. Wider personal, relational and social factors also played an important role in responses to MUP.

CONCLUSION

This is the first qualitative study to provide a detailed exploration of the impact of MUP among people with experience of homelessness. Our findings suggest that MUP worked as intended for some people with experience of homelessness, while a minority reported negative consequences. Our findings are of international significance to policymakers, emphasising the need to consider the impact of population level health policies on marginalised groups and the wider contextual factors that affect responses to policies within these groups. It is important to invest further in secure housing and appropriate support services and to implement and evaluate harm reduction initiatives such as managed alcohol programmes.

Reduction of Alcoholic Strength: Does It Matter for Public Health?

In this work, reduction of alcoholic strength was discussed as a means to reduce consumption and alcohol-attributable harm. Statistical modelling was conducted to (1) estimate its potential for the largest six Western and Central European countries (France, Germany, Italy, Poland, Spain, UK); (2) calculate the increase in taxation necessary to reach this potential, and (3) estimate the mortality gains achieved with the introduction of no- or low-alcohol beverages in the UK and Spain. The high public health potential of reducing alcoholic strength was demonstrated via modelling a scenario in which the strength of all beverages was reduced by 10%, which would avert thousands of deaths in these six European countries per year. However, methods by which to achieve these gains were not clear, as the alcohol industry has shown no inclination toward reductions in the alcoholic strength of beer, wine, or spirits via a reformulation on a large scale. The increase of excise taxation to achieve the public health gains of such a reduction would result in markedly increasing prices-a situation unlikely to be implemented in Europe. Finally, the introduction of beer and wine with an alcoholic strength below 0.5% led to some substitutions of higher-strength beverages, but did not show a marked public health impact. New taxation initiatives to achieve the potential of a reduction of alcoholic strength will need to be implemented.

A Genome-Wide Association Study Reveals a BDNF-Centered Molecular Network Associated with Alcohol Dependence and Related Clinical Measures

At least 50% of factors predisposing to alcohol dependence (AD) are genetic and women affected with this disorder present with more psychiatric comorbidities, probably indicating different genetic factors involved. We aimed to run a genome-wide association study (GWAS) followed by a bioinformatic functional annotation of associated genomic regions in patients with AD and eight related clinical measures. A genome-wide significant association of rs220677 with AD (p-value = 1.33 × 10^-8 calculated with the Yates-corrected χ² test under the assumption of dominant inheritance) was discovered in female patients. Associations of AD and related clinical measures with seven other single nucleotide polymorphisms listed in previous GWASs of psychiatric and addiction traits were differently replicated in male and female patients. The bioinformatic analysis showed that regulatory elements in the eight associated linkage disequilibrium blocks define the expression of 80 protein-coding genes. Nearly 68% of these and of 120 previously published coding genes associated with alcohol phenotypes directly interact in a single network, where BDNF is the most significant hub gene. This study indicates that several genes behind the pathogenesis of AD are different in male and female patients, but implicated molecular mechanisms are functionally connected. The study also reveals a central role of BDNF in the pathogenesis of AD.

Capturing Russian drinking patterns with the Alcohol Use Disorders Identification Test: An exploratory interview study in primary healthcare and narcology centers in Moscow

BACKGROUND

Despite a considerable reduction in alcohol consumption, Russia has one of the highest levels of alcohol-attributable burden of disease worldwide due to heavy episodic drinking patterns. Further improvement of alcohol control measures, including early provision of screening and brief interventions (SBI), is needed. The legislative framework for delivering SBI in Russia was introduced in 2013. As part of the creation and validation of a Russian version of the Alcohol Use Disorders Identification Test (AUDIT), the present contribution explored challenges in using the AUDIT in Russia to inform a subsequent validation study of the tool.

METHODS

Qualitative in-depth expert interviews with patients and healthcare professionals from four primary healthcare and narcology facilities in Moscow. A total of 25 patients were interviewed, 9 from a preventive medicine hospital, 8 from a polyclinic, and 9 from narcology clinics. Also, 12 healthcare professionals were interviewed, 5 of whom were primary healthcare doctors and 7 were narcologists.

RESULTS

Patients and healthcare professionals expressed difficulties in dealing with the concept of a "standard drink" in the AUDIT, which is not used in Russia. Various patients struggled with understanding the meaning of "one drinking occasion" on the test, mainly because Russian drinking patterns center around festivities and special occasions with prolonged alcohol intake. Narcology patients had specific difficulties because many of them experienced zapoi-a dynamic drinking pattern with heavy use and a withdrawal from social life, followed by prolonged periods of abstinence. Surrogate alcohol use was described as a common marker of alcohol dependence in Russia, not accounted for in the AUDIT.

CONCLUSIONS

The provided analyses on the perception of the Russian AUDIT in different patient and professional groups suggest that a series of amendments in the test should be considered to capture the specific drinking pattern and its potential harms.

Exploring the diversity and consistency of China’s information technology policy

Information technology (IT) policies have played an indispensable role in China’s IT research and development (R&D) and industrial development. However, there has been a lack of quantitative and clear understanding of the consistency and diversity of China’s IT policy mixes. In this article, we constructed policy target network to simulate the real policy mixes. Based on the distribution and evolution of networks, we identify and analyse the ‘diversity’ and ‘consistency & continuity’ of China’s IT policy. Our results show that China’s IT policies cover 12 different demands, and each demand corresponds to 5–10 core policy goals. At the same time, we divide the history of IT policy into seven periods and compare the characteristics of each period. Despite the scale of the policy mixes continuing to expand, the synergy between different policy targets has become clearer, forming unique communities. Among them, there are 25 core policy targets that reflect varying degrees of consistency and continuity. This study not only deepens the understanding of China’s policy characteristics and patterns, but also provides a quantitative framework for the assessment of policy consistency and diversity.

Prevalence of alcohol use disorders in primary health-care facilities in Russia in 2019

AIMS

To estimate prevalence of alcohol use disorders (AUD) and alcohol dependence (AD) for Russia in 2019, based on clients in primary health-care facilities.

DESIGN

Cross-sectional assessment of AUD and AD. Prevalence estimates were cross-validated using a treatment multiplier methodology.

SETTING

A total of 21 primary health-care facilities, including dispanserization units (population health preventive care settings).

PARTICIPANTS

A total of 2022 participants (986 women and 1036 men) 18 years of age and older.

MEASUREMENTS

Composite International Diagnostic Interview.

FINDINGS

The prevalence of AD and AUD was 7.0% [95% confidence interval (CI) = 5.9-8.1%] and 12.2% (95% CI = 10.8-13.6%), respectively. Marked sex differences were observed for the prevalence of AD (women: 2.8%; 95% CI = 1.7-3.8%; men: 12.2%; 95% CI = 10.3-14.1%) and AUD (women: 6.1%; 95% CI = 4.6-7.7%; men: 19.5%; 95% CI = 17.2-21.8%). Age patterns of AD and AUD prevalence were sex-specific. Among women, the prevalence of AUD and AD was highest in the youngest age group and decreased with age. Among men, the prevalence of AUD and AD was highest among men aged 45-59 years. Sensitivity analyses indicated that the prevalence of AD as estimated using a treatment multiplier (6.5%; 95% CI = 5.0-8.9%) was similar to the estimates of the main analysis.

CONCLUSIONS

Even though alcohol use has declined since 2003 in Russia, the prevalence of alcohol use disorders and alcohol dependence remains high at approximately 12 and 7%, respectively.

Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation

Background

Personalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated.

Objective

This study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia.

Methods

A systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS).

Results

We identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing.

Conclusions

Russian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458

The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations

BACKGROUND

The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use.

METHODS

Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide.

RESULTS

Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined.

CONCLUSIONS

Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.

Forty-year study of rates of homicide by people with schizophrenia and other homicides in the Chuvash Republic of the Russian Federation

BACKGROUND

The extent to which rates of homicide by people with or without schizophrenia vary over time has theoretical and practical implications in understanding homicide by people with mental illness.

AIMS

The aim was to report on the rates of homicide by people diagnosed with schizophrenia over time in a region in which there were dramatic changes in the overall rates of homicide.

METHODS

An examination of homicide by people diagnosed with schizophrenia in the course of judicial psychiatric examination, and the rate of other homicide in the Chuvash Republic of the Russian Federation between 1981 and 2020 was undertaken.

RESULTS

During the 40 years of the study a total of 5741 people faced legal proceedings for a homicide offence, of whom 179 (3.1%) were diagnosed with schizophrenia. During the study period the average annual total homicide rate rose from about 9 per 100 000 in the 1980s, peaked at 17 per 100 000 in the 1990s before falling to 13 per 100 000 in the 2000s and 6 per 100 000 in the 2010s. Rates of homicide by people with schizophrenia also rose and fell over this period and were significantly associated with the rates of other homicide (r = 0.503, d.f. = 38, P = 0.001).

CONCLUSIONS

The rise and fall in rates of homicide by people diagnosed with schizophrenia in parallel to total homicide suggests that homicidal behaviour might not be intrinsic to the clinical manifestations of the illness, and might instead reflect a heightened vulnerability to social factors that are associated with homicide by people without schizophrenia.

Development of the policy of control over unrecorded alcohol in Russia in the period after 1991

Relevance. Unrecorded alcohol in Russia includes a variety of sources of cheap, often highly concentrated, ethanol, the use of which is associated with an increased risk of morbidity and death. Since 1991, various changes in the policy of control of unrecorded alcohol in Russia have been made, which became the subject of the analysis of this work.

Methods. The paper provides a narrative review and analysis of the regulation of unrecorded alcohol in Russia in the period from 1991 to 2021. The sources of information on legislative regulation were the ConsultantPlus and Garant electronic legal reference systems, published key scientific papers and reports of international organizations on the topic of alcohol regulation, and our own analysis of alcohol policy.

Results. During the study period, there was a large-scale restructuring of the regulation of the sphere of alcohol, including unrecorded alcohol, in Russia in the conditions of a new market economy. After the abolition of the Soviet alcohol monopoly and the regulatory pause of the first half of the 1990s, since 1995, the new legislative framework has been developed aimed at strengthening state control over the production and distribution of alcohol. In subsequent years, increased control over unrecorded alcohol by improving federal law No. 171-FZ, tougher sanctions for acts in the field of illegal production and distribution of alcohol through the improvement of the Code of Administrative Offenses and the Criminal Code of the Russian Federation, the introduction of minimum prices for alcoholic beverages, have been made. An electronic system for monitoring the volumes of produced and sold alcoholic beverages was introduced, the Federal Service for the Regulation of the Alcohol Market was established, and bans were introduced on the sale of alcohol-containing products with a low unit cost of ethanol.

Conclusions. Overall, the policy on the control of unrecorded alcohol in Russia in the period after 1991 from the standpoint of public health can be characterized as positive and in line with international standards. However, it is necessary to strengthen control over the implementation of the already existing alcohol control policy measures, as well as to develop and implement new measures aimed at controlling unrecorded medicinal/pharmaceutical alcohol, medicinal alcohol-containing products, illegal alcoholic beverages and non-beverage products used as alcohol surrogates.

The Alcohol Use Disorders Identification Test (AUDIT) in the Russian language - a systematic review of validation efforts and application challenges

The Alcohol Use Disorders Identification Test (AUDIT) is one of the most frequently used screening instrument for hazardous and harmful use of alcohol and potential alcohol dependence in primary health care (PHC) and other settings worldwide. It has been translated into many languages and adapted and modified for use in some countries, following formal adaptation procedures and validation studies. In the Russian Federation, the AUDIT has been used in different settings and by different health professionals, including addiction specialists (narcologists). In 2017, it was included as a screening instrument in the national guidelines of routine preventive health checks at the population-level (dispanserization). However, various Russian translations of the AUDIT are known to be in use in different settings and, so far, little is known about the empirical basis and validation of the instrument in Russia—a country, which is known for its distinct drinking patterns and their detrimental impact on health. The present contribution is the summary of two systematic reviews that were carried out to inform a planned national validation study of the AUDIT in Russia.

Two systematic searches were carried out to 1) identify all validation efforts of the AUDIT in Russia and to document all reported problems encountered, and 2) identify all globally existing Russian translations of the AUDIT and document their differences and any reported issues in their application. The qualitative narrative synthesis of all studies that met the inclusion criteria of the first search highlighted the absence of any large-scale rigorous validation study of the AUDIT in primary health care in Russia, while a document analysis of all of the 122 Russian translations has revealed 61 unique versions, most of which contained inconsistencies and signaled obvious application challenges of the test.

The results clearly signal the need for a validation study of the Russian AUDIT.

Scientifc assessment of the degree of implementation of the state policy to reduce abuse of alcoholic products and prevent alcoholism among the population of the Russian Federation until 2020

Goal. The goal of this study was to assess the scale of the implementation of the measures of the Concept to Reduce Alcohol Abuse Alcohol Dependence among the Population of the Russian Federation for the Period up to 2020.

Methods. Research methods included legal analysis, as well as epidemiological and sociological data analysis.

Results. The goals and the indicators of the Concept were achieved generally. According to our assessment, 15 (71%) out of 21 of the Concept’s measures have been implemented, among them 12 were fully, and 3 were partially (14%) implemented. Out of the 17 evidence-based measures of the Concept, 15 (88%) were implemented in full or in part.

Alcohol consumption decreased from 15,7 to 9,1 liters of ethanol per capita (or by 42%) in 2008–2019. Mortality from accidental alcohol poisoning decreased by 60% (from 16,9 to 7 per 100.000) between 2008 and 2020. There was a signifcant decrease in the indicators of alcoholism in Russia during the period of the implementation of the Concept.

Conclusions. The study shows that the goals, the objectives, the measures and the indicators of the Concept have been largely achieved. This was accompanied by the decrease in morbidity and mortality associated with alcohol consumption in Russia.

Alcohol Control Policy in Europe: Overview and Exemplary Countries

Alcohol is a major risk factor for burden of disease. However, there are known effective and cost-effective alcohol control policies that could reduce this burden. Based on reviews, international documents, and contributions to this special issue of International Journal of Environmental Research and Public Health (IJERPH), this article gives an overview of the implementation of such policies in the World Health Organization (WHO) European Region, and of best practices. Overall, there is a great deal of variability in the policies implemented between countries, but two countries, the Russian Federation and Lithuania, have both recently implemented significant increases in alcohol taxation, imposed restrictions on alcohol availability, and imposed bans on the marketing and advertising of alcohol within short time spans. Both countries subsequently saw significant decreases in consumption and all-cause mortality. Adopting the alcohol control policies of these best-practice countries should be considered by other countries. Current challenges for all countries include cross-border shopping, the impact from recent internet-based marketing practices, and international treaties.