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- Gmel, G., et al.
(författare)
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Contrasting individual and aggregate studies in alcohol research? Combining them is the answer!
- 2004
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Ingår i: Addiction Research and Theory. - : Informa UK Limited. - 1058-6989 .- 1606-6359 .- 1476-7392. ; 12:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- The reprint of Rose's (1985) seminal paper reiterated the distinction between two etiological questions: What are the causes of individual cases, and what are the causes of population incidence? The first question deals with within-population variability and the second with between-population variability, suggesting that individual level studies should be used to answer the first question and aggregate level studies to answer the second. What findings should be trusted, however, when the results from aggregate and individual level studies on the same topic diverge? One example of the divergence of findings in the alcohol field is that of studies on coronary heart disease. The overwhelming majority of individual level studies have shown the protective effect of moderate alcohol consumption for coronary heart disease, however aggregate level studies have failed to corroborate this finding. This discrepancy has been taken by some as evidence that the aggregate level disproved a causal relation at the individual level. This implies that the same hypothesis could be tested at both levels. The present editorial will reiterate the notion of Rose (1985) that both types of analyses answer different questions and cannot be expected to coincide in results.
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- Kuendig, H, et al.
(författare)
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Beyond drinking: differential effects of demographic and socioeconomic factors on alcohol-related adverse consequences across European countries
- 2008
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Ingår i: European addiction research. - : S. Karger AG. - 1421-9891 .- 1022-6877. ; 14:3, s. 150-160
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background/Aims:</i> Evidence underlines the importance of drinking patterns and individual characteristics in experiencing adverse alcohol-related consequences; however, little research has been conducted to explore who does and who does not experience consequences with similar drinking patterns. Using data from seven European countries, this study assesses the association between demographic and socioeconomic characteristics and six adverse consequences. <i>Methods:</i> Conditional logistic regression models were estimated, cases (experiencing a consequence) being matched to controls (not experiencing the consequence) by drinking patterns. <i>Results:</i> In general, protective effects with increasing age and being in a partnership were consistent. Gender effects were mixed, but mainly protective for women. Educational achievement and economic status showed consistent effects across countries, but different directions of effect across consequences. Consequences mostly associated with individual drinking pattern <i>(injury, blackout</i>, and <i>loss of control over drinking)</i> exhibited similar patterns of associations, but varying ones arose for consequences additionally influenced by societal reaction to drinking <i>(guilt</i>, <i>role failure</i>, and <i>pressure to cut down drinking)</i>. <i>Conclusion:</i> Differences in strengths and directions of effects across consequences pointed to the possibility that the reporting of adverse consequences is not only influenced by alcohol consumption, but also by attributional processes related to demographic and socioeconomic statuses.
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- Rehm, J., et al.
(författare)
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Alcohol
- 2004
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Ingår i: Comparative quantification of health risks. - Geneva : World Health Organization. - 9241580313 ; , s. 959-1108
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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- Rehm, J., et al.
(författare)
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Alcohol as a risk factor for global burden of disease
- 2003
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Ingår i: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 9:4, s. 157-164
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Tidskriftsartikel (refereegranskat)abstract
- AIM:To make quantitative estimates of the burden of disease attributable to alcohol in the year 2000 on a global basis.DESIGN:Secondary data analysis.MEASUREMENTS:Two dimensions of alcohol exposure were included: average volume of alcohol consumption and patterns of drinking. There were also two main outcome measures: mortality, i.e. the number of deaths, and disability-adjusted life years (DALYs), i.e. the number of years of life lost to premature mortality or to disability. All estimates were prepared separately by sex, age group and WHO region.FINDINGS:Alcohol causes a considerable disease burden: 3.2% of the global deaths and 4.0% of the global DALYs in the year 2000 could be attributed to this exposure. There were marked differences by sex and region for both outcomes. In addition, there were differences by disease category and type of outcome; in particular, unintentional injuries contributed most to alcohol-attributable mortality burden while neuropsychiatric diseases contributed most to alcohol-attributable disease burden.DISCUSSION/CONCLUSIONS:The underlying assumptions are discussed and reasons are given as to why the estimates should still be considered conservative despite the considerable burden attributable to alcohol globally.
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- Rehm, J., et al.
(författare)
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Defining Substance Use Disorders : Do We Really Need More Than Heavy Use?
- 2013
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Ingår i: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 48:6, s. 633-640
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of the study was to explore whether the concept of heavy substance use over time can be used as definition of substance use disorder. Methods: Narrative review. Results: Heavy use over time clearly underlies the neurobiological changes associated with current thinking of substance use disorders. In addition, there is evidence that heavy use over time can explain the majority of social problems and of burden of disease (morbidity and mortality). A definition of substance use disorders via heavy use over time would avoid some of the problems of current conceptualizations, for instance the cultural specificity of concepts such as loss of control. Finally, stressing the continuum of use may avoid the high level of stigmatization currently associated with substance use disorders. Conclusion: ‘Heavy substance use over time’ seems to be a definition of substance use disorders in line with results of basic research and epidemiology. Additionally, it reduces stigmatization. This approach should thus be further explored.
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- Rehm, J., et al.
(författare)
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The global distribution of average volume of alcohol consumption and patterns of drinking
- 2003
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Ingår i: European Addiction Research. - : S. Karger. - 1022-6877 .- 1421-9891. ; 9:4, s. 147-156
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Tidskriftsartikel (refereegranskat)abstract
- AIMS:To make quantitative estimates on a global basis of exposure of disease-relevant dimensions of alcohol consumption, i.e. average volume of alcohol consumption and patterns of drinking.DESIGN:Secondary data analysis.MEASUREMENTS:Level of average volume of drinking was estimated by a triangulation of data on per capita consumption and from general population surveys. Patterns of drinking were measured by an index composed of several indicators for heavy drinking occasions, an indicator of drinking with meals and an indicator of public drinking. Average volume of consumption was assessed by sex and age within each country, and patterns of drinking only by country; estimates for the global subregions were derived from the population-weighted average of the countries. For more than 90% of the world population, per capita consumption was known, and for more than 80% of the world population, survey data were available.FINDINGS:On the country level, average volume of alcohol consumption and patterns of drinking were independent. There was marked variation between WHO subregions on both dimensions. Average volume of drinking was highest in established market economies in Western Europe and the former Socialist economies in the Eastern part of Europe and in North America, and lowest in the Eastern Mediterranean region and parts of Southeast Asia including India. Patterns were most detrimental in the former Socialist economies in the Eastern part of Europe, in Middle and South America and parts of Africa. Patterns were least detrimental in Western Europe and in developed countries in the Western Pacific region (e.g., Japan).CONCLUSIONS:Although exposure to alcohol varies considerably between regions, the overall exposure by volume is quite high and patterns are relatively detrimental. The predictions for the future are not favorable, both with respect to average volume and to patterns of drinking.
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- Rehm, J., et al.
(författare)
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The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease : an overview
- 2003
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 98:9, s. 1209-1228
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Forskningsöversikt (refereegranskat)abstract
- Aims As part of a larger study to estimate the global burden of disease attributable to alcohol:• to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and• to combine exposure and risk estimates to determine regional and global alcohol-attributable fractions (AAFs) for major disease and injury categories.Design, methods, setting Systematic literature reviews were used to select diseases related to alcohol consumption. Meta-analyses of the relationship between alcohol consumption and disease and multi-level analyses of aggregate data to fill alcohol–disease relationships not currently covered by individual-level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi-level analyses with prevalence data.Findings Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed.Conclusions Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.
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- Rehm, J., et al.
(författare)
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The tangible common denominator of substance use disorders : a reply to Commentaries to Rehm et al. (2013a)
- 2014
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Ingår i: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 49:1, s. 118-122
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Tidskriftsartikel (refereegranskat)abstract
- In response to our suggestion to define substance use disorders via ‘heavy use over time’, theoretical and conceptual issues, measurement problems and implications for stigma and clinical practice were raised. With respect to theoretical and conceptual issues, no other criterion has been shown, which would improve the definition. Moreover, heavy use over time is shown to be highly correlated with number of criteria in current DSM-5. Measurement of heavy use over time is simple and while there will be some underestimation or misrepresentation of actual levels in clinical practice, this is not different from the status quo and measurement of current criteria. As regards to stigma, research has shown that a truly dimensional concept can help reduce stigma. In conclusion, ‘heavy use over time’ as a tangible common denominator should be seriously considered as definition for substance use disorder.
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