HAKAN
LEIFMAN
Alcohol and Primary Prevention
in Scotland and Sweden
A Comparative Study
This study compares primary alcohol prevention in Scotland and Sweden and the effectiveness of preventive actions with special reference to developments from the mid- or late 1970s when alcohol consumption peaked in both countries and when changes were made
in their alcohol policies. A short historical overview shows many similarities between the countries, e.g. strong prohibition-oriented
temperonce movements, a history of alcohol (spirits) abuse and restrictive legislation. A major difference is the much more dominating
role of private profit motives in Scottish alcohol trade. During the last 15-20 years, the two countries have chosen different strategies
to prevent alcohol-related problems. Sweden has put heavy emphasis on restricting the availability of alcohol but also invested substantially in information, whereas Scotland has concentrated on the latter. A comparison of the trends during the last 15-20 years
suggests that whereas Swedish alcohol control reduced the level of alcohol consumption and related problems in the late 1970s and
early 1980s, the Scottish did not, even though the upward trend was broken for most indicators. The drinking sensibie message has
not been powerful enough to reduce the number of non-sensible drinkers. In fact, a continuing upward trend of liver cirrhosis deaths
in Scotland, especially for women, may suggest the opposite. The study also shows that, despite rather stable overall consumption
for the last 10 years, the specific alcohol-related problem of drinking and driving has been decreasing in both countries. This indicates
that even if consumption increases in the future, as is likely in Sweden due to current changes in alcohol control policy, drinking in
specific contexts may still be preventable.
Key Words: alcohol policy, primary prevention, sensible drinking, Sweden, Scotland
The main purpose of this study is to compare the
alcohol prevention policies and practices of Scotland and Sweden as they have developed during
the post-war period, with special emphasis on the
last 15-20 years_ Scotland and Sweden show some
interesting similarities in their past experiences
with alcohol. During the last 15 years, however,
there have been some clear differences between
the two countries .
Concerned chiefly with primary alcohol prevention, this study will focus on the control system
that regulates the supply of and the demand for
alcohol, the former mainly via availability and the
latter via information and education. To gain a
deeper understanding of prevention in general
•
Acknowledgement: This research was made possible by an institutional grant from the Swedish Natural Science Research
Council within the scope of the EU 'Human Capital and Mobility' programme and the research project 'Comparative
studies in social welfare' under the guidance of prof. Duncan
Timms, University of Stirling, Scotland.
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31 -
and its efficacy in particular, the control system
will be studied in relation to the extent of alcohol
use and alcohol-related problems. Although there
exists no single chain of causality (d. MakeHi et al.
1981), it is assumed that the degree of control affects the level of consumption which, in turn, affects the extent of problems.
An implicit conception that permeates the
whole study is the view that all three alcohol components (control, use and consequences) in
general, and alcohol policy in particular, are much
influenced by the economic and political development in society, whereas the alcohol components
themselves have only little impact on this development. Control policy should thus not only
be seen as a response to changes in the level of alcohol consumption and alcohol problems, but
perhaps even more as an instrument to be used in
regard to societal changes (see Bruun 1973).
Therefore, although this study will pay most attention to the internal dynamics of alcohol-related
phenomena, these will also be placed into a
broader context by taking into account historical
circumstances and ongoing societal processes.
One approach to weighing the pros and cons of
Scottish and Swedish ways of tackling alcohol
problems is to study different indicators of the extent of alcohol problems. A national policy,
however, may be as effective as another even if it
shows higher rates of alcohol problems; it may
simply be confronted with a drinking culture
which has more and bigger problems to start
with. The main emphasis here will therefore be
on a comparison of trends in the indicators between the two countries.
To study the effects of primary preventive actions, the ideal method would be to use various
incidence measures to find out whether the
recruitment of new problem drinkers has
diminished. However, such measures are not
available and therefore we have to content ourselves with prevalence measures, e.g. the proportion of heavy drinkers. This may cause difficulty
in evaluating the effect of preventive actions, since
as long as the inflow of problem drinkers exceeds
the outflow, even if the inflow is lowered, the
prevalence will increase and it will appear as if the
prevention actions have failed. On the other
hand, if the inflow is reduced more than temporarily, this will also be expressed in lowered
prevalence rates over a longer period of time. This
is one reason why this study has adopted a rather
long study period.
Historical background
One advantage of a comparative study is that it
can highlight alternatives to existing arrangements and allow policy-makers to learn from
others' and own past experiences, especially
when the countries concerned have many historical similarities but different approaches today.
Both Scotland and Sweden have a long history of
alcohol abuse and legal controls on drink and
drinking. In both, the early temperance movement emerged during the first half of the
nineteenth century at a time when the consumption of both countries' predominant beverage,
spirits, reached levels never equalled thereafter
and probably never before (see Franberg 1988; Paton 1976, 1992; Wilson 1940). The prohibitionoriented temperance movement had much influence on the restrictive acts that were passed in
both countries from the second half of the
nineteenth century (see e.g. McLauglin 1989;
Smout 1986; Bruun & Franberg 1985). At the beginning of the twentieth century, the Scottish
licensing acts have been described as the most
restrictive in Britain and the society as polarised
on the question of alcohol, in this respect showing more resemblance with Scandinavia than
England (paton 1992). In Scotland and Sweden alcohol has also been a major source of revenue to
the state, and for Sweden also to local municipalities (McLauglin 1989; Franberg 1985).
However, the similarities should not conceal the
differences. First, the restrictions introduced were
more profound in Sweden and have in some fundamental parts continued until the changes occurring today (1995). Second, the private profit
motive was largely kept out of alcohel trade in
Sweden but not in Scotland, even if the power of
the alcohol industry was curtailed during the restrictive era. Third, the general impression is that
the temperance movement in Sweden not only
had more public support but also kept its influence over alcohol policy for a longer time than
in Scotland. This could perhaps be illustrated by
the fact that there was no real increase in the duty
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on spirits i Scotland from 1860 until 1909, i.e. during a time when the temperance movement is said
to have been at its peak (McLauglin 1989). Fourth,
Sweden did not participate in either of the two
world wars, which Scotland did. The wars were
perhaps the most important factor behind the
drop in consumption and alcohol problems in
Scotland (e.g. McLauglin 1989). (In Sweden consumption had already started to decline in the
closing years of the nineteenth century.) Fifth,
there was at least one evident difference between
the drinking habits of the two countries, i.e. the
pub culture. The restrictive restaurant policy in
Sweden almost caused the pub culture to disappear. The same year as the rationing system was
abolished (1955), the total number of on-licensed
premises in Sweden amounted to no more than
one per 13 474 inhabitants (Koskikallio 1985) compared to Scotland's one per 726 inhabitants l (The
Brewers' Society 1994).
Alcohol policy in Scotland and Sweden
The Swedish alcohol control system is currently
going through some of the most radical changes
it has seen this century. One of the first visible
changes in connection with Sweden's membership of the EU, from 1 January 1995, was a higher
permitted level of import of alcohol, from 1 litre of
wine and spirits and 2 litres of beer to 5 litres
wine, 15 litres beer and an unaltered amount of
spirits. With the possibility of even higher permitted levels of import for private use in the future,
concerns has been voiced about the impacts that
such an increase could have on future Swedish alcohol policy, especially pricing (e.g. SOU 1994a;
Romanus 1992). 2
A more fundamental change that also came into
force on 1 January 1995, was the abolition of state
monopolies on production, wholesale,. import
and export. Instead, a new government authority,
the National Alcohol Board, was set up where private companies can apply for a licence for import,
export, distribution and production. Only retailing remains in the hands of a state monopoly.
Membership will intensify Swedish integration
with the rest of Europe and in the long run probably render it difficult to maintain a restrictive alcohol policy. In the future Swedish alcohol strate-
gies will most probably have to put less emphasis
on reducing the availability of alcohol and more
effort'on influencing the demand for alcohol.
The Scots neither possess their own government nor a parliament, but they have a strong national identity and a distinct legal and governmental apparatus, including several political and
social institutions. Scotland also has considerable
independence in health and social issues, and alcohol issues that concern the social and health
domain and legislation are handled by the Scots
themselves. However, other aspects of alcohol
policy cover the whole of the UK, the most important of these being fiscal policy, excise and custom
duties and import and export restrictions (see
Tether & Harrison 1989). When the text below
refers to Scotland only, this means that the policy
concerns Scotland, although the policy for England/Wales may appear very similar. When the
text refers to the UK, it also includes Scotland.
In an EU perspective, not only the new member
states Finland and Sweden have a distinctive alcohol control system; the same applies in part to
Scotland and the UK as well. In recent policy
documents, alcohol has been identified as a firstorder health education priority, and for the first
time national targets have been set up to reduce
the proportion of non-sensible drinkers, in Scotland by 20 % (Scottish Office 1992). Furthermore,
the British government has recognized that the
taxation of alcohol may have an impact on consumption and harm (DOH 1992).
No unified model can be applied either to Scotland or to Sweden under which all control actions
could be categorized. Both countries have several
different types of bodies, national and local, official and unofficial (e.g. idealistic organizations),
with sometimes conflicting interests, but all strive
to influence different sectors in the alcohol arena.
In contrast to other drugs, alcohol use is legal,
which implies that a common means of alcohol
control relates to availability rather than penal
law. However, this does not mean that control by
penal law is not used at all; today it is most commonly used in the context of drinking and driving
(more on this later).
In addition to general control, there is individually based control which has been common in
Sweden, especially in connection with the Brattsystem. 3 Individual control may be targeted to
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the whole population or alternatively to those at
risk. The Bratt-system combined both, but with
more emphasis on the latter.
Overall alcohol consumption and alcohol-related problems increased dramatically in almost all
Western countries, including Sweden and the
UK, from the 1950s up until the mid- or late 1970s.
This was a matter of growing concern in both
countries as well as at the wHo, which in the late
1970s changed its policy; the priority now was to
lower the per capita consumption by reducing the
availability of and the demand for alcohol (WHO
1980). Both in Sweden and in the UK there was
renewed concern about the harmful effects of alcohot and changes were introduced in legislation
and policy. (For details on important events and
changes, see Appendix.) In Sweden, the abolition
of the rationing system and the passbook in 1955
was followed by a dramatic increase in consumption and alcohol-related problems. From 1954 to
1956, the consumption of spirits increased by 25 %
and total alcohol consumption by 17 %. To counteract this increase, the price on spirits was put
up, from November 1956 to February 1958, by
almost 50 %, which led to a drop in overall consumption to the level just before the abolition of
the passbook. Since then prices have formed one
central part in Swedish alcohol policy. During the
Bratt-system, prices were kept low (compared to
the period after 1955) and the maximum purchase
amount of spirits was fairly high (at least for a
moderate consumer).
Not all principles of the Bratt-system vanished
with the abolition of the passbook. The principle
of disconnecting private profit motives from alcohol trade was not affected by the 1955 reform, nor
was the· apprehension that alcohol misusers
should not be allowed to purchase alcohol. In
fact this type of individual control was behind
the introduction of black-lists in 1957 which
prevented listed people from purchasing alcohol
in any of the state owned retail shops.
Scotland, too, had its own so-called black-list
clause (in the 1959 Licensing 'Scotland' Act),
which proscribed persons who were convicted of
certain drunkenness offences from obtaining liquor (see Clayson 1973). This was repealed with
the entry into force of the 1976 Licensing (Scotland) Act.
Over time, individual control in Sweden was
gradually diminished. One step was the abolition
of the black-lists and the decriminalization of public drunkenness in 1977, another the coming into
force of the Social Services Act of 1982 that
replaced several more specific laws, among them
the 1954 Temperance Act, which had explicitly
stated that signs of alcohol abuse, such as convictions of public drunkenness, should bring about
individually based measures.
Most changes in alcohol policy in Sweden and
Scotland during the 1960s indicated a more liberal
stance towards alcohol.· Sweden in the 1960s is
perhaps best remembered for bringing medium
strength beer (1965) into food shops. In Scotland,
it was during the 1960s that the number of onand off-premised licences really started to increase.
The rather liberal era in Sweden gradually gave
way to a more restrictive policy and legislation
and several major alcohol information campaigns
in the late 1970s and early 1980s. The main purposes of the new alcohol policy and alcohol laws
(SFS 1977a; 1977b) was to reduce overall alcohol
consumption by reducing availability, to restrict
private profit interests from alcohol trade and to
protect young people. A few years later the WHO
target of a 25 % overall reduction in alcohol consumption was adopted (see WHO 1986; cf. SOU
1994a; 1994b). These laws were replaced by a new
alcohol law on January 1st 1995, which marks a
clear break in traditional Swedish alcohol policy:
this law opens up alcohol trade, with the exception of retailing, to private profit interests.
The UK has never adopted the WHO targets,
but the 1970s marked an important turning point
in public and official attitudes towards drinking.
The government set up several committees (see
Appendix) and by the end of the decade there
was an agenda for action against alcohol misuse
and a consensus outside the government as to
what kind of public policy changes were needed
(HEA 1994). Several of the recommended changes
were emphasized in a report by the Central Policy
Review Staff (CPRS) (the government's "think
tank") in 1979. Among other things, the report
recommended that the government pursues an
active alcohol policy, much in agreement with the
WHO guidelines (see e.g. the WHO-report by
Bruun et al. 1975), to at least prevent additional
increases in consumption. This was apparently
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too much for the government who decided not to
publish the report. According to the British Journal of Addiction (1982), one reason for the suppression of the report could have been that it was
out of consideration for the politically powerful alcohol industry.
Other public policy changes that were on the
agenda stressed the importance of effective
government co-ordination of alcohol strategies
and that there should exist definitive goals first to
halt the upward trend in alcohol consumption
and then to reduce the level of consumption
(HEA 1994). The most important government
response to this pressure was the discussion
document "Drinking Sensible" produced by all
the UK Health Departments in 1981. The document did not deny the extent of alcohol-related
problems but rejected some of the proposed suggestions, including the idea that fiscal policy
should be used as a means to regulate consumption and that controls over advertising should be
enforced by law. Further, the licensing laws
should neither be more relaxed nor become more
restrictive.
The propositions in the document (see also Appendix) still constitute the fundamental elements
in the UK's overall alcohol policy. The central
theme in "Drinking Sensible" is health education,
which is seen as the key to preventing alcohol
problems. Since then sensible drinking has been
the core concept in both Scottish and British
primary prevention, the purpose being to influence drinking practices by suggesting what is
safe or sensible drinking. The weekly limit of sensible drinking is set at 21 units for men and 14 for
women (one unit = 1 cl 100 % alcohol), and for
harmful drinking a man should consume more
than 50 units and a woman 35 units a week. (The
limits of sensible drinking will soon be put up to
28 units for men and 21 for women; DOH 1995.)
The purpose is thus not to reduce the overall demand for alcohol, but to reduce the proportion of
people drinking more than the sensible level. The
message is contained in information and education directed to the whole or parts of the population, and indirectly especially to those with drinking levels above the limit.
In Sweden, most alcohol-related issues are coordinated by, and are the responsibility of, a
single government department, Le. the Ministry
of Social Affairs. However, the Ministry of
Finance has a leading interest in the taxation of alcoholic beverages. In the UK there is no single
government responsibility. The "Drinking Sensible" document also rejected the idea of setting up
a formal mechanism for co-ordinating government policy. Today there are several government
departments responsible for different alcoholrelated issues, but this is more true for England/Wales since the Scots handle a considerable
part of all alcohol issues themselves via the Scottish Office4 • In 1987, central government set up
the inter-departmental Ministerial Group on Alcohol Misuse, including no less than 12 government departments with interests in different alcohol issues, with the specific aim of improving the
co-ordination of alcohol policy. The establishing
of this group coincided with renewed concern
about alcohol and external pressure to execute a
more active alcohol policy. However, the
Ministerial Group has reiterated the government's
belief of activities that encourage sensible drinking, especially on the local level (Lord President's
Report 1991).
The alcohol industry and alcohol advertising
A vital difference between the UK and Sweden is
the much more outstanding position of private
profit interests and the powerful alcohol industry
in the VK. Whereas private profit motives are visible in all parts of the alcohol trade in the UK, in
Sweden they were confined, until 1995, to the
beer industry and on-licensed premises. Being
the third largest producer of spirits and the sixth
largest producer of beer in the world, Britain is today one of the major centres of world alcohol
trade (McNeill 1993). The alcohol industry is an
important economic force in the UK, particularly
in Scotland. In 1993, the total value of exports of
Scotch whisky was about $ 2.1 billion, or roughly
1.8 % of the total value of all UK exports (Scotch
Whisky Association 1993; Annual Abstract of
Statistics 1994).
Through its export company Vm & Sprit AB
(demonopolized in 1995) the Swedish state has
also been increasingly engaged in international alcohol trade with the success of the spirit brand
''Absolut Vodka". In 1993 the value of Vm & Sprit
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spirits export amounted to SEK 1.11 billion, an increase of 39 % on 1992; and in 1994 to SEK 1.9 billion, an increase of 72 % on 1993 (V&S 1994; 1995).
The export of Swedish beer has also been increasing lately due to improving sales to the Baltic
States and Russia. In volume terms, however, exports are still quite modest, constituting only a
few percent of domestic beer sales (Svenska Bryggareforeningen 1994).
In Scotland the production, wholesale, import
and export are run by private companies. Retail
outlets are also in private hands and partly owned
by the drink companies. This, so-called tied
house system, is used by the drink companies to
make sure they have the outlets they need for
their own products (see Williams & Brake 1980).
Tied-houses have been more common in England/Wales where the majority of pubs are owned
or controlled by breweries. According to a survey
of 2CJ7 public house licensees in Scotland carried
out in 1984, somewhat less than 40 % of the licensees were tenants or managers of brewery-owned
pubs (Goddard 1986).
Even though the alcohol industry, particularly
the producers, permeates all parts of the alcohol
trade in the UK, it is not the only actor in the alcohol policy arena. As well as guaranteeing economic liberty to the alcohol industry, the state has
to take into consideration the matter of public
health. In recent year associations, the voluntary
sector, and the scientific community have become
important actors in the alcohol arena, putting the
state in the position of mediator between the interest groups (see Osservatorio Permanente sui
Giovani e I.:alcool 1994). The different actors are
not necessarily as powerful as the alcohol industry, most notably represented by its pan-industry
association the Portman Group, which in 1992
reported a yearly budget of $ 2 million (NAT
1992). Some of that money is spent on funding alcohol research and promoting sensible drinking.
The alcohol industry in the UK also spends considerable sums on advertising. In 1992 alcohol advertisement expenditure amounted to $ 150 million (SCA 1994). Although many authoritative
bodies would like to stop alcohol advertising, successive UK governments have so far accepted the
viewpoint of the alcohol and advertising industry
that there is not enough evidence of a link
between advertising, level of consumption and al-
cohol-related harm (e.g. Waterson 1983; 1989) and
has therefore refrained from any legislative actions. There are, however, regulations which limit
the way that the industry may promote its
products; these are voluntary codes of practice
governing different media (e.g. Tether & Robinson
1986). As regards television, the Independent
Television Association has imposed an additional
restraint of no spirits advertising (see Harrison &
Godfrey 1990).
In Sweden the advertising of strong beer, wine
and spirits has been banned in all the media (except professional journals specifically aimed at
manufacturers or distributors of alcohol, and on
premises where alcoholic beverages are being
served) since the 1978 legislation (SFS 1978). Ordinary strength beer (3.5 % alcohol by volume
/ABV/) can be advertised in moderation in the
press but not on radio or television. Since the alcohol content in light beer « 2.25 % ABV) is too
low as to be classified as an alcoholic beverage,
there are no legal restrictions on advertising.
MEANS OF PRIMARY PREVENTION
The objective of primary prevention is to prevent
alcohol problems from emerging. Actions are
usually aimed at the whole population, but they
can also be targeted to specific subgroups. The
common denominator, however, is that the target
group is the population or subpopulation at large
and not, as in secondary prevention, high consumers at risk of developing alcohol-related
problems. Primary preventive actions may be
dichotomized into those aiming to control or restrict the supply side, i.e. limiting the availability of
alcohol, and those intended to control or reduce
the demand, i.e. trying to change the individual's
attitudes and behaviour by education and information.
Limiting the availability
The post war decades have witnessed major
changes in the number and types of premises selling alcoholic beverages, with more dramatic
changes taking place in Scotland and the whole
UK than in Sweden. It has been argued that the
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increase in the number of off-licence premises in
the 1960s and 1970s in the UK is one major factor
explaining the simultaneous increase in drunkenness (e.g. Williams & Brake 1980) and most likely
in consumption.
In Sweden, all alcoholic drinks stronger than
3.5 % ABV for consumption off the premises are
sold through the Swedish Alcohol Retail Monopoly stores (i.e. state monopoly stores), though alcohol can also be ordered from the monopoly
stores at the around 540 delivery places. 5
When medium strength beer was introduced in
1965 it was sold in ordinary food shops, which at
the time it was withdrawn in 1977 meant an additional 11 550 outlets. Except this, and the eight
and a half month experiment of selling strong
beer in food shops in 1967/68, all alcohol stronger
than 3.5 % ABV for consumption off the premises
has since the 1920s been sold in the state retail
outlets. Weaker alcohol is available in ordinary
food shops. The age limit for the purchase of alcohol in the state retail outlets is 20 years. Ordinary
strength beer can be bought from the age of 18. A
further restriction is through opening hours: retail
outlets are open Mondays to Fridays from 9.30
a.m. to 6 p.m., except on Thursdays to 7 p.m.
In the whole of Britain alcohol may only be sold
through licensed outlets, either on or off the
premises. On-licence rights permit the holder to
sell alcohol for consumption both on and off the
premises, while an off-licence only applies to
sales in retail shops. In Scotland, the responsibility for administrating and granting all kinds of licences is in the hands of licensing boards. Each
board covers the equivalent area of a district council and is made up of district councillors. (Mainland Scotland is divided into 53 districts.) The
age-limit for buying any alcoholic beverage on offlicensed premises is 18 years. The most recent
licensing change took place in December 1994
when the Sunday ban for selling alcohol was
lifted.
Figure 1 shows the development of the number
of retail outlets during the post-war period. In
Scotland, the number has increased dramatically
by 146 % from 1956 to 1993. The increase in
Sweden has been negligible. For the whole period
the absolute number of retail outlets has been
much higher in Scotland than in Sweden. In 1993,
Scotland had 117 outlets per 100 000 inhabitants
Figure 7. Number of retail outlets in Scotland and Sweden
per 100000 inhabitants, 1956-1993
Sweden per 100 000 in h.
Scotland per 100000 inh.
5
~ ........
4
~~
~
2
----~
~---
---------
120
.-0-". 100
80
60
40
20
o
o
---0---
State-owned retail shops
~ Retail shops (off licence)
in Sweden per 100 000
in Scotland per 100 000
inhabitants (left axis)
inhabitants (right axis)
compared with Sweden's 4.2. However, it should
be remembered that beer with an alcohol content
equal to or lower than 3.5 % ABV is available at
about 12 500 shops in Sweden (in terms of consumption ordinary beer is in fact more popular today than strong beer) and that alcohol can be ordered at the approximately 540 delivery places.
One action at least partly responsible for the
growth in Scotland was the abolition of resale
price maintenance in 1966 (see also Appendix).
This led immediately to sharp cuts in prices and
more importantly, it encouraged supermarkets
and the like to sell alcoholic beverages and thus to
apply for off-licences (e.g. Tether 1989; Williams
1968). This was also a period of steady economic
growth: Western Europe became more affluent,
people had more money to spend and modern
supermarkets were built to meet the growing demands.
The 1960s was also a rather liberal era in general, not least in its relation to alcohol, and with a
youth culture that flourished as never before. The
increase in consumption and alcohol-related
problems during this time can therefore hardly be
explained away by reference to an increase in purchasing power or changes in the control system.
The Scottish licensing laws, for instance, did not
change until 1976. The Clayson-report (1973) stated that the growth in the number of premises
with off-sales only in a limited sense was the
result of the prevailing licensing law, but rather of
a change in demand and a greater willingness on
the part of the licensing boards to grant licences.
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This implies that the licensing boards were also
influenced by prevailing attitudes.
The combination of economic prosperity and
relaxed attitudes was probably the major cause of
the increase in the number of retail outlets in
Scotland. Scottish licensing laws have become
more liberal over the years. The latest major
changes were implemented in the 1976 Licensing
(Scotland) Act. The main changes concentrated
on opening hours for licensed premises, which
became more relaxed. Evening hours for public
houses and hotels were extended on weekdays
from 10 p.m. to 11 p.m., and public houses were
allowed to open doors on Sundays. In addition, licences were available to public houses (MondaySaturday), hotels and clubs (all days of the week)
for permanent extensions of normal hours, thereby allowing them to remain open during the afternoon break (2.30-5 p.m.) and after 11 p.m. (see
Jameson 1988).
These extensions were soon routinely granted
(Tether et al. 1990), which had an effect on availability. In 1984, 89 % of the premises in Scotland
were open throughout the afternoon at least once
a week, and around 40 % had a regular extension
after 11 p.m. (Goddard 1986). As a result of the
Law Reform (Miscellaneous Provisions) (Scotland) Act of 1990, an application is no longer
necessary for regular extension during the afternoon. From 1990, public houses can also apply for
regular extension of their normal hours on Sundays (e.g. Duffy 1992). Today you can easily be
served alcohol on all seven days of the week from
the morning to the late evening in Scotland.
However there remain some age rules. Young
people between 16-18 years of age may be served
alcoholic beverages except spirits for consumption
at a meal in a separate part of the premises. From
the age of 18 it is legal to purchase all alcoholic
beverages at the bar, including spirits.
For alcohol to be sold on the premises in
Sweden a permission (or licence) is needed. Until
the end of 1994 applications for permission to
serve alcohol were sent to the county administration who were responsible for granting such licences. The municipalities, however, had the veto
to reject an issued licence. In the new alcohol law
from 1995 (SFS 1994), the decision lies entirely
with the municipal level. At the same time the examination of the need for outlets, included in the
Figure 2. Number of on-licences in Scotland (public
houses, hotels, restricted hotels and restaurants) and
Sweden (restaurants with permission to serve alcohol) per
100000 inhabitants, 1957-1993
Per 100 000 inh.
200
180
.."...0-""
160
140
120
.-o.~
~
100
80
60
40
20
-------
o
- - Number of restaurants in
Sweden with licence per
100 000 inhabi1anls
---0--
----
T-otal of on-licences (public
houses, hotels, restricted hotels
and restaurants) in Scotland per
100 000 inhobi1anls
previous law to prevent local overestablishment of
premises, has been abolished. The age-limit for
being served alcohol on the premises in Sweden
is 18 years, which is two years lower than for buying alcohol at the retail outlets.
Sweden has also moved in a more liberal direction in terms of hours of sale, with many establishments having permission to serve alcohol later
than the stipulated closing hour of 1 a.m. (SFS
1977b), usually extended to 3 a.m. but also to 5
a.m. The closing hour was not changed in 1995,
but the opening hour was moved from 12 to 11
a.m. For about a century until the 1960s, the
primary means of control for restaurants in
Sweden was the disconnection of private profit
interests. Prices were fixed and the possibility of
profits highly limited. However, this was abandoned in 1963, which thus marks the return of
private profit motives.
Since 1963 it has become more and more
difficult for municipalities to conduct a restrictive
licensing policy. In the beginning though, it was
rather restrictive. But this appears to have
changed in the 1970s and particularly in the 1980s
when the number of on-licence premises started
to increase, despite unaltered legislation. As is
shown in Figure 2, the number increased by 150
% from 1977 to 1993, i.e. from 30 to 76 per 100 000
inhabitants, but is still well below the Scottish
figure which in 1993 was 187 per 100 000 inhabitants. 6 This dramatic increase implies that the
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 38-
municipalities have not been restrictive in their
licensee policy and that the attitudes over time
have become more liberal. Today, an on-licence is
a necessity for a restaurant business, which
makes it hard to deny one owner of a restaurant
the right to serve alcohol while permitting
another one in the same municipality (see Kiihlhorn 1993).
The boards responsible for granting licences in
Scotland have, as their counterpart in Sweden
had until 1995, the right to assess the need for
outlets in their locality. They could therefore play
an important role in a community's prevention
strategies. However, the prevention potential of
licensing remains more or less unfulfilled. One
reason for this is that the concept of need, that
could form the basis for a decision by the boards
to grant or withhold licences, is not very well clarified. It can mean anything from the total number
of outlets per inhabitant, the quality, or the range
of different types of outlets etc.
In addition, all licensing decisions must be
made judicially, which means that there is in fact
very little room for decisions resting on vague
judgements of the "need" for a licence in the locality. Each particular case should be judged on its
own merits, not in reference to an overall view
that the area already has enough outlets (see
Tether & Robinson 1986; Tether et al. 1989). Many
licensing boards have therefore given up the
struggle to restrict the number of outlets and are
routinely granting licences. Decisions about
"need" are subsequently left to the market forces
(Tether & Robinson 1986; Tether 1989).
Price policy
Before we take a closer look at prices, it should be
pointed out that alcohol still accounts for a substantial proportion of government revenue in both
Britain and Sweden; over the past few years the
figure has been aroung 5 % of total revenue in
both countries (The Brewers' Society 1993; Socialstyrelsen 1994; SCB 1992).
Several studies have shown that alcohol, as
almost all commodities, is sensitive to price (e.g.
Olsson 1991; bsterberg 1992; Edwards et al. 1994).
Control of the price level may therefore be an important measure in limiting the demand for (or
availability of) alcohol. The alcohol policy in
Sweden, as expressed in most of the government's alcohol reports, recognizes and stresses
the importance of an active price policy as one
part of a generally restrictive control policy (e.g.
Prop. 1991).
The UK government has recently recognized
that taxation of alcohol has a bearing on the level
of consumption and harm (DOH 1992). However,
the policy advocated in the "Drinking Sensible"
report still predominates: "Government cannot
accept recommendations that have been made for
the systematic use of tax as a means of regulating
consumption" (p. 58-59). The most important
criterion for determining alcohol taxation is the
need to raise revenue (e.g. Harrison & Tether
1990; Leedham & Godfrey 1990).
Whatever the reasons for the taxation of alcohol, more important from a preventive point of
view is the actual taxation and price level. According to the estimates of Ramstedt and Trolldal
(1995) comprising all current EU countries, 7
Sweden had in 1990 the second highest price level
when not corrected and the third highest when
corrected for the purchasing power in each country. Only the Irish and the Finns found it more expensive than the Swedes to buy alcohol in their
own country. The UK also has comparatively high
prices. For both the corrected and non-corrected
prices the UK is ranked number five from the top,
with a higher price level than all the Mediterranean and central European countries, for instance.
Most studies of prices and consumption have
estimated the effect of changes in prices on the
sales figures by means of econometric methods.
The results have generally shown that when the
price in real terms rises, consumption falls, and
vice versa (for Sweden, see Assarsson 1991; Huitfeldt & Jorner 1972; Ramstedt 1993; for the UK,
see Godfrey 1990).
The real prices of different alcoholic beverages
together with the trends in consumption for these
beverages are shown in Figures 3 (UK) and 4
(Sweden) (next page). The Swedish real prices
have been calculated from the prices at the state
owned retail shops. Alcohol served in restaurants
is not considered. The UK figures include both off
and on sales of alcohol. Whereas the UK figures
for all three alcoholic beverages appear to be more
or less consistent with earlier evidence of alcohol
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 39-
Figure 3. Trends in real prices (off and on sales) and consumption of beer, spirits and wine in the UK, 1978-1993
Index 1980= 100
180,------------------------------------
Figure 4. Trends in real prices (off sales) and of consumption of beer, spirits and wine in Sweden, 1978-1993
Index 1980 = 100
140,--------------------------------------130+-----------------------~~--~------
160+-------------------------------~~-
140+-----------------~~--------------~
120+-------------------~~__~~~~~~~_
110*-~----~~;t:';~~----~
-"''0
90+7~--~~=_----------------------------
__ ~..o_-···o--····o
l00~~~~--~-4F_---~--~~-~---~~=---=---~=-~---~-~=---=--o~-=----~---~=+_~~------
~---------~
80+-----------~",----------------------­
...... .....
-.~ ~..........
70+---------------------~c_-------------.~---~
80~--------------------------------~-
•...
-~~.
-,
60+-----------------------------~=-~---........
-"'- ........
50+_-r~--r_~_+--r_+__r~--+__r~--r_~~
10
-.0
...... co 0co co co co co co co ~
~
000000-
""
------+-----
Spirits prices
Spirits consumption
----0--
Beer prices
-------<>------
- - Beer consumption
- . - Wine prices
- ; 1 ( - Wine consumption
as a price sensitive commodity, the Swedish data
appear not so. The price of beer in Sweden increased by 14 % from 1980 to 1993, showing the
same upward trend as in the UK. But in contrast
to the UK the consumption of beer also increased,
by 12 % from 1980 to 1993.
The prices of spirits have been rather stable during the last 15 years, yet the consumption has
halved. Wine prices showed a small real increase
up until 1990, but have thereafter decreased to a
level slightly below the 1980 figures. Wine consumption has increased more or less steadily and
was in 1993 almost 20 % higher than in 1980. The
comparison thus implies that despite large national differences in official policy on alcohol taxation, and differences in the absolute price level,
the actual employment of taxation, as expressed
in real prices over the last 15 years, are quite similar in the UK and Sweden.
Control of demand
Both Scotland and Sweden have conducted national and local primary preventive actions and
.....
------0------ Spirits prices
------+------ Spirits consumption
~ Beer prices
~
~
~
0:
~
--+- Beer consumption
- x - Wine prices
- x - Wine consumption
campaigns. Although some of that prevention is
directed to the whole population, much of it is
aimed at specific segments of the population.
Drivers of motor vehicles and the youth are two
common target subgroups. The message to such
subgroups often differs from prevention targeted
to the whole population.
Prevention today seldom advocates total or
nearly total abstinence, but when it does it is
usually in association with certain subgroups.
The message advocated in drink-drive campaigns
in both countries is total abstinence in connection
with driving. In Sweden, the message to young
people and to pregnant women is also to abstain
from alcohol completely. For the youth the aim is
an alcohol-free upbringing and thus to postpone
the alcohol debut into late adolescence or early
adulthood. The guidelines for young people's
drinking in Scotland is to promote sensible or
responsible levels of alcohol consumption, and
the recommendation to pregnant women is to
drop alcohol completely or to limit oneself to a
maximum of one or two units a week (HEBS
1989).
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 40-
""g:
Swedish campaigns, but as in Scotland it is
difficult to answer the most fundamental question
as to whether the campaigns have changed the
behaviour of the target groups in the expected
direction. 11 Despite the ongoing liberalization of
Swedish alcohol policy, there has as yet been no
increase in the amount of money spent on nationally organized campaigns.
Additional alcohol information is conducted by,
for instance, the Swedish Alcohol Retail Monopoly, which spends roughly SEK 20 million ($ 1.7
million) on information about the potential risks
associated with alcohol (Systembolaget 1995).
Their information effort is also largely focused on
young people and alcohol, e.g. reminding people
about the 20-year age-limit and deterring bootlegging to young people.
The retail monopoly has also been campaigning
in favour of weaker rather than stronger alcoholic
beverages and encouraging more moderate drinking habits. On several occasIons it has distributed
brochures informing customers about the potential risks associated with alcohol. For men the
"safe" limit is set at a maximum of 30 cl pure alcohol per week, for women at 20 cl. Here the message is thus not to stop drinking altogether, but as
in Scotland, to drink sensibly. But contrary to
Scotland, the national alcohol policy in Sweden is
not built upon this sensible drinking concept.
From this brief overview of prima..-nj preventive
campaigns, a few things emerge quite clearly.
First, Sweden not only conducts an active control
policy on restricting availability but also invests in
primary prevention on the demand side. Even
though information campaigns may play a more
important role in Scotland than in Sweden relatively speaking, this does not mean that the
amount of resources spent are less in Sweden. In
fact the opposite is true. Second, as exemplified
by the "Drink with your head" campaign, the
message of these campaigns in Sweden is becoming quite similar to the Scottish sensible drinking
message.
National preventive campaigns
One effort to implement sensible drinking among
the public in Scotland is through the nation-wide
"drinkwise" campaigns that have been running
since the mid-1980s B• The basic aim of the campaigns is to increase public awareness of the need
to adopt sensible drinking. The yearly budget, including the work done locally by the local Councils that are affiliated with one of the central organizers of the campaigns, the Scottish Council of
Alcohol,9 has been estimated at $ 45,000. There
has been no real evaluation of the effectiveness of
the campaigns in Scotland, and those that have
been made in England and Wales are too limited
in extent to assess whether the campaigns have
had any significant effect in reducing the number
of non-sensible drinkers. iD
Besides the "drinkwise" campaigns there are
few, if any, examples of national campaigns aimed
at the whole adult population. The remaining nation-wide alcohol information campaigns usually
concern specific subgroups and particularly
drivers of motor vehicles.
The national agency for health education in
Scotland, the Health Education Board of Scotland, is responsible for alcohol health education
and has alcohol as one of their first-order priorities. In 1994-95, they had a total budget for alcohol
education of $ 450,000 (HEBS 1995).
Swedish alcohol policy is known chiefly for its
control measures on availability. However, alcohol
education and information also form one part of
overall alcohol policy. During the last 15 years
several nation-wide campaigns have been conducted. Worth mentioning are two major campaigns that were aimed specifically at young people in the early 1980s, at a time when Swedish alcohol policy in general became more restrictive.
The latest campaign - launched in May 1995
and conducted by the National Institute of Public
Health (Folkhalsoinstitutet, FBI) that since 1993
has been responsible for alcohol and drug information - was called "Drink with your head". This
was the first national campaign where the target
group was the adult consumers and not young
people. The message was to drink sensibly, not to
abstain. This is probably the shape of future campaigns to come.
Evaluations have been conducted of most
Local alcohol prevention
A likely outcome of weakened national control
measures in Sweden is that questions of responsibility will become decentralized and transferred
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
-
41 -
to local levels. Hints of this are already evident. In
its main report, the Alcohol Commission suggests
that local alcohol preventive actions should be
strengthened and given more resources (SOU
1994a). The National Institute of Public Health
has also received an additional SEK 50 million for
budget year 1994/95, mostly to be spent on local
alcohol and drug preventive projects. This increase in resources to support locally based
prevention will continue, at least until the end of
1996 (FHI 1995). In Scotland, alcohol prevention is
already largely conducted locally.
It should be remembered that local alcohol activities are by no means a new phenomenon
either in Scotland or in Sweden. Much of the
work by the temperance movement was carried
out locally. Moreover, education and information
to young people are to a large extent locally based.
One example is alcohol education carried out in
schools, which is included in the school curriculum in both countries. Special curricula have been
developed in Scotland for different age groups,
but decisions on the intensity of alcohol education will be made by each individual school.
Sweden is moving in the same direction. The
latest 1994 school curriculum includes less
detailed guidance than the previous ones, but
stresses decentralization of power and responsibility from the state to municipalities and schools.
Consequently, the decision on how to organize alcohol education, as part of ANT-education (Alcohol, Narcotics and Tobacco), rests increasingly on
each community and school.
Studies conducted by the Alcohol Commission
showed that the schools' ANT-education is given
only vague guidelines in the municipalities'
school plans and treated differently in different
schools. Most typically alcohol and drug issues
are acknowledged in the schools' working plans
but described at a relatively diffuse and general
level (SOU 1994c).
It is hard to specify any other primary prevention targeted to young people. Some of the local
prevention work is carried out by local authorities
like the social services, primary care and even the
police. However, it is impossible to estimate how
far these actions are primary prevention.
One form of local preventive work which has
become increasingly popular in recent years is
community action. (Other names used are com-
munity intervention and community organization.) Such preventive work takes place mainly
through comprehensive local programmes,
worked out together with local authorities and
the local population, to influence people's drinking habits or attitudes towards drinking in that
particular community.
Two community action projects in Sweden are
FIA (Prevention Against Alcohol on Kungsholmen) and the Kirseberg project. 12 Both have the
aim of reducing overall alcohol consumption (in
Kirseberg by 25 % by the year 2000) and alcoholrelated problems (Hansson & Larsson 1990i
Romelsjo et al. 1992). Both also have as their target
group the whole population in their respective
area, with the general message to the adult population that they should try to drink moderately or
senSibly. Since the Kirseberg project will continue
until the end of the 1990s, no final evaluation is
available on the effects on consumption. An
evaluation of the period 1990-1994 showed minor
non-significant changes in alcohol consumption
(Kirseberg 1995). An evaluation is in progress on
the FIA project (Romelsjo 1995).
In a recent study of local alcohol prevention
based on a sample of communities in Sweden, it
was shown that the quality and quantity of locally
conducted alcohol prevention were dependent on
local enthusiasts (Bjor et al. 1995). It is likely that
with the continuing decentralization of alcohol
prevention, the dependence on these real enthusiasts will increase even further. This, in turn,
will probably lead to even bigger differences between municipalities in their involvement in alcohol prevention.
Even though most prevention in Scotland is
conducted locally, I have not come across any
"typical" community action programmes. In line
with the general trends in the Scottish and the
UK societies during the last decades, activities
have been stepped up in the voluntary sector.
Among the fastest growing centres of activities
are the local Councils on alcohol, that are spread
out all over Scotland. The work conducted by the
local Councils is dominated by counselling to individuals experiencing alcohol problems.
However, primary preventive work is also carried out through "drinkwise" campaigns, which
(although organized nationally) are largely carried
out locally by the local Councils. In this respect
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 42-
I
the "drinkwise" campaigns are, as many campaigns in Sweden, examples of projects co-ordinated nationally but with much of the work conducted locally.
Drinking and driving
Drinking and driving prevention is an interesting
case from an alcohol policy point of view because
it may shed further light on the likelihood of influencing alcohol-related behaviour without
primarily aiming at reducing overall consumption
in society. During the past decades both Scotland/Great Britain (GB)13 and Sweden have increased their preventive measures on drinking
and driving. However, whereas the former have
mainly confined their actions to information and
increased breath testing, the latter has on several
occasions also adopted more restrictive legislation.
The first and still valid legal blood alcohol concentration (BAC) in drivers in GB is 80 mg/l00 ml,
which was introduced in the Road Traffic Act of
1967. At the same time the police were also given
powers to stop and test drivers suspected of having alcohol in the body, who had committed a
moving traffic offence or who had been involved
in an accident (called random stopping or targeted testing).
Random breath testing at roadside checkpoints,
regardless of any evidence of drinking, have over
the years met with fierce opposition from the
motorists' organizations and other quarters, and
are still not legal (see Tether & Godfrey 1990;
Dunbar 1992). The British government has regarded random stopping as an effective measure
against the drunken driver. However, this method
has also been subjected to criticism, one being
that it fails to detect heavy drinkers, another that
it, in contrast to highly visible random breath
tests, does not lead to any perception among
drivers of a high possibility of being tested and
therefore fails to work as a general deterrent
measure (see Peacock 1992).
In Sweden legal blood alcohol limits were first
introduced in 1941. From 1957 until 1990, it was
considered as a criminal act if the driver had a
BAC above 50 mg/l00 ml. If BAC exceeded 150
mg/l00 ml, the act was considered more serious
and on conviction the perpetuator was usually
sentenced to a couple of months' imprisonment.
The lower limit was reduced even further in 1990
to 20 mg/l00 ml. The police have been able to stop
drivers for random breath testing since 1976 and
amendments in legislation in 1994 also gave the
police unfettered discretion to request breath
tests. Also in 1994, the higher limit was reduced
to 100 mg/l00 ml.
The legal blood alcohol level is thus higher in
GB than Sweden, but the message in the preventive campaigns is the same: don't mix drinking
and driving. Even here there is more emphasis on
information campaigns in GB and Scotland than
in Sweden. This is thus one area where both
countries advocate total abstinence.
During the last two decades there have been
several anti-drink drive campaigns in GB. From
1987, the campaigns have been run twice a year,
one during the summer and the other during
Christmas and New Year. The campaigns consist
of information about the dangers of drinking and
driving and are spread via the media, especially
television. In 1993, $ 2.3 million was spent on the
summer and Christmas campaigns (DOT 1994).
The campaigns are developed with the support of
many other bodies, some of which have their own
campaigns that normally are tied in with the national campaigns. The police, for instance, have
their annual breath test campaigns at the same
time as the national summer and Christmas campaigns. Scotland also has its own "Scottish Road
Safety Campaign" at approximately the same time
as the GB campaigns. They have been running
annually from 1985 and from 1986 backed up with
increased police enforcement. The Christmas
campaigns usually run from late November to
early January, and the summer campaigns in JulyAugust. Besides using the media (television,
films, leaflets, etc.) and intensified police enforcement, the campaigns also involve private companies that help in spreading the message.
ALCOHOL CONSUMPTION AND
ALCOHOL-RELATED PROBLEMS
An assessment of the success of different prevention policies should include a look at the targets of
prevention, namely alcohol consumption and al-
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 43-
Figure 5. Per capita alcohol consumption in Sweden and
UK per inhabitant aged 15 and over, 1960-1993
terms of the development of different alcoholrelated problems over the last 15-20 years.
Litres 100 % alcohol
10
9
7
6
;r
A~
D
Alcohol consumption
~
~~
~
~
........,
~/
5
4
3
2
o
~
~
Sweden
--a---
United Kingdom
cohol-related problems. There is ample evidence
from the research literature that alcohol education
and information in general have a very modest
impact on alcohol-related behaviour, although it
may raise knowledge leVels about alcohol and
perhaps affect attitudes (see e.g. Moskowitz 1989;
Bagnall1992; Edwards et al. 1994). This evidence,
however, originates mostly from evaluations of
programmes limited both in time and scope.
The drinking sensibly message, with the goal of
changing problem drinking to socially drinking,
has been around for 15 years. The first national
"drinkwise" campaign was held 10 years ago. It is
possible that this may have had a gradual impact
on the Scots' attitudes and behaviour in a longer
time perspective. If this is the case, it should be
visible in the development of alcohol-related indicators.
Several reviews on the effectiveness of a policy
aiming at restricting the availability have come to
the same conclusion, i.e. that restrictions on availability lower per capita consumption, and as a
consequence also the extent of alcohol-related
problems (e.g. Bruun et al. 1975; Edwards et al.
1994). However, according to Room (1991) the evidence on the effectiveness of restrictive measures
is mostly based on evaluations of relatively shortterm effects; the long-run effects may be weaker
or even reversed from the short-term effects.
This study does not aim to evaluate the shortterm effect of single restrictive measures, information programmes, or the effects of relaxing the
control system. 14 The main issue is the effectiveness of two different preventive strategies in
There are no separate details on overall consumption in Scotland after the Second World War, but
there are data available for the whole of UK.
Figure 5 shows the overall registered consumption
in Sweden and the UK from 1960 to 1993. Consumption increased in both countries until the
mid- or late 1970s. After 1976, when consumption
in Sweden peaked at 7.3 litres, the figures
dropped by 22 % until 1984; since then there has
been less fluctuation. In the UK consumption
peaked in 1979 at 9.8 litres, then declined for 3
years in a row and has for the last 10 years been
on a rather stable level, varying between 9 and 9.5
litres absolute alcohol.
The officially registered consumption level
should not be confused with true consumption
since the former does not include privately
produced and privately imported alcohol or alcohol consumed abroad, but it does include what is
bought in the country by foreign visitors. In
Sweden, a recent preliminary estimation based
on two representative surveys from 1993 suggests
that approximately one third should be added to
registered consumption in order to reach the
"true" figure, i.e. from the sales figures of 6.3 litres
to about 8.4 litres pure alcohol per capita for individuals 15 years or older (Kiihlhom 1994).
The question is therefore if and how real consumption differs between Scotland (not merely
the UK) and Sweden. To answer that question,
we turn our attention now to survey data. One advantage of surveys is that one asks about drinking
irrespective of the source of production and purchase of the beverages consumed. In addition,
with the help of survey data the population can be
broken down into smaller subgroups which permits a comparison between Sweden and Scotland, as well as GB. For Sweden primary data
have been used, for GB/Scotland only data published in the General Household Survey Reports
(e.g. OPCS 1992).
Survey estimates of consumption in the general
population, almost without exception, suffer from
both underreporting and selective non-response,
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 44-
Table la. Distribution of consumption for Scottish and Swedish men 1986/1987, 1988, 1990 and 1992, %
Normal/usual week consumption
(cl 100 ale. by volume)
0
<1
1-10
11-21
22-35
36-50
51+
Total
n
Scotland
Sweden
1986
1988
1990
1992
7
10
37
22
13
4
7
1007
93
9
10
36
22
13
6
4
1008
00
8
9
35
25
14
6
4
1007
01
7
9
36
22
12
7
7
1007
18
1987
23 1
1
34
24
12
4
3
1015
75
1988
23 1
1
30
31
7
5
3
1005
60
1990
23 1
1
35
24
10
4
3
1005
63
1992 1994
10
9
5
8
40
41
30
25
10
8
4
5
1
3
1005 9947
28
1
Sources: Scotland: The General Household Surveys from 1986, 1988, 1990 and 1992. Sweden: SIFO from 1987 to 1990. TEMO 1992,
1994.
1 In 1987,43 % of them were abstainers (last 12 months), i.e. 10 % of all males, the rest probably consumers, who do not drink during
a normal week. In 1988, the corresponding figure was 37 %, i.e. 8 % of all males, and in 1990,32 % and 7 %, respectively.
Table lb. Distribution of consumption for Scottish and Swedish women 1986/87, 1988, 1990 and 1992, %
Normal/usual week consumption
(cl 100 ale. by volume)
0
<1
1-7
8-14
15-25
26-35
36+
Total
n
Scotland
Sweden
1986
1988
1990
1992
14
23
43
13
5
18
24
39
12
5
14
23
40
16
5
2
1
100
943
1
100
958
16
25
39
14
5
1
0
100
884
101
884
1987
371
2
38
16
5
1
101
548
1988
35 1
2
40
14
6
2
1
100
542
1990
36 1
4
40
13
5
1
100
548
1992 1994
13
15
38
23
8
2
17
21
42
13
6
100
523
101
462
Sources: Scotland: The General Household Surveys from 1986, 1988, 1990 and 1992 (e.g. opes, 1992). Sweden: SIFO
from 1987 to 1990. TEMO 1992, 1994.
11n 1987,45 % of them were abstainers (last 12 months), i.e. 17 % of all females, the rest probably consumers, who do not drink during
a normal week. In 1988, the corresponding figure was 33 %, i.e. 11 % of all females, in 1990, 33 % and 12 %, respectively.
both lowering the number of heavy drinkers. The
degree of underreporting has also been shown to
depend on the measurement technique used.
The technique used in the Swedish surveys (the
period-specified-week approach) has been shown
to produce higher consumption estimates than
the Quantity-Frequency scale used in the Scottish
surveys (see Kiihlhorn & Leifman 1993). The
coverage rate15 for the Swedish surveys varies between 70-80 % (Kiihlhorn & Leifman 1993). The
1992 General Household Survey showed a coverage rate of about 58 % (apeS 1992). Any crosscomparison should therefore be cautiously inter-
preted. However, the trend for each country may
provide clues of the development in the last years.
Tables 1a-b show the distribution of alcohol consumption for men and women separately, in Scotland for 1986-92 and in Sweden for 1986-94. Table
2 (next page) shows the estimated mean consumption for both genders. Three conclusions can
be drawn from these tables. Firstly, the number of
high consumers appears to have been rather stable during the periods concerned for both countries. Over a longer time period, though, consumption among women has increased both in
absolute and relative terms, whereas consump-
Nordisk Alkoho/tidskrift Vol. 12, 1995: English Supplement
- 45-
Table 2. Estimated mean consumption for men and women in Scotland (1992) and Sweden (1992-1994), in litres
100 % alcohol per year
Scotland
Sweden
Women
Men
(n = 718)
Women
(n = 884)
Men
(n = 1462)
(n = 1464)
8.8
2.4
6.7
3.1
Sources: Scotland: The General Household Surveys from
1992 (OpeS 1992). Sweden: TEMO 1992, 1993, 1994
summed to one bigger sample.
tion among men has declined or been rather stable (Kiihlhorn 1995; Plant 1985; Goddard 1986).
Secondly, despite problems of comparison between surveys using different measurement techniques, the mean consumption and proportion of
male high consumers is lower in Sweden than in
Scotland. According to the surveys, nearly a
quarter of the Scottish men drink more than sensibly, compared to 15-19 % among Swedish men.
For women, it is more difficult to say. The higher
mean consumption and high consumers for
Swedish women could be explained by the higher
coverage rate in the Swedish survey.
Thirdly, prevention by drinking sensibly has so
far failed in its most important task, namely to
reduce the proportion of Scots drinking non-sensibly. In addition, what is not shown in the tables
is that the proportion of heavy consumers is a few
per cent lower in Scotland than in GB, for both
genders.
Drinking paHerns
It is beyond the scope of this study to give any
more than a brief picture of drinking patterns inthe two countries. Both Scotland and Sweden are
commonly regarded as spirits drinking countries,
but consumer preferences have changed over the
past few decades.
According to the UK sales trend, the proportion
of beer in relation to total consumption has
decreased from about 70 % in the early 1970s to
about 55 % in 1993. During the same period, the
proportion of spirits has been rather stable, accounting for about 20 % of total consumption
(which is probably somewhat lower than in Scotland), whereas wine has doubled its share and accounts in 1993 for 20 % of consumption. Survey
studies for Scotland suggest that the Scots nowadays are predominantly beer drinkers (e.g. Goddard 1986; Crawford et al. 1985). In a 1984 Scottish survey, beer constituted 62 % of all the reported consumption, spirits 27 % and wine 23 %
(Goddard 1986).
The wine trend in Sweden is the same as for the
UK. Wine has increased its share from about 15 %
in 1970 to 30 % in 1994. Contrary to the UK, spirits
consumption has decreased substantially, both in
absolute and in relative terms, from around 50 %
in the 1970s to only 27 % in 1994. The trend for
beer consumption is also different from the UK.
The proportion of beer has increased and is in the
1990s the single largest beverage type in Sweden.
In 1994, beer (3.5 % ABV or more) accounted for
44 % of total consumption (FHI & CAN 1995).
Another dimension of drinking styles is the distribution of public and private drinking. It is only
during the last 15 years that the number of
restaurants in Sweden with licences to sell alcohol
has really started to increase and a pub culture
has begun to take shape. In connection with this,
a larger proportion of all alcohol, predominantly
beer, is also consumed at restaurants; from 7 % in
1980 to 15 % in 1993 (Socialstyrelsen 1985; 1994).
In Scotland, a much higher proportion of all
drinking takes place on premises (e.g. Dight 1976;
Goddard 1986).
A striking feature in Scotland has been the
separation of male and female drinking. The main
drinking setting for Scottish men has long been
the public house and the licensed club. Scottish
women, who were long virtually excluded from
drinking (at least public drinking) by social custom, drink mostly in private settings (own or
someone else's home) (Goddard 1986). During
the last decades, however, at the same time as the
relative importance of public drinking has
decreased (as has been the case in other countries
where the proportion of public drinking has been
high IMakeUi et al. 1981/), these gender differences have become less pronounced (e.g. Goddard 1986).
This shift towards more private drinking coincides with general changes in shopping habits
(with an increase in off-sales), a more home-
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 46-
Figure 60. Mortality of liver cirrhosis in Scotland and
. Sweden, women only 1946-1993, per 100000 inhabitants,
underlying cause only
Figure 6b. Mortality of liver cirrhosis in Scotland and
Sweden, men only 1946-1992(93), per 100 000 inhabitants, underlying cause only
Deaths per 100 000 inh.
peaths per 100 000 inh.
8,--------------------------------c~
18,-------------------------~---------
7~--------------------~--~~~~--
6r---------------------r-~~--~---5r---------~----~~~~~_+~--~r_
4r-~--~~~~~~~------~--~~~
16r---------------------~--~--------14r-----------------~~~--~---------
12r------------------,~------~----~~
10r---------------~~----_,~~~~~~
8r---------~~~~----~~----~~~~
3~.~~nc~---------------------------
2~----------------------------------
6r------7~~~~c?~~--------------­
.4~~~~~~---L--~~---------------
2r-------------------------------~--O~~rH~~~~+MH+~H+rH++~~~~~~
~
~
Swedish wamen
-<>--
Scattish wamen
~
~
centred leisure life-style, but perhaps most important, with the increase in, and the more liberal
and relaxed attitudes towards, women's drinking
(Goddard 1986).
Drinking among young people
One important question concerns the development over time of drinking habits among young
people. It cannot be taken for granted that the
consumption of young people follows the same
trend as overall consumption.
In Sweden, the alcohol data for young people
do in fact show some resemblance with the overall trend in the population. When overall alcohol
and
several
alcohol-related
consumption
problems peaked in Sweden in the late 1970s, the
extent of alcohol misuse was also high among
youth. From the late 1970s until the mid-1980s, the
situation improved, as it did in Swedish society in
general. This improvement thus occurred during
a period when several steps were taken to combat
alcohol problems, including the abolition of medium strength beer which was the typical youth
beverage of that period. In fact, it has been shown
that the decline in various alcohol-related indicators has been greater among young people than
adults (Romelsj6 1987a).
Thus, the more restrictive climate of that time
not only affected adult drinking but the drinking
of the young people as well. Except the data for
~
Swedish men
~
-<>--
~
Scattish men
1994 which show a rather dramatic increase in
consumption among young people, the period
from the late 1970s onward has been fairly stable,
which is also in line with the overall development
(see FIll & CAN 1995).
Compared to Sweden, the more sporadic youth
surveys in Scotland give a more limited basis for
monitoring recent trends (see Plant & Plant 1992).
However, the results from the few youth surveys
conducted in the whole of Britain and only Scotland indicate, as in Sweden, that the trends of
drinking in young people follow the overall development (see Plant & Foster 1991; Plant & Plant
1992; Duffy 1991; Plant et al. 1985; Marsh et al.
1986). Hence, it is possible that the proportion of
non-sensible drinkers among both adults and
young people has remained rather stable.
Liver cirrhosis mortality
The death rates from liver cirrhosis are often used
as an index of the magnitude of overall consumption and alcohol problems. Figures 6a-b display
the development of liver cirrhosis mortality,
separately for men and women. In both countries
the mortality rate increased more or less steadily
for both genders from the early 1950s to the late
1970s or early 1980s. The Swedish mortality rates
for both genders were almost halved during the
first years in the 1980s, and have since then
levelled off at a much lower level.
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 47-
Figure 7a. Mortality of alcoholism/alcohol dependence in
Scotland and Sweden, women only 1956-1993, per
100000 inhabitants, underlying cause only
Figure 7b. Mortality of alcoholism/alcohol dependence in
Scotland and Sweden, men only 1956-1993, per 100000
inhabitants, underlying cause only
Deaths per 100000 inh.
Deaths per 100000 inh.
2,5
12,------------------------------------
2r-----------------~--~-----*------
10+-----------------------~~~~----8+---------------------~--~--4_~~-
1,5 r------------------+-------Art---uC"""T....J--c-l------A-6+-------------------~~----------~~
4r-----------7L~+_~--~~--~-------
0,5 +-----------,.-+--P'II-o-<bd-----------------
~
Scattish women
-<>-
2~------_7~-,._+_-------------------
~
Swedish women
For men the decline has actually continued but
at a much slower pace. In Scotland, the trend was
first halted or (for women) slightly declining, but
never showed any significant drop. Since the
break of the upward trend the death rate for men
has been rather stable, although the last few years
have shown a slight increase. For women, the
trend was only temporarily halted and, consequently, from the mid-1980s once again resumed
its upward trend.
The sensitivity of liver cirrhosis and other diagnoses is linked to the procedure of classification of
causes of death. In Sweden the classification system ICD-9 (International Oassification of Diseases) was introduced in 1987, in Scotland in 1979.
The mortality figures following 1987 and 1979,
respectively, are therefore not fully comparable to
previous years. However, this does not appear to
have had any significant effect in the cirrhosis
mortality statistics. At least there is no visible
break in the trend in 1987 (Sweden) and 1979
(Scotland).
The trend for liver cirrhosis deaths in Scotland
thus implies that the drinking sensibly campaigns
over the last decade have not been sufficiently effective either to reduce the number of non-sensible drinkers or to break the upward trend of liver
cirrhosis mortality, especially in the case of women. Since cirrhosis of the liver is one of the more
serious consequences of heavy or abusive drinking, the overall increase in the cirrhosis death rate
may actually suggest that the proportion drinking
Scottish men
-<>-
Swedish men
more than sensibly has increased.
The drop in liver cirrhosis mortality in Sweden
can be explained, first and foremost, by the 22 %
reduction in per capita alcohol consumption
between 1976-84 (Romelsjo 1987b), in itself partly
attributable to the removal of medium beer from
food shops in 1977 (Noval & Nilsson 1984) and
perhaps to the generally more restrictive policy
adopted in the late 1970s.
However, liver cirrhosis deaths have declined
not only in Sweden. Many Western countries, but
not Scotland, have shown a similar trend in the
late 1970s and 1980s. One other factor that could
account for some of the drop in cirrhosis deaths
in Sweden and elsewhere is increased or changed
alcoholism treatment (Romelsjo 1987b; Smart &
Mann 1991; Holder & Parker 1992).
Alcoholism mortality
The rate of alcoholism (or "alcohol dependence"
in ICD-9) is probably not as good an indicator of
the extent of alcohol-related problems and overall
consumption in a society as liver cirrhosis, because different countries have different practices
in recording alcoholism as a diagnosis at death
certification. However, it may still be a valid indicator of the development of alcoholism and the
degree of alcohol problems in society. Figures 7a-b
show that the alcoholism mortality rate increased
in both countries for both genders from 1965 until
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 48-
,
Figure 80. Number of conducted breath tests during the
Christmas campaigns in Scotland and the number found
above the legal limit (80mg1l00ml) per 100000 inhabitants
Figure 8b. Number of conducted breath tests in Sweden
and number of reported drinking and driving offences per
100 000 inhabitants
Breath tests per 100000 inh.
Breath tests per 100 000 inh.
Number above legal limit per 100000 inh.
1200
1000
800
....-.0.--..
~~
600
400
200
~
~
/
........., ~
20000
20
15000
Num""r of breath tests
..........-
~
10000
~
~
~
~O
200
150
100
50
o
1~
1~
~
Number found above legal limit
the late 1970s (Scotland) or 1980 (Sweden), which
thus coincided fairly well with the development
of liver cirrhosis mortality.
A substantial part of the drop in Scotland from
1978 to 1980 may be attributed to the introduction
of ICD-9 in 1979. This seems even more likely in
view of the fact that the rate since 1980 has been
rather stable, with only a minor and gradual
decrease for both men and women. The dramatic
drop in Sweden from 1986 to 1987 may also be
due to the changes in classification. The trend
since then looks about the same as before 1987.
The most likely interpretation of the data is that
there have been no real changes in either the
Swedish or the Scottish alcoholism mortality rate
since 1980. For Scotland this rather stable level
during the last 15 years corresponds with the development of alcohol consumption. For men it
also accords rather well with the trend of liver
cirrhosis deaths. For women, though, deaths
from liver cirrhosis have increased, whereas the
level of alcoholism deaths has been stable.
In Sweden the rate of alcoholism mortality since
the late 1970s does not coincide with either the
trend of liver cirrhosis that dropped substantially
or the consumption that declined by 22 % from
1976 to 1984. One possible explanation is that alcoholism is a more severe diagnosis arid therefore
more difficult to prevent by primary preventive
measures than liver cirrhosis. However, if the incidence of high consumers and alcohol abusers is
~
5000
5
~
300
15
o
0
1986:87 1987:88 1988:89 1989:90 1990:91 1991:92 1992:93 1993:94 1994:95
-0-
350
10
~
Reported offences per 100 000 inh.
25000
30
1&
lm
1~
Number of breath tests
lm
lm lm
~
lm lm
0
1~
Number of reported offences
reduced for many years in a row, this should
sooner or later also appear in a decline in alcoholism deaths.
The much higher alcoholism mortality rate for
Swedish than Scottish men during the last 15
years should be interpreted with caution. The
sharp increase for Swedish men started in 1975
and continued until 1982, which coincides with a
simultaneous drop in the per capita consumption
by 16 %. It is thus unlikely that the time-series
mirror true differences in the prevalence of alcohol problems or alcoholism in the two countries.
Men in Scotland have, for instance, both a higher
death rate of liver cirrhosis and a higher percentage of high consumers than Swedish men.
Differences in the procedure of classification between the countries may be one explanation.'
Drinking and driving
Drinking and driving is a type of offence where
the number of offences depends on the level of
police activity. When the resources available increase, the number of reported offences normally
increases, too. Figures 8a-b show the number of
breath tests and drivers found alcohol positive
during the Christmas campaigns in Scotland (the
total number of breath tests is not known) and the
total number of breath tests and the reported
number of drinking and driving offences in
Sweden.
Nordis!< Alkoholtidskrift Vol. 12, 1995: English Supplement
- 49-
Table 3. Number of fatal road accidents in GB and Sweden where one driver or rider was positive and the number and
proportion above the 80 mg/lOO ml BAC of all drivers and riders killed whose blood alcohol level was known
Year
1984
1989
1990
1991
1992
1993
Total number of fatal casualties in road accidents
GB
5599
5373
5217
4568
4229
3814
Percentage of drivers or riders
killed in road accidents with a
BAC above 80 mg/lOO ml of
all drivers and riders killed
with a known BAC
Sweden
801
904
772
745
759
632
GB
26
19
18
19
20
18
Sweden
25
25
19
19
Number of fatal road casualties where one
driver/rider was
above 80
rng/lOO rnl
alcohol
Number of
killed drivers or
riders with a
BAC above 80
rng/lOO rnl
alcohol
GB
1170
810
760
660
660
550
Sweden
94
83
57
64
Sources: GB: DOT 1994; Sweden: SCB (1994a). Data of all drivers and riders killed in road accidents 1989-1992, obtained
from Vogverket.
At the same time as the number of tests has increased, the number of drivers with excess blood
alcohol levels has, contrary to expectations,
decreased. This is particularly evident in the Scottish campaigns that account for a substantial part
of all breath tests taken. Despite 47 566 tests carried out during the last Christmas campaign, a
smaller number of drivers were found over the
limit (1 010) than during the first campaign, when
only 7 810 tests were conducted and 1 386 drivers
were positive. Scotland also shows a declining
number of l'l'!ported offences and especially of
convicted drunken drivers during the last 10 years
(Annual Abstract of Statistics 1994; The Brewers'
Society 1994. In Sweden the rate of reported
drinking and driving offences remained rather
stable until 1991. Thereafter, and thus after the
reduction of the legal limit to 20 mg/l00 ml, the
number of offences (above 20 mg/l00 ml) have
decreased by 21 %, despite a doubling of the
number of breath tests carried out during the
same period.
Is all this then indicative of a primary preventive
or general deterrent effect, or can it be attributed
to some other factors, such as changes in the
procedure of conducting the breath tests? There
are other indicators that can be analysed and have
been so especially in GB and Scotland. Since
1986, the policy in Scotland is to test all drivers
that are involved in accidents. The data show that,
from 1986 when the tests were intensified to 1993,
the number of breath tests are almost the same
(1986: 18279 tests, 1993: 18332 tests) but the actual number of drivers over the legal limit and involved in accidents has diminished by 45 %, from
1118 to 613 (see e.g. Scottish Office 1993). Unfortunately no similar drink-driving accident data
are available for Sweden.
The percentage of drivers and riders killed with
a BAC of 80 mg/l00 ml of all drivers and riders
with a known BAC is shown for Sweden and GB
in Table 3 (no data are available for Scotland only).
The blood alcohol levels, obtained from post mortem examinations, are for Sweden available only
from 1989 to 1992. For 1993, I have information on
the proportion of drivers with any alcohol,
regardless of BAC. As concerns GB, the percentage of drivers or riders killed with a BAC of at
least 80 mg/100 ml has declined steadily from 26
% in 1984 to 18 % in 1990. No further decline is
visible from 1990.
In Sweden, the proportion exceeding 80 mg/100
ml decreased from 25 % 1989 to 19 % in 1991 (and
1992), i.e. after the reduction of the legal limit to
20 mg/l00 ml. The percentage of all drivers/riders
with any detectable BAC (or a BAC above 20
mg/l00 ml) has also been declining in Sweden
from about 30 % 1989-91 to 24 % in 1992 and 21
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 50-
% in 1993 (Laurell 1994).
The comparison also reveals that the proportion
of killed drunken drivers and riders is almost the
same in both countries despite differences in
legislation and police enforcement, not only for
BAC-Ievels exceeding 80 mg/l00 ml. Of all drivers
and riders killed in 1990, 29 % had a BAC above
9 mg/l00 ml in both GB (Clayson & Everest 1993)
and Sweden. Finally, Table 3 shows that the fatal
casualties in road accidents have diminished in
both countries, although during different time
periods, and as expected, that the number of
drink-driving related fatal accidents (GB) and the
number of killed motorists above 80 mg/l00 ml
(Sweden) has gone down.
The drink-driving related indicators should also
be interpreted cautiously in a cross-national comparison. In the first place the BAC is known for
about two thirds of all drivers killed in road accidents in GB (DOT 1991) but for approximately
90 % of all drivers killed in Sweden (Laurell1994).
Cross-country comparison is also complicated by
the lower legal BAC-Ievel in Sweden. However,
taken together, the data indicate that there has
been a real decline in the number of drunken
drivers in Scotland and Sweden, in Scotland
probably as a result of comprehensive preventive
campaigns towards drinking and driving, and in
Sweden during the last few years after the altered
legislation in 1990.
Compared to Sweden, the decline in Scotland
(and GB) appears to be greater. It should be
remembered that Sweden in the mid-1980s probably had a lower level of drunken drivers than
Scotland (even though the fatality statistics show
remarkable similarities between Sweden and
GB). When the Christmas campaigns were started
in Scotland in 1986/87, almost every fifth breath
test was positive, five years later only 2.8 %. The
figures since then have dropped only marginally,
and the last campaign showed a higher percentage of drivers over the limit than the year before.
The downward trend in the proportion of BACpositive motorists in accidents in Scotland and in
fatal accidents (GB) has also bottomed out in recent years.
One interpretation of these results is that it may
be easier to improve the drinking and driving
situation when the initial point of departure of behaviour is rather high. In the first phase those be-
ing deterred might to a greater extent be "social"
drinkers and drinking drivers compared to those
not deterred. This may also explain the similarities between Scotland and Sweden in the proportion of alcohol-related fatal accidents. When the
rate has come down to a certain level, the effect of
the deterrent countermeasures shows a decreasing marginal utility because those left undeterred
are members of social categories that are more immune to general deterrent measures. In other
words, those being undeterred in Sweden, and
increasingly so in Scotland as well, are probably
to an increasing extent alcohol abusers and
recidivists who are especially likely to experience
serious traffic accidents.
GB still has the potential to reduce the permitted BAC and to introduce unfettered discretion
and/or random breath tests, both with a potential
deterrent effect. Even police enforcement can be
intensified. In Sweden, roughly 1.5 million breath
tests were administered in 1993 to a population of
8.5 million. GB conducted during the same year
600 000 tests in a population seven times larger.
DISCUSSION
This study has stressed the importance of including a historical perspective in comparative
research. In the course of the post-war era there
has been a gradual but clear shift in both Sweden
and Scotland from advocating the benefits of abstaining to the benefits of moderate drinking. This
shift appears to have been more drastic in Scotland than in Sweden. After World War 11, the level
of consumption and alcohol-related problems was
low in Scotland (and Sweden) and presumably,
the Scots had other and more important questions to deal with than alcohol. In addition, both
the temperance movement and the most temperance friendly party, the Liberal Party, had lost
much of its power.
Consequently, when consumption began to rise
again in the 1950s, there was no culture of abstinence and no political opposition to fight against
it (Paton 1992), as was the case in Sweden. Scotland also started off with a less restrictive control
system than Sweden after World War 11. Consumption and alcohol-related problems continued to increase during the 1960s and the first
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
-
51 -
half of the 197Os. Sweden also felt the liberal
winds of that time, most noticeably in the steady
rise in consumption and the introduction of medium strength beer for sale in ordinary food shops.
A vital difference between Sweden and Scotland is the private profit motive that characterizes
all alcohol trade in Scotland. The increases in consumption during the 1960s and 1970s were in
Scotland accompanied by an increase in, especially, the number of off-licences. In Sweden, the
number of off-licences (Le. the Swedish Retail
Monopoly stores), remained almost stable and at
a much lower absolute level than in Scotland. A
plausible interpretation is that the Swedish control system could resist large parts of the increased demand for alcohol, whereas the Scottish
could not. The Swedish control system was actually intensified in the late 197Os, which led to
reduced availability. The number of off-licensed
premises in Scotland is still rising.
The effect on consumption of an increase in
availability in general and in off-licences in particular is another question. It goes beyond this study
to find causal explanations for the increase in consumption. However, it would be naive to suggest
that the increased availability did not play a part.
It is true that consumption also increased in
Sweden, but the period of the sharpest increase,
1965-1977, coincided with the short duration of
medium strength beer on the market that became
available in thousands of food shops. The decline
period came after the abolition of the same beer
for sale in food shops.
Except for certain subgroups, today's prevention
policies are aimed at preventing people who are
already alcohol consumers from abusing alcohol.
This shift in targeting will perhaps become more
apparent in Sweden when the traditional means
of control are no longer available and primary
prevention is a matter of education and information. However, the messages will most likely be
targeted only at those people drinking more than
sensibly. In fact, this development seems to have
started already. Last May (1995) witnessed the
first national campaign aimed at the adult population in general, and those in the risk zone in particular, as target groups with a drinking sensibly
message. In this respect the individual drinker
will be more emphasized than before.
Sweden still has its most important control
measure intact, namely the state owned retail
shops. The question is, for how long. Most experts seem to agree that this last monopoly will be
abolished in the near future, which will draw increased attention to the prevention of the demand
for alcohol. The future of the retail monopoly is
not just a question of availability, though. In a
WHO-report on prevention in Western Europe,
Moser (1980) writes that the sale of alcoholic
beverages together with other commodities in
food shops, rather than in specialized stores, has
made it much easier to consider alcohol as a commodity like any other. It is then also likely that the
risks associated with alcohol will be changed and
perceived in the same way as those of other commodities, Le. as a health risk if not used sensibly.
In the end this may lead to an increased emphasis
on the connection between the life-style of each
individual and alcohol.
The question arises as to whether it is possible
to change people's drinking habits in the long run
without major restrictions on the supply of alcohol? It should be obvious by now that primary alcohol prevention in Scotland and Sweden
represent two different categories of policies.
Whereas Sweden has strived to regulate both the
demand for and particularly the supply of alcohol, Scotland has mainly been concerned with
the demand side. The data presented clearly
show that the unified front against alcohol in
Sweden in the late 1970s and early 1980s was followed by a decline in consumption and most alcohol-related problems, particularly for young people (Romelsjo 1987a). In Scotland, the prevention
applied has not been sufficient to bring about a
reduction in drinking levels. On the other hand
the level has showed no real increase either (even
though the liver cirrhosis death rate for women
has continued to rise).
Further, based on the much higher availability
of alcohol in Scotland than Sweden, the anticipated differences in consumption and problem rates
could have been assumed to be even greater than
they are. This, and the rather stable situation in
Scotland during the last 10-15 years, may imply
that although future Sweden will show a reduced
control on the supply side and an increased emphasis on the demand side, the presumable increase in the level of drinking will perhaps be
quite moderate.
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 52-
There are of course other non-alcohol specific
circumstances that also have an impact on the alcohol components. As regards the recent changes
in alcohol control policy, for instance, they must
be understood in relation to Sweden's EU membership and the more liberal attitudes towards alcohol in recent years. Today, the cornerstone of
Swedish alcohol policy, the state monopoly on the
retail side, does not have much public support.
Both in 1980 and 1988 less than 40 % of the people
took a positive attitude towards the sale of table
wine in food shops. In 1993, the proportion of
supporters had increased to 75 % (Leifman 1994).
Moreover, the proportion of Swedes who perceive
alcohol as a very serious social problem has
decreased substantially, from 66 % in 1981
through 43 % in 1990 to only 14 % in 1994 (Kiihlhorn & Ramstedt 1995). At the same time the level
of consumption has shown only smaller fluctuations.
Changes in alcohol consumption are also partly
explained by factors external to alcohol control.
The upward trend in consumption during the
1960s and 1970s, for example, must be seen in the
light of the rather liberal era in general, which also
included attitudes towards alcohol, as well as the
steady economic expansion and increase in disposable incomes. In the same manner, at the
same time as the increase in alcohol consumption
was halted in the late 19708 and early 1980s, and
changes in alcohol policy were made in many
Western countries, the economic conditions also
grew worse.
As concerns Scotland, Kendell et al. (1983) have
shown that the real increase in prices in 1981 on
alcoholic beverages (the first one during the past
30 years) and the widespread economic recession
with high unemployment was followed by a
reduction in consumption. The changes in beverage preferences that have occurred during the last
decades (see Figures 3-4) is another example as to
where the causes should be sought outside the alcohol policy arena.
The Scottish example also shows that even
without major centralized alcohol control and
with an overall consumption that has remained at
the same level, preventive efforts may yield
results when targeted to certain subgroups and
certain types of behaviour. This is most evident in
drinking and driving where all the available data
indicate a lowered level of problems. Compared
with general directed prevention, prevention targeted to specific groups has the advantage that it
enjoys widespread public support.
Generally, control measures are likely to be
more effective if preparations have been made to
ensure public acceptance. In the early 1980s the
campaigns, the control system and perhaps even
the intensified control measures in Sweden in the
late 1970s and early 1980s were probably accepted
by the large majority. Once again we see the huge
differences between the early 1990s and 1980s,
which may also be part of the explanation for the
relative success of the preventive measures at that
time.
The UK policy-making approach has been
referred to as the negotiating model which aimes
to strike a balance between the actors of conflicting interests in the alcohol arena. The sensible
drinking message applied in the UK could
perhaps be seen as an expression of the balance
that the UK government has struck between the
social and public health consequences of misuse,
on the one hand, and the benefits of drinking socially, culturally and not least economically, on
the other. Consequently, the UK has never accepted the WHO-target of a 25 % reduction in overall
consumption, regardless of drinking practices,
and has instead set up its own targets solely aiming at a reduction in the proportion of non-sensible drinkers.
Even if there exists a balance between different
forces, they are not necessarily equally strong.
The alcohol industry has doubtless been one of
the most influential actors, which could perhaps
be illustrated by the fact that during the last 50
years no steps have been taken towards increased
restrictions on licensing laws. The changes that
have occurred have all led to a liberalization of
licensing policy. During the last decades the policy of the alcohol industry has also been facilitated
by the prevailing government belief in the virtues
of a free market and in the freedom of individuals
to make their own choices, including their preferences for alcohol.
The alcohol industry, personified by the Portman group, has been actively engaged in recent
years in the formulation of alcohol policy. Besides
promoting sensible drinking, the industry has
taken a firm negative stand against the WHO's
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 53-
targets and the total consumption model (NAT
1992). This should come as no surprise. Political
and public acceptance of the total consumption
model could of course result in a more critical
stance towards the drinking culture and in the
long run jeopardize the alcohol industry's future
success. With new private actors in the Swedish
alcohol arena, it is undeniably hard to avoid the
thought that the prevailing conditions in the VI<
may soon be reality in Sweden.
FOOTNOTES
1. The sum of public houses, hotels and registered clubs.
2. Border trade in the UK had also been debated the last
years. As part of the Single Market, visitors to France have
since January 1993 been allowed to purchase 110 litres of beer,
20 litres of strong wine, 90 litres of wine and 10 litres of spirits
under the much lower French duty rates. This has led to heavy
imports, particularly of beer, and to pressure being exerted on
the government by the alcohol industry to reduce the excise
duty on beer by half (see e.g. Brewers and Licensed Retailers
Association 1994).
3. The Bratt-system was gradually implemented during
1915-1920. The retail and wholesale of wine and spirits were
nationalized. Restaurant policy also remained very restrictive
and the private profit motives were almost completely removed (see Koskikallio 1985; Kiihlhorn 1993). One of its
characteristics was the passbook that was needed to purchase
wine and spirits. All purchases were registered, but the purchase of wine was not normally subject to rationing. The book
was usually given to men from the age of 25, or if they were
married, at the age of 21. Married women did not receive passbooks at all and gainfully employed unmarried women were
allowed a smaller ration. People registered for drunkenness
would not be given an individual ration or for that matter a
passbook for some years.
4. Scotland is represented in the government by the Secretary of State of Scotland with the Scottish Office, with its
headquarters located in Edinburgh, as the Secretary's department.
5. Delivery places are often ordinary shops (usually food
shops) appointed to this assignment. They are typically in
rural areas at long distances from the nearest liquor shop.
6. Neither the Scottish nor the Swedish figures include what
in Scotland are categorized as registered clubs (in Sweden:
"slutna siillskap"), which require membership. In Scotland,
they have grown steadily from around 900 in 1950 to almost
2 800 in 1992. In Sweden registered clubs may either be of a
permanent or a temporary character. In Sweden the number
of permanent clubs in 1992 was 1 844. It is probably correct to
state that it is more common to visit these clubs in Scotland
than in Sweden. This means that the difference in availability
is even greater than shown in Figure 2.
7. The corrected prices have been calculated by dividing the
uncorrected prices with the average purchasing power in each
separate country and then recalculated to the same currency.
The data refer to the year 1990, the latest year with available
data (see Ramstedt & Trolldal1995).
8. The first one in Scotland was held in 1985, organized by
the Scottish Council on Alcohol. The second one was held in
1989. Since then they have been organized jointly by the
Health Education Board in Scotland and the Scottish Council
of Alcohol and have been spread over a one-week period. The
campaigns have combined events designed to attract national
publicity with local activities organized by local Councils on alcohol. One criticism of "drinkwise" campaigns in recent years
has been that they are too centrally organized and that they
therefore lack local anchorage, which was one of the intentions
in the first place (SCA 1995).
9. The Scottish Council on Alcohol (SCA) is a national
charitable body set up in 1973 and supported both by charitable bodies, major Scottish and UK companies, and central and
local government. The SCA co-ordinates much of the work
done locally by the local Councils but the Councils, are still autonomous local bodies.
10. The Health Education Authority in EnglandlWales (HEA)
has conducted "post drinkwise day" evaluations, but has only
been concerned with evaluating whether the messages of
units and sensible drinking has come across. Not surprisingly,
a higher percentage says the day after the drinkwise day that
they are aware of the term unit and the recommended weekly
limit (HEA 1991). An evaluation of the 1992 "Drinkwise" campaign in Wales examined public awareness of the campaign,
but also its effects on alcohol-related knowledge and behaviour (Murphy & Smith 1992). Altogether 1 017 respondents
were face-to-face interviewed a short time after the 1992 Drinkwise campaign was completed. Twenty-three percent had
heard about "Drinkwise" Wales. Of these 23 %, 15 % (3.5 % of
the sample) said it had made them change their drinking
habits.
11. The two campaigns at the beginning of the 1980s, Actions against alcohol - Stop the bootlegging and Actions
against drugs, have been evaluated together in the same report
(Socia1departementet 1983). The evaluation report states that
the multiplicity of activities (articles, adverts, etc.). had at least
the effect that the absolute majority of the Swedish population
(96 %) has paid attention to the first of the two campaigns.
Yearly surveys show that consumption among young people
was reduced, with attitudes becoming more restrictive
towards alcohol at the beginning of the 1980s, i.e. when the
campaigns were running. Parents also became more restrictive
in buying alcohol for their youngsters. But as pointed out by
the evaluators, it is impossible to ascertain that these changes
were brought about by the campaigns.
12. The PIA-project (Forebyggande Insatser mot Alkoholrelaterade problem pi KungsholmenlPrevention Against Alcohol-related problems on Kungsholmen) that started in 1990
and that was completed in 1994 was mainly focused on a
primary preventive project but also included some secondary
prevention components. The community of Kungsholmen in
central Stockholm was selected as the intervention area and a
similar community in Gothenburg as a control area. Kirseberg
is also a metropolitan community, in the third biggest city in
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 54-
Sweden, Malmo. The Kirseberg project, which started up in
1989 and will continue throughout the 1990s, adopts a public
health view. One of their subprojects concerns alcohol.
13. The Department of Transport, which works in association with the Scottish Office, has the responsibility for road accidents and related legislation for Great Britain, but not for
Northern Ireland. The information and data presented thus
concern GB.
14. The most intensively debated reform in Scotland during
the last decades concerns the effects of the relaxation of Scottish licensing laws in 1976. In general, studies have not found
any causal effects in terms of increased consumption or alcohol-related problems due to the changes in the licensing law.
However, the impact of the licensing law on consumption and
problems is complex and difficult to evaluate, particularly
when it comes to controlling for non-licensing factors (see e.g.
Oayson 1984; Goddard 1986; Duffy & Plant 1986; Saunders
1985; Duffy 1992). For short-term effects of restrictive measures
in Sweden, see e.g. Socia1departementet (1982) on the effect of
Saturday closure of retail outlets and Nilsson (1984) on the effect of the removal of medium beer from food shops.
15. The coverage rate is defined as the ratio between the survey estimate of mean per capita consumption and the known
per capita consumption according to the registered sales
and/or production data.
REFERENCES
Annual Abstract of Statistics: The Government Statistical
Service, HMSO 1994
Assarsson, B.: Efterfragan pa alkohol i Sverige 1978-1988. In:
Alkoholskatteutredningen.
Alkoholbeskattningen.
Slutbetiinkande av alkoholskatteutredningen. Statens Offentliga
Utredningar No. 52. Finansdepartementet, Stockholm 1991
Bagnall, G.: Does alcohol education work? In: Plant, M. &
Ritson, B. & Robertson, R. (eds.): Alcohol and drugs. The
Scottish Experience, pp. 67-74. Edinburgh University Press,
Edinburgh 1992
Bjor, J. & Gomer, G. & Kiihlhorn, E. & Olsson, 0.: Kommunal Alkohol- och Narkotikaprevention. Delrapport 1.
Manuscript. Department of Sociology, Stockholm university,
Stockholm 1995
Brewers' Society: Statistical handbook. A compilation of
drinks industry statistics. 1994 Edition. Brewing Publication
Limited, London 1994
Brewers and Licensed Retailers Association: News Release.
Embargo Wednesday 21 September 1994
British Journal of Addiction: Editorial 77 (1982): 1-2
Bruun, K.: Alkohol i Norden. Aldus/Bonnier, Stockholm
1973
Bruun, K. & al. (eds.): Alcohol Control Policies in Public
Health Perspective. Finnish Foundation for Alcohol Studies,
Helsinki 1975
Bruun, K. & Franberg, P. (eds.): Den svenska supen. Prisma,
Stockholm 1985
Oayson, c.: Report of the Departmental Committee on
Scottish Licensing Law. Scottish Home and Health Department, Scottish Office. HMSO, Edinburgh 1973
Oayson, c.: Licensing law and health: the Scottish experience. In: Policy Forum: Licensing Law and Health Report.
Action on Alcohol Abuse, London 1984
Clayson A. & Everest, J.T.: Decline in Drinking and Driving
Crashes, Fatalities and Injuries in Great Britain.. Proceedings of
the Conference Strategic Highway Research Program and
Traffic Safety on Two Continents. The Hague, Linkoping,
Sweden 1993, pp. 175-186
CPRS: Alcohol Policy. unpublished in UK; reprinted by
Department of Sociology, University of Stockholm, Stockholm
1980
Crawford, A. & Plant, M. & Kreitman, N. & Latchman, W.:
Self-Reported Alcohol Consumption and Adverse Consequences of Drinking in Three Areas of Britain: General Population Studies. British Journal of Addiction 80 (1985): 421-428
DHSS: Prevention. Report by the advisory committee on alcoholism. 1977
DOE: Drinking and driving. Report of the Committee of Inquiry into drinking and driving (Blennerhassett Committee).
HMSO, London 1976
DOH: The Health of the Nation: A strategy for health in
England. Department of Health. HMSO, London 1992
DOH: Sensible Drinking. The Report of an InterDepartmental Working Group. Department of Health, December 1995
DOT: Drinking and driving injury road accidents. Department of Transport. Great Britain 1991: the facts. Accident fact
sheet, series 2, no. 4. 1991
DOT: Drink drive publicity. Department of Transport. Road
Safety Division, Manuscript, December 1994
Dight, S.E.: Scottish Drinking Habits. HMSO, London 1976
Drinking Sensible: Prevention and Health: Drinking Sensible. A discussion document prepared by the Health Departments of Great Britain, and Northern Ireland. DHSS, HMSO,
London 1981
Duffy, J.c. & Plant, M.A.: Scotland's liquor licensing
changes: an assessment. British Medical Journal, 292 (1986):
36-39.
Duffy, J.c.: Trends in Alcohol Consumption Patterns
1978-1989. NTC Publications Ltd, Henkley on Thames 1991
Duffy, J.c.: Scottish licensing reforms. In: Plant, M. & Ritson, B. & Robertson, R. (eds.): Alcohol and drugs. The Scottish Experience. Edinburgh University Press, Edinburgh 1992
Dunbar, J: Drink and driving. In: Plant, M. & Ritson, B. &
Robertson, R. (eds.): Alcohol and drugs. The Scottish Experience. Edinburgh University Press, Edinburgh 1992
Edwards, G. et al. (eds.): Alcohol Policy and the Public
Good. World Health Organization, Europe. Oxford University
Press 1994
Expenditure Committee: Preventive medicine. First Report
from the Expenditure Committee. Session 1976-77. HMSO,
London 1977
FHI & CAN: Rapport-serie (1995) Alkohol och narkotikautvecklingen i Sverige. Rapport Nr 2. Centralforbundet for
alkohol- och narkotikaupplysning (CAN), Folkhiilsoinsitutet,
Stockholm 1995
FHI: Folkhiilsoinstitutets verksamhetsplanering 1994195,
1995
Franberg, P.: Den svenska supen. In: Bruun, K. & Franberg,
P. (eds.): Den svenska supen. Prisrna, Stockholm 1985
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 55-
Frimberg, P.: The Swedish Snaps: A History of Booze, Bratt
and Bureaucrazy - A summary. Contemporary Drug
Problems/Winter 1987. Federal Legal Publications Ltd 1988
Goddard, E.: Drinking and attitudes to licensing in Scotland. Office of Population Censuses and Surveys. Social Survey Division. HMSO, London 1986
Godfrey, c.: Modelling demand. In: Maynard, A. & Tether,
Ph. (eds.): Preventing Alcohol and Tobacco Problems, Vol. 1.
Avebury Gower Publishing Company Limited, England 1990
Hansson, B.S. & Larsson, S.: Kirsebergsprojektet - ett folkhiilsoprojekt i en stadsdel i Malmo. Socialmedicinsk tidskrift,
No.3 (1990): 144-150.
Harrison, L. & Godfrey, c.: Alcohol and advertising. In:
Godfrey, C. & Robinson, D.: Preventing Alcohol and Tobacco
Problems, Volume 2, pp. 44-74. Avebury Gower Publishing
Company Limited, England 1990
Harrison, L. & Tether, P.: Tax policy: structure and process.
In: Maynard, A. & Tether, P.: Preventing Alcohol and Tobacco
Problems, Volume 1, pp. 75-95. Avebury Gower Publishing
Company Limited, England 1990
HEA: The Drinkwise Campaign - 1991 Report. Health Education Authority 1991
HEA: Health Education Authority. Health promotion and alcohol misuse - the policy framework. Manuscript, SSA Annual Symposium 1994
HEBS: That's the limit. A Guide to Sensible Drinking.
Health Education Board of Scotland 1989
HEBS: Jonathan Watson, personal communication 1995
Holder, H. & Parker, R.N.: Effect of alcoholism treatment on
cirrhosis mortality: a 20-year multivariate time series analysis.
British Journal of Addiction, 87 (1992): 1263-1274
Huitfeldt, B. & Jorner, u.: Efterfragan pa rusdrycker i
Sverige. En ekonometrisk undersokning av konsumtionens
utveckling efter motbokens avskaffande. Rapport fran Alkoholpolitiska utredningen (APU), No. 91, 1972
Jameson, J.N.: A Practical Guide to Scottish Licensing Law.
Jameson Publishing, Edinburgh 1988
Kendell, R.E. & de Roumanie, M. & Ritson, E.B.: Effect of
Economic Changes on Scottish Drinking Habits 1978-82. British Journal of Addiction, 78 (1983): 365-379
Kirseberg: Alkoholkonsumtion i Kirseberg 1990 och 1994.
Manuscript. Institutionen for klinisk samhiillsmedicin.
Alkohol- och narkotikakliniken. Malmo 1995
Koskikallio, I.: Restaurangpolitiken. In: Bruun, K. & Franberg, P. (eds.): Den svenska supen. Prisma, Stockholm 1985
Kiihlhorn, E.: Svenska alkoholrestauranger pa viig in i Europa. Samordningskansliet fOr brottsforebyggande ittgiirder,
Stockholms stad, Stockholm 1993
Kiihlhorn, E.: Statistikford och icke-statistikford alkohol. In:
Kiihlhorn, E. & Leifman, H.: ICA-nubbe eller hemkort? Om
konsumenternas okade niirhet till alkohol. Department of Sociology, Stockholm univeristy, Stockholm 1994
Kiihlhorn, E: Svenska alkoholvanor i ett foriindringsperspektiv. Manuscript, Department of Sociology, Stockholm
University, Stockholm 1995
Kiihlhorn, E. & Leifman, H.: Alcohol surveys with high and
low coverage rate: a comparative analysis of survey strategies
in the alcohol field. Journal of Studies on Alcohol, 54 (1993):
542-554
Laurell, H.: Promillen och trafiksiikerheten. En kunskaps-
oversikt om alkohol och trafik. Forskning & Fakta, nr 13. CAN
& SAD, Stockholm 1994
Leedham, W. & Godfrey; c.: Tax policy and budget decisions. In: Maynard, A. & Tether, 1'.: Preventing Alcohol and
Tobacco Problems, Volume 1. Avebury Gower Publishing
Company Limited, England 1990
Leifman, H.: Attityder till forsiiljning av alkoholdrycker i
livsmedelsbutiker. In: Kiihlhorn, E. & Leifman, H.: ICAnubbe eller hemkort? Om konsumenternas okade niirhet till
alkohol. Department of Sociology, Stockholm university,
Stockholm 1994
Lord President's Report: Lord President's Report on Action
Against Alcohol Misuse. HMSO, London 1991
Miikelii, K. & Room, R. & Single, E. & Sulkunen, P. &
Walsh, B. (eds.): Alcohol, Society, and the State. Voll. A comparative study of alcohol control. Addiction Research foundation. Toronto, Canada 1981
Marsh, A. & Dobbs, J. & White, A.: Adolescent drinking,
HMSO, London 1986
McLauglin, P,M.: Responding to drunkenness in society: A
socio-historical study of responses to alcohol problems. Thesis. Department of Sociology and Social Policy. University of
Stirling, Scotland 1989
McNeill, A.: Alcohol policies, problems and prevention
trends: country profile - UK. Alcologia, 5 (1) (1993): 43-46.
Moskowitz, J.M.: The primary prevention of alcohol
problems: a critical review of the research literature. Journal of
Studies on Alcohol 50 (1989): 54-88
Moser, J.: Prevention of Alcohol-related Problems. WHO,
Geneva 1980
Murphy, S. & Smith c.: Drinkwise Wales 1992: an evaluation of the campaign. Health Education Journal, 52 (1992):
227-230
NAT: The Portman Group. An interview by Kerstin Stenius
with the Director for the Portman Group, Dr. John Rae. Nordisk Alkoholtidskrift 9 (1992): 188-189
Nilsson, T. (ed.): Niir mellanolet forsvann. Samhiillsvetenskapliga institutionen. Linkopings universitet, Linkoping 1984
Noval, S. & Nilsson, T.: Mellanolets effekt pa konsumtionsnivan och tillviixten hos den totala alkoholkonsumtionen. In:
Nilsson, T. (ed.): Niir mellanolet forsvann. Samhiillsvetenskapliga institutionen. Linkopings universitet, Linkoping 1984
OPCS: Office of Population Censuses and Surveys. General
Household Surveys. Social Survey Division. HMSO, London
1992
Olsson, 0. : Prisets och inkomstens betydelse fOr alkoholkonsumtion, missbruk och skador. En forskningsoversikt.
Centralforbundet for alkohol- och narkotikaupplysning,
Stockholm 1991
Osservatorio Permanente sui Giovani e I~lcool: Young people and alcohol in Europe: A tool for monitoring consumption
patterns and institutional action policies. A study made in collaboration with Progetto Europa and by agreement with the
Commission of the European Community. Assobirra. Rome
1994
Osterberg, E.: Effects of Alcohol Control Measures on Alcohol Consumption. The International Journal of the Addictions
27 (1992): 209-225
Paton, D. : Drink and the temperance movement in
nineteenth century Scotland. Thesis, University of Edinburgh
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 56-
1976
Paton, D.: The legend of drunken Scotland. In: Plant, M. &
Ritson, B. & Robertson, R (eds.): Alcohol and drugs. The
Scottish Experience. Edinburgh University Press, Edinburgh
1992
Peacock, e.: International Policies on Alcohol-Imparied
Driving: A Review. The International Journal of the Addictions, 27 (1992): 187-208.
Plant, M.L.: Women, drinking and pregnancy. Tavistock
Publications, London 1985
Plant, M.A. & Foster, J.: Teenagers and alcohol: results of a
Scottish national survey. Drug and Alcohol Dependence 28
(1991): 203-210
Plant, M.A. & Peck, D.E & Samuel, E.: Alcohol, drugs and
school-leavers. Tavistock Publications, London 1985
Plant, M.L. & Plant, M.A.: Risk-Takers. Alcohol, drugs, sex
and youth. Routledge, London 1992
Prop.: Alkoholpolitiskt program. Proposition 1976/77: 108.
Stockholm 1977
Prop.: Utvecklingslinjer for hiilso- och sjukvarden m.m.
PropOSition 1984/85: 181. Stockholm 1985
Prop.: FoIkhiilsopropositionen 1990/91: 175. Stockholm 1991
Ramstedt, M. : Efterfriigan pii alkoholdrycker i Sverige
1978-1990 - en tidsserie-ekonometrisk analys. Department of
National Economy (C-uppsats). Stockholm university 1993
Ramstedt, M. & KiihIhorn, E.: Eroderingen av den helnyktra
sektorn. Manuscript. Department of Sociology, Stockholm
university 1995
Ramstedt, M. & Trolldal, B.: Alkoholpris och konsumtionsnivii i ett internationellt jamforande perspektiv. ManUSCript,
Department of Sociology, Stockholm university 1996
Romanus, G.: Svenska argument for alkoholmonopol. Nordisk Alkoholtidskrift, 9 (1992): 275-279
Romelsjo, A.: Decline in Alcohol-related In-patient Care and
Mortality in Stockholm County. British Journal of Addiction,
82 (1987): 653-663, 1987a
Romelsjo, A: The decline in alcohol-related problems in
Sweden was greater among young men. British Journal of Addiction 82 (1987): 1114-1124, 1987b
Romelsjo, A.: The Kungsholmen Project. Paper presented at
the 37 International Congress on Alcohol and Drug Dependence, 20-25 August 1995 in San Diego
Romelsjo, A. & Andren, A. & Borg, S.: Design, Implementation, and Evaluation of a Community Action Program for
Prevention of Alcohol-Related Problems in Stockholm City: Initial Experiences. In: Greenfield, T.K. & Zimmerman, R
(Eds.): Experiences with commu..nity action projects: New
research in the prevention of alcohol and Changes in alcohol
consumption during pregnancy. U.S. Department of Health
and Human Services. Washington 1992
Room, R.: En omojlig drOm? Hur minska alkoholproblemen
i en nykterhetskultur? Nordisk Alkohol Tidskrift 8 (1991):
195-207
Royal College of Physicians: A Great and Growing Evil.
Tavistock, London 1987
Royal College of Psychiatrists: Alcohol and Alcoholism, the
Report of a Special Committee of the Royal College of Psychiatrists. Tavistock, London 1979
Royal College of Psychiatrists: Alcohol: our favourite drug.
Tavistock, London 1986
SAMO: Om alkoholpolitiken. Forslag friin Samordningsorganet for alkoholfriigor. Socialdepartementet. Stockholm 1980
Saunders, W.: Licensing law: the Scottish experience - a reply to Oayson. Action on Alcohol Review, 2, July/August, 3-14
1985
SCA (Scottish Council on Alcohol): Ann Furst, personal
communication 1995
SCA (Scottish Council on Alcohol): 1994 United Kingdom
alcohol statistics. Produced and compiled by the SCA 1994
SCB: Statistisk Arsbok '93. For Sverige. Statistiska Centralbyriin 1992
SCB: Statistisk Arsbok '95. For Sverige. Statistiska Centralbyriin 1994a
Scotch Whisky Assocation: The Scotch Whisky Association
Statistical Report 1993
Scottish Office: Scotland's Health: A challenge to us all.
Scottish Office and Health Department, HMSO, Edinburgh
1992
Scottish Office: Road Accidents Scotland: A Publication of
the Government Statistical Service. 1993
SFS: Svensk forfattningssamling 1977: 292. Lag om tillverkning av drycker m.m., 1977a
SFS: Svensk fOrfattningssamling 1977: 293. Lagen om handel
med drycker, 1977b
SFS: Svensk fOrfattningssamling 1978:763. Lag med vissa
bestammelser om marknadsfOring av alkoholdrycker, 1978
SFS: Svensk forfattningssamling 1994: 1738. Alkohollag,
1994
Smart, RG. & Mann, R.E.: Factors in Recent Reductions in
Liver Cirrhosis Deaths. Journal of Studies on Alcohol 52
(1991): 232-240
Smout, T.e.: A century of the Scottish people 1830-1950.
Fontana Press, London 1986
SOU: Alkoholpolitik 2. Atgarder. Betiinkande avgivet av
alkoholpolitiska utredningen. Statens Offentliga Utredningar
1974:91. Finansdepartementet, Stockholm 1974
SOU: Svensk alkoholpolitik - en strategi for framtiden.
Huvudbetankande av Alkoholpolitiska kommissionen. Statens Offentliga Utredningar (SOU) 1994: 24. Socialdepartementet, Stockholm 1994a
SOU: Svensk alkoholpolitik - bakgrund och nulage. Delbetankande av alkoholpolitiska kommissionen. Statens
Offentliga Utredningar (SOU) 1994: 25. Socialdepartementet,
Stockholm 1994b
SOU: Att forebygga alkoholproblem. Delbetankande av
alkoholpolitiska kommissionen. Statens Offentliga Utredningar (SOU) 1994: 26. Socialdepartementet, Stockholm 1994c
Socialdepartementet: En utvardering av forsoket med lordagsstangda systembutiker sommaren 1981. Rapport friin en
expertgrupp. Ds S 1982:2. Socialdepartementet, Stockholm
1982
Socialdepartementet: Slutrapport - Stoppa langningen,
Aktion mot droger. Socialstyrelsen (1994) Alkoholstatistik
1993. Sveriges Officiella Statistik, Socialstyrelsen. Stockholm
1993
Socialstyrelsen: Alkoholstatistik 1984. Sveriges officiella
statistik (Alcohol statistics, National Board of Health and Welfare) Stockholm 1985
Socialstyrelsen: Alkoholstatistik 1993. Sveriges officiella
statistik, Stockholm (Alcohol statistics, National Board of
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 57-
Health and Welfare). Stockholm 1994
Svenska Bryggareforeningen: Fakta om 01, om skatter och en
hotad svensk industri. Svenska Bryggareforeningen, Stockholm 1994
Systembolaget: Systembolagets verksamhet 1993. Systembolaget, Stockholm 1993
Systembolaget: Rydberg, B., personal communication 1995
Tether, P.: Liquor licensing: Theory, practice and potential.
In: Anderson, D. (ed.): Drinking to Your Health: The Allegations & the Evidence. Social Affairs Unit, London 1989
Tether, P. & Godfrey, c.: Drinking and driving. In: Godfrey,
C. & Robinson, D. (eds.): Preventing Alcohol and Tobacco
Problems, Volume 2. Avebury Gower Publishing Company
Limited, England 1990
Tether, P. & Harrison, L.: Alcohol Policies: Responsibilities
and Relationships in British Government. Addiction Research
Centre, Universities of Hull and York 1989
Tether, P. & Leedham, W. & Harrison, L.: liquor licensing.
In: Godfrey, C. & Robinson, D. (eds.): Preventing Alcohol and
Tobacco Problems, Volume 2. Avebury Gower Publishing
Company limited, England 1990
Tether, P. & Robinson, D.: Preventing alcohol problems: A
guide to local action. Tavistock Publications, London 1986
Tether, P. & Robinson, D. & Teller, J. (eds.): Local action on
alcohol problem. Tavistock/Routledge, London 1989
Waterson, M.: Advertising and Alcohol Abuse. Advertising
Association, London 1983
Waterson, M.: Advertising and alcohol: A review of the evidence. In: Anderson, D. (ed.): Drinking to Your Health: The
Allegations & the Evidence. Social Affairs Unit, London 1989
WHO (World Health Organization): Problems related to alcohol consumption. Report of a WHO Expert Committee.
Technical Report Series 650. Geneva 1980
WHO (World Health Organization): Targets for health for all
by year 2000. WHO Regional Office for Europe. Copenhagen
1986
Wllson, G.B.: Alcohol and the nation. Nicholson & Watson
Ltd, London 1940
Williams, G.P': Social effects of the ending of resale price
maintenance of alcoholic beverages 1%6 and 1967. Christian
Economic and Social Research Foundation. London 1968
Wtlliams, G.P. & Brake, G.T.: Drink in Great Britain
1900-1979. Edsall & Co. Ltd, London 1980
V&S: Vin & Sprit AB Arsredovisning 1993. Stockholm 1994
V&S: Vm & Sprit AB Arsredovisning 1994. Stockholm 1995.
APPENDIX
Some important events and changes in the control system after
World War IT
SCOTLAND AND/OR UK
1959
The Licensing (Scotland) Act from 1959 contained the basic
code of the licensing law until the changes in 1976, and was in
itself much a consolidating measure which repealed and
reproduced earlier enactments.
1%2
The licensing (Scotland) Act 1962, which was much an
amending measure, laid down the standard permitted hours
in licensed premises until 1976. The weekday permitted hours
for on-sales were 11 a.m.-2.30 p.m. and 5 p.m.-l0 p.m. On
Sundays there are no permitted hours for public houses. Of£sale premises may not be open for liquor sale before 8 a.m.
and not later than 10 p.m., and not at all on Sundays (Oayson
1973).
1966/67
The distillers decided not to put the case for retention of the
Resale Price Maintenance before the Restrictive Practices
Court. The Court had no option but to declare that the Resale
Price Maintenance was henceforth illegal in the UK. This encouraged supermarkets/grocery stores to sell alcoholic bever-
ages (see also the text) (Wtlliams 1968).
1967
The 1%7 Road Traffic Act was enacted, setting for the first time
a legal blood alcohol concentration for drivers of motor vehicles at 80 mglI00 ml.
1975
The Advisory Committee on alcoholism was set up, of which
one of the reports (DHSS 1977) was about prevention. Among
other things they argued that legal restrictions of availability
should be enforced vigorously and not be relaxed until sufficient evidence existed that a relaxation would not bring about
further harm, and that fiscal powers should be utilized to ensure that alcohol does not become cheaper in real terms.
1976
The latest major changes in Scottish licensing laws were implemented in the 1976 licensing (Scotland) Act, which led to
a relaxation of the licensing system, especially in opening
hours for on licensed premises.
The Blennerhassett Committee, set up in 1974 in order to look
at the whole question of drinking and driving, came with a
report two years later (DOE 1976). The Committee suggested,
i.a., the removal of limitations on the powers of the police to
stop and test drivers (pointing out that unfettered discretion
Nordisk Alkoholtidskrift Vol. 12, 1995: English Supplement
- 58-
was needed) and recommended that the 80 mg/l00 ml limit be
retained. The recommendations concerning police discretion
did not meet with success. However other Committee suggestions were accepted, e.g. the need for evidential breath testing.
chaired by the Lord President of the Council. In its report ''AI;tion Against Alcohol Misuse" (1991) it reiterated the government's belief in activities that encourage sensible drinking, especially on the 10calleve1, and discourages alcohol misuse.
lW7
The House of Commons Expenditure Committee (1977)
reported on preventive medicine and made many proposals,
La., that the overlap of preventive work concerned with alcoholism should be reduced by co-ordinating the preventive effort under one umbrella organisation and that the age-limit for
purchasing or being served alcohol should not be lowered under any conditions.
1992
Targets to reduce the proportion of insensible drinkers were
for the first time set up both in England/Wales (The Health of
the Nation) and Scotland (Scotland's Health: A challenge to us
all).
1979
1955
The corner stone of the Bratt-system, the rationing system is
abolished in October.
The Royal College of Psychiatrists published its report '~cohol
and Alcoholism'~ arguing for a more restrictive policy. They
called for an enhanced government commitment to public
education and persuasion to reduce the extent of alcohol
problems, for a fiscal policy that would be applied in the interests of health by gradually lowering per capita consumption, and for definite goals of preventive actions in a longer
time perspective (10 years) to reduce consumption levels and
harm.
The Central Policy Review Staff (CPRS) reported its results and
recommendations in a paper that yet has not been published.
The CPRS argued for reforms much in line with the WHO's
recommendations, such as an increase in or unchanged real
prices of alcohol, extension of controls over advertising, developing health education and a strengthening of the liquor
licensing law.
1981
The government response to the pressure to change alcohol
policy, the "Drinking Sensible" document, was published.
Some of the propositions in the document included actions on
drinking and driving, initiatives at the workplace, voluntary
action by the alcohol industry, and self-regulations by the media of alcohol advertising rules. There was no proposition to
change the legislation. The key prevention tool should be
health education, with the message to drink sensibly.
1986
The Royal College of Psychiatrists (in Alcohol: our favourite
drug) once again reiterated the seriousness of alcohol
problems by calling it the major health issue of our time and
by suggesting more or less the same measures that had been
called for in the late 1970s.
1987
The Royal College of Physicians (in: A Great and Growing
Evil) also emphasized the seriousness of alcohol problems and
called for similar measures as the Royal College of Psychiatrists, i.e. a more active alcohol policy much in line with
what was suggested in the late 1970s.
1987
The government set up the Ministerial Group on Alcohol Misuse which comprised 12 government departments and was
SWEDEN
1957
So called black-lists (spiirrlistor) were introduced. People who
were on these lists were not allowed to buy any alcohol in the
state owned retail shops. It was up to the so-called temperance
boards to draw up the lists, which were distributed to all retail
shops. When the lists were first introduced they only included
alcohol misus~rs, but over time they also came to embrace
others, such as bootleggers and those guilty of more than one
drunken driving or drunkenness offence during the last 12
months. The lists were renewed each month, and the maximum time any group could be kept on the list was 12 months.
1963
The control system at restaurants, which was responsible for
the fixed prices and restricting the prospects of profits, was
abolished. This marked the reintroduction of private profit
motives in the restaurant business.
1965
The Governmental Commission on Alcohol Policy was set up
in order to examine the first 10 years after the abolition of the
rationing system. The launch of the investigation could be
seen as an attempt by the state to win back some of the ground
that had been lost 10 years ago.
Medium strength beer was introduced for sale in food shops.
1967
A no-restrictions experiment for the sale of strong beer was
carried out in two of the twenty-four Swedish counties. The
experiment started in November 1 and was supposed to run
throughout 1968, but indications of increased alcohol abuse,
especially among the young people, resulted in it being abandoned after eight and a half months.
1970
A law was passed that made it possible to merge child welfare
committees, social welfare committees and temperance
boards.
1974
The Governmental Commission on Alcohol Policy in 1965
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published its main report (SOU 1974:91). The investigation
started its work with a rather liberal outlook, e.g. with the introduction of medium strength beer and the experimental sale
of strong beer in ordinary food shops. However, their attitude
became more restrictive over time, which later led to the adoption of several restrictive measures in the late 1970s and early
1980s (see below).
should be closed on Saturdays.
The temperance boards were abolished.
Act.
1977
Public drunkenness was decriminalized.
1985
The Swedish government approved the WHO target from 1984
to cut overall consumption from 1980 to 2000 by 25 % as a national target (WHO 1986; Prop. 1985).
Black-lists were abolished.
Medium strength beer was withdrawn from food shops on
July 1st.
The Swedish parliament adopted the WHO message by accepting that the control measures applied should be aimed at
reducing overall per capita consumption and thereby the
abuse of alcohol (Prop 1977).
1982
Since this year the state owned liquor shops have been closed
on Saturdays.
The Social Services Act of 1982 came into force and replaced
several more specific laws, among them the 1954 Temperance
1991
The so-called "public health government bill' from 1991 (Prop
1991) re-emphasized that the main goal of Swedish alcohol
policy in the future should be to reduce total alcohol consumption in order to restrict the adverse effects of alcohol. This
should be done by means of an active price policy and by
maintaining a generally restrictive control system. These
guidelines were later accepted by parliament.
New alcohol laws were introduced (SFS 1977a; 1977b).
1978
The parliament decided upon a new law on alcohol advertising (SFS 1978) which led to an almost complete ban on alcohol
advertisement.
1995
A new alcohol law was introduced January 1st (SFS
1994:1738), thereby replacing the laws from 1977, which among
other things led to the abolition of the state monopolies on
production and wholesale trade, import and export.
1980
The co-ordination body of alcohol issues (SAMO) published
its first policy document which contained several suggestions
for restrictive measures. These were later to be passed in
parliament, i.a., that the Swedish Retailing Monopoly outlets
Sweden joins the EU as from 1st January, leading e.g. to a
higher permitted level of import of alcohol for private use from
1 litre of wine and 2 litres of beer to 5 and 15 litres respectively.
The permitted level of imported spirits remains the same at 1
litre.
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