2009-09-30
Report on preventive work to combat alcohol, narcotics, doping and tobacco related problems in Sweden in 2008.
Summary of a publication in Swedish.
Consumption trend
In 2008, the consumption of alcohol, narcotics and tobacco did not change to any major extent compared with the year before. Total alcohol consumption was 9.5 litres of pure alcohol per person, which is a three per cent decrease compared with the year before, but is still considerably higher than ten years ago. Sales by Systembolaget (the Swedish alcohol retail monopoly) increased while private imports by travellers, mediumstrong beer sales (not under monopoly control), smuggling and Internet alcohol sales decreased.
In 2008, approximately seven per cent of the population had hazardous alcohol habits, a percentage that has not changed to any considerable extent in recent years. However, hazardous consumption has increased markedly among young men ages 20 to 29. The consumption of narcotics appears to be stable, at least with regard to adolescents, where available data indicates low levels of consumption in Sweden. Consumption among adults is more difficult to assess since fewer studies have been done on this group. Data from the National Public Health Survey 2008 indicates that slightly more than nine per cent of the population has used cannabis at some time, which is a slight decrease from the previous year. In an international perspective, the proportion of drug users is small in Sweden, especially with regard to adolescents. The most recent European School Survey (2007) indicates that seven per cent of Swedish ninthgrade students have used narcotics at some time in their lives while the average in other countries was 20 per cent.
Tobacco consumption has continuously dropped since the beginning of the 1980s. The proportion of daily smokers is relatively low in Sweden – 14 per cent of women and 11 per cent of men – but total tobacco use remains high due the use of moist snuff (Swedish snus). Among adolescents, the trend of fewer tobacco users seems to have levelled off and we can see a marginal increase among schoolchildren in the past two years. The use of doping agents appears to be stable, with less than one per cent of the population having used doping preparations at some time in their lives. This trend is difficult to judge, however, since few studies have been done and the estimates are somewhat uncertain. Data from confiscation and crime statistics indicates a larger supply of doping agents.
Harm trend
Acute injuries related to alcohol consumption, such as traffic accidents and abuse, are on the rise. During the period 1997 to 2008, the number of reported drink-driving crimes grew by more than 40 per cent and reported crimes of abuse increased by nearly 50 per cent. However, there was no appreciable change in chronic alcoholrelated disease over the same period. In 2008, the number of people who died with narcotics in their blood continued to rise, a trend that began in 2007. The infectious disease hepatitis C, which is common among injecting narcotics users, also increased. In terms of tobacco, the tobacco-related death rate dropped among men while it rose among women. Reliable data concerning injuries and the harm trend is not available for doping.
International policy
Within in the World Health Organization (WHO), efforts are being conducted along the lines of a Nordic initiative to formulate a global alcohol strategy to reduce alcohol-related problems. In the area of narcotics, the previous EU action plan has been evaluated and a new plan has been presented for the period 2009 to 2012.
In the area of tobacco, the WHO Framework Convention on Tobacco Control aims to stimulate global cooperation in efforts against tobacco. In 2008, guidelines were adopted for the labelling of tobacco products, where pictures are recommended as a complement to warning texts. In the EU, efforts were made to reduce tobacco consumption by increasing tax rates in 2008. Through the Swedish National Institute of Public Health (SNIPH) and other bodies, Sweden has actively participated in international drug prevention efforts for many years.
National policy
In the bill, A renewed alcohol policy, the Swedish Government presents its ambitions for the period 2008 to 2010. The bill confirms that international cooperation should be strengthened since Sweden is strongly affected by changes beyond its borders at the same time that long-term prevention efforts at the local level must continue. The overhaul of alcohol legislation that began in 2007 continued in 2008. In March 2009, a number of changes were proposed, including a clarification of the municipalities’ responsibility for serving permits and a proposal that special plans should be established for how supervision under the Alcohol Act should be carried out.
There is a national action plan for narcotics that extends over the period 2006 to 2010. In 2008, the report, Better control of addictive substances, was presented, which proposes measures to improve the efficiency of the narcotics classification of new substances. The Swedish National Institute of Public Health was already charged to monitor and study the need for narcotics classification and the report proposes that SNIPH be given extended authority in this work.
In the area of tobacco, the Government gave SNIPH a special assignment in 2008. The Tobacco Commission 2008-2010 focuses on national coordination, antidotal tobacco-use treatment and strengthened supervision under the Tobacco
Act. In 2008, the Government also appointed a commission on illicit tobacco sales, which proposed making the Tobacco Act more stringent. There is a national action plan for doping for the period 2006 to 2010. The plan is a part of the narcotics policy action plan.
Drug prevention at the national, regional and local level
The organisation of national drug prevention efforts changed somewhat in 2008. The commissions, Mobilisation against narcotics, which coordinated narcotics policy efforts, and the Alcohol Committee, which had the corresponding task in the alcohol area, were disbanded at year-end 2007 and their activities were transferred to SNIPH and the Swedish National Board of Health and Welfare. To coordinate national policy concerning efforts against alcohol, narcotics, doping and tobacco, a special workgroup with representatives from all ministries involved was established at the Government Offices (SAMANT) and a special ANDT Secretariat was established.
As of 2008, SNIPH is responsible for the national coordination of prevention efforts in the areas of alcohol, narcotics, doping and tobacco. Supporting and developing regional prevention efforts are included in this assignment. In 2008,
every county had at least one county coordinator in charge of coordinating drug prevention efforts in the county. In the municipalities, prevention efforts are often coordinated by a drug coordinator. In 2008, eight out of ten municipalities had a drug coordinator. Local drug prevention work is usually summarised in a municipal programme. In 2008, barely 90 per cent of the municipalities had a politically adopted programme to prevent alcohol and narcotics-related problems, while action programmes to prevent the use of tobacco and doping agents were in place in barely one third of the municipalities.
In terms of the effects of alcohol and tobacco prevention efforts, the price policy is the most significant to reducing harm. Price also probably has a major impact on the consumption and harm trend for illegal drugs such as narcotics and doping agents. Efforts to limit the supply are central to prevention work. Here, legislation is the most important instrument with retail monopolies and import quotas, age limits for the serving of alcohol and in the retail trade, the customs service’s and police’s seizures, and active supervision work. Examples of evidence-based methods include the Kronoberg model to prevent peddling to adolescents, parental programmes such as the Örebro prevention programme and the responsible serving of alcohol according to the STAD model. Influencing norms and attitudes is another important factor in the drug prevention work. Informational endeavours and campaigns can contribute to reducing demand, but these efforts may be of even greater significance to maintaining a restrictive attitude among the public and creating understanding for the need of other types of prevention measures. Also in this area, legislation is an important instrument for regulating the marketing of alcohol and tobacco, for example. In 2008, a number of information and opinion-influencing efforts were carried out. Social factors such as the growth environment, family, school, working life and leisure time have a clear correlation to health and drug use. There are different methods and programmes in this area, including those to strengthen parents, reduce behavioural problems among children and adolescents, and to combat bullying. Although many of the methods are not directly aimed at alcohol and drug use, there are associations to prevention in that the risk that children and adolescents will use drugs can be reduced. Lastly, we discuss how individual factors can be influenced in the interests of prevention. Individuals with a sensation-seeking personality and children with extrovert behaviour run greater risk of beginning to use drugs. Children who grow up in families where the parents abuse drugs also have an elevated risk. Today, there are many programmes to address various kinds of behavioural problems, but there is little research on the potential significance of these programmes to later drug habits.
During 2008, the organisation of alcohol and drug prevention efforts was improved, the level of knowledge among prevention practitioners was raised, and local and regional activity increased. For the prevention field to continue to develop, continued investments in research and method development are needed, and work must continue to be coordinated through national, regional and local functions.
updated Wednesday, September 30, 2009
