Kettil Bruun is more relevant than ever

Kettil Bruun is best known for the total consumption model introduced in 1975 in the collective work “Alcohol control policy in public health perspective”. There were three tracks in particular that led Bruun's research towards the total consumption model: research on the distribution of power, research on international drug policies, and his contributions to criminology and social policy. Kettil Bruun’s lifework shows that the innovation, intersectionality, and synergy which are now rehearsed in pompous research strategies were a non-question 40 years ago. These aspects were a natural part of the scientific pursuit of answers. Maybe in a much more modest and homemade form, but all the more import in terms of applicability at the general level of principle.

The total volume of gambling and the prevalence of gambling problems

The total consumption model (TCM) implies that only a small fraction of gamblers account for a very large fraction of all gambling activities and of all gambling expenditures. This does not necessarily mean that every gambler with high gambling expenses has problems, but the probability increases with increasing intensity. Ironically, heavy gamblers are influenced by the activities of those who participate only moderately: the more people take up gambling, the more likely vulnerable individuals will be recruited as well. The importance of total volume of gambling in society is reinforced by the fact that the accumulated harm caused by low-risk gamblers in fact exceeds the harm caused by excessive gambling. Although adaptation theory suggests that harmful consequences recede once the novelty of innovation subsides, every increase in consumption increases the risk of harm.

The total consumption model applied to gambling: Empirical validity and implications for gambling policy

Aim: The total consumption model (TCM) originates from studies of the distribution of alcohol consumption and posits that there is a strong association between the total consumption and the prevalence of excessive/harmful consumption in a population. The policy implication of the TCM is that policy measures which effectively lead to a reduction of the total consumption, will most likely also reduce the extent of harmful consumption and related harms. Problem gambling constitutes a public health issue and more insight into problem gambling at the societal level and a better understanding of how public policies may impact on the harm level, are strongly needed. The aim of this study was to review the literature pertaining to empirical validity of the TCM with regard to gambling behaviour and problem gambling and, on the basis of the literature review, to discuss the policy implications of the TCM. Methods: The study is based on a literature mapping through systematic searches in literature databases, and forward and backward reference searches. Results: The literature searches identified a total of 12 empirical studies that examined the total consumption model or provided relevant data. All but one of these studies found empirical support for the TCM; that is, a positive association between population gambling mean and prevalence of excessive or problem gambling. Such associations were found both with cross-sectional data and with longitudinal data. Conclusion: There is a small but fairly consistent literature lending empirical support to the total consumption model. An important policy implication is that interventions which are successful in reducing overall gambling are likely also to reduce problem gambling incidence.

The controversial discourse on beer in Iceland

Aims This study investigates the motives and discourses around the decision taken by the Icelandic parliament in 1989 to legalise beer sales after a prohibition of 74 years. A bill was passed in 1988 that allowed the selling of beer in licensed restaurants and the state alcohol monopoly stores. Design The sources used for this study are mainly newspaper articles and other materials and reports published in the period 1980 to 1989. Results The passing of the bill was preceded by many controversial discourses in Iceland. Lobbying groups with commercial interests campaigned for the legalisation of beer, while representatives of the alcoholism movement took no formal stance on the issue, parliamentarians broke from party lines and medical doctors were split into two factions. Common questions included the plausibility of the total consumption model, various understandings of WHO recommendations, diverging interpretations of other countries’ experiences of beer, and different views on how beer would affect individuals suffering from alcoholism. Conclusions The changes in Icelandic alcohol policy to legalise beer were in keeping with contemporary societal processes of globalisation and modernisation, but public health arguments were given less priority. While the decision to legalise beer increased the commercial functions of the state alcohol monopoly, it also strengthened the monopoly's role as an actor in alcohol policy.

Alkohol och äldre

M. Ramstedt: Alcohol use and related harms among older people in Sweden – not a marginal issue anymore There has been an increasing interest in drinking among older people in Sweden in recent years as today's older people drink more than previous generations and also constitute a larger part of the population. This paper examines survey data on drinking habits in combination with register data on alcohol-related harms to obtain a clearer picture of the importance of alcohol among older people in Sweden today. A clear majority older people in Sweden drink alcohol at least on a monthly basis; in 2007, the differences when compared to younger age groups were quite small. Still, as regards levels of drinking and frequency of binge drinking, older people drank less than younger age groups. In contrast to younger age groups who reported less drinking between 2002 and 2007, older age groups tended to have stable or increasing consumption. In addition, alcohol-related mortality and hospitalisation as well as drink-driving, have increased among older people in recent years but not among younger groups. Cohort effects and media reports of the beneficial effects of alcohol are brought up as plausible explanations for the results. Implications for the total consumption model and the theory of collectivity of drinking culture are also discussed.