Apart from an American beer commercial of several years ago that featured bikini-clad Swedish women, alcohol and Sweden are not commonly linked in thought. In fact, one of the authors of a study in the July issue of Alcoholism: Clinical & Experimental Research called Sweden a country "where the alcohol policies are known to be strict." Despite that, the study also found that alcohol’s role in all unnatural deaths to be what that same author called "astonishingly high."
"It is obvious that alcohol is a very important factor in causing an incident to happen," explained Anders Eriksson, professor of forensic medicine at Sweden’s Umeå University and senior author of the study, "determining the outcome of an incident, and determining the outcome of an injury after an incident. Of course, not all incidents have the same degree of alcohol-inebriated persons involved, but the outcome of an incident can be expected to be much more serious if the person involved is under the influence of alcohol."
The consequences of alcohol use and abuse can include social problems, disease and death. Most people think of traffic accidents when they think of alcohol-related deaths, yet alcohol is involved in a surprising number of other kinds of deaths. This study distinguished between ‘unnatural’ deaths (deaths other than those caused by disease) that are intentional in nature, such as suicides and homicides, and those that are unintentional (or accidental), such as traffic crashes, falls, fires, and drownings. Indeed, the study found that the most common types of unnatural deaths, in order of association with alcohol, were suicides, falls, traffic injuries, asphyxia, intoxication, and homicides. Furthermore, the authors found that nearly 29 percent, and possibly as much as 44 percent, of all unnatural deaths were associated with alcohol.
"The sober person," said Eriksson, "does not take the same risks and, to some extent, can avoid dangers and risks, which decreases the risk of accidental incidents. Alcohol also blurs your mind, and it is well known that both self-destructive behavior and aggression toward other people is much higher under the influence of alcohol than during sobriety."
"This study makes it clear," said Anders Romelsjö, a physician with Sweden’s Center for Alcohol and Drug Prevention, "that the risk of unnatural death, and injury, is high after alcohol use. There’s a real need to be careful. Secondly, people have a responsibility to act and interact in situations where other people drink a lot, not least if they are going to use a car afterwards."
Romelsjö also noted that this study has several policy implications. "Binge drinking," he said, "is particularly problematic. This takes place not least in restaurants and bars. It is not uncommon, according to several studies, that intoxicated persons, or those who have already ordered alcohol several times, are served anew." Romelsjö had two recommendations: mandatory server training and random breath testing.
"According to other studies," he said, "server training can lead to reduced overserving of intoxicated patrons. In Oregon, for example, where server training has become mandatory, a significant decrease in traffic deaths has been reported." A study in New South Wales in Australia, he added, "has shown that an increase in random breath testing has led to a lasting decrease in the proportion of people driving with a positive blood alcohol level."
"People have likely not realized that alcohol is so important in causing both intentional and unintentional deaths," said Eriksson. "This study demonstrates that alcohol is a problem not only when it comes to drunk driving and traffic deaths, but in a significant number of all unnatural deaths. This means that you run a greater risk in almost all aspects when you are under the influence of alcohol."
Eriksson added that, although it is hard to compare different study methodologies and data, the same problem likely exists in other countries where alcohol is part of the culture. A recent Finnish study showed a relatively higher alcohol involvement (40 percent) in accidental and violent deaths. Studies from the United States have shown a range of alcohol involvement, between 34 and 53 percent, in trauma or all deaths.
"In general," said Eriksson, "these findings can probably be transposed to countries with a similar culture and alcohol policies." Although in the United States, he added, "the figures can most probably be expected to be higher than the ones we found in Sweden." Eriksson said this is because Sweden has stricter alcohol policies than the U.S., which is demonstrated by the much greater involvement of alcohol in fatal traffic crashes in the U.S. as compared to Sweden.
Eriksson is concerned about what may happen in Sweden up to, and following, the year 2004. "Sweden currently has strict alcohol policies. However, the alcohol policies of Sweden - as well as Denmark and Finland - are bound to adapt to those of the European Union before the year 2004," he explained. Lower taxes will lead to lower prices which would, in turn, likely lead to greater consumption. "Major changes in alcohol consumption are to be expected. Major changes in alcohol-related deaths can be supposed to take place in the new few years."
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Sjögren, H., Eriksson, A., & Ahlm, K. (2000, July). Role of alcohol in unnatural deaths: A study of all deaths in Sweden. Alcoholism: Clinical and Experimental Research, 24(7), 1050-1056.