Nordic Studies on Alcohol and Drugs

Adverse effects of alcohol on the fetus are currently defined as a serious public health problem in all western countries. Exposure of the fetus to alcohol may result in a spectrum of adverse effects, referred to collectively as fetal alcohol spectrum disorders (FASD). Different countries vary in terms of policy regarding alcohol consumption during pregnancy. This paper sets out to examine and compare official recommendations on alcohol intake during pregnancy in Finland and Denmark since the 1970s. In addition, the paper analyses the rationale behind these recommendations.

The method used is qualitative content analysis. The data consists of 1) health education material for pregnant women and 2) reports and guidelines produced by government health authorities. The data comes from Finland and Denmark and covers the period between the 1970's and today.

The article demonstrates how the official Finnish and Danish recommendations regarding alcohol intake during pregnancy have in the last decades fluctuated between a more permissive and a total abstinence approach. Both countries have recently adopted a total abstinence message. This policy line is not, however, based on research evidence pertaining to the harmfulness of a small-to-moderate alcohol intake during pregnancy but rather on the principle of precaution. The Finnish data contains very little information about the background of the changing recommendations whereas the Danish trajectories are explained in policy documents and expert debates. The paper suggests that the recent adoption of a total abstinence message in Finland and Denmark is closely linked to a change in the social and cultural climate regarding FASD. Moreover, it is argued that the adoption of the total abstinence model in Finland and Denmark is part of a wider international trend.

The knowledge gap with regards to the fetal effect of low-to-moderate levels of alcohol consumption combined with an urge to protect the fetus makes the formulation of health education messages complicated. The paper discusses problematic features in the current Finnish and Danish policy arguing that the recommendations to pregnant women contain contradictory elements. Future research should focus on women's and health professionals’ risk perceptions and international trends with regards to the total abstinence model.

Finnish treatment of drug abuse has during the last two decades shifted from a predominantly psychosocial approach to a more medical mode. This is especially evident in the rapid implementation of substitution treatments (STs). My aim is to show that labelling this development as ‘medicalisation’ or ‘rationalisation’ as a form of medical progress will not increase our understanding of the change.

I analysed texts from several periodicals with psychosocial, social policy and medical perspectives between 1997 and 2005. Four basic conceptual and argumentative underpinnings emerged which gave credence to the medical and rationalapproach, and the validity of these four elements was then investigated. I also collected all the texts on drug addiction and its treatment from two medical journals in 1965–1976 to examine the way in which drug addiction was conceptualised during this earlier phase.

The material shows that there are at least four reasons why medicalisation and rationalisation cannot explain the implementation of substitution treatments in Finland. First, progress in medical research on addiction did not make STs necessary. Second, the effectiveness of substitution treatments hinges on a particular kind of scientific rationality that cannot be equated with rationality per se. Third, it was not the 1990s and 2000s that drug addiction was coded as a medical problem for the first time. Fourth, it is difficult to include into the medicalisation theory how people actively want to be ‘medicalised’. Medical knowledge and technology open up new domains of knowledge with possible relations to practices of power and offer people new ways of self-understanding. How these different practices work is a question of empirical research. Both ‘rationalisation’ and ‘medicalisation’ are concepts often used in an inflationary way, and this may make them insensitive as analytical instruments.

This study aimed at describing the effects of missing data when surveying alcohol consumption using a Random Digit Dialling procedure.

Data was part of the Monitor project including repeated monthly data on the alcohol habits in the general Swedish population. Non-respondents during four months were followed up a year later and asked to do a shortened telephone interview and were compared to a concurrent sample of respondents (n=2552 versus n=6005). Further, using a second approach, the monthly levels of non-response was related to the level of measured alcohol use in a time series analysis (n=67500).

The results indicated no differences in the level of reported alcohol or tobacco use with except for a slightly higher proportion of alcohol abstainers in the sample of initial non-response. The time series showed no pattern of co-variation between the obtained non-response levels and the assessed levels of alcohol or tobacco use.

On the basis of the results it was meaningful to make a distinction between “soft” non-respondents (responding after extensive contacting effort) and “hard” non-respondents (not responding albeit extensive effort) and the results suggest that inclusion of the “soft” non-respondents does not by necessity lead to higher levels of assessed alcohol use.

Internet gambling has been associated with Increased risk of problem gambling. In this study different clusters of gambling activities and behavioral measures of gambling were used In analyses, which aimed at Investigating prevalence of problem gambling in Internet poker gamblers and In other gamblers.

The study consisted of secondary analyses of a Finnish population data set collected in 2007 (telephone survey, reaching 5,008 Finns aged 15 years and over). Bivariate statistics and logistic regression models were used in the analyses.

When only age and sex were added to logistic regressions, overseas Internet poker (IP) gamblers were almost three times more likely to be problem gamblers than other gamblers. However, when also behavioral measures of gambling were added to equations, no difference in problem gambling between IP and other gambling was found. In the slot machine (SM) cluster an opposite phenomena occurred: when behavioral variables were added to analyses, subjects in SM cluster were more likely to be problem gamblers than other gamblers. When IP and SM were compared in the same multivariate analysis, subjects in both of these gambling clusters were more likely to be problem gamblers than other gamblers.

The present study shows the importance of behavioral measures in gambling research. The level of involvement in gambling should be one of the primary interests in studies and interventions.