STAD – Stockholm Prevents Alcohol and Drug Problems Stockholm County Council and Karolinska Institutet (Stockholm förebygger alkohol- och drogproblem)

Alcohol sales in Sweden (litres of pure alcohol per inh. 15+)

Alcohol consumption (sales) divided by type of beverage

Alcohol consumption (sales) divided by ’purchase source’

Distribution of alcohol consumption in different percentiles 2004, 2007, 2008 och 2009 among men.

Distribution of alcohol consumption in different percentiles 2004, 2007, 2008 och 2009 among men

Self-reported alcohol consumption in different age groups in the years 2004/05, 2006/07 and 2008/09, among men

Self-reported alcohol consumption in different age groups in the years 2004/05, 2006/07 and 2008/09, among women

Self-reported consumption among boys and girls grade nine (age 15-16)

Binge drinking among women, based on monthly survey data (Monitor project)

Binge drinking among men, based on monthly survey data (Monitor project)

Used cannabis among year olds (Source: Eurobarometer, Young people and drugs, 2004) Ever usedPast month EU-15 SwedenEU-15 Sweden % 17 %11 % 4 % % 14 %11 % 3 %

Culture acceptance More culturally accepted -- Yes and no More integrated in everyday life - wine, beer Still restrictive attitudes – more positive towards high taxation and keeping the retail monopoly More people abstain altogether from alcohol

Prop (%) women and men who agree completely or largely that wine should be sold in grocery stores, year 2002 and

Alcohol policy On many levels, and today more than before on local level Have a written national alcohol policy – strategy, so also most municipalities Still – low physical and econ. availability – corner pillars in the alc. policy – number of outlets, age limits, taxation, opening hours, One major reason – affecting young people

Alcohol policy Recent years – focus more on local level and on other ’new’ methods to compensate for the weakening of most important national alc. policy measures (i.a. due to closer European integration – cross border shopping, abolishment of all monopolies except on the retail side) Local – regional organisation and coordination built up and resources spent on strengthening and developing methods, especially young people

Alcohol policy Local level: -Limit availability incl. social availability constraints (drinking context) - surveillance, enforcement, RBS -Illegal alcohol – ‘Kronoberg method’ -Parental/family programs – strengthening parenthood – some prg. focusing on alcohol – clear rules, caring parents etc. -Students at high school and particularly univ. – RBS, brief intervention (Student health care org.) -Some focus on schools and prg (but not explicit alc.)

During the intervention period (July 1998-July 2000), reported violent crimes during night time (between hours) were reduced by 29 per cent in the intervention area compared to the trends in the control area (Wallin, et al., 2003)

Alcohol policy Local level: -More focus on mothers (parents) to be – in prenatal care – AUDIT, brief intervention -In new strategy as from 2011 – much focus on new born and children brought up in dysfunctional families, incl. alcohol and drug abuse: how to reach these children, cooperation between different actors – school, social services, health care, police etc.

Eval. alcohol policy -Main pillars in the alcohol policy – strong scientific support, but the emphasise on local level – no ‘real’ evaluation, but follow-ups. We don’t know why young people drink less – does the local prevention and the increase in prev. matters? We must know better. Therefore in the new strategy on alcohol, drugs, doping and tobacco (ANDT):

Swedish national strategy for alcohol, narcotics, doping and tobacco (ANDT) from Overall goal – a drug and doping free society, less harm from alc. and tobacco - Seven long-term goals (L-T G) targets – (1) lower availability, (2) protecting children (incl. unborn, new born child), (3) lower levels among young people (age on onset etc), (4) reduced risk cons., harmful use, dependence, (5) increased avail. to treatment, (6) reduced harm rates - morbidity and mortality, (7) Sweden – active work internationally - Within each LT, several prioritised (policy) goals (PG) – If possible, develop measurable indicators ( but difficult, e.g. indicator/s on ‘more effective crime prevention concerning illegal alcohol’, ‘more coordinated and effective supervision of on-premise sales and sales at grocery stores’ For each level and goal – indicators should be suggested.

Structure for the ANDT-strategy L-T G 1 L-T G 2 L-T G 3 L-T G 4 L-T G 5 L-T G 6 L-T G 7 Overall goal: a drug and doping free society and reduced medical and social harm from alcohol and tobacco use P G 1 P G2 P G 3 P G 4 etc P G 1 P G2 P G 3 P G 4 etc P G 1 P G2 P G 3 P G 4 etc P G 1 P G2 P G 3 P G 4 etc P G 1 P G2 P G 3 P G 4 etc P G 1 P G2 P G 3 P G 4 etc P G 1 P G2 P G 3 P G 4 etc

Suggest measurable indicators – long term (goals) (outcomes: behaviour change – risk cons., heavy use, harm reduce etc.) and prioritised goals (policy, activities, processes) Not only give definition – but the whole chain from def. to concrete analyses: what data, which scale, how to analyse Core indicators: most important to follow – some should also be plugged into local studies (surveys) – bridge between national main surveys and local surveys Expanded indicators – complementing core indicators – focus on more detailed diff. aspects of the core indicators Additional/developmental indicators: open up new areas, need development before ready as indicators – cannot be used today Also – suggest a follow-up system, including who should and what should be collected and how the new “guidelines” of indicators and monitoring should be disseminated on national and to the local level Indicators – what should be done

Indicators – Why this? (1) Increases the possibilities to understand/explain changes and (2) a driving force for more systematic work. Since local level important – also indicators on local level, when applicable Policy/activities Consumption/ harm National level: Regional/ local level: Policy/activities Consumption/ harm