The aim of this study was to determine if spirits consumption is more harmful than consuming milder beverage types in Sweden, using monthly survey data for the period 2005-2009. Logistic regression modeling was performed to estimate the association between different beverages and harmful drinking, controlling for gender, age, and socioeconomic factors. There was no support for the idea that spirits consumption is characterized by more harmful drinking patterns and consuming strong beer, in particular, was a better predictor of heavy drinking and harm. It also appeared that people who include spirits, strong beer, and cider/alcopops in their consumption pattern more often had harmful drinking patterns and experiences of alcohol-related problems. The present findings suggest that strong beer is the most problematic alcoholic beverage in Sweden, but also that patterns combining several beverage types are also good measures of harmful drinking, particularly patterns including strong beer, cider/alcopops, and spirits.
KEY WORDS: Beverage-specific consumption, alcohol-related problems, alcohol survey, Sweden.
Several alcohol policy measures in Sweden, such as taxation and restrictions in availability and advertisements, start out from the idea that spirits is more harmful than milder alcoholic beverages. Consequently, availability and taxation have generally been stricter for spirits, and the recent removal of the ban of alcohol advertisements in 2003 did not apply to spirits. Moreover, norms in the general population suggest that spirits is regarded as more harmful than lighter beverage types, and public opinion is significantly more in favor of increasing the availability of wine and beer than of spirits (Leifman, 2000).
The main aim of the present article is to determine whether there is any evidence for the idea that spirits consumption is more harmful than consuming milder beverage types in Sweden. As a measure of harmfulness, we apply the likelihood that a given amount of consumption is associated with both harmful drinking patterns (e.g., binge drinking and risk drinking) and actual experiences of alcohol-related harm. Differences in harmfulness by alcoholic beverage type could either result from the characteristics of those drinking the beverage or differences in the beverages (Mäkelä, Mustonen, & Österberg, 2007). In addition, if a beverage is preferred by people with a heavy drinking orientation, like younger men, it is more likely that a given amount of drinking will cause trouble than if a beverage is preferred by elderly women. However, differences in taste and the alcohol content of alcoholic beverages are examples of beverage characteristics, per se, that could influence the likelihood of drinking being harmful. For instance, strong and sweet beverages may more easily lead to intoxication and therefore to a higher risk of harm.
As to spirits, it is not theoretically unlikely that the high alcohol content attracts people with a heavy drinking orientation, e.g. by offering a quick way to intoxication. Furthermore, the notion that spirits is less suitable to consume with a meal may also imply that drinking in general becomes more oriented towards intoxication. In fact, some research suggests that alcohol poisoning is more likely to occur with spirits than with milder beverage types (Poikolainen, Leppänen, & Vuori, 2002).
There is some earlier empirical evidence that sprits consumption actually has been more closely related to alcohol-related harm in Sweden during the postwar period. Beverage-specific time-series analyses based on data for 1950-2000 showed that spirits consumption, but not consuming wine and beer, was associated with mortality outcomes such as homicide (Rossow, 2001), suicide (Norström & Rossow, 1999) and liver cirrhosis (Stokkeland, Brandt, Ekbom, Osby, & Hultcrantz, 2006). Recent analyses by Landberg (this issue) seem to support this conclusion.
According to more recent analyses based on individual-level data, however, it is not clear that spirits is more strongly linked to harmful drinking than are milder alcoholic beverages. …