Published in Swedish in CAN 100 År: 1901-2001, jubilee number of Alkohol och Narkotika 95(6):139-142, 2001.

Sweden in an international perspective: alcohol policy and drinking habits

Robin Room

Centre for Social Research on Alcohol and Drugs, Stockholm University

Sweden’s period of greatest influence internationally in alcohol policy was probably around 1900, in the days prior to the comprehensive Bratt system, including individual ration-cards, of 1917-1955. In the late 19^th century, there was much attention in the English-speaking world (e.g., Gould, 1893) and elsewhere (for Russia, see McKee, 1997), as well as in other Nordic countries, to the “Gothenburg system”, originally a system of municipal ownership of taverns, and eventually also of off-premise retail shops. The first such system had actually been set up in Falun in 1850, but it was its implementation in the larger city of Gothenburg which caught international attention.

In the late 1890s and early 1900s, the Gothenburg system of government ownership of alcohol sales outlets became in many places the major competitor to prohibition as the solution to the “liquor question”. By and large, it was the solution of the moderate “wets” in the policy debate, and as in Sweden it was detested by supporters of prohibition. Prohibition won out in the short run in the United States and Canada, as well as in Russia and several Nordic countries. But when prohibition was dismantled, as early as 1919 in Quebec, in the 1920s in most of the rest of Canada, and in the United States in 1933, government ownership of off-sales stores became the pattern in all the Canadian provinces and eventually in 18 of the U.S. states. Enterprises patterned on the Gothenburg system could also be found by 1920 in Britain, Australia, and the British colonies in southern Africa (Room, 1993).

A second period of considerable Nordic influence on thinking about alcohol policy internationally has been in the last 25 years. The influence has come from Finland and Norway, as well as Sweden. One aspect of this contribution has been the term “alcohol policy” itself, which seems to have come into English from Nordic usage (Room, 1999). Beyond this, Nordic social and epidemiological research has been prominent in putting forward and providing research support for what is called in Sweden the “total consumption model”, discussed elsewhere in this issue. It was a Swedish initiative, also, which was responsible for the first, eventually short-circuited, effort in 1983 by the World Health Organization to analyze the issue of the effects of the alcohol trade on public health (McBride and Mosher, 1985).

These days, Sweden is playing an important role internationally in putting alcohol policy onto the public health agenda. This initiative was symbolized by a policy meeting on young people and alcohol hosted by the Swedish government in Stockholm in February 2001. (http://www.youngalcohol.who.dk/home.htm) This was a WHO-EURO health minister’s meeting on the European Alcohol Action Plan, including all European countries and the Asian countries formerly part of the Soviet Union. At the same time, it was also a ministerial meeting of the European Union during the term of the Swedish presidency. In the wake of the meeting, the first EU declaration with a public health orientation to alcohol policy was adopted. (http://eu2001.se/eu2001/news/news_read.asp?iInformationID=15578)

In an international perspective, Swedish concerns about alcohol policy take some particular forms. Public health is the common rubric for dealing with alcohol policy internationally, but in Sweden the societal concerns about the problems of drinking have primarily been oriented to matters of welfare, safety and order. This way of thinking about alcohol problems reflects the longstanding forms and habits of Swedish drinking customs. Swedish drinkers drink relatively infrequently, compared to other western Europeans. In a recent comparative study of adult general populations, for instance, Leifman (forthcoming) found that only 7% of Swedish men and 2% of Swedish women reported drinking as often as four times a week, while the corresponding figures for Germany were 18% and 7%, and for Italy 45% and 30%. While abstention is a minority phenomenon these days in Sweden (7% of men and 13% of women), fully 47% of Swedish men and 64% of Swedish women reported drinking less often than once a week.

On the other hand, when Swedes do drink, they are quite likely to drink at least five or six drinks at a time. Swedish men reported drinking the alcohol equivalent of a whole bottle of wine on 33% of their drinking occasions, and women on 18%. The corresponding figures for Germany were 14% and 7%, and for Italy 13% and 11%.

It is not that Swedish drinking habits have remained totally unchanged. Abstainers used to be more common -- as recently as 1965, they were 12% of men and 28% of women. Also, distilled spirits no longer predominate as the type of alcoholic beverage Swedes drink: by the mid-1990s, beer had become the dominant beverage type (Leifman, 2001). Drinking in restaurants and taverns has been increasing, though it still accounts for only about 20% of total consumption. But the pattern of relatively infrequent drinking (by European standards), but of intoxication being a frequent result of drinking, has long been characteristic of Swedish drinking patterns.

In the European spectrum of drinking habits, Sweden is thus near one end of a continuum. But it should be recognized that in a wider global perspective, Swedish drinking practices are often more in the middle of the range (except that there are many more abstainers in much of the developing world). In Sweden, 28% of the men who drink as often as weekly drink the alcohol equivalent of a bottle of wine on at least one occasion in the week. In both Germany and Italy, the corresponding figure is 15% (Leifman, forthcoming). But in Mexico, the corresponding figure is about 50%, and in Nigeria, according to one study, 69% (Room et al., forthcoming). The pattern of drinking on weekends rather than daily, but of often drinking to intoxication, is even more marked in many places in the developing world than it is in Sweden.

The Swedish alcohol policy system has developed over many years in response to the specific characteristics of Swedish drinking customs. There is much to be learned internationally from the Swedish experience, given the strong Swedish tradition of experimental and evaluative studies on alcohol policies. But these comparisons suggest that it is in the developing world, more than in the rest of western Europe, that the greatest potential may exist for application of Swedish policy perspectives and experience.

REFERENCES

Gould, E.R.L. (1893) The Gothenburg System in America, Atlantic Monthly 72:538-545. Web: http://cdl.library.cornell.edu/cgi-bin/moa/moa-cgi?notisid=ABK2934-0072-83

Leifman, Håkan (2001) Homogenisation in alcohol consumption in the European Union, Nordic Studies on Alcohol and Drugs 18 (English supplement): 15-30.

Leifman, Håkan (forthcoming) A comparative analysis of drinking habits in six EU countries in the year 2000, Contemporary Drug Problems.

McBride, Rob and Mosher, James F. (1985) Public health implications of the international alcohol industry: issues raised by a World Health Organization project, British Journal of Addiction 80:141-147.

McKee, William A. (1997) Taming the Green Serpent: Alcoholism, Autocracy and Russian Society, 1881-1914. PhD dissertation, history, University of California, Berkeley.

Room, Robin (1993) The evolution of alcohol monopolies and their relevance for public health, Contemporary Drug Problems 20:169-187.

Room, Robin (1999) The idea of alcohol policy, Nordic Studies on Alcohol and Drugs 16 (English supplement): 7-20.

Room, Robin, Jernigan, David, Carlini-Marlatt, Beatriz, Gureje, Oye, Mäkela, Klaus, Marshall, Mac, Medina-Mora, Maria Elena, Monteiro, Maristela, Parry, Charles, Partanen, Juha, Riley, Leanne and Saxena, Shekhar (forthcoming) Alcohol in Developing Societies: A Public Health Approach. Helsinki: Finnish Foundation for Alcohol Studies.

Author’s note: the percentages in the text are taken or recalculated from Tables 2, 9 and 11 of Leifman, forthcoming and Table 5.5 of Room et al., forthcoming.