Drinking Less But Greater Harm

Could Polarized Drinking Habits Explain the Divergence Between Alcohol Consumption and Harms Among Youth?

Mats Hallgren; Håkan Leifman; Sven Andréasson


Alcohol Alcohol. 2012;47(5):581-590. 

In This Article

Abstract and Introduction


Aims: This paper describes changes in alcohol consumption among Swedish youth over the past decade with the aim of exploring the polarization hypothesis, which asserts that while a majority of young drinkers have reduced their alcohol consumption, a subgroup have increased their drinking substantially, resulting in greater harm.
Methods: We analysed repeated cross-sectional self-report data from 45,841 15–16-year olds and 40,889 18–19-year-old high-school students living in the Stockholm municipality between 2000 and 2010. The questionnaire assessed alcohol and drug use, and risk factors for alcohol misuse. Changes over time at different levels of consumption are presented by age and gender.
Results: We find evidence of a polarization effect in youth drinking, with consumption reducing significantly over the past 10 years among all young people, except the heaviest drinkers, where consumption and binge drinking tended to increase. The dispersion in per capita consumption also increased over time, indicating more heavy drinkers. The total number of risk factors for alcohol misuse decreased among most survey participants from 2000 to 2010, but with variability between years.
Conclusion: Polarized drinking habits are a likely explanation for the recent divergence between per capita alcohol consumption, which has decreased, and alcohol-related hospitalizations, which have increased sharply among Swedish youth in recent years. We suggest that ongoing social changes could be affecting young people in the form of greater disparities, which are associated with a higher incidence of social problems generally, including heavy drinking.


Alcohol consumption is strongly associated with the three main causes of death and injury among Western youth; namely violence, suicide and motor vehicle accidents (Cohen and Potter, 1999). There is also a positive association between per capita consumption and alcohol-related harm, both in adults and younger populations (Norström and Ramstedt, 2005). Consequently, researchers and policy-makers focus considerable attention on yearly changes in per capita consumption. In Sweden, consumption among youth aged 15–16 years reached a peak in 2000 before reducing steadily until 2010 (CAN, 2010). These reductions contrast with sharp increases in hospitalizations due to alcohol intoxication over the same period. For example, between 2000 and 2010, the number of hospital admissions in Stockholm due to alcohol intoxication or poisoning increased by 89% among 15–16-year olds and by 182% among 18–19-year olds—changes that occurred during population increases of only 15 and 33%, respectively (Ahacic and Thakker, 2010; Valdatabasen, 2011) (Fig. 1). Increases were also observed nationally during this period (CAN, 2010). A similar divergence between consumption and alcohol-related harm has recently been reported in the UK (Meier, 2010) and Australia (Livingston et al., 2008), which raises important questions about the relationship between per capita consumption, heavy drinking and alcohol-related problems.

Figure 1.

Alcohol-related hospital admissions and per capita alcohol consumption for youths aged 15–16 and 18–19 years living in Stockholm. Hospital admissions are based on 'acute intoxication' (ICD-10 code F10.0) and 'alcohol poisoning' (ICD-10 code T51) as the main diagnoses. The figure shows a sharp increase in youth hospital admissions in Stockholm for acute alcohol intoxication and poisoning, while per capita alcohol consumption reduced slightly over the same 10-year period.

On a population basis, reductions in per capita consumption are associated with less heavy episodic drinking and fewer alcohol-related harmful effects (Duffy, 1986; Rose and Day, 1990), and this relationship underpins many prevention strategies currently implemented around the world. Swedish alcohol policies, for example, aim to reduce per capita consumption through tight controls over the availability of alcohol, an approach heavily influenced by Ole-Jörgen Skog's theory of the collectivity of drinking, which asserts that reductions in yearly consumption influence all levels of drinking concurrently, including heavy consumption (Skog, 1985). Over the past 10 years in Sweden, however, the opposite trend has occurred among youth, with per capita consumption decreasing, while alcohol-related hospitalizations have risen. These changes have emerged in the context of large increases in the number of young people who abstain from alcohol completely, a scenario that does not conform to Skog's theory.

One possible explanation for this divergence is that a subgroup of young people are drinking more alcohol than their peers over time, or in ways that are causing more alcohol-related problems. This has been termed a 'polarization effect', where some young people, possibly with an accumulation of risk factors for alcohol misuse, have increased their drinking over a specified period, while the majority have reduced their consumption. However, whether or not such a polarization exists remains unclear. To our knowledge, this is the first paper to test the polarization hypothesis empirically. We achieve this by examining changes at different levels of self-reported alcohol consumption among Stockholm youth aged 15–19 years between 2000 and 2010. We also explore one possible explanation for the polarization effect; namely that emerging social and health inequalities could be increasing the number of risk factors for alcohol misuse among heavy drinkers over time, while the majority of young people drink less and are exposed to fewer risk factors.


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