Alcohol consumption, alcohol disorders and public health in Finland

the number of heavy consumers is estimated to be even 500 000 (6–12% of the adult population). This 10% of drinkers with the highest consumption account for almost half of the alcohol (over 40%) consumed in Finland. The percentage of alcohol consumers is greatest among young adults and middle-aged people.

About 10% of adults of both sexes are abstainers. Men tend to use alcohol more often and to consume more drinks on one occasion than women. Most young people start to experiment with drinking between the ages of 12 and 16 years, with only one-fifth of 16-year-olds not using alcohol at all (Nylander et al., 2007).

In Finland, alcohol consumption was well below the mean in other European countries up to the 1960s. After new alcohol legislation in 1969, allowing among other things the sale of medium strong beer (class III) in grocery stores,

consumption in Finland more than doubled in ten years. Thereafter there was a more or less steady increase during the upswing in the economy in the1980s, and this has continued since the end of 1990s after a temporary decrease. The latest rapid increase in consumption and adverse effects of the increase were seen after the lowering of taxes on alcoholic beverages at the beginning of 2004. Connected to this, the quotas on tax-free imports of alcohol from other EU countries to Finland were abolished, and nearby Estonia with very low retail prices on alcohol joined the EU, enabling cheap and rather unrestricted importing of alcohol. In 2006 the real retail prices (adjusted for inflation) in Finland were still 20% lower than in 2003 (Nylander et al., 2007).

In 2006 the total alcohol consumption of an average adult was 10.6 litres of 100% alcohol. Again, the total consumption has more than doubled over the past three decades, since the first boom in the 1970s. This has brought Finland to the medium level of alcohol consumption among other European countries.

Compared with them, binge drinking (heavy intoxication) continues to be more common in Finland. One man in four reported drinking at least six units of alcohol on one occasion weekly, and one woman in eight at least four units on one occasion weekly. One man in six, but only one woman in twenty, reported being heavily intoxicated at least once a month during the previous year (Mäkelä, 2003; Nylander et al., 2007). The prevalence of hazardous, heavy drinking possibly preceding abuse or dependence at least in some cases was 5.8% in a Finnish study, being more prevalent among middle-aged, divorced, and unemployed males (Halme et al., 2008). The authors thought that this very probably is an underestimation.

In an annual postal survey follow-up carried out by the National Public Health Institute (KTL) between 1978 and 2006 among working-age citizens in Finland, the trends in chronic disease-related health behaviours were mainly positive concerning smoking, food habits and leisure time activities (Helakorpi et al., 2007). However, overweight had become more prevalent, and the consumption of alcohol had steadily increased. The difference in consumption between educational groups had disappeared among men, but highly-educated women

were drinking slightly more than those with a lower educational level (Helakorpi et al., 2007).

Mortality rates among heavy drinkers and alcoholics are claimed to have increased at least two-fold, or even up to eight-fold compared with the general population. On the other hand, the number of deaths related to alcohol has generally been underestimated in the statistics (Saarnio and Mäkelä, 1997).

The number of alcohol-related deaths was estimated to be 3050 in 2006, and there has been an increase of over 20% in the seven years since 1999, and an especially rapid growth since 2004. The increase was exclusively due to alcohol-related diseases or alcohol poisonings, since the number of fatal accidents, or violence with alcohol involved, had not changed. Alcohol-related causes were the most common cause of death among working-age (15–64 years) males and females in Finland in 2006. In addition, using a broader definition alcohol was a contributory cause of death in 1600 more cases (Nylander et al., 2007).

Inpatient wards registered over 36 000 periods of care with an alcohol-related disease as a primary or secondary diagnosis in 2006. Traditionally, a strong link has existed between alcohol use and violent offences in Finland. In recent years, 70–80% of the fatal violent offences and assaults have been committed under the influence of alcohol. In 2006 over 31 000 violent offices were recorded by the police in Finland. Almost 26 000 cases of drunk driving were detected by the police, and alcohol was involved in one in four fatal road traffic accidents (Nylander et al., 2007).

It was estimated that in 2005 Finnish society paid almost one million euros in direct costs, and between three and six billion in indirect costs as a result of alcohol use. A third of the direct costs were caused by public disturbances.

Health care accounted for a quarter, and social services for a one-fifth of the direct costs (Nylander et al., 2007). Reducing the level of alcohol consumption and preventing related harms has been the main objective of Finnish alcohol policy also in recent years. This seems reasonable considering the costs and the diverse negative effects of alcohol on the health of the Finnish population,

specifically of the heaviest drinkers. Still, less than half of the municipalities have an alcohol and drug strategy of detoxification or other treatments. Only half of the municipalities in Finland can offer immediate access to a detoxification program, and in one in ten municipalities there is no available detoxification treatment at all (Nylander et al., 2007).