Alkohol, andre rusmidler og vold i epidemiologisk perspektiv

Abstract

SAMMENDRAGDen medisinske interessen for vold og voldsskader har økt kraftig i løpet av de siste to tiårene. Det epidemiologiskeperspektivet på vold har blitt forsterket og et mer etiologisk og preventivt syn på volden er mere merkbarinnenfor sosialmedisinsk forskning. Alkoholen er en etiologisk faktor som har vist seg å være forbundet med voldi de aller fleste samfunn. I denne artikkelen beskrives de viktigste epidemiologiske metodene og funnene i studietav alkoholens sammenheng med vold. Denne sammenhengen har vist seg ikke å være direkte, men er avhengig aven rekke andre faktorer, og noen forskjellige typer av kausal avhengighet beskrives i artikkelen. Den epidemiologiskeforskningen om andre rusmidlers sammenheng med vold er betydelig mindre omfattende enn den er foralkohol. Det er også åpenbart at andre rusmidler ikke er like sterkt sammenknyttet med vold som alkoholen.Pernanen K. Alcohol, other drugs, and violence in an epidemiological perspective.Nor J Epidemiol ENGLISH SUMMARYThe public health approach to violence has become increasingly accepted during the last couple of decades. Thishas led to more epidemiological research into violence, and a stronger medical interest in the etiology and preventionof violence. However, epidemiological research on the prevalence of violence in different societies is stillmainly criminological in nature, being based on information about violence that has come to the attention of thepolice or processed in the courts. The study of the relationship between alcohol use and violent behaviour is alsopredominantly based on police and court materials, although an increasing number of emergency room andhospitalization studies have examined the role of alcohol in injuries caused by violence.There are two basic methodological approaches in the study of the relationship between alcohol use andviolence. The alcohol-involvement studies estimate the extent to which drinking by the offender or the victim waspresent in episodes of violence. Time trend studies and so-called natural experiments measure how rates of violentcrime covary with levels of alcohol consumption in a population. Generally, these studies indicate that alcohol useis a potent factor in determining the prevalence of violent behaviour in a society. However, there is no evidenceshowing that a significant part of alcohol-related violence is directly caused by the presence of alcohol in theorganism. Four types of conditional factors affecting the risk of violent behaviour after drinking are discussed: (1)the nature of the alcohol factor, (2) characteristics of the individual drinker, (3) the socio-cultural context in whichdrinking occurs, and (4) situational factors.The epidemiological evidence for a relationship between violence and the use of other drugs is much morescattered. It is complicated by the fact that most drug users use more than one type of drug. When an illegalpsychoactive drug is implicated in violent behaviour, it is often also accompanied by alcohol use. Clinical andexperimental evidence shows that the risk of aggression and physical violence depends, in addition to the type ofdrug, on the amounts used, the method of application, the phase of acute intoxication, and the long-term pattern ofuse. However, the violence associated with the use of illegal drugs is perhaps most closely determined by thecharacteristics of an illegal economy. Rival criminal organizations manufacture, distribute and sell these drugs,and they use violence and threats as a means of regulating this economy. In addition, many drug users resort toviolent crime in an effort to secure the funds needed for their addiction.1996; 6 (1): 29-36.