Introduction: Social consequences of alcohol — the forgotten dimension?

Health consequences of long-term drinking along with issues of drinking and driving have dominated public discussion on alcohol-related problems. Such social consequences as non-traffic injuries, spouse/family problems, stranger violence, and suicide or attempted suicide have received much less public or research attention. Recent instances of this selective perspective are the report prepared for the Australian Commonwealth Department of Health and Aged Care [1] and the 10th Special Report to the United States Congress on ‘Alcohol and Health’ [2]. Though the emphasis of the latter report is largely on aspects of neuroscience and biology, including genetics, and on medical consequences, it includes sections on ‘Alcohol and Violence’, ‘Psychosocial Factors’ and ‘Alcohol-Impaired Driving’, in recognition of the relevance of non-medical consequences of alcohol consumption. This may be indicative of a growing interest in a broader concept of alcohol-related consequences, including harm-reduction as a concern of drug/alcohol policy and research [3]. An example of the increasing recognition of alcohol as an agent of social problems is the release by the British Home Office in August 2000 of an action plan entitled Tackling alcohol related crime, disorder and nuisance [4]. The scientific community also has been devoting increased attention to the relationship between patterns of consumption and social consequences. Two combined factors are associated with harmful social consequences of drinking: the volume of alcohol consumed, and the frequency of heavy-drinking events. Conferences held in 1995 in Toronto (International Conference on Social and Health Effects of Drinking Patterns) and a follow-up meeting in 1998 in Perth, Australia, have shed more light on these hitherto unexplored issues and highlighted the need to collect more data and improve methods of assessing alcohol-related social outcomes (see a selection of articles and summaries in Addiction 11, 1996, the thematic issue of Contemporary Drug Problems 3, 1996, and [5, 6]). This leads us to the focus of this book.