Harm to others from alcohol: the role of socio-cultural variables / Daño a otros por causa del alcohol: la contribución de las variables socioculturales / Dano a outros causado pelo álcool: o papel das variáveis socioculturais

This paper describes the changes in alcohol research, from a traditional individual focus on individual bodily and mental effects, to a broader focus on harm to others. This shift has coincided with broader sequential definitions of the progression from normal through harmful alcohol dependence, both in the specialized epidemiological and also in the newer classificatory systems (DSM 5 and CIE 11 draft). After presenting updated global, regional and chilean data, an international collaborative Project (Alcohol Harm to Others, ATOH) is described, with the participating institutions: the local study and the chilean components of the research team, the conceptual framework of harm to others (families, children, women; neighbors, friends, co-workers; society at large). Ethical aspects and institutional approval are presented and the principal results outlined: socio-demographic data (with special focus on the role of gender, socio-economic level and religiosity/spirituality). The data is presented for the chilean sample, with examples from other participating countries. The complexity of the link between alcohol harm to others and religious and spiritual factors is studied comparing data from several of the participating countries, and the impact upon vulnerable populations, especially women and children. The discussion reviews some of the confounding and intervening factors that could influence the results. The conclusion about prevention and policy development closes the paper.

Este artículo describe los cambios en investigación sobre el abuso de alcohol, desde un enfoque tradicional sobre los efectos corporales y mentales en el individuo, a un enfoque amplio sobre el daño a otros. Este cambio ha coincidido con definiciones secuenciales más amplias de la progresión desde el estado normal a la dependencia dañina al alcohol, ambas en la especialidad de la epidemiología y también en los nuevos sistemas de clasificación (DSM 5 y propuesta de CIE 11). Después de presentar datos actualizados globales, regionales y chilenos, se describe un proyecto internacional colaborativo (Daño a Otros por Causa del Alcohol, ATOH) con las instituciones participantes: el estudio local y los componentes chilenos del equipo de investigación, la estructura conceptual de daño a otros (familias, niños, mujeres; vecinos, amigos, compañeros de trabajo; la sociedad en general). Se presenta la aprobación institucional y aspectos éticos, así como se delinean los principales resultados: datos sociodemográficos (con enfoque especial en el rol de género, nivel socioeconómico y espiritualidad/religiosidad). Se presentan los datos de la muestra chilena, con ejemplos de otros países participantes. Se estudia la complejidad del vínculo entre el daño por alcohol a otros y factores religiosos y espirituales, comparando datos de varios de los países participantes, y el impacto sobre poblaciones vulnerables, especialmente mujeres y niños. La discusión revisa algunos de los factores de confusión y de intervención que podrían influenciar los resultados. Se cierra el artículo con conclusiones sobre prevención y desarrollo de normativas.

Este artigo descreve as alterações na pesquisa do álcool, a partir de um foco individual tradicional sobre os efeitos orgânicos e mentais individuais, para um foco mais amplo sobre danos a outros. Essa mudança coincidiu com mais amplas definições sequenciais da progressão do normal através de dependência de álcool prejudiciais, tanto na epidemiologia especializada como nos sistemas classificatórios mais recentes (DSM 5 e CIE 11 minuta). Depois de apresentar dados atualizados globais, regionais e chileno, um projeto internacional colaborativo (Alcohol Harm to Others, ATOH) é descrito, com as instituições participantes: o estudo local e os componentes chilenos da equipe de pesquisa, o quadro conceitual do dano a outrem ( famílias, crianças, mulheres, vizinhos, amigos, colegas de trabalho, e sociedade em geral). Aspectos éticos e aprovação institucional são apresentados e os principais resultados delineados: dados sócio-demográficos (com especial destaque para o papel do sexo, nível socioeconômico e espiritualidade / religiosidade). Os dados são apresentados para a amostra chilena, com exemplos de outros países participantes. A complexidade da relação entre efeitos nocivos do álcool para os outros e fatores religiosos e espirituais é estudada comparando os dados de vários dos países participantes, bem como o impacto sobre populações vulneráveis, especialmente mulheres e crianças. A discussão revê alguns dos fatores de confusão e intervenientes que poderiam influenciar os resultados. A conclusão sobre a prevenção e desenvolvimento de políticas define o papel.

Daño a niños y sus familias por el consumo de alcohol: resultados de una encuesta poblacional / Alcohol's impact on children and families: A population survey

Introducción Entre los adultos jóvenes el uso de alcohol es frecuente. Este consumo puede afectar negativamente a los menores que conviven con ellos, lo que constituye el objetivo de este estudio, que forma parte de un estudio colaborativo internacional financiado por Thai Health y la OMS. Sujetos y método Se describen los efectos negativos en niños, mediante un muestreo multietápico, aplicando una entrevista adaptada por los coinvestigadores a 1.500 chilenos de más de 18 años. Resultados Un total de 408 encuestados (27,2%) convivían con niños en el hogar. De ese total, el 10,5% estimó que el uso de alcohol de algún miembro de la familia había afectado negativamente a un niño. Los efectos más comunes fueron la violencia verbal (29,7%), presenciar violencia en el hogar (23,1%), ausencia de supervisión (18,7%), falta de dinero para proveer necesidades básicas (14,3%) y violencia física (7,7%). Casi en la mitad de los casos (46,3%) el bebedor era el padre o la madre, el padrastro/madrastra, o la pareja de la madre/padre, luego venían otros parientes (24,4%), un hermano/a del niño (4,9%) o un tutor del niño (2,4%). Conclusión Estos datos corroboran la observación clínica de que el consumo de alcohol es frecuente en los hogares. El consumo excesivo daña la salud física y mental no solo del bebedor sino también de quienes lo rodean. La violencia verbal y ser testigo de violencia grave en el hogar son frecuentes, así como los problemas económicos al no poder proveer sus necesidades básicas.

Introduction Alcohol is widely used among young families, and leisure time is frequently family time. Heavy alcohol consumption can adversely affect children. The objective of this work is to measure the harm to others in Chile. Subjects and method This descriptive and probabilistic study forms part of a collaborative research funded by Thai Health and WHO. The survey was adapted by co-researchers and applied to a nationally representative sample of 1500 Chileans over 18 years of age. Results A total of 408 respondents (27.2%) lived with children at home. Of this total, 10.5% felt that the use of alcohol by any member of the family had adversely affected a child. The most common adverse effects were verbal violence (29.7%), domestic violence (23.1%), unsupervised homes (18.7%), lack of money to provide basic needs of the child (14.3%), and physical violence (7.7%). Furthermore, in 6.6% of the cases child or family services agencies became involved. In almost half of the cases (46.3%), the drinker was the father, mother or step-parents. This was followed by other relatives (24.4%) and brothers (4.9%), or guardian of the child (2.4%). Conclusion These data support the clinical observation that alcohol is common in Chilean homes. Its consumption not only damages the physical and mental health of the drinker but also those around him. Verbal violence and witnessing serious physical violence are frequent issues, as well as economic problems that end up with the inability to provide the child with its basic needs.

Daño a terceros producido por el alcohol: resultados de un estudio poblacional en Chile / The harm to others from drinking: A population study

Background: Alcohol can harm both drinkers and their human environment. Most of research in Chile has focused on the drinker. This work focuses on the damage to others. Governmental expenditures due to drinking are estimated to quadruple the income earned through taxation. Aim: To report the results of a population survey conducted in Chile in 2013 to assess the harm done to others from drinking by a known or unknown drinker. Material and Methods: A household survey of a sample of 1500 subjects living in urban areas, predominantly over 50.000 inhabitants, was conducted by trained interviewers. Results: A significant number of respondents reported that the effect of alcohol consumption by third parties was somewhat (18.7%) or very negative (14.8%). The most frequent negative effects were verbal abuse (37.4%), being bullied (17.4%), feeling fearful at home or in a private meeting (19.6%) and family problems (16.9%). Conclusions: About one third of Chileans surveyed have suffered negative effects due to alcohol consumption of a known or unknown drinker. This finding signals the need of designing public policies addressed to minimize or prevent collateral effects of drinking.