Accessing supports due to others' harmful drinking.

INTRODUCTION: Alcohol's harm to others (AHTO) refers to harms caused to those other than the drinker. The current paper estimates the prevalence of formal and informal supports sought due to AHTO and examines whether the type of support accessed varies by sociodemographic, economic and harm-related characteristics. METHODS: An Australian sample of 2574 people completed the 2021 AHTO survey, out of which 888 perceived they experienced harm from another's drinking. Prevalence of accessing services and supports was measured. Additionally, several sociodemographic factors, economic factors and harm-related factors were included in multivariable logistic regression models predicting service/support use. Specifically, four models were constructed probing use of any service/support, use of police, use of counselling services and use of family/friend support. RESULTS: Of the survey sample, 12.4% accessed any support/service. Seeking support from family and/or friends was most common, followed by police, counselling, healthcare services and being admitted to hospital. Women had higher odds of accessing counselling and family/friend support. Respondents with a higher education level and two or more financial stressors had higher odds of accessing police and counselling. Respondents harmed by a stranger had higher odds of accessing police, whereas respondents harmed by someone they know had higher odds of seeking support from family/friends. Experiencing more severe harm was associated with greater odds of accessing any support. DISCUSSION AND CONCLUSIONS: Several sociodemographic and economic factors were associated with accessing different supports. These findings may inform service development, interventions and policy changes for people affected by others' drinking.

Harm from the drinking of people you know: A range of effects from different relationships.

AIMS: To describe the range of effects experienced due to the drinking of people respondents know and analyze risk and protective factors for harm from the drinking of partners and household members, other relatives and friends and co-workers. DESIGN, SETTING AND PARTICIPANTS: Surveys of 2574 participants' experiences were obtained from two samples: 1000 people responded to random digitally dialled Australian mobile calls and 1574 participants responded from the Life in AustraliaTM panel survey. MEASUREMENTS: Respondents were asked whether they had been negatively affected in the previous 12 months by the drinking of persons they knew who were 'a heavy drinker or drank a lot sometimes' and the nature of these harms. Weighted logistic regressions were used to analyze differences in rates of key negative outcomes from known others' drinking by gender, age and socio-economic status. FINDINGS: Almost two thirds [60.2%; 95% confidence interval (CI) = 57.7%-62.7%] of participants reported having heavy drinkers in their lives and 21.8% (95% CI = 19.8%-23.9%) reported being negatively affected by the drinking of people they knew well in some way. Participants reported a gamut of effects, including, most commonly, adverse social effects: having to transport relatives and friends who had been drinking, role failure and faults, being emotionally hurt or neglected, serious arguments, family problems, having to care for drinkers and verbal abuse. Less commonly, respondents reported physical or sexual harm, property damage, financial stress and threats from others' drinking. Women (odds ratio = 1.49; 95% CI = 1.13-1.95), younger people, rural, Australian-born (vs. respondents born overseas in non-English speaking countries) and more frequent drinkers were more likely to report harm from a drinker they knew than their counterparts after adjusting for other variables in the model. CONCLUSIONS: Australians appear to be commonly adversely affected by the drinking of people they know. Harms from known drinkers are more likely to be experienced by women than men, particularly from the people they live with and other relatives.

What are the impacts of alcohol supply reduction measures on police-recorded adult domestic and family violence in the Northern Territory of Australia?

BACKGROUND: During 2017-18, the Northern Territory (NT) introduced a Banned Drinker Register (BDR) and Minimum Unit Price (MUP) NT-wide; Police Auxiliary Liquor Inspectors (PALIs) in three regional towns; and restrictions on daily purchases/opening hours (DPOH) in one regional town. The BDR is an individual-level alcohol ban; MUP is a pricing policy; and PALIs enforce bans on restricted areas at takeaway outlets. This study examines the impact of these policies on adult domestic and family violence (DFV). METHODS: We examined DFV assaults and breaches of violence orders from January 2014 - February 2020 using interrupted time series models for NT, Greater Darwin, Katherine, Tennant Creek, and Alice Springs. To account for increasing numbers of individuals on the BDR we tested two timepoints (Sept 2017, March 2018). FINDINGS: Following DPOH, assaults (78 %) and alcohol-involved assaults (92 %) decreased in Tennant Creek. After PALIs, assaults (79 %) in Tennant Creek, and breaches (39 %) and alcohol-involved breaches (58 %) in Katherine decreased. After MUP, assaults (11 %), alcohol-involved assaults (21 %) and alcohol-involved breaches (21%) decreased NT wide. After MUP/PALIs in Alice Springs, alcohol-involved assaults (33 %), breaches (42 %), and alcohol-involved breaches (57 %) decreased. BDR (Sept 2017) found increases in assaults (44 %) and alcohol-involved assaults (39 %) in Katherine and assaults (10%) and alcohol-involved assaults NT-wide (17 %). There were increases of 21 %-45 % in breaches NT-wide, in Darwin, Katherine, and Alice Springs. Following March 2018 found increases in assaults (33 %) and alcohol-involved assaults (48 %) in Katherine. There were increases - from 20 % to 56 % - in breaches in NT-wide, Katherine, and Alice Springs. CONCLUSION: PALIs and DPOH were associated with some reductions in DFV; the BDR was associated with some increases. The upward trend commences prior to the BDR, so it is also plausible that the BDR had no effect on DFV outcomes. Although MUP was associated with reductions in the NT-wide model, there were no changes in sites without cooccurring PALIs.

National and regional prevalence of interpersonal violence from others' alcohol use: a systematic review and modelling study.

Background: While alcohol use is an established risk factor for interpersonal violence, the extent to which people are affected by interpersonal violence from others' drinking has not yet been quantified for different world regions. This modelling study aims to provide the first estimates of the national and regional prevalence of interpersonal violence from others' drinking. Methods: An international systematic literature search (02/28/2023, Prospero: CRD42022337364) was conducted to identify general adult population studies assessing the prevalence of interpersonal violence from others' drinking with no restrictions to publication date or language. Reports that did not provide data on interpersonal violence from others' drinking (primary outcome), were no original research studies, or captured a selected group of people only, were excluded. Observed prevalence data were extracted and used to build fractional response regression models to predict past-year prevalence of emotional and physical violence from others' drinking in 2019. Random-effects meta-regression models were used to aggregate the observed prevalence of sexual and intimate partner violence. Study risk of bias (ROB) was assessed using a modified version of the Newcastle-Ottawa Scale. Findings: Out of 13,835 identified reports, 50 were included covering just under 830,000 individuals (women: 347,112; men: 322,331; men/women combined: 160,057) from 61 countries. With an average prevalence of 16·8% (95% CI: 15·2-18·3%) and 28·3% (95% CI: 23·9-32·4%) in men and women combined in the GBD super regions High Income and Central Europe, Eastern Europe, & Central Asia, respectively, emotional violence was the most common form of interpersonal violence from others' drinking. Physical violence averaged around 3% (women) and 5% (men) in both regions. The pooled prevalence of sexual violence from others' drinking in men and women was 1·3% (95% CI: 0·5-3·3%, 95% PI: 0·1-16·9%) and 3·4% (95% CI: 1·4-8·3%, 95% PI: 0·2-35·3%), respectively, and ranged between 0·4% (95% CI: 0·1-1·6%, 95% PI: 0·0-7·3%) and 2·7% (95% CI: 1·1-6·3%, 95% PI: 0·2-30·0%) for different forms of intimate partner violence. ROB was moderate or critical for most reports; accounting for critical ROB did not substantially alter our results. Interpretation: The share of the population experiencing harms from others' drinking is significant and should be an integral part of public health strategies. Funding: Research reported in this publication was supported by the Canadian Institutes of Health Research (CIHR; grant: CIHR FRN 477887).

When advisors do not know what is best for advisees: Uncertainty inhibits advice giving.

While seeking advice can be beneficial for advisees, advisors may not always possess the necessary knowledge to provide appropriate guidance. Poor-quality advice can mislead advisees rather than offering assistance. Despite the research interest in advisees, few studies have investigated advisors' psychological and behavioral responses, especially when they faced uncertainty regarding the optimal course of action for advisees. To fill this gap, we developed novel paradigms aiming at manipulating advisors' uncertainty, allowing for a systematic investigation of advisors' behavior, motivation, and emotion. Across four studies, we consistently found that advisors under uncertainty give less advice. Furthermore, we observed that uncertainty modulates advisors' motivation to influence, worry about harm to others, and/or sense of power. The motivation to influence and/or worry about harm to others can mediate the effect of uncertainty on advice giving. Besides, we identified nuanced distinctions in the effects of ambiguity and risk, two distinct types of uncertainty, on advisors' psychological processes. Our findings shed light on advisors' self-monitoring of the quality of their advice, thereby contributing to a deeper understanding of advisor-advisee communication from the perspective of advisors.

Quantifying alcohol-attributable disability-adjusted life years to others than the drinker in Aotearoa/New Zealand: A modelling study based on administrative data.

BACKGROUND AND AIMS: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability-adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking. DESIGN: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. SETTING AND PARTICIPANTS: The study took place among the Aotearoa/New Zealand population in 2018. MEASUREMENTS: The involvement of others' drinking was obtained from prevalence, alcohol-attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta-Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. FINDINGS: In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Maori, was impacted at a higher rate (DALYs among Maori were 25 per 1000 population; among non-Maori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). CONCLUSIONS: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms.

Estimated cost of extra work hours from co-workers' drinking in Thailand.

INTRODUCTION: Alcohol's harm to others (AHTO) in workplaces has received little attention. A few studies from high-income countries have estimated the cost of AHTO in workplaces, while data from the low- and middle-income countries are lacking. This study aimed to estimate the cost of AHTO in workplaces and to explore factors associated with the cost of AHTO in workplaces. METHODS: Data were taken from 1392 employed respondents who participated in a survey conducted in Thailand from September 2012 to March 2013. The cost of extra work hours was estimated from the hourly wage and extra hours of work. The hourly wage was computed by converting monthly income to weekly income and dividing weekly income by weekly working hours. The gamma regression with log link was used to determine factors associated with the cost of extra working hours. RESULTS: The past-year prevalence of harm from co-workers' drinking was 17.8% among the employed population. The prevalence of working extra hours was 6.1%. On average, an affected worker worked 16.0 extra hours due to co-workers' drinking. In total, 28.8 million hours of extra work was attributed to co-workers' drinking in 1 year. The cost of these extra work hours was 1.8 billion Thai baht (57.8 million USD). Age, education and type of employment were associated with the cost of working extra hours. DISCUSSION AND CONCLUSIONS: The burden of alcohol in workplaces extends beyond drinking workers. Our findings indicate that alcohol imposes a significant cost on co-workers of drinkers.

Social disparities in alcohol's harm to others: evidence from 32 European countries.

BACKGROUND: Alcohol use can cause harm not only to the person who consumes it but also to others. Prior research has found that these alcohol-attributable harms to others differ across socioeconomic groups, though several findings have been contradictory. The aim of this contribution was to study the role of individual-level and population-level income inequalities in alcohol's harm to others among women and men. METHODS: Logistic regression analysis of cross-sectional survey data from 2021, covering 39,629 respondents from 32 European countries. Harms from others' drinking were defined as experiences of physical harm, involvement in a serious argument, or involvement in a traffic accident, due to another person's drinking, within the past year. We examined the association of individual-level income and country-specific income inequality (Gini index) with harms from a known person's or a stranger's drinking, adjusting for the respondent's age, daily drinking levels, and at least monthly risky single-occasion drinking. RESULTS: At the individual level, people with lower incomes had 21% to 47% increased odds of reporting harms from a known person's drinking (women and men) or stranger's drinking (men only) than their same-gender counterparts in the highest income quintile. At the national level, countries with higher income inequality showed increased risks of harms from a known person's drinking among women (OR = 1.09, 95% confidence interval [CI]: 1.05 - 1.14), while among men the risk of harm from strangers' drinking decreased with higher income inequality (OR = 0.86, 95% CI: 0.81 - 0.92). These associations with income inequality were observed among respondents from all but the lowest income groups. CONCLUSION: Alcohol can cause harm to others, with women and people with low incomes being disproportionally exposed to these harms. Alcohol control policies targeting high consumption levels, especially among men, as well as upstream policies to reduce inequalities, are needed to lower the health burden of alcohol beyond those who consume it.

[Ethics considerations on brain-computer interface technology].

The development and potential application of brain-computer interface (BCI) technology is closely related to the human brain, so that the ethical regulation of BCI has become an important issue attracting the consideration of society. Existing literatures have discussed the ethical norms of BCI technology from the perspectives of non-BCI developers and scientific ethics, while few discussions have been launched from the perspective of BCI developers. Therefore, there is a great need to study and discuss the ethical norms of BCI technology from the perspective of BCI developers. In this paper, we present the user-centered and non-harmful BCI technology ethics, and then discuss and look forward on them. This paper argues that human beings can cope with the ethical issues arising from BCI technology, and as BCI technology develops, its ethical norms will be improved continuously. It is expected that this paper can provide thoughts and references for the formulation of ethical norms related to BCI technology.

Alcohol's harm to others in 2021: Who bears the burden?

BACKGROUND AND AIMS: Alcohol's harm to others (AHTO) has become a key driver of national and international alcohol policy. This study aimed to produce a contemporary, comprehensive estimate of the correlates and harms from others' drinking in 2021 in Australia. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Across Australia, 2574 adults (1380 women; 1172 men) were sampled via two cross-sectional survey modes: a random-digit dial mobile phone sample of 1000 people and 1574 people from the Life in Australia™ panel survey. In 2021 participants were asked about harms they had experienced from the drinking of family, friends, co-workers and the public in the past year. Applying combined sample weights from each mode, bivariable and adjusted multivariable logistic regressions were used to analyse differences in rates of AHTO by participant gender, age, residence in rural or metropolitan regions, country of birth, education and employment. FINDINGS: In 2021, 23.6% reported being negatively affected by strangers' drinking and 21.3% by the drinking of someone they knew, with 34.3% reporting being negatively affected a lot or a little by either; 42.4% of respondents reported specific harms from strangers' drinking. Thus, 48.1% of respondents reported any harm (negative effects or specific harms) from others' drinking. Women, younger people, Australian-born and heavier episodic drinkers reported significantly higher rates of AHTO compared with other respondents. Smaller percentages (7.5%) of participants reported being harmed substantially by others' drinking, including by people they knew (5.8%) or strangers (2.3%). Stratified analyses showed that heavier drinking, furloughed, younger men who were born overseas in English-speaking countries were affected by others' drinking, whereas women were affected regardless of these factors (apart from age). CONCLUSIONS: More than one-third of Australian adults appear to have been negatively affected by others' drinking in 2021, with women, younger people and heavier drinkers at greater risk. Substantial harm appears to be more likely to arise from the drinking of people Australians know than from strangers' drinking.

Alcohol's harm to others in Japan: Different rates for different relationships to the drinker in a 2018 national survey.

INTRODUCTION: No study in Japan has investigated alcohol's harm to others (AHTO). Therefore, this study aimed to reveal the situation of AHTO in Japan and examine the factors associated with it based on the relationship with the drinker. METHODS: A cross-sectional population-based survey was performed in 2018 with 2121 men and 2507 women. Respondents were asked questions about factors such as verbal or physical aggression, being forced to drink alcohol, sexual harassment and their relationship with the drinker. Binomial logistic regression was performed to quantify the associations of AHTO with participants' socio-demographic status and drinking patterns. RESULTS: The lifetime experience of AHTO was 24.7% for men and 19.3% for women. AHTO from the father and co-workers were the most common in and outside the home, respectively. The frequency of AHTO from the spouse or co-workers showed no significant difference for abstainers and drinkers. However, AHTO from the father was more commonly reported among drinkers and those with Alcohol Use Disorders Identification Test scores ≥8 points than abstainers. Of those who experienced AHTO, 24.5% of men and 27.6% of women, and 6.1% of men and 12.9% of women were profoundly affected by it in and outside the home, respectively. DISCUSSION AND CONCLUSIONS: One in five Japanese residents experienced AHTO in their life, and the characteristics associated with AHTO differed according to the affected individual's relationship with the drinker. Continued monitoring of AHTO and measures aimed at reducing alcohol-related harm that include AHTO should be promoted.

Ethics considerations on brain-computer interface technology / 生物医学工程学杂志

The development and potential application of brain-computer interface (BCI) technology is closely related to the human brain, so that the ethical regulation of BCI has become an important issue attracting the consideration of society. Existing literatures have discussed the ethical norms of BCI technology from the perspectives of non-BCI developers and scientific ethics, while few discussions have been launched from the perspective of BCI developers. Therefore, there is a great need to study and discuss the ethical norms of BCI technology from the perspective of BCI developers. In this paper, we present the user-centered and non-harmful BCI technology ethics, and then discuss and look forward on them. This paper argues that human beings can cope with the ethical issues arising from BCI technology, and as BCI technology develops, its ethical norms will be improved continuously. It is expected that this paper can provide thoughts and references for the formulation of ethical norms related to BCI technology.

The Association among Alcohol Consumption Patterns, Drink-Driving Behaviors, and the Harm from Alcohol-Related Road Traffic Injuries Due to the Drinking of Others in Thailand.

Thailand has one of the highest rates of traffic-related fatalities and alcohol-related road traffic injuries globally. Previous studies focused on alcohol consumption and road traffic injuries. However, no existing studies investigate the association between drink-driving behaviors and road traffic injuries due to the drinking of others. This study aims to explore any potential associations among alcohol drinking patterns, drink-driving behaviors, and the harm from alcohol-related road traffic injuries due to the drinking of others. The Thai Tobacco and Alcohol Use Household National Survey data in 2017 (n = 80,797) were analyzed using multiple logistic regression. This study found that current drinkers and binge drinkers were more likely to suffer from road traffic injuries due to others' drink-driving behavior, i.e., 1.50 times (95% CI: 1.49-1.51) and 2.31 times (95% CI: 2.30-2.33), respectively, compared with non-drinkers. In addition, we found that drink-driving behavior was associated with harm from road traffic injuries due to others' drink-driving behavior by 2.12 times (95% CI: 2.10-2.14) compared with the non-drinker group. This study calls for effective measures to reduce drink-driving behaviors to prevent road traffic injuries due to the drinking of others.

Conceptualizing and considering Cannabis-Related "Harm-to-Others": The Role of Cannabis-Related Violence.

Public health-oriented frameworks for cannabis use of control, including legalization, are evolving. Most frameworks aim to reduce cannabis-related health harms that materialize among users; there has been comparably limited focus on cannabis-related "harm-to-others". A longstanding issue for other psychoactive substances, and increasingly recognized form of cannabis-related harm-to-others involves violence/aggression. We briefly review relevant epidemiological and psycho-behavioral data related to cannabis-related violence and aggression, and discuss intervention prospects. Systematic review and other study data show a moderately positive association between cannabis use and perpetration of physical (including intimate-partner) violence, for example involving assault, aggression, and fighting; this risk may be further elevated by intensive use patterns. Such harms may involve injuries/deaths and contribute to the cannabis-related burden of disease. Within the contexts of public health-oriented frameworks for cannabis control, greater awareness and targeted interventions regarding the risk for exposure to violence related to cannabis use should be promoted in addition to protections for users' health.

The good, bad and ugly of dispositional greed.

Greed is the insatiable desire for more. It is an important economic motive with numerous implications for consumer behavior and decision processes. We describe research showcasing the good, the bad and the ugly of dispositional greed. The good of greed refers to the potential advantageous consequences for society as a whole and for greedy people themselves. The bad of greed refers to the potential harm that it causes to others, and the ugliness of greed refers to the disadvantageous consequences of being greedy for the people themselves.

Fathers' alcohol consumption and risk of substance-related disorders in offspring.

BACKGROUND: Few studies have assessed how children are affected by parental alcohol consumption without clinically diagnosed alcohol problems, especially in relation to more long-term and severe consequences. The aim is to investigate how fathers' alcohol use is related to the risk for substance-related disorders in offspring. METHOD: A prospective cohort study of 64 710 Swedish citizens whose fathers were conscripted for compulsory military training at ages 18-20 in 1969/70. Information on fathers' alcohol consumption, frequency of intoxication and apprehended for drunkenness, was collected during conscription. Offspring was followed for substance-related disorders from age 12 to end of follow up in 2009. RESULTS: All measures of fathers' alcohol use were significantly and positively associated with risk for substance-related disorders in offspring. The associations were to a large extent explained by other risk factors in childhood. In the fully adjusted model, those with fathers in the highest alcohol consumption quintile still had a 63% higher risk (HR=1.63 CI 1.26-2.12) of substance-related disorders compared to those whose fathers' reported abstinence. The highest risk was found among offspring to fathers with alcohol-related disorders or that had been apprehended for drunkenness, with a more than two-fold increased risk for substance-related disorders. CONCLUSIONS: Despite the lower risk found among offspring to fathers with sub-clinical drinking when compared to those with alcohol-related disorders, the former group accounts for a much larger proportion of all cases of substance-related disorders in the population, prompting universal prevention efforts targeting the level of total alcohol consumption in society.

A gender-focused multilevel analysis of how country, regional and individual level factors relate to harm from others' drinking.

BACKGROUND: The aim of this study was to examine how gender, age and education, regional prevalence of male and female risky drinking and country-level economic gender equality are associated with harms from other people's drinking. METHODS: 24,823 adults in ten countries were surveyed about harms from drinking by people they know and strangers. Country-level economic gender equality and regional prevalence of risky drinking along with age and gender were entered as independent variables into three-level random intercept models predicting alcohol-related harm. FINDINGS: At the individual level, younger respondents were consistently more likely to report harms from others' drinking, while, for women, higher education was associated with lower risk of harms from known drinkers but higher risk of harms from strangers. Regional rate of men's risky drinking was associated with known and stranger harm, while regional-level women's risky drinking was associated with harm from strangers. Gender equality was only associated with harms in models in models that did not include risky drinking. CONCLUSIONS: Youth and regional levels of men's drinking was consistently associated with harm from others attributable to alcohol. Policies that decrease the risky drinking of men would be likely to reduce harms attributable to the drinking of others.

Country-Level Heavy Episodic Drinking and Individual-Level Experiences of Harm from Others' Drinking-Related Aggression in 19 European Countries.

INTRODUCTION: There is limited knowledge about how individual experiences of harm from others' drinking are influenced by heavy episodic drinking (HED) at the country level. The present study aimed to assess (1) the association between the country-level prevalence of HED and the risk of experiencing harm from others' drinking-related aggression and (2) if HED at the country level modifies the association between consumption of alcohol per capita (APC) and such harm. METHODS: Outcome data from 32,576 participants from 19 European countries stem from the RARHA SEAS study. Self-reported harm from others' drinking included having been verbally abused, harmed physically, or having serious arguments. Data on country-level drinking patterns were derived from the World Health Organization. Associations between country-level prevalence of monthly HED and experiences of aggression (at least 1 of 3 studied harms) were derived through multilevel models - adjusted for country-level age structure and by including the respondent's own HED patterns as a mediator. RESULTS: A 1% increase in the prevalence of monthly HED was associated with 5% higher odds (odds ratio [OR] 1.05) of experiencing others' alcohol-related aggression among men, and 6% (OR 1.06) among women. The results suggest that the association between APC and harm was stronger in countries with high prevalences of HED, but the modifying effect could not be confirmed. DISCUSSION/CONCLUSION: Harm from others' drinking-related aggression depends not only on individual factors but is also influenced by the drinking patterns of the population. However, the country-level prevalence of HED only explains a small part of the variance of this type of harm.