Abstract
The paper examines how family members in 18 countries attempt to influence each other to drink less. Data come from the GENACIS (Gender, Alcohol and Culture: an International Study) dataset. Countries included were Argentina, Costa Rica, Czech Republic, Denmark, Finland, Germany, Hungary, Iceland, India, Japan, Nigeria, Norway, Spain, Sri Lanka, Sweden, Uganda, UK and Uruguay (overall sample 44,115). In each country, the percentage of people who had experienced family member pressure to drink less were compared to country abstinence rate, mean drinking volume per drinker and other societal-level factors. While countries differed greatly on proportion of drinkers having experienced family members' pressure to drink less, in all countries drinking women reported less pressure than drinking men in their own society. In all studied countries, informal pressure was exerted most often by the spouse or sexual partner. However, other family members were also involved. Informal pressure was found to be highly correlated with the country's socioeconomic conditions. Informal pressure to drink less by family members is on one hand an expression of social and family problems, caused by heavy drinking, especially in the economically less developed countries, suggesting alcohol-related deprivation. On the other hand, similar gender differences were seen in all the societies, men reporting receiving more informal pressure than women. Thus, informal pressure to drink less tended to reflect the gender conflict caused by heavy use of alcohol by men.
Indexing key words: Informal control, alcohol, gender, country variation
Introduction
Intimate social networks are important in shaping the individual's drinking habits. They can also play a role when an individual wants to change his or her habits. Close networks can be seen as important resources for prevention of harms from drinking and also for natural recovery (see, e.g. Granfield & Cloud, 2001). The informal pressure goes in two directions: others can induce the individual to drink more, or they can try to make him or her him or her drink less. In this article we examine only the informal influence that aims at reducing the other's drinking.
Spouses' drinking patterns tend to be influenced by each other (Price & Vandeberg, 1980; Caetano, 1987; Corbett, Mora & Ames, 1991; Hammer & Vaglum, 1989; Gleiberman et al., 1992; Demers & Bisson & Palluy, 1999). Spouses' influence on each other's drinking is dependent on what type of drinking settings they share, partly because drinking norms are situation specific (Klein & Pittman, 1990; Greenfield & Room, 1997). For instance, if the couple drinks together at home over meals, they are likely to drink in a more homogenous way than when the drinking takes place in a bar and is not a part of a meal (Joosten & Knibbe, 2001).
Several studies have described the methods that family members use in trying to influence each others' drinking (Holmila 1987; Holmila, Mustonen & Rannik 1990; Asher, 1992; Järvinen, 1991; Room, Greenfield & Weisner, 1991; Wiseman, 1991; Room, Bondy & Ferris, 1996; Orford, 1998; Velleman, Copello & Maslin (eds.), 1998; Suonpää 2005). These studies have shown that the role of warden or moderator of their partner's drinking is frequently a feminine role; conversely, men take more often the role of inciter in relation to their wives' drinking. The predominant direction of efforts to control drinking within the family is from women to men and from older generations to younger.
It has also been suggested that men's drinking control is more externalised than women's, making men more prone to bingeing in situations in which external control is not effective, or when a situation is defined as “time out” and thus outside normal controls. Women, on the other hand, are thought to have a more internalised mechanism of drinking control, and they are less likely to indulge in binge drinking. A study on Finnish working class men, who were interviewed in a treatment centre brought out that the men found self-control of drinking to be antithetical to men's inner “nature” and to constitute a limit to their freedom. Consequently, these male heavy drinkers often defined their life history as an oscillation between settling down with a “good woman” and “breaking out” into freedom in a drunken binge (Alasuutari 1990). On the other hand, in those cultures, where women have started to use alcohol more often and more similarly as men, gender differences in informal control patterns can also be levelling off.
The informal pressure to drink less can be done by various verbal, non-verbal and contextual messages and acts. Some of these are conscious; some are unconscious and habitual. Informal influence can take place during drinking situations between people who drink together, but also outside actual drinking situations, for instance when family members try to influence a drinker by talking about his or her drinking and the problems related to it. Strategies can be verbal or they can be based on some action (for instance trying to stop the drinker from being able to buy or otherwise obtain alcohol). They can also be either direct, e.g. talking frankly and directly with the other, or indirect (e.g. trying to advert the other's interest to something else). The strategies also differ in their strength: they can be gentle and passing (e.g. small signs at a party indicating that it is time to go home) or they can take the form of strong sanctions and persistent demand for the other to stop using alcohol (for instance threat of divorce, physical aggression).
Informal pressure is not limited to cases of problem drinking, but is carried out among light drinkers as well, even if less often (Holmila 1988, Raitasalo 2003, Suonpää 2005). Heavy drinkers are most likely to be the objects of pressures to drink less, in Finland at least. Analyses of the Finnish GENACIS-data showed that there seems to be a strong link between frequent binge drinking and having one's own worries over drinking on one hand, and being the one pressured by the others on the other hand(Raitasalo & Holmila 2005).
This study is an international comparison between 18 countries, looking at the informal pressure that drinkers in each country had experienced coming from their family members. The study aims to answer the following questions:
What kinds of characteristics of drinking culture are connected with frequent reports of informal pressure among the drinking population? We hypothesize that there is a connection between country level indicators of alcohol use (the rate of abstinence and the mean volume of total consumption of alcohol among the drinkers) and prevalence of informal pressure within the family.
Family problems caused by drinking are likely to be more severe if the family lives in poverty and in social insecurity. It is thus likely that characteristics of family structure, women's position in the society, rate of urbanization and economic welfare have some influence in how often people in the informal networks react to others' drinking.
We expect to find clear gender differences in the prevalence of informal control in all of the countries studied so that women report less informal pressure than men.
Data and analyses
The data for this study are part of the project, Gender, Alcohol and Culture: An International Study (GENACIS). The data from 18 countries included the question on informal control of drinking. These countries were: Argentina, Costa Rica, Czech Republic, Denmark, Finland, Germany, Hungary, Iceland, India, Japan, Nigeria, Norway, Spain, Sri Lanka, Sweden, Uganda, United Kingdom and Uruguay. In some analyses, only 15 or 13 countries are included due to data availability. The numbers of respondents in each country are presented in Table 1.
Table 1.
The study countries and the sample sizes per country.
| Country | N men | N women | N total |
|---|---|---|---|
| Argentina | 402 | 598 | 1000 |
| Costa Rica | 416 | 857 | 1273 |
| Czech Republic | 1244 | 1282 | 2526 |
| Denmark | 897 | 1133 | 2030 |
| Finland | 945 | 987 | 1932 |
| Germany | 3688 | 4459 | 8147 |
| Hungary | 1094 | 1198 | 2292 |
| Iceland | 1168 | 1271 | 2439 |
| India | 1508 | 1471 | 2979 |
| Japan | 1116 | 1138 | 2254 |
| Nigeria | 1114 | 956 | 2070 |
| Norway | 1034 | 1136 | 2170 |
| Spain | 894 | 956 | 1850 |
| Sri Lanka | 608 | 593 | 1201 |
| Sweden | 2656 | 2816 | 5472 |
| Uganda | 721 | 758 | 1479 |
| UK | 963 | 1038 | 2001 |
| Uruguay | 624 | 376 | 1000 |
Aggregation to the country level occurs by use of statistics, e.g. percentages and means of drinking variables; so also with percentages for pressure (Fig 1) and by source (Table 3). Correlation analyses were done by using the country as the unit of analysis. Analyses were conduced by gender of respondent but pressures from male and female family members were combined.
Figure 1.
Percentages of men and women who have experienced pressure to drink less from any family member per country by gender
Table 3.
Percentage of respondents who have experienced pressure to drink less per country by gender
| Source of control | Spouse / partner | Child(ren) | Other family member | Any family member | ||||
|---|---|---|---|---|---|---|---|---|
| Country | Men | Women | Men | Women | Men | Women | Men | Women |
| Argentina | 14 | 3 | 5 | 1 | 12 | 1 | ||
| Costa Rica | 27 | 9 | 14 | 9 | 27 | 11 | 39 | 19 |
| Czech R. | 24 | 6 | 7 | 4 | 14 | 6 | 33 | 11 |
| Denmark | 5 | 1 | 1 | 0 | 3 | 1 | 7 | 2 |
| Finland | 15 | 3 | 2 | 2 | 3 | 1 | 18 | 6 |
| Germany | 9 | 2 | 2 | 1 | 4 | 1 | 12 | 3 |
| Hungary | 17 | 3 | 7 | 2 | 10 | 3 | 21 | 5 |
| Iceland | 11 | 2 | 6 | 4 | - | - | - | - |
| India | 38 | 14 | 26 | 14 | 27 | 14 | 44 | 20 |
| Japan | 22 | 6 | 10 | 3 | 11 | 2 | 26 | 8 |
| Nigeria | 23 | 12 | 10 | 10 | 18 | 13 | 29 | 20 |
| Norway | 4 | 1 | 0 | 1 | 4 | 2 | ||
| Spain | 4 | 0 | 1 | 0 | 2 | 1 | 6 | 1 |
| Sri Lanka | 47 | 11 | 23 | 3 | 30 | 10 | 59 | 18 |
| Sweden | 6 | 1 | - | - | - | - | - | - |
| Uganda | 47 | 23 | 11 | 7 | 41 | 26 | 58 | 37 |
| UK | 12 | 7 | 7 | 5 | 6 | 4 | 14 | 8 |
| Uruguay | 5 | 1 | 2 | 2 | 6 | 1 | 9 | 3 |
The percentage of (male / female) drinkers in each country describes the amount of respondents over 18 years of age who have drunk some alcohol during the last 12 months. The annual total consumption of 100 % alcohol in litres is the mean drinking volume per person (male / female), calculated from the beverage specific quantity-frequency measure of drinking among drinkers over 18 years of age in each country. The abstinence rates as well as means of volume of consumption in each country are presented in Table 2.
Table 2.
Means of annual volume of drinking in litres of 100 % alcohol, percentage of drinkers and social indicators per country by gender.
| Volume of drinking | % drinkers | GDP | Urbanisation % | Ratio females / males in higher education | Number of persons in household | |||
|---|---|---|---|---|---|---|---|---|
| Country | Men | Women | Men | Women | ||||
| Argentina* | 7.1 | 1.4 | 92.8 | 77.6 | 10880 | 89.9 | 1.5 | 4.4 |
| Costa R. | 4.9 | 1.5 | 67.3 | 42.4 | 8840 | 60.1 | 1.2 | 4.5 |
| Czech R. | 13.4 | 4.0 | 90.4 | 79.9 | 15780 | 74.2 | 1.1 | 4 |
| Denmark | 7.9 | 3.5 | 96.9 | 92.0 | 30940 | 85.2 | 1.4 | 2.6 |
| Finland | 5.9 | 2.0 | 92.2 | 90.2 | 26190 | 61.0 | 1.2 | 2.7 |
| Germany | 8.6 | 4.0 | 95.5 | 94.1 | 27100 | 87.9 | 1.0 | 4.1 |
| Hungary | 4.3 | 0.8 | 90.6 | 74.9 | 13400 | 64.7 | 1.3 | 3.5 |
| Iceland | 4.3 | 2.1 | 87.0 | 84.7 | 29750 | 92.7 | 1.7 | - |
| India* | 15.9 | 8.1 | 33.3 | 5.9 | 2670 | 28.1 | 0.7 | 5.7 |
| Japan | 8.4 | 2.4 | 91.1 | 77.0 | 26940 | 65.3 | 0.9 | 2.7 |
| Nigeria* | 14.6 | 12.3 | 42.1 | 22.3 | 860 | 45.9 | - | 5.8 |
| Norway | 5.4 | 2.1 | 91.5 | 88.6 | 36600 | 77.6 | 1.5 | 2.6 |
| Spain* | 8.9 | 3.8 | 67.1 | 43.8 | 21460 | 76.4 | 1.2 | 2.9 |
| Sri Lanka | 10.1 | 0.5 | 53.6 | 6.4 | 3570 | 21.1 | - | 4.6 |
| Sweden | 3.0 | 1.5 | 88.4 | 79.1 | 26050 | 83.3 | 1.5 | 2.7 |
| Uganda* | 19.9 | 6.0 | 51.2 | 39.5 | 1390 | 12.2 | 0.5 | 5.4 |
| UK | 8.1 | 3.4 | 89.6 | 81.9 | 26150 | 89.0 | 1.2 | 2.7 |
| Uruguay | 8.4 | 2.4 | 81.1 | 60.3 | 7830 | 92.4 | 1.8 | 3.7 |
Tha data of drinking variables is regional in these countries
We assumed that the general socio-economic well-being as well as equality between men and women would have importance in how often people in the informal networks react to each others' drinking. To look at these issues, several indicators for the country's socio-economic conditions were used: the gross domestic product, urbanisation rate, ratio of females and males in higher education and number of persons in household (see Table 2). The Gross Domestic Product (GDP per capita in US$) is one of the three indices on which the human development index is built and measures the country's economic development (UN Human Development Report, 2004).
Urban population (% of total) means the midyear population of areas classified as urban according to the criteria used by each country, as reported to the United Nations (UN Human Development Report, 2004). Ratio females / males in higher education (tertiary gross enrolment ratio, female rate as % of male rate) is the number of students enrolled in a level of education, regardless of age, as a percentage of the population of official school age for that level. The gross enrolment ratio can be greater than 100% as a result of grade repetition and entry at ages younger or older than the typical age at that grade level (UN Human development report, 2004). In the GENACIS questionnaire there was also a question about the number of persons living in the same household with the respondent. The mean number of persons living in the same household is calculated for each country. The distributions of these variables are presented in Table 2.
The GENACIS data for drinking for some of the countries (Argentina, India, Nigeria, Spain and Uganda) is based on a regional sample, whilst the indicators for the countries' socio-economic development are national. Conclusions of the impact of the effects of the socio-economic situation should thus be made with some caution.
The experience of pressure to drink less coming from family members (spouse / partner, child(ren), other family members) was asked in the GENACIS questionnaire by a question. “During the last 12 months, has any of the following persons attempted to influence your drinking so that you would drink less or less often?” This question was asked only from drinkers. Male and female family members were combined in the analysis because the response alternatives were not asked gender-specifically in each country. Percentages of the drinkers over 18 years of age, who had experienced pressure to drink less from spouse, partner, child(ren), other members of any of them were calculated in each country.
Only the respondents who had used alcohol during the last 12 months were included in the analyses. The percentage of those who had experienced pressure to drink less from any family member (spouse / partner, child(ren), other family member) in each country were correlated (Pearson's r) against the ratio of drinkers / abstainers, the country's mean volume of drinking (litres of 100 % alcohol / year / person) as well as against the societal indicators (GDP in US $, percentage of urban population, ratio of men and women in higher education and number of persons per room). The analyses were done separately for men and for women.
Results
The studied countries differed quite a lot as to what proportion of drinkers had reported of having experienced pressure to drink less coming from their family members (Figure 1). In Sri Lanka and Uganda more than half of the male drinkers had had such experiences. Pressure was common also among the drinkers in India, Costa Rica, Czech Republic, Nigeria and Japan. In Denmark and Spain, on the other hand, only 7% and 5% the drinking men reported having been pressurised by their family to drink less. In Argentina, Finland, Germany, UK and Uruguay the percentage of men reporting to have been pressured by someone in the family varied between 9 % and 18 %. Western European men and women reported generally less informal control than men and women from other parts of the world, with the exception of Uruguay, where the percentages were also rather low.
Female drinkers in all countries reported less informal pressure coming from the family than men did. However, the order of the countries as to how frequent it was to be pressured to drink less, was quite similar for men and women. Thus a considerable part of female drinkers in Uganda (37%), India (20%), Nigeria (20%), Costa Rica (19%) and Sri Lanka (18%) reported that their drinking had been criticised by someone in the family, whilst only a small part of drinking women in Denmark (2%), Spain (1%), Germany (4%) or Uruguay (3%) did so.
In most of the countries studied, the informal pressure comes most often from one's spouse or other sexual partner, less so from other family members such as children, parents, sisters or brothers. Especially for the men, the spouse is the most important source of informal control: in 13 of the 18 countries the spouse was most often mentioned as the source of informal control. In Argentina, Costa Rica, Norway, Uganda and Uruguay men mentioned other family members more often, or almost as often as they mentioned spouses. Other family members were more important in this respect for the women. In Czech Republic, Denmark, Hungary, Nigeria, Sri Lanka, Uganda and Uruguay women mentioned other family members more often, or almost as often as the spouses. In all of the countries, children (who could be either adults or young) were also mentioned as a source for pressurising, but less often than spouses or other family members.
In order to understand the differences between the countries, we looked at the correlations between informal pressure and two indicators of the countries' drinking cultures. These indicators were the percentage of drinkers in the country and the mean volume of annual drinking per person). The correlation analysis shows that the more abstainers there are in the country, the more there is informal pressure to drink less (Table 4). This is true for both men and women. Similar result was found when the rate of informal control was compared with the level of drinking among the men, but not for women. The higher the mean consumption among the drinking men in the country, the more often family members have been trying to pressure the drinkers to drink less. Female drinkers' experience of being pressurized was related to the rate of abstinence in the country, but not to the level of alcohol use among the female drinkers in the country.
Table 4.
Correlation of experience of control from the family with drinking and social indicators.
| Control from any family member | ||
|---|---|---|
| M | F | |
| % abstainers in the country | .668 ** n=15 |
.649 ** n=15 |
| Annual total consumption of 100% alcohol in litres | .585 * n=15 |
.395 ns n=15 |
| Gross Domestic Product in US $ | -.696 ** n=15 |
-.702 ** n=15 |
| Urbanisation rate (%) | -.898 *** n=15 |
-.862 *** n=15 |
| Ratio females / males in higher education | -.740 ** n=13 |
-.725 ** n=13 |
| Number of persons per household | .685 ** n=15 |
.745 ** =15 |
p<.001,
p<.01,
p<.05
There is also a correlation between informal pressure and indicators describing the countries' economic welfare, rate of urbanisation and housing conditions as well as gender equality. The bigger the country's gross domestic product (GDP) the less informal control is reported. The urbanisation has the same effect: in urbanised countries family members try less often to pressure the respondent to drink less than in more rural societies. The ratio of females in higher education has similar connection with the rate of pressure, indicating that in societies with more gender equality women are less likely to control their family members' drinking. In countries, where the average number of people living in the same household is high, informal control of drinking is also more common.
The socioeconomic variables and the drinking variables are highly correlated (Rahav et al. 2005, 176). The country variance in pressure to drink less is thus connected to both conditions at the same time. In order to see if the drinking culture had any independent effect on the experiences of having been pressured, we carried out partial correlations standardizing the social indicators (Table 5)
Table 5.
Correlations between proportion of abstainers and the mean volume of drinking and drinking control from family standardised by social indicators
| Proportion of abstainers | Mean volume of drinking | |||
|---|---|---|---|---|
| M | F | M | F | |
| Control from any family member | .668 ** | .694 ** | .585 * | .395 ns |
| GDP in US $ (stand.) | .265 ns | .190 ns | .352 ns | .166 ns |
| Urbanisation rate (%) (stand.) | .189 ns | .026 ns | .042 ns | .356 ns |
| Ratio females/males in higher education (stand.) | .460 ns | .479 ns | .352 ns | .253 ns |
| Number of persons per household (stand.) | .285 ns | .241 ns | .236 ns | .056 ns |
When the correlations between the abstinence rate of the country and the experiences of having been pressured to drink less are looked at so that the societal indicators are standardized one at time (partial correlation), the correlation coefficients become much smaller and insignificant. Abstinence, volume of drinking among the drinkers and social indicators used in this study are so much interconnected that no conclusions about the independent effects of either drinking culture or societal indicators can be made.
Conclusions
Family members' informal pressure to drink less varied a lot in the countries studied. In some countries more than half of the drinking men had had such experiences, in others less than 5%. In all countries women reported less informal pressure than men. However, between countries the variance in proportion of women reporting informal control was as large as the variance for men. We looked for reasons for this great variance by analysing the connections with some characteristics of the drinking culture, as well as some characteristics of the country's socioeconomic conditions.
Informal pressure was correlated with the rate of abstinence in the country. The more there are abstainers in the country, the more there is informal pressure to drink less. This result was same for men and women. When drinking is not a part of a “normal” pattern of behaviour, practised by most people, drinkers are more likely to be criticised by their family, maybe even if drinking does not cause severe problems.
Among the men, but not among the women, informal pressure was also correlated with the mean annual volume of drinking among the drinking population. The highest volumes of drinking among the men were in Uganda, India, Nigeria, Czech Republic and Sri Lanka. A possible interpretation is that the degree of informal pressure is directly related to the cultural pattern of drinking large amounts when drinking at all.
Informal pressure was highly correlated with the country's socioeconomic conditions. Family members are more likely to intervene with the others' drinking especially in non-urbanised societies with low level of income, gender inequality and crowded housing conditions. Examples of such countries in our data are Nigeria, India, Uganda and Sri Lanka. As the socioeconomic variables and the drinking variables used here are highly correlated, we tried to see if the drinking culture had any independent effect on the rate of informal pressure. However, in the countries studied here the inter-correlations between on one hand the rate of abstinence and volume of drinking and on the other hand the social indicators are too high to draw conclusions about independent effects of either set of variables. It is possible that high rates of informal control are caused by the families' economic vulnerability, when men in low-income groups drink heavily. Given that women in countries, where many people are poor are often, if not typically, non-drinkers, the conflict between heavy drinking man and the abstinent woman around alcohol use is common. These results confirm the observation made in the study on alcohol in developing countries (Room et al, 2002, 32). The authors of that study noted that gender conflicts concerning drinking seem to remain strong in the developing societies, and are often exacerbated by changing circumstances, urbanization, cultural change and alcoholic drinks becoming easily available.
In spite of the great cultural variance, the gender difference was the same in all of the countries: drinking women in all countries reported less informal pressure than men. The level of informal control among the drinking women, however, followed the men's pattern. The reason for this seems to be less related to heavy drinking among the drinking women and more to the deviance of women's drinking per se. Drinking women's experience of being pressurized was related to the rate of abstinence but not to the level of alcohol use among them.
In all of the countries studied the informal pressure comes most often from one's spouse or sexual partner, but also from other family members. Women are more often than men pressured by other members of the family, whilst in most of the countries men are mostly pressured by their spouses. In many of the countries the respondents were also asked about the pressure coming from friends and work colleagues.
Informal pressure to drink less can thus be seen from two angles. It is on one hand an expression of social deprivation, where heavy drinking causes great problems for the family. Family members do what they can to watch their family members' drinking in order to prevent the harms it causes to the family. Women are more often the actors, and men the recipients of these efforts.
On the other hand, informal pressure is a result of a change in the drinking culture. Alcohol becomes an object of a lot of disagreement and opposition, when large groups in the communities are abstainers, but drinking is becoming more common and is often consumed in an un-controlled fashion, causing severe family problems and harms to the drinker and those living with him or her.
Informal pressure is, however, not only carried out in families of the developing countries. This article looks only at the drinking population, and their share of the total population is low in Sri Lanka, India, Nigeria and Uganda. The traditional pattern of a drinking husband and pressurising wife exists among the heavy drinkers in the richer countries, too, and as drinking is a wide-spread activity there, the conflict between drinking and family touches a considerable part of the total population in these countries.
Acknowledgments
The data used in this paper are from the project, Gender, Alcohol and Culture: An International Study (GENACIS). GENACIS is a collaborative international project affiliated with the Kettil Bruun Society for Social and Epidemiological Research on Alcohol and coordinated by GENACIS partners from the University of North Dakota, the University of Southern Denmark, the Charité University Medicine Berlin, the Pan American Health Organization, and the Swiss Institute for the Prevention of Alcohol and Drug Problems. Support for aspects of the project comes from the World Health Organization, the Quality of Life and Management of Living Resources Programme of the European Commission (Concerted Action QLG4-CT-2001-0196), the US National Institute on Alcohol Abuse and Alcoholism/National Institutes of Health (Grants R21 AA012941 and R01 AA015775), the German Federal Ministry of Health, the Pan American Health Organization, and Swiss national funds. Support for individual country surveys was provided by government agencies and other national sources. The study leaders and funding sources for data sets used in this paper are:
Argentina: Myriam Munné, M.S., World Health Organization; Costa Rica: Julio Bejarano, M.Sc., World Health Organization; Czech Republic: Ladislav Csémy, Ph.D., Ministry of Health (Grant MZ 23752); Denmark: Kim Bloomfield, Dr.P.H., Sygekassernes Helsefond, Danish Medical Research Council; Finland: Pia Mäkelä, Ph.D., National Research and Development Centre for Welfare and Health (STAKES); Germany: Ludwig Kraus, Ph.D., German Federal Ministry of Health (BMGS) and in cooperation with the Institute for Therapy Research, Munich, Germany; Hungary: Zsuzsanna Elkes, Ph.D., Ministry of Youth and Sport; Iceland: Hildigunnur Ólafsdóttir, Ph.D., Alcohol and Drug Abuse Prevention Council, Public Health Institute of Iceland, Reykjavík, Iceland; India: Vivek Benegal, M.D., World Health Organization; Japan: Shinji Shimizu, Ph.D., Japan Society for the Promotion of Science (Grant 13410072); Nigeria: Akanidomo Ibanga, M.Sc., World Health Organization; Norway: Sturla Nordlund, Ph.D., Norwegian Institute for Alcohol and Drug Research; Spain: Juan Carlos Valderrama, M.D., Dirección General de Atención a la Dependencia, Conselleria de Sanidad, Generalitat Valenciana; Comisionado do Plan de Galicia sobre Drogas, Conselleria de Sanidade, Xunta de Galicia; Dirección General de Drogodependencias y Servicios Sociales, Gobierno de Cantabria; Sri Lanka: Siri Hettige, Ph.D., World Health Organization; Sweden: Karin Helmersson Bergmark, Ph.D., Ministry for Social Affairs and Health, Sweden; Uganda: M. Nazarius Tumwesigye, Ph.D., World Health Organization; United Kingdom: Martin Plant, Ph.D., and Moira Plant, Ph.D., Alcohol Education and Research Council, European Forum for Responsible Drinking, University of the West of England, Bristol; Uruguay: Raquel Magri, M.D., World Health Organization.
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