Alkohol, andre rusmidler og vold i epidemiologisk perspektiv
Den medisinske interessen for vold og voldsskader har økt kraftig i løpet av de siste to tiårene. Det epidemiologiske
perspektivet på vold har blitt forsterket og et mer etiologisk og preventivt syn på volden er mere merkbar
innenfor sosialmedisinsk forskning. Alkoholen er en etiologisk faktor som har vist seg å være forbundet med vold
i de aller fleste samfunn. I denne artikkelen beskrives de viktigste epidemiologiske metodene og funnene i studiet
av alkoholens sammenheng med vold. Denne sammenhengen har vist seg ikke å være direkte, men er avhengig av
en rekke andre faktorer, og noen forskjellige typer av kausal avhengighet beskrives i artikkelen. Den epidemiologiske
forskningen om andre rusmidlers sammenheng med vold er betydelig mindre omfattende enn den er for
alkohol. Det er også åpenbart at andre rusmidler ikke er like sterkt sammenknyttet med vold som alkoholen.
Alcohol, other drugs, and violence in an epidemiological perspective.
Nor J Epidemiol
The public health approach to violence has become increasingly accepted during the last couple of decades. This
has led to more epidemiological research into violence, and a stronger medical interest in the etiology and prevention
of violence. However, epidemiological research on the prevalence of violence in different societies is still
mainly criminological in nature, being based on information about violence that has come to the attention of the
police or processed in the courts. The study of the relationship between alcohol use and violent behaviour is also
predominantly based on police and court materials, although an increasing number of emergency room and
hospitalization 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 and
violence. The alcohol-involvement studies estimate the extent to which drinking by the offender or the victim was
present in episodes of violence. Time trend studies and so-called natural experiments measure how rates of violent
crime covary with levels of alcohol consumption in a population. Generally, these studies indicate that alcohol use
is a potent factor in determining the prevalence of violent behaviour in a society. However, there is no evidence
showing that a significant part of alcohol-related violence is directly caused by the presence of alcohol in the
organism. 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 which
drinking occurs, and (4) situational factors.
The epidemiological evidence for a relationship between violence and the use of other drugs is much more
scattered. It is complicated by the fact that most drug users use more than one type of drug. When an illegal
psychoactive drug is implicated in violent behaviour, it is often also accompanied by alcohol use. Clinical and
experimental evidence shows that the risk of aggression and physical violence depends, in addition to the type of
drug, on the amounts used, the method of application, the phase of acute intoxication, and the long-term pattern of
use. However, the violence associated with the use of illegal drugs is perhaps most closely determined by the
characteristics 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 to
violent crime in an effort to secure the funds needed for their addiction.1996; 6 (1): 29-36.
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