Nordic Studies on Alcohol and Drugs

If and how various ways of expressing oneself creatively might help heal and resolve mental problems is a question that has been discussed for decades. Creative writing is typically used as an add-on to traditional therapy rather than being an integrated part of the therapy. There is a lack of research into the effect of implementing creative writing as an add-on to therapy for alcohol dependence. The aim of this study was to introduce creative writing to chronic alcohol-dependent clients.

A creative writing course was held as a pilot study with six workshops each lasting two hours. Six clients recruited from a harm reduction unit in a Danish alcohol treatment centre and suffering from chronic alcohol-use disorder participated in the workshops. The workshops were led by two professional authors experienced in teaching creative writing. At the end we conducted three interviews: one with the clients, one with the therapist and one with the authors. The interviews were analysed with a focus on the clients’ perspective.

In the analysis, we found that writing can give the clients a lower self-esteem, make them fear failure, and it can be too private. We also found that writing can increase the clients’ self-confidence and unity in the group, give them new nuances of life, stimulate their brain, give zest for life, and improve relations between clients and care providers. Further, we identified a few points of importance to be added to the organization of the workshops.

We found that clients suffering from alcohol-use disorder participating in creative writing profited from increased self-confidence, a sense of unity, were better able to appreciate the nuances of life, experienced stimulating brain activity, had more zest for life, and that the intervention improved relations between clients and care providers.

Alcohol ranks as a major risk factor for health-related harm and mortality. Older males who encounter alcohol problems late in life are an under-studied part of the affected population. This article seeks to broaden our understanding of this group by combining empirical data with humanistic cultural analysis. Specifically, it seeks to show how the desire to cope alone can be linked to generationally specific constructions of hegemonic masculinity.

Clinical empirical methods are fused here with those of literary analysis. The subjects which the clinical researcher chooses for scrutiny are different from those most natural to literary study, yet the interpretive approaches of qualitative phenomenological investigation and literary close reading are in fact quite similar, and we argue that new knowledge can be generated by evaluating cultural texts alongside the testimony of phenomenological research subjects.

Our findings illustrate a thematic connection between subject testimony and literary texts from the relevant historical period. In the sources we compared – a qualitative study conducted in Denmark and a British novel, Kingsley Amis’s 1954 Lucky Jim – we found a strong link between the values of masculinity and the values of independence. Older men’s resistance of institutional treatment for alcohol problems has motivations which go beyond the desire not to rely on outside aid, a desire which may apply to any illness. As Lucky Jim helps us show, alcohol use functions for men of a certain generation as a symbol of rebellion against institutions, and having institutions play a dominant role in their alcohol cessation may create resistance in these men.

To examine the cultural impact on the diagnosis of alcohol-use disorders using European countries as examples.

Narrative review.

There are strong cultural norms guiding heavy drinking occasions and loss of control. These norms not only indicate what drinking behaviour is acceptable, but also whether certain behaviours can be reported or not. As modern diagnostic systems are based on lists of mostly behavioural criteria, where alcohol-use disorders are defined by a positive answer on at least one, two or three of these criteria, culture will inevitably co-determine how many people will get a diagnosis. This explains the multifold differences in incidence and prevalence of alcohol-use disorders, even between countries where the average drinking levels are similar. Thus, the incidence and prevalence of alcohol-use disorders as assessed by surveys or rigorous application of standardised instruments must be judged as measuring social norms as well as the intended mental disorder.

Current practice to measure alcohol-use disorders based on a list of culture-specific diagnostic criteria results in incomparability in the incidence, prevalence or disease burden between countries. For epidemiological purposes, a more grounded definition of diagnostic criteria seems necessary, which could probably be given by using heavy drinking over time.

A drinking pattern is not only a major drinking variable, but is also one indicator of a country’s drinking culture. In the present study, we examine drinking patterns within and across the neighbouring countries of Denmark and Germany. The aim of the research is to determine to what extent drinking patterns differ or are shared at the sub-national level in the two countries.

Data came from the German 2012 Epidemiological Survey of Substance Use (n = 9084) 18–64 years (response rate 54%), and the Centre for Alcohol and Drug Research’s 2011 Danish national survey (n = 5133) 15–79 years (response rate 64%), which was reduced to a common age range, producing a final n = 4016. The drinking pattern variable included abstention, moderate drinking, heavy drinking, risky single occasion drinking (RSOD), and was investigated with bivariate statistics and gender-specific hierarchical cluster analysis.

For men three clusters emerged: one highlighting abstention and RSOD, moderate/heavy drinking, RSOD and RSOD + heavy drinking. For women, two clusters appeared: one highlighting abstention and moderate/heavy drinking and the other highlighting RSOD and RSDO + heavy drinking. The clusters revealed different geographical patterning: for men, a west vs. east divide; for women, a north–south gradient.

The analysis could identify for each gender clusters representing both separate and shared drinking patterns as well as distinctive geographical placements. This new knowledge can contribute to a new understanding of the dynamics of drinking cultures and could indicate new approaches to prevention efforts and policy initiatives.