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Political actors participate in policy debates as an advocacy strategy to influence political opponents and public opinion. They often engage in cross-sectoral advocacy by participating in multiple adjacent debates. To investigate what factors influence cross-sectoral advocacy in policy debates, we examined advocacy coalitions in two health policy...
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... the best-fitting logit model (among the first three) was used to predict probabilities for selected scenarios to aid model interpretation. Figure 1 shows the estimated ability parameters and their 95% HPD intervals for the most active actors (those who make at least ten statements). Figure 2 filters these positions by actor type. ...
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... We identified changes in discourse coalitions by conducting a discourse network analysis (DNA) (Leifeld, 2013(Leifeld, , 2017Leifeld & Haunss, 2012). DNA is currently predominantly used to map advocacy coalitions around the shared agreement or disagreement on policy instruments (Leifeld et al., 2022). We contribute to further broadening the DNA application range towards tracking evolutions of discourse coalitions by redefining concept nodes as storyline nodes and omitting the dis-/agreement qualifier. ...
... The literature on policy integration discusses multiple subsystems and sectors (Candel & Biesbroek, 2016;Kefeli et al., 2023;Tosun & Lang, 2017;Trein et al., 2023). Policy research has studied multiple issues, multiple-policy subsystems, an integration of instruments from multiple policy sectors, or actors engaging in multiple debates (Brandenberger et al., 2022;Hedlund et al., 2021;Leifeld et al., 2022). Despite this recent progress, we still lack studies on how actors from different sectoral backgrounds interact as they form coalitions. ...
Grand sustainability challenges span multiple sectors and fields of policymaking. Novel technologies that respond to these challenges may trigger the emergence of new policy subsystems at the intersection of established sectors. We develop a framework that addresses the complexities of ‘multi-system settings.’ Empirically, we explore belief and coalition formation in the nascent policy subsystem around hydrogen technologies in Germany, which emerges at the intersection of electricity, transport, heating, and industry and is characterised by a broad range of actors from different sectoral backgrounds. We find two coalitions: a rather unusual coalition of actors from industry, NGOs, and research institutes as well as an expectable coalition of gas and heat sector actors. Actors disagree over production, application, and import standards for hydrogen. However, there is widespread support for hydrogen and for a strong role of the state across almost all actors. We explain our findings by combining insights from the advocacy coalition framework and politics of transitions: Belief and coalition formation in a nascent subsystem are influenced by sectoral backgrounds of actors, technology characteristics, as well as trust and former contacts. Our study contributes to a better understanding of early stages of coalition formation in a multi-system setting.
... Beyond the BSPR concept, social science scholarship has explored the role of ideas in policy-making (Béland 2009;Campbell 1998Campbell , 2004Kamkhaji and Radaelli 2021;Schmidt 2008). Studies show that ideas have the capacity to influence policy outcomes via the construction of political coalitions (Béland and Cox 2016) or advocacy coalitions according to their belief systems (Leifeld et al. 2021;Sabatier 1998). They can be understood as paradigms, frames of reference, or belief systems (Hall 1993). ...
While European governance of individual policy sectors has received considerable academic scrutiny, less attention has been paid to the development of intersectoral coordination. This paper charts the emergence of a supranational boundary-spanning policy regime (BSPR) in education and employment in Europe. By looking at issues, ideas, interests and institutions, we gain a deeper understanding of the conditions for the emergence and further institutionalisation of European intersectoral coordination in education and employment from the 1990s onwards. The study relies on semi-structured interviews with European policy-makers in education and employment and EU policy documents. We analyse how endogenous and exogenous factors frame (policy) issues that contribute to the emergence and further strengthening of intersectoral coordination, the extent to which ideas for European education and employment stress intersectoral policy designs, how interests support or hinder intersectoral work, and which institutions are developed with intersectoral reasoning. We find that endogenous forces (rather than exogenous ones) played a significant role in the emergence of a European BSPR in education and employment. Structural aspects and policy instruments (institutions), alongside ideas and interests, then contribute to the institutionalisation of the European BSPR in education and employment.
... We identified changes in discourse coalitions by conducting a discourse network analysis (DNA) (Leifeld, 2013(Leifeld, , 2017Leifeld and Haunss, 2012). DNA is currently predominantly used to map advocacy coalitions around the shared agreement or disagreement on policy instruments (Leifeld et al., 2022). We contribute to further broadening the DNA application range towards tracking evolutions of discourse coalitions by redefining concept nodes as storyline nodes and omitting the dis-/agreement qualifier. ...
The European Commission is pursuing a circular bioeconomy to tackle pressing sustainability challenges, such as climate change and fossil dependency. Previous bioeconomy policy studies demonstrated the existence of competing bioeconomy discourses in the European Union. However, it remains nebulous how such discursive conflicts emerge and change, particularly in online settings. In this paper, we provide a more in-depth analysis of how argumentative changes of actors alter the network of online dynamic discourse coalitions. We base our findings on interviews and a qualitative discourse network analysis of 9983 tweets about European Union bio-economy policies from the period 2008-2021. Our results indicate that initially, expert debates centred around storylines on bioeconomy advantages. After the 2012 Bioeconomy Strategy, the debate diversified with the entry of new actors and storylines. Two discourse coalitions, 'Green future' and 'Planetary boundaries', emerged around conflicting storyline clusters. In the aftermath of the 2018 Bioeconomy Strategy update, the debate simplified into core argumentations of few, highly conflicting storylines, leading to a polarization of the two discourse coalitions. Storyline hijacking further added to polarization and conflict. Understanding the evolution of online dynamic discourse coalitions provides new opportunities for practitioners to open up discourses towards storylines from other parts of the discourse network. This can help to prevent locking-in the limited range of solutions in congruence with the dominant 'Green future' discourse.
... Existing scholarly works have employed computational linguistic tools and content analysis in various contexts, such as providing insights into persuasion strategies of radicalized Islamist groups (Windsor, 2020). This study uses the framework of the Sussex School of discourse analysis and is inspired by the studies conducted by Leifeld and his colleagues (Leifeld, 2017(Leifeld, , 2020Leifeld et al., 2021;Malang & Leifeld, 2021) in which network analysis is used as a method to examine content of political communication to identify links between verbal content and normative claims or policy formation. ...
Political leaders of pariah authoritarian states communicate their political discourse unilaterally, in a closed environment without free and open media access or the space for public scrutiny or debate. They use their speeches for various aims such as to respond to external shocks, justify hardship, appeal to domestic and international sympathy, assert autonomy and power, and influence policy and governance. This research uses Iran as a case study and offers an in‐depth analysis of 10 years of speeches by the country's Supreme Leader. In a case study of unilateral political communication method in an authoritarian environment, it sheds light on various aspects of the discourse generated by the country's Supreme Leader over a decade. It also analyzes the Leader's effort to influence policymaking and governance structure through practical official guidelines. Building upon existing theories of populism, the study seeks to unpack an understudied approach in populist politics that is based on a political discourse by the leadership which defines the populist dichotomy of people versus elite at the global level.
... Few existing applications of IRT evaluate underlying latent relationships between policy problems and solutions (Leifeld et al., 2021), and we are unaware of any such efforts in the environmental governance context. Instead, application of IRT to environmental topics has focused on comparison of environmental attitudes, perceptions, and sustainability between countries (Rodríguez-Casallas et al., 2020), populations (Vincenzi et al., 2018), and industries (Trierweiller et al., 2013). ...
Sea‐level rise is a “nascent subsystem” with policy actors actively developing initial policy preferences through participation across multiple policy forums in a polycentric system. This paper uses item‐response models to empirically analyze how actors, perceived problems, and preferred policy solutions are related in a latent “policy space”. We focus on California's San Francisco Bay region, where in the last decade, sea‐level rise emerged to become one of the most salient climate adaptation issues. We find that actors and policy preferences are arranged in a two‐dimensional space, with highly engaged actors more likely to consider environmental justice and ecological aspects of sea level rise. Our findings have implications for theories of nascent subsystems within the Advocacy Coalition Framework, and for understanding how a local policy subsystem develops to address and prioritize the multi‐faceted impacts of climate change.
Journalism unions are among the chorus of voices advocating for digital platform regulation. Yet, despite the documented impacts of platformisation on working conditions and labour markets, few of the recent inquiries into platform power have addressed the impacts of platforms on labour. In this article, we ask: what is the role of labour unions in shaping digital platform regulation? As our case study, we analysed how Australia's journalism union (the MEAA) articulated the interests of news workers in submissions to the Digital Platform Inquiry and the resulting News Media Bargaining Code. Through a critical discourse analysis of the union's submissions, we found that the MEAA's lobbying efforts championed the interests of freelancers, advocated for a more inclusive Code, and sought guarantees that the revenue it generated would be used to pay for content creation. The MEAA used a range of discursive strategies, including seizing on ambiguity surrounding the definition of the policy problem and key actors. For the most part, the submissions aligned the union with the regulator, state and media companies in pursuit of platform regulation. However, the competing interests among this advocacy coalition became increasingly clear in the later stages of the policy-making process. Ultimately, the union's strategies were constrained by the hegemony of market-centric discourses that framed the inquiry and shaped the policy outcomes.
Summary
From Temperance Movements to Evidence-based Alcohol Policy: An Evaluation of the Lithuanian Case
There would not be as many issues and political discussions if alcohol were a common product and were not harming drinkers or people around them. Examining the harm to the drinker is typical from the standpoint of public health. Alcohol’s harm to others (AHTO) has received increased attention in recent years and has been the subject of numerous studies. According to the Room et al. (2010) conceptual model, alcohol-related harm affects people besides the drinker themselves in the following ways: first, those who have close social ties to the drinker (such as children, siblings, parents, or spouses), followed by employers, coworkers, friends, or society as a whole. Insecurity on the streets to extreme violence like homicide are just a few of the negative effects that alcohol has on other people.
AHTO is a political issue. “All persons have the right to a family, community, and working life free from violence, accidents, and other harmful effects of drinking” (WHO, 1996). The WHO advises using so-called “best buys” policies, which are the least expensive interventions and have been shown to reduce hazardous drinking and related harm. These efficient and cost-effective approaches include increasing excise taxes, banning advertising, and limiting alcohol availability (Bhatia et al., 2019).
In Lithuania, there is a political discussion regarding the adverse effects of alcohol, and this discussion tends to pick up steam following tragic incidents like homicides. The different sorts of alcohol harm, such as harm to the drinker, harm to others, and injury to the state or society, are not differentiated in these debates. The focus of the argument is frequently reduced to “combating alcoholism”. The consequences for others are taken into consideration by the legal, medical, and social spheres. The majority of children are encompassed by the protection of children’s rights since at least one adult’s excessive alcohol use puts their safety in jeopardy (Tamutienė, 2018). A person who has been injured by a drunk driver, or one who was born with fetal alcohol syndrome, are only two examples of how someone else’s alcohol usage can have long-lasting consequences. It is crucial to keep in mind that alcohol-related harm is avoidable.
Since regaining its independence, Lithuania has openly stated that the goal of its law on alcohol control is to prevent any harm to the economy and public health. Aside from the prohibition on drunk driving, AHTO is referenced in the discussion of alcohol policy, but does not result in any clear objectives or ways to reach them. Why? One of the most challenging and important goals of this monograph is to provide an answer to that question.
This study’s major goal is to investigate how attitudes concerning AHTO affect the formulation of alcohol policies and their results. The main objectives are: 1) to review how AHTO was problematized during three hegemonic alcohol discourses (temperance, diseases, and alcohol risk/harm minimization) and how these discourses shaped policy development; 2) to investigate how Lithuanian alcohol policy development was influenced by alcohol hegemonic discourses; 3) to assess the results of evidence-based strict alcohol control in Lithuania over a 5-year period (2015–2020); 4) to look at how AHTO is conceptualized, positioned, and addressed in Lithuanian policy-formation processes; 5) to make suggestions on how to deal with the AHTO problem there.
Research methodology and methods
The first part of the monograph is based on a narrative discourse analysis. Hajer defines discourse as a set of ideas, concepts, and categories that are created, reproduced, and transformed by certain social actions and that give meaning to physical and social realities (Hajer, 1995:44). Prevailing discourse, according to its “rules of the game”, which structurally orients thoughts, actions, and practices, while sweeping competitors as not strong enough, is of great importance for the development of alcohol policy. Hegemony is a kind of political practice that captures the formation and disintegration of political coalitions. It can also be seen as a form of rule that can clarify the influence of a regime, practice, or policy on a group of entities by gaining their consent or ensuring their compliance. Hegemony as a form of rule presupposes various tactics of transformation, negotiation, and compromise to protect and restore a regime or practice. At the same time, the form of the rule is the result of hegemonic projects that have won or secured consent in a variety of contexts and places (Howarth, 2010).
In the analysis of the discourse, the object of research is seen in social, cultural, and historical contexts, which allows the interpretation of historical policy processes and practices related to the issue of alcohol.
In the analysis of the discourse, great importance is given to knowledge (how the alcohol problem was seen and what the reactions of different groups of society were to the problem at the time), communication (how that knowledge was shared; what information channels were used) and practice (how the hegemonic ideas shaped everyday practices, including institutionalization). In the broader socio-political context, temperance movements, alcoholism as a disease, and the emerging risk/harm reduction discourses (Lucas, 2004) are discussed. The Lithuanian alcohol policy development case was analyzed from the Valančius temperance movement to nowadays. The narrative is based on a secondary literature analysis that includes about 300 sources. The narrative is written in a transdisciplinary perspective and in no way pretends to be a historical study.
Standardized European alcohol surveys
Europe has high alcohol consumption. The issue of AHTO is therefore very relevant. 2006 The EU has adopted an Alcohol Strategy, which has launched the RARHA (Joint Action on Reducing Alcohol-Related Harm Action on Reducing Alcohol Related Harm), which has developed a standardized study of alcohol policy. Based on this methodology, the 2015 and 2020 standardized alcohol surveys were done in Lithuania. Both surveys were based on the standardized European Alcohol Research Methodology (Joint Action on Reducing Alcohol-Related Harm: RARHA SEAS-1) (Moskalewicz et al., 2016). The first study was conducted in 2015, in September–October (N = 1513) (SEAS-1) as part of RARHA SEAS-1, and the second in 2020, in August–September (N = 1015) (SEAS-2). In both studies, the target population was the population aged 18–64 years. Multilayer stratified probabilistic sampling was used. The response rate was 38.9% in 2015 and 38% in 2020. The CAPI (computer-assisted personal interview) method was used. All data from the CAPI software were converted to an SPSS file. Data were weighted by sex, age, and place of residence. SEAS-1 and SEAS-2 data were combined (N = 2528) into a single file. UAB “Spinter Tyrimai” conducted the survey in accordance with the requirements of the ESOMAR Code of the European Public Opinion and Market Research Association. The survey was conducted by professional interviewers with several years of experience working with surveys. Interviewers were trained on the instructions for conducting the survey. The survey field supervisor checked the quality of the interviewers’ work by phone (the logic and correctness of the interviewers’ work was checked), 10% of the respondents were contacted, checking the quality of 10% of the questionnaire data entry. Computer-Assisted Personal Interviews (CAPI) were applied, which avoided errors during the data entry. In the first stage, the logic and consistency of the responses were checked during the data processing by calculating the distribution and the interrelationships of the responses. The amounts of missing values in this data analysis were small and therefore did not change the statistical significance and therefore could not cause errors. After all checks, the values remained within the confidence intervals.
In the second stage, the quality of the data was reviewed, and the remaining errors and discrepancies were corrected using a special computer program developed for this purpose, which was used in the SEAS-1 survey. Several assumptions regarding the reasons for the inconsistency have been made in the development of this program. For example, if a respondent indicated that he or she drank six standard alcoholic beverages, but had a lower number of beverages, the latter was prescribed as six beverages. When a reasonable assumption was not possible, the erroneous value of the variable was moved to the missing values. The final cleaning of the data file SEAS-2 was performed by Janusz Sieroslawski and Jacek Moskalewicz, members of the Board of European Standardization Research.
Research instrument and measuring scales
SEAS-1 questionnaires were developed by RARHA project partners from 20 European countries. It consists of seven chapters that examine the main aspects of alcohol epidemiology and culture: alcohol consumption, heavy episodic drinking, the context of drinking, alcohol harm to non-drinkers, attitudes toward alcohol policy. The research tool integrates globally validated alcohol consumption, alcohol abuse, alcohol dependence scale, laissez faire, population and individual level alcohol control policy measures, variables related to alcohol harm in the respondent’s childhood and eight categories of AHTO. Reference time set up to 12 months, because the amount of alcohol consumption that causes harm depends on a person’s gender, weight, and other individual parameters. The respondent’s height and weight variables are included in the study tool. Two research tools have been developed for men and women, as the methodology distinguished between different units of alcohol consumption.
Validated scales such as specific beverage frequency (BSQF), Risky Single Occasion Drinking (RSOD); rapid alcohol problem screen test (RAPS) (Cherpitel, 2000), and Composite International Diagnostic Interview (CIDI) (Robins et al., 1989) were used to assess various drinking patterns.
Descriptive analyses were done. Pearson Chi square test was used to evaluate differences of results of two independent samples (2015, 2020). Significance level was set up at 0.05.
Qualitative semi-structured interview
The research presented in the third part of the monograph is based on a qualitative methodology and interpretive analysis of public policy. Two theoretical approaches are used to explain the process of alcohol policy and its development: 1) Advocacy Coalition Model; 2) Framework for multiple streams. Qualitative research methods allow us to understand the views of research participants from different professional and social contexts of engaging in advocacy. The phenomena examined and the theoretical approaches presupposed the need to combine individual interviews with document analysis.
The target group of the qualitative semi-structured interview is alcohol policy participants. Theoretical sampling was used. The informant map was made according to several criteria. Firstly, long-term involvement in advocacy networks and involvement practices relevant to the research period. Secondly, roles in organizations, coalitions, and positions in alcohol policy fields (as institutional or individual actors). Informed parties were identified through documents (formal membership in coalitions, informal agreements, facts of engagement in the alcohol policy process, etc.). 34 informants participated in the study. Interviews were transcribed and thematically coded. Themes for qualitative research were created deductively from the ACF (taking main concepts and theoretical assumptions for raising qualitative research questions) and empirical research. Interview data were triangulated with the documents. The parts of policy documents were retrieved from Lithuanian Parliament information systems (https://e-seimas.lrs.lt/) and government websites.
Informed consent of study participants was obtained. The names of the study participants were made anonymous. Furthermore, original quotations used and all principles of research ethics were ensured.
A qualitative study was conducted during March–December 2021. Thematic content analysis was used to analyze empirical data.
Structure of the publication
The first part of this monograph explores the role of attitudes towards alcohol harm in the development of alcohol policy, highlighting the prevailing hegemonic discourses (temperance movement, disease, and risk/harm minimization). In the second part, we evaluate how policy outcomes have changed since the transition from moderate to strict alcohol control was implemented. The third part examines the process of alcohol policy formation in order to understand how the issue of AHTO is positioned, problematized, and addressed.
The monograph consists of three parts. The first part singles out three hegemonic discourses that have had a significant impact on alcohol problematization and how to address it. Hegemonic alcohol discourses on TM, disease, and alcohol risk/harm reduction were described. These discourses have mainly affected alcohol policies worldwide, including Lithuania.
Hegemonic discourse of temperance movements (TM). Alcohol harm was perceived holistically during the TM period as harm to the drinker’s social status and health, productivity, personal development, and AHTO – children and other family members, society, economy, and development. During the first wave of TM, moral regulation dominated; during the second – the requirement of state responsibility, the apogee of which was the prohibition. A review of the literature has revealed that Lithuania, albeit belatedly, is entering the global context of alcohol hegemonic discourses. In 1818 J. Šimkevičius’ work on alcohol laid the conceptual framework for understanding the harm of alcohol, the importance of sobriety for prosperity, and the role of alcohol policy.
Valančius’ TM was the first such movement in the Russian Empire, although it was formally active for only a few years, but its informal significance is much deeper and broader. The Valančius TM corresponded to the ideas and methods of the first world wave of TM. At the turn of the 20th century, the second wave of TM in the world occurred, including Lithuania. As in many countries, various interest groups have become involved in the movement. The periods of both waves in Lithuania coincide with the abolition of serfdom and the creation of an independent state. We can assume that TM has contributed to this. In the Russian Empire, Tsar Nicholas II, before the mobilization of the First World War, introduced a ban in order to increase the productivity of the soldiers and the well-being of their country. Even after the Bolsheviks seized power, the ban was not lifted. Scholars explain this by proletarian ethics: it took a sober man to cultivate communist consciousness. After Lithuania created an independent state, the TM was the force that largely contributed to the development of the national alcohol policy. A similar process took place after the restoration of independence in 1990.
The alcohol policy of the independent state came to an end with the outbreak of World War II and the Soviet occupation of Lithuania. In occupied Lithuania, the Soviets had introduced a state monopoly on the hegemonic discourse of a disease prevailing in the world during its existence. The hegemonic discourse of the disease has focused both science and politics on the drinker, discussing whether alcohol consumption is harmful, problematic, excessive, and what amounts of consumption are safe. In this way, drinking practices were normalized, pushing abstainers and those with alcoholism to the margins. Alcohol’s harm to others was ignored because the individual’s right of choice was furnished above.
An alcohol monopoly was established during the Soviet era. At the same time, the approach to the problem of consumption has changed and the focus has shifted to the hegemony of the disease model and financial interest. In the Soviet Union, which included occupied Lithuania, treatment methods were similar to those in the West, but less humane, due to the heavy weight given to repressive structures. Later, during the “Sąjūdis” in Lithuania, after Gorbachev announced an anti-alcohol campaign, the TM became more active, contributing to the restoration of the Independent State of Lithuania, the development of an independent alcohol control policy and the protection of public health interests. It can be stated that the third wave of TM began to emerge in Lithuania, the activities of which have been documented in detail by Kačerauskas (2013). Nevertheless, the third wave of TM did not acquire hegemony. This can be explained by the general global trend towards the liberalization of alcohol control, the dominant hegemony of the disease discourse. Despite the lack of hegemony, the TM coalition has become the most influential in defending the public health interest in alcohol policy-making processes. The Temperance Coalition and its supporting groups united into the National Coalition for Tobacco and Alcohol Control, which united 36 organizations at the time of writing the monograph (National Tobacco, 2022). The formation and operation of this coalition has made a significant contribution to the transition to another discourse: risk and harm reduction.
In the world, the hegemonic discourse of alcohol disease has been weakened by the new public health paradigm, which has opened a window through which alcohol harm has been looked at more broadly. Research on alcohol-related harm has intensified significantly since about 2000, and in recent decades, a holistic understanding of alcohol-related harm has returned to science and the WHO. This emerged from scientific evidence that has also become a resource for evidence-based policy. Recently, evidence-based perceptions of harm and evidence-based policies have prevailed. Effective interventions to consume and reduce alcohol-related harm are being sought. It can be argued that the discourse on alcohol risk and harm reduction is institutionalized in the documents and activities of internationally important institutions was set in place. International documents such as the 2030 Agenda for Sustainable Development (2015), the World Health Organization Global Strategy to Reduce Harmful Alcohol Consumption (World Health Organization, 2010), The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) (World Health Organization, 2015). The global goals of sustainable development are related to the prevention and treatment of the use of psychoactive substances, the prevention of violence, especially in early childhood. There is growing evidence that the skills developed in early childhood, in the interaction between the child and the environment around him or her, not only determine the future of human life, but also have a profound impact on future generations and on the economic capacity of states (Shonkoff et al., 2012; Campbell et al., 2014). For this reason, global organizations: the UN, UNICEF, the World Bank Group, UNESCO and the World Health Organization have given priority to early childhood care in their programs. Recognizing the significant contribution of parental alcohol use to child harm, these documents emphasize that evidence-gathering in research is an essential tool for developing a national, science-based database, addressing gaps in support for the youngest children and ensuring the rights of all children, especially the most vulnerable, so that no child goes unnoticed. To this end, a World Care Network has been set up (World Health Organization, 2019b).
The identification and conceptualization of alcohol-related harm in others has a clear direction in research. Emerging evidence of the complexity of the harm and the even more complex negative consequences help to strengthen the validity and importance of the measures taken. This not only facilitates political decision-making, but also reduces the influence of the alcohol industry and the arguments for free choice of alcohol consumption (Warpenius, Tigerstedt, 2016). Evidence-based policies to reduce alcohol consumption can reasonably be considered effective in preventing the risk of AHTO. Meanwhile, measures to help other people who have already suffered alcohol related harm from drinker are very important for eliminating the damage, mitigating its consequences. Research into the effectiveness of their application has begun in the last decade, and research into the effectiveness of intervention in recent years has revealed how difficult it is to reduce this AHTO effectively. Therefore, there is no doubt that states need to strengthen the overall reduction in alcohol consumption and, in parallel, develop strategies to reduce alcohol-related harm and recovery.
The second part of the monograph is devoted to the standardized European Alcohol Surveys in 2015 and 2020. To begin with, Europe has high alcohol consumption. The issue of alcohol-related harm is therefore very relevant. 2006 The EU has adopted an Alcohol Strategy, which has launched the RARHA (Joint Action on Reducing Alcohol-Related Harm), which has developed a standardized study of alcohol. Based on this methodology, the 2015 and 2020 standardized alcohol surveys were done in Lithuania. In Lithuania (and in other European countries) the dominant beverage among men is beer, whereas among women it is wine. In addition, the overall structure of net alcohol consumption shows that spirits among men account for a larger share than spirits among women. According to the alcohol consumption habits of the population, the countries can be divided into several groups. Northern Europe, Central Europe, and the Mediterranean. In addition, post-Soviet countries with a specific pattern of alcohol consumption can be singled out. Lithuania can be placed in two groups of countries according to alcohol consumption habits. First, there are the Nordic countries, which have a pattern of alcohol consumption where alcohol is rarely consumed, but relatively high in alcohol at the same time. Second, Lithuania can be classified as a region of post-Soviet countries, where spirits make up a larger part of the structure of alcohol consumption. This group of countries includes Estonia, Poland and Bulgaria.
The results of the standardized European alcohol surveys conducted in 2020 show that the proportion of people who have consumed alcoholic beverages in Lithuania at least once in the last 12 months has hardly changed. The survey data show that the structure of alcohol consumption in Lithuania has changed slightly in recent years, gradually moving from spirits to beer and wine. Examining the circumstances of alcohol consumption, it was found that from 2015 to 2020 the incidence of male alcohol consumption at the bar increased, while for women, the opposite holds. The frequency of alcohol consumption by both men and women from 2015 to 2020 was lower than in 2015. It is likely that such changes may have been influenced by the COVID-19 pandemic and the introduction of quarantine, as the second survey was conducted during the pandemic year. In addition, the incidence of alcohol use by men alone increased, but among women, this rate has declined.
No significant changes in high-risk alcohol use and subjective intoxication were identified, but fewer respondents reported experiencing alcohol-related problems. From 2015 to 2020, there has been a decrease in the number of respondents in Lithuania who have experienced problems with alcohol dependence and alcohol abuse. This trend is particularly pronounced among women, who are less likely than men to experience these problems anyway. The results of the questionnaire survey show that the number of addicts decreased from 21.5% to 19.8% among men and from 7.7% to 3.5% among women. In addition, the number of people abusing alcohol decreased from 27.7% to 14.5% among men and from 11.1% to 4.3% among women.
The overall AHTO statistically has declined significantly over five years. The survey data revealed that the overall AHTO from 2015 until 2020 decreased by 8.1% (from 78.7% to 68.5%, respectively). It is therefore insightful that the tightened alcohol policy contributed to the fact that as many as 185,857 adults did not experience AHTO after five years. Although the AHTO rate decreased significantly, in 2020 the European average (2015) was not reached (64%). Assessing AHTO by item, statistically we see a significant reduction in the rates of physical violence, involvement in serious arguments, and insecurity in public places.
AHTO was found to decrease in the age categories of older and middle-aged populations. In the senior category, verbal violence and involvement in a serious argument fell by a third and traveling with a drunk driver halved. In the middle-aged category, the harm of engaging in a serious dispute or insecurity in public places has fallen by almost a third. Statistically speaking, no significant change was observed in any of the harm indicators in the junior category.
The need for targeted assistance for children and other family members living with problem drinkers in the same dwelling remains very high. When comparing 2015 with 2020, we found 184,724 children lived in households at least with one adult who has a problematic alcohol use pattern, and 90,877 children lived with a person who had more than two alcohol problems (positive answer to two or more RAPS questions). To sum up, we can state that even after five years, there is a tendency for one third of all Lithuanian children to be at risk of having a harmful childhood due to problem drinkers in households.
As the World Health Organization’s “best buys” measures were implemented during the period under review, research into policy outcomes has also become the focus of international researchers. Both the results of our analysis and those of other researchers reveal a mixed picture, but at the same time confirm the trend of declining harm to both the drinker and others. Five years later, we are seeing a moderate liberalization of attitudes towards alcohol control measures, although it varies greatly between different social groups. The trend of liberalization has affected men more than women.
The survey data may have been affected by the management of COVID-19, as the second SEAS, which was supposed to take place in the spring, was postponed to the fall due to the country’s first quarantine. Quarantine may have affected alcohol consumption due to sudden stress, as well as restrictions on access to it abroad. However, the decline in harm rates and rates of alcohol abuse and dependence shows a positive impact of the five-year policy. The shift towards support for moderate policy measures towards liberalization can be partly attributed to the weakening of the public health coalition’s public activities in public space because, as the participants in the qualitative study put it, “we rested because we knew the Seimas would not allude to liberal proposals”. It is important to work with decision-makers in policymaking processes, but it is as important to have a constant dialogue with the public.
The third part of the monograph is aimed at finding an answer to the question: why is the AHTO not on the current alcohol policy agenda as an issue to be addressed? To explore this research problem, qualitative interviews were conducted with alcohol policy-making actors (34 semi-structured qualitative interviews with politicians, NGO advocates and representatives, business lobbyists). The Advocacy coalitions (Paul Sabatier and Hank Jenkins-Smith) and multiple streams theories were used to conceptualize and problematize the research.
It was established that the ideas of the AHTO as public policy beliefs were important for the functioning of the Lithuanian Public Health Coalition (PHC). They have been used to put in place science-based, cost-effective controls to reduce alcohol consumption, which are also measures to prevent AHTO.
Having analyzed the individual alcohol policy beliefs of the Lithuanian PHC and the factors that have shaped and changed them, it is possible to move on to a generalization and analysis of the alcohol system and its functional links. The actors in the PHC Coalition have been empowered to act together by common public policy evidence — the importance of scientific evidence in alcohol policy. The PHC was expanded, consolidated and mobilized for more action on the basis of this evidence. Scientific evidence on alcohol policy as a public policy belief brought different actors closer together — medical associations, researchers, some politicians (or parties), and traditional organizations of the sobriety or health movement. In fact, scientific evidence for public policy has brought the state institutions closer to the PHC, to the agencies under the ministries, and to others as well. These policy convictions have been the main force behind the PHC. Not only have the beliefs not changed since around 2007, but the normative importance and relevance of scientific evidence has become even stronger between 2018 and 2021.
The PHC’s “core” beliefs (the importance of scientific evidence in alcohol policy) have been hierarchically balanced with “secondary” beliefs: effective regulatory measures for alcohol control and WHO policy recommendations on the choice of alcohol policy instruments. The PHC (throughout its active life from 2007 to 2021) has “aligned” scientific evidence (as the “core” policy belief) with “secondary” beliefs (AHTO, effective alcohol control policy measures). Notably, the coalition leaders and other members have chosen the “golden keys” to change policy or maintain policy continuity. Scientific evidence on alcohol policy was framed in terms of issues (“issue framing”), combined with alcohol control measures, in order to change the attitudes of politicians and the public.
The research raised an issue which derived from qualitative research and showed an active involvement of the alcohol industry encouraging the application of evidence-based alcohol policy beliefs. The confrontation between the interests of the two camps had an integrating effect on the policy belief system. It also encouraged the linking of scientific evidence (as “core” beliefs) with “secondary” policy beliefs (AHTO, WHO policy recommendations). Overall, the analysis of the interview material showed that the “health advocates” were well aware of the impact of research on decision-makers through appropriate advocacy. Evidence-based policy beliefs were thus understood as influencing not only processes but also policy change.
The effective involvement of this coalition in advocacy was one of the factors behind the change in alcohol policy. PHC has been operating in the field of Lithuanian alcohol policy for more than three decades. Its activities were initially coordinated by several organizations and naturally later centralized and professionalized. The study examined how the convictions of the AHTO in the coalition promoted the inclusion in the coalition of the target groups representing the NGOs (children who had abused their relatives, etc.). The research revealed that interested NGOs representing the AHTO groups were also involved in the PHC networking. The involvement of a significant number of organizations was long-term, based on membership in associated organizations coordinating the coalition’s activities. However, the quality of the involvement of these NGOs in the alcohol policy process was variable, more passive and based on the support and advice of key advocates. This was determined by the lack of resources, social scientists who would analyze the phenomenon of AHTO in Lithuania, and the lack of leadership in the search for a solution to the problem of AHTO. On the other hand, even passive involvement in networking has benefited PHC. The involvement of organizations representing the target groups of the AHTO provided additional benefits to the PHC: it increased the overall authority of the coalition, and strengthened the messages sent.
The “flow of problems” of the AHTO (although resonant events were widely used in PHC advocacy, debates, companies) did not have the expected effect, i.e., the issues of harm and assistance to the target groups were not included in the agendas of alcohol treatment or social policies. It only intensified the search for a solution to the problem of alcohol use and general harm. The “strong three currents” combination did not change alcohol policy in 2016, but these changes occurred several years later.
At the end of the monograph, summary conclusions and recommendations are provided. Alcohol policy, which has adapted science-based controls, is said to be conducive to the prevention of alcohol-related harm, including in the AHTO. It is noteworthy that public support, especially for men, for science-based and effective measures to reduce alcohol consumption and harm is declining. It is therefore necessary to maintain the current alcohol control policy without liberalizing it, but in addition to helping the drinker, there is a need to develop and strengthen a system of support for others (children, family members, employers and colleagues, the public). According to the authors, it is not enough to tighten alcohol control policy, but it is necessary to develop a broad campaign on the effectiveness of alcohol control measures in reducing harm. Evidence-based policies require to be based on research. It is important in the future to prioritize research into efficacy, effectiveness in the application of alcohol control measures and effectiveness toward different groups of society. In addition to the expert work of the Public Health Coalition, which is producing excellent results in policymaking, it is essential to involve the public, as its acceptance/disapproval of various alcohol policies in the long term is also becoming a key argument in policymaking. In addition, it is important to include in the field of alcohol policy the part of society that experiences AHTO and those who work with the consequences of alcohol-related harm. Supporting the child rights, police, social and health sectors, and proposing effective solutions to the problem, can have long-term benefits not only in maintaining a science-based alcohol policy by reducing overall alcohol consumption, but also in finding effective ways to reduce harm and ensure the social well-being of others, especially children. It should be noted that the launch of the CRAFT project, the effectiveness of which has been tested and proven at international level, is a positive step towards solving the problem. It is crucial to examine whether the measures taken to address the problem of AHTO are effective. So far, no such measures have been taken in Lithuania. This should be a priority area for improving the well-being of those around the drinker and for calculating public spending on alcohol-related harm.
