Background

Hungarian researchers have in recent decades shown an unsteady interest in risk behaviours. Alcohol consumption and drug use as social issues first appeared in the 1980s and the 1990s, respectively. They were defined as social problems and so were supposed to be controlled and managed by the state. After the 2000s research on alcohol and drug was neglected. Nevertheless, alcohol-attributable mortality continues to be one of the crucial issues leading to Hungary’s persistently poor mortality rates, with excessive alcohol and drug use being one of the most significant health risk factors. Recent years have seen a significant improvement in various health indicators, but the reasons behind have so far remained unrevealed.

When analysing key indicators of alcohol and drug use, reliability of data proves to be a more severe problem than in the case of analysing other indicators. Alcohol and drug use indicators are particularly sensitive to changes in the legal framework and to society’s perceptions. Alongside the decline of classical addictive behaviours, new drugs and addictions have emerged, which partially replace and partly complement classical addictive behaviours. Little is known about the distribution, motivation for use and social patterns of the new psychoactive substances (NPS) or the prescription psychotropic medicines. International experts have found prescribed psychotropic medicines troubling. At the same time, problematic use of information and communication technologies is becoming increasingly widespread, especially among youngsters, having an adverse effect on their social relationships and psycho-social well-being. According to mainly international data, one should assume that risk behaviours have been rampant, yet it is the most disadvantaged social groups that have been most affected by risk behaviour-related issues. Aim of our project is to fill research gaps in order to reveal and understand the social patterns, characteristics, causes and interrelations of risk behaviours. In our view, a deeper understanding of these phenomena may help tackling the persistently poor health indicators experienced throughout the last decades in Hungary.

Excessive drinking is one of the major risk factors leading to illness, disability and mortality. 5.9% of the world's total annual number of deaths (3.3 million deaths) are due in some way to at-risk drinking. In Europe, in international comparison, alcohol-attributable mortality is particularly high (13.3%; WHO 2014). In Hungary, mortality rates are extremely high in comparison to international data (Orosz 2017). Excessive alcohol consumption is one of the crucial factors leading to persistently high mortality rates in Hungary. Alcohol-attributable mortality rate exceeded the EU average by 90% (Bálint and Elekes 2016), and the crude death rate for chronic liver diseases and cirrhosis was five times the EU-15 average in 2013 (Nagy et al. 2013).

The amount and quality of alcohol consumed, drinking habits, and further circumstances of consumption (Anderson and Bamberg 2006, Rehm et al. 2012, Mackenbach et al. 2015) are some of the several factors determining the extent of harm caused by drinking. Alcohol per capita consumption (APC) across Europe is highest in the world. Recorded APC of Europe surmounts the WHO average by 75%. Recently, however, APC has been falling in most of the European countries (WHO 2014). Simultaneously, from the beginning of the early 2000s, illicit and legal psychoactive substance use started to decrease among young people in almost all European countries (Hibell et al. 2009, 2012, Inchley et al. 2016). On this positive trend, (a several) hypotheses have been appeared on the international scene.

In recent years, recorded APC and the death rate for chronic liver diseases and cirrhosis have both dropped in Hungary (Kovács and Bálint 2015, Bálint and Elekes 2016). Research carried out among the adult and young population has also suggested that alcohol consumption has been falling in recent years (Elekes 2016, 2018).

Gathering data on alcohol consumption, reliability is a key issue. The statistics reflect reported sales and do not include unrecorded alcohol consumption deriving from homemade and smuggled alcoholic drinks. According to estimates based on mortality data, unrecorded alcohol consumption increased APC by 33% between 2003 and 2005 and by 18% between 2008 and 2010, in Hungary (WHO 2014). It is likely that after 2010, the year in which the Hungarian government championed a law allowing citizens to make their own pálinka (Hungarian home-made spirit), unrecorded alcohol consumption has been on the rise. Alcohol-attributable mortality was affected by various revisions on ICD, modification to the Central Statistical Office's death registration system (2005-2006), and the methods of financing health care. All these events make the interpretation of the trends difficult.

When tracking alcohol consumption/psychoactive substance use over time, Room (2015) found that consumption is subject to temporal models. This can be explained by the reaction of a group of consumers to the consumption behaviours (and the related outcomes) of their predecessors. That is to say that improvements in alcohol consumption in recent years have been interpreted as a response of young generations to the drinking habits of previous high-consumption generations (Freyssinet and Wagner 2004, Room 2010).

Research in Hungary, in part adapting to the requirements of the international studies, has focused on young people’s addictive habits. At the same time, studies carried out among adults suggest that while the senior generation consumes less illicit drugs than the young generation, they consume much more alcohol and other licit drugs (Elekes 2004). According to the European Health Interview Survey (EHIS), the Hungarian population shows a cohort effect: high levels of alcohol consumption are common to an aging population (Elekes 2018).

The improving trend does not affect all social strata in the same way. Most studies carried out within the general population do not show any social differences in alcohol consumption and drug use. As for the damage caused by alcohol and drug use, however, differences based on social status are striking: poor and disadvantaged groups are more likely to have problems than better educated people or those with a higher income, due to poor living conditions, marginalization and stigma (Room et al. 2015, Room 2015). Disadvantaged groups are prone to at-risk drinking and hazardous ways of drug use. Recent Hungarian studies have proven the thesis (Moskalewicz et al. 2016, Elekes 2016).

According to study based on mortality data of 17 European countries, social inequalities in mortality is to a large extent due to the rapid increase in alcohol-attributable mortality among disadvantaged social groups. According to the study in the population aged 35-79 up to 10% of mortality inequality may be the result of high level of alcohol-attributable mortality among disadvantaged social groups. According to researchers, this can be ascribed to poor living conditions, low quality alcohol and at-risk drinking (Mackenbach et al. 2015).

Recently, the emergence and spread of two new drugs have sparked attention of researchers. It is a question whether the two new drugs are supposed to substitute the classical drugs.

There appears to be a significant increase in the use and excessive consumption of prescribed psychotropic medicines. Young people often use psychotropic medicines as a substitute for illicit drugs (Room et al. 2015). ESPAD 2015 research found that abuse of painkillers by young people is particularly high in some CEE countries, including Hungary (ESPAD 2015).

The use of new psychoactive substances (designer drugs, legal highs) began almost a decade ago and became widespread among young people within a short period of time. Hungarian research suggests that designer drugs are used by the very consumers that take other illicit and legal drugs (Paksi 2017, Csák et al. 2017, Elekes 2017). However, other studies conducted in segregated settlements of extreme poverty have argued that the use of new psychoactive substances supersedes both the use of classical illegal substances and alcohol (Szécsi 2017).

Illicit and legal psychoactive substance use among young people is closely linked to leisure time use (Parker et al. 1998, Parker 2005, Beccaria and Guidoni 2002). Previous research findings in Hungary are very similar (Demetrovics, Rácz 2008, Elekes 2009). According to recent research outcome, youngsters’ leisure time use and relationships have changed dramatically. Researchers say this is primarily the result of the spread of information communication technologies (ICT) and, above all, smartphones. According to research conducted in the US, since the spread of smartphones, young people are less likely to meet their friends in person, they spend much more time at home and on devices; using various social media channels, they connect with their friends primarily via digital media (Twenge 2017). The harmful effects of the excessive use of ICT and social media have been the subject of a growing number of studies. They argue that the overuse of social media increases the likelihood of developing depression, body dysmorphic disorder or eating disorders. It increases the likelihood of suicide attempts and it may lead to the reduction of subjective well-being (Baker and Algorta 2016, Tromholt 2016). The disperse of ICT has facilitated access to any media content. Therefore, it is likely that the overall impact of the media on Digital Natives’ perception of risk behaviours is more powerful than it has ever been before.

Based on research recently done in Hungary one can assume that the above described trends can be experienced in Hungary too. According to Youth Survey 2016, 85% of 15-29 year olds have a smartphone and 87% have an Internet subscription at home. Youngsters spend most of their leisure time on devices. Research has found that the number of young people spending face time with their friends has increased, but only a few percent of respondents reported attending “events of live discussion" with their friends (Székely and Szabó 2016). Hungarian research too has pointed out the increasing level of loneliness, the drop in the number of friendships and the rising social isolation among young people – even though not explaining the phenomena as a result of the spread of ICT (Dávid and Lukács 2015, Albert and Dávid 2016). Research carried out among high school students gives information on the prevalence of problematic Internet and social media use. According to the study, nearly 20% of ninth and tenth graders should be considered as affected by problematic internet use (Király et al. 2016, Elekes 2016). Problematic social media use affects 4.5% of the high school students. Most of the affected students have a low self-esteem, also, a higher incidence of depressive symptoms has been reported within the group (Bányai et al. 2016).