Professor Ingeborg Rossow is a senior researcher at the Norwegian Institute of Public Health in Oslo and head of the institute’s alcohol research group. She is a member of the World Health Organisation’s expert advisory panel on Drug Dependence and Alcohol Problems and she has served on UNDCP’s advisory expert panel on international standards for drug prevention. Her research activities have included epidemiological studies of alcohol and drug use, health and social consequences of substance use, and research on alcohol and drug policy. She was interviewed by Professor Keith Humphreys on 9 November 2017 in Newcastle upon Tyne, during the SSA’s Annual Conference. A video recording of the conversation can be found here.
Keith Humphreys: Hello and welcome to another edition of Addiction Lives, sponsored by the Society for the Study of Addiction. My name is Keith Humphreys. I’m a Professor of Psychiatry at Stanford University and a scientist at the VA Palo Alta Medical Society in Palo Alta in California. It’s my pleasure and my privilege to interview today Dr Ingeborg Rossow, distinguished epidemiologist in the field. Good to see you again, Ingeborg.
Ingeborg Rossow: Thank you, likewise Keith.
So I’m really looking forward to chatting with you. We’ve got to work together many times but I now, having studied your career even more, realise that there are things about you that I don’t know that I think people watching will want to know. So why don’t we start at the beginning, where were you born, where did you grow up?
I was born in Oslo Norway and I also grew up there.
Wow so you’ve had a very stable career in life, because you are still based in Oslo.
Absolutely, yeah.
So you’ve obviously made a lot of contributions and scientific work and mathematics is also key you know to a lot of your work, your modelling work, so I just wondered as a kid growing up, were you a Math and science whizz, interested in Math and science or did that come later?
I wouldn’t say that, but I was pretty, I had good grades in Maths at school, so it wasn’t very difficult for me, it came easy. But I wasn’t particularly interested in Maths as such.
So are you surprised, would the young Ingeborg be surprised where the adult Ingeborg’s career has gone?
Definitely. Absolutely.
So where did you think you were going to be when you grew up?
I had all sorts of ideas actually. In one period I wanted to be a glass artist, to blow artistic glass. I wanted to be a social worker. In one period I thought I would be a medical doctor, working in a hospital. So I also worked for one year in a psychiatric hospital as an unskilled nurse and then decided this was not for me.
Okay. Then when you went to university, you majored in criminology. So that’s another thing, so how did you pick criminology?
Well at that time it was among the few studies that were open. I had been studying philosophy in France in a small mountain farm during the summer term and it was the autumn and when I came back all the studies were closed. So I had to go into one of the studies that were open and then the Faculty of Law, criminology was still available. So that’s why I studied that.
Oh wow, okay. And did you find criminology fascinating when you got into it?
Yeah I did. Both the subject and the people at the institute at that time. This was also a very radical period in Norway, in the mid/late 1970’s, the Marxist-Leninist movement was very strong among academics at that time and that was also very clear at the Institute of Criminology at that time.
So how did they look at crime?
Crime was very much part of societal structure. So it was um, more of a social science approach to studying crime, rather than kind of perhaps typical law school approach to it.
And that captured your imagination, I mean you found it interesting?
Yeah I thought it was interesting. But on the other hand at that time having studied criminology for one and a half years, I had the idea that sitting behind a desk, would be deadly boring. So I wanted to do something else. So doing clinical work was then the idea.
And so criminology leads naturally to dentistry. (Laughs.)
Well not naturally, it was kind of … (laughs) more opposite or the other, well yeah kind of opposite to um a very um desk.
Well, working with patients and…
Yeah doing more practical things, working clinically I thought would be more interesting, more stimulating than sitting behind a desk. So the irony is of course that now I’m actually spending all my days behind a desk.
But you were in dentistry for quite a while and I see you also had a scholarship in dentistry, you published studies about dentistry. So I take it then you enjoyed some aspects of it.
I absolutely enjoyed being a dentist in some respects and I also still miss some aspects to it. Helping patients and having contact with all sorts of people that’s the things I miss from dentistry now. Doing dental research was, I found very interesting and that’s why I wanted to continue within research.
And then you got an unusual opportunity to do a postdoctoral fellowship in this field, so, which is again another interesting shift from dentistry into the addiction field. So how did that come about, how did you make that decision?
Well when I was about to finish my PhD I knew I wouldn’t have any job at the Dental Faculty in Oslo, there were no positions for me at that time. So I was looking out for jobs and a friend told me that there was a vacant position at the National Institute for Alcohol and Drug Research in Oslo, on the project on alcohol and suicide and I thought I would just give it a try. I didn’t have any expectations at all. I just wanted to see whether they would at all find me relevant as an applicant. So I was very surprised and happy when I got the job.
And do you know, did they ever tell you why it is they picked you, given your different field, what it was they thought you were going to bring?
I think it was my training in epidemiology that was relevant. Although what I had been doing in epidemiology was not so much into alcohol and drugs research. I had been doing a couple of studies on alcohol and tobacco, but that was you know, very little.
And so what was the study and with whom did you work?
The project was on alcohol and suicide and the project was led by Ole-Jørgen Skog who…
A quite eminent scholar in the field.
Absolutely. So it was really a gift to be able to work with him.
What did you like, what did you learn from him, what was he like as a colleague?
He was what I’d call an intellectual giant. He was very sharp minded, had a seldom, a capacity of analysing all sorts of matters. But at the same time and he could be quite, he could be um strong and sometimes even harsh with people if he felt that people were not doing the role quite correctly, or um …
So was he intimidating?
Perhaps sometimes, yes. But on the other hand he was also very warm-hearted and had lots of humour. He was widely interested in other topics in research as well. So we had very many good talks and laughs over the years.
That’s great. So what did you, what was your role on this project, what did you do day to day?
The project was, we wanted to look at the association between alcohol consumption and suicide at the population level. So we did that with data from Norway and there was also a comparative project, so other people from other countries, mainly in Europe, but also in the Americas, were also part of the project. So what we did was to analyse, using the same methodology, the same type of aggregate level data from these various countries and look at whether the associations between alcohol consumption and suicide rates varied across different drinking cultures and you might also say different suicide cultures. There was a huge variation in the estimated magnitude of the association.
Where is the association strong between drinking and suicide?
Um the association is strongest in countries where the drinking culture is um, where heavy episodic drinking is a typical feature of the drinking culture, like the Norwegian, or Swedish, Finnish.
And you’ve continued to work in this field. I mean you’ve done a lot of work on alcohol and suicide. You’ve also done work on alcohol and homicide as well I noticed.
Yes.
So what do you think now looking back on what you’ve learnt and what other people in this field have learnt, what do you think we know about how, what role drinking plays in why people take their own life, or take another person’s life?
I think we know much better nowadays than we did twenty years ago that there is an association and also at the aggregate level which is of course important from a public health perspective and a policy perspective, knowing that there is a causal relationship between the amount of alcohol drunk in a society and the amount of suicide, so the amount of homicides implies that doing something with the total consumption of alcohol in a society will likely impact on the level of these death rates. So policies that are successful in reducing total consumption will then impact on these outcomes.
So the work is not just important for science, it’s got a policy implication that might save people’s lives.
Yeah I think so.
You have done a lot of excellent work that is connected to the policy world, including work that I’ve got to work with you on, so I know a bit about it, but I want to explore that a bit. So you were a key part of two major international collaborations, one around alcohol and public policy and international work on drugs. So just to start with the one on alcohol, which was edited I think by Tom Babor, is that right?
Mm.
So how did you get involved in this project and what did you, what did you learn?
I think it was in 1999 something like that, I was asked to contribute on some papers that would found the basis for the ‘Alcohol No Ordinary Commodity’ book. So I attended a meeting in Copenhagen and I wrote at least one chapter, sorry a paper that was kind of a background paper for the book. Then I was invited to take part in the author group and do something with the epidemiology part of the book.
And who else was involved in that book?
Well at that time Tom Babor was the captain of the ship so to speak, Griffith Edwards, Sally Caswell, Raul Caetano, um Norman Giesbrecht, Harold Holder, Kate Graham, um Robin Room and um, I’m terribly sorry I’m forgetting two names now.
But it was a large international collaboration. So was that fun to work with people all over the world like that?
It was very fun, intellectually and socially. Very competent people in various areas and also very nice people to be with. So these meetings and working together was very pleasant.
So in working with people from many different countries and many different disciplines, you mentioned people with training in sociology, economics, psychology, I wonder if you learned things by writing that book that surprised you as you broadened out across these diverse people and where they were from and what they did?
I’m certain I learned a lot of things. There were really surprises? I’m not quite sure.
The book had quite an impact and it was cited many, many times and was updated as well I believe, a second edition and you were involved in that also, is that right, yeah?
Yeah.
That’s terrific. So you were also involved, as I know very well, in a similar effort, also led by Tom Babor, who leads a lot of these things on the drug side and I guess that started I should remember, maybe ten years ago or something like that. So was that something that, I mean you’d done a lot of work in alcohol, you came to that book, was that much of a switch for you, or at that point were you doing a lot of work on illicit drugs as well as alcohol in your career?
Well the epidemiology part describing the distribution of use of drugs was not entirely new to me, I’d been doing a bit of work on that already and also on the various harmful outcomes from illicit drug use. So um, er I had already done a bit of work on that.
So you’ve done these two books, in multiple editions now, both of them for drugs and alcohol and at least part of the point of the book was to persuade people about how to make policy. Do you feel that they’ve been used in anyway, had any impact on policy in Norway, or indeed anywhere?
Well first of all from my point of view, I wouldn’t say that the point of the books is to persuade people, but they should inform people.
Fair enough, fair enough.
That being said I have the impression that they have made an impact and that they have been important. So it’s easier to see it in my own country in Norway where I know particularly those who are in favour of a restricted alcohol policy are very clear about the book ‘No Ordinary Commodity,’ some people call it their Bible.
Oh wow that’s quite a compliment.
Well yeah. Tom was joking that it’s No Ordinary Bible! (Laughs.)
That’s good, that’s very good. So one of the areas that those books address is community level prevention, what can communities do and you’ve studied that a lot and I’m wondering what would be your advice now when a city or a town says we would like to have fewer problems with drugs and alcohol in our community, what do you think science has to inform them?
Yeah, (laughs), I try to be clear about informing and not advising.
Right, understood.
But of course in general we know that price and availability are very strong measures to keep the level of consumption and therefore also the level of harm at a relatively low level. So to the extent that policymakers are able to restrict availability, which is what they can usually do something about at the local level. That is a possibility to reduce harm. On the other hand we know from the literature also that actually how you want to restrict availability at the local level, exactly what it looks like, may not be so easy to say. Would it be to restrict the number of specific types of outlets, or types of on premise licences, would it be concentration, or the total number, those kinds of things are not that exactly, that clear as the more general picture.
Meaning they are not clear, from science we don’t know or that it’s just hard to make the choices for community?
I think both. Um, it’s hard to know exactly what it should look like in one specific community and of course it’s what is a good choice, would always be a matter of how you weigh various concerns. So public health concern could be in the one hand and um trade, er types of crime and so on could be in the other and those things have to be weighed and that’s a matter of value.
So it’s part of the political process, not the scientific process. So that leads naturally to a question about an unpleasant experience in your career, which is at one point you um, you were attacked by the alcohol industry, the people who make money selling drink and they were unhappy with your work and the conclusions about public health. Can you explain like what happened and how did you deal with that?
Yeah. Um we had published an article about on premise trading hours and violence, showing that restriction in trading hours led to less violence and vice versa and the article got enormous media attention in Norway. But it was also attacked by the hospitality industry, who said it was rubbish, it was poor science and they also doubted our integrity as researchers and implicated that we had been um twisting or making the results the way that the Ministry of Health wanted them to be.
How did they do that, they were saying this in the media, accusing you of fraud or of being dishonest?
They didn’t use exactly those words. But they, the media were full of frontlines and big headlines with full war between experts for instance, there was doubt about both the quality of the research and also our integrity as researchers, which was extremely unpleasant and the media were calling constantly. So it was a huge rush and quite painful.
What happened in the end, did it blow over, or was there any resolution?
Yes. Yes it blew over.
The media got tired of it and moved on to other things.
Yeah well other things happen.
That’s good you can count on the media in that way. So this, I mean this is a reality of the field right that people, you know for everyone who is addicted, is also a good customer for somebody else, there is always a financial interest for some people in selling addictive products. So all researchers who do public health work could end up in this situation. Do you have any advice to people, maybe junior people who are worried about that or wonder what should I do about that based on what you went through, in terms of how do you handle it, think about it?
I think it would be good to be better prepared. I wasn’t prepared for that kind of attack. In retrospect I know I should have been, you know there is a huge literature on this from tobacco for instance, um but I wasn’t prepared and so didn’t, and it also happened in a period when many people were on holidays. So I didn’t have many people around me to support me, at the institute at the time.
So it was isolating. That’s difficult.
So I think being prepared and having some kind of support around you would be a good thing. But I can’t imagine that you could really do anything to escape it. When you are hitting the industry on the toes so to speak, I think you are asking for some kind of reaction that is inevitable.
In some way now it’s probably even worse, because there are now new media for which people can attack researchers right, over twitter and Facebook and everybody can do that yeah that’s a risk of the field. So you mentioned the Institute, let’s talk about that, I mean one of the things I admire about Norway is the commitment they make to science, I mean the consistent resources. I mean your career is unusual actually in having, not entirely been at the same place, but almost entirely that same steadily funded Institute. So that, what do you see as like, what have been the outcomes of that policy? I mean do you think that’s been a good investment for Government and something that continues to be valued?
I think that coming from an Institute which was at the time almost fully funded by the Government meant that research could be, have a very long perspective. You could invest in long term research projects and invest in building capacity among scientists over a long period of time and keeping focus on certain things over a long period of time, which is, I think more difficult when you have to apply for money, wherever you can find it and switching from one area to another and changing focus quite often.
Yeah, no it’s much more difficult to sustain intellectual work over a long period when you can’t count on it being supported. And is that still the case in Norway?
Things have changed. So about two years ago our Institute was merged with the Public Health Institute and so now we are in a really gigantic Institute, where alcohol and drug research of course is just a tiny part of it. We are also facing harsher times, with respect to funding and money, so we are much more dependent on getting external funding.
And in all those years having, being supported by the Government, some people would say well the down side would be that you can’t produce a finding that shows a Government programme doesn’t work, or you can’t show that a Government policy has been … Did you ever feel the dark side of that, or that you felt you had to trim your sails, did that ever happen?
No. No I can’t say that. The overall picture is that we was an independent Institute from the Ministry of Health and um whatever we found, whatever we thought was important to do research on, was not subject to any ties or any restrictions from the Ministry. There is however one example of the opposite which was, it happened just after I started at the Institute in 1992, a colleague here was in the media and was very clear about his views on cannabis and a very liberal view on cannabis. A few months after that the budget for the Institute was cut into the half, which was dramatic and we don’t know for certain whether there was, the latter was a consequence of the first, but it could well be the case. So it was a lot of um, it was, well a lot of discussions around whether that should have any impact on how researchers were talking in public about drugs or other things. The Institute Director at the time, Ole-Jørgen Skog, was very clear that we should not feel any kind of constraints in that respect. So we should feel absolutely free to say whatever we wanted. That should be a principle. And in the end the money came back. Julio resigned from his position. There was lots of attention from colleagues around the world who wrote to the Ministry and in the end the money came back.
That’s great, that’s terrific. You mentioned Julio before as an influence on your career, someone who inspired you and supported you, I’m just curious who are some other people that as you’ve gone along your journey have had an impact on you?
A number of people have had an impact and I’ve been very happy and lucky to work in these international collaborations, with you for instance. But I think it’s in particular, Robin Room has been a very important person to me, professionally and personally.
In what way, I’m just curious, how did he shape your thinking or how you do science?
Well he has this very broad interest in the addiction area. Everything is interesting and fascinating and inspiring to him it seems and he also has this enormous capacity to have this overview of the field and see parallels and analyse from a very broad perspective that, which I find very fascinating and viable.
So what about let’s think in the other direction in terms of mentoring, I know you are much sought after as a mentor by younger people and I’m just curious what have you learnt about impacting other people’s careers, how do you think about training the next generation of scientists?
Do you mean PhD students?
PhDs or MDs really, but people who are going in the field, what do you try to offer them, how do you guide them?
Well I have many trained PhD students and um in very different areas, so um I can’t think of much um that is, at least that comes to my mind right now that’s very common. On the contrary it seems to be that the PhD students have been on very different kinds of projects where they have had very different kinds of academic backgrounds and all people have different ways of working and interacting with supervisor and colleagues. So I think each mentor relationship has been unique in a sense.
Is it something you enjoy doing?
Absolutely.
Yeah that’s wonderful. I wanted to, before we wrapped up, talk about the future. Where do you think the field should go? What are the big questions that are either, old questions that we haven’t looked at enough, or maybe new things you think that addiction researchers should be thinking about over the next generation?
I think when we look at the literature it’s very dominated from a few countries, rich countries in the world, so North America and a number of European countries. So our knowledge from the rest of the world, the low and middle income countries is much less. So I think one important way to go is to stimulate research in the rest of the world, in order to, both for us to understand better various aspects of the addiction fields, but also for these countries to be better informed about the state in their own countries.
Do you have, I know you’ve done all these international collaborations, you’ve also been an advisor for the World Health Organisation, so you’re a presence on the international scene, do you have ideas about what are the mechanisms we should be using to stimulate the science you are talking about in low and middle income countries?
I’m sure every kind of financial support would be a kind of basis, but I also believe that the international research community can do a lot by making things a bit easier for instance that journals may use more time on serving, helping, coming up with good review, constructive review, comments and help people from LAMI countries to publish, to increase their capacity and publication.
It makes a lot of sense. Well as always it’s been a pleasure to talk to you, thanks so much for giving us your time, it’s absolutely delightful.
Thank you for interviewing me.
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