Prevention paradox in alcohol-related problems

Researchers have examined the applicability of the prevention paradox in alcohol-related problems: One year after Rose’s paper, in 1986, Norman Kreitman did jus that. He published his findings in the British Journal of Addiction.

As Rose did, Kreitman also used others’ data in his endeavor.

Kreitman’s paper

I chose two studies from his paper and created graphs for each to highlight the critical points.

1986 British study

Kreitman discussed a British study conducted by Wilson involving 2000 adults. The following graph summarises their key findings.

Alcohol consumption and problem impact paradox: based on data available in the 1986 Kreitman’s paper (created by Prasantha De Silva)

In the above graph, the dark brown area represents alcohol-related problems relevant to alcohol consumption limits; at the left corner, you find that among those who consumed alcohol below the limit three percent reported problems and those who consumed above the limit 31 percent reported such problems.

On the other hand, the light brown area refers to the proportions of alcohol-related problems out of all problems; as you can see that those who consumed below the limit reported 66 percent of all such problems. However, those who consumed above the limit reported less than half – 43 percent – of all problems.

Three Areas study

Kreitman uses data from another study to highlight the prevention paradox. In this study, the researchers used three consumption levels – a more detailed assessment than the previous one.

alcohol consumption and problem impact paradox: based on data available in Kreitman’s paper (created by Prasantha De Silva)

As you can see, this study too follows a similar pattern; although only 8 percent of light drinkers reported alcohol-related problems, they contribute 54 percent of all alcohol-related problems. It reverses among heavy drinkers; 20 percent of heavy drinkers reported alcohol-related problems although they contribute to only 12 percent of all alcohol-related problems.

2007 Finnish study

The previous studies I mentioned suffered quite a formidable limitation; all were based on self-reports. Kari Poikilonein addressed this limitation to a certain extent by looking at alcohol-related hospital admissions. Based on their data available in their published paper, I created the following graph which resembled the alcohol-related hospital admissions.

In 2007, Kari Poikilonein and her study team examined the prevention paradox in terms of alcohol-related hospital admissions and deaths. I created the following graph based on their data published in their paper in the Addiction journal in 2007.

Prevention paradox in alcohol-related hospital admissions

In the following graph, the brown and blue colors represent the proportion of women and men hospitalized out of all alcohol-related ones due to alcohol-related problems respectively.

alcohol intake and hospitalization paradox:
based on data available in the Kari Poikilonein et al. paper appeared in the Addiction journal
(created by Prasantha De Silva)

As you can see, of those who were hospitalized as a result of alcohol-related problems, if you look at the left end of the graph, an overwhelming majority – 71 percent of men’s and 64 percent of women – claimed to have light drinking habits as defined by the study, constituted the alcohol-related hospital admissions. The researchers further found a sub-group among light drinkers: those who drank five or more standard drinks in one session – they were called “heavy episodic drinkers”.

In contrast, if you shift your eyes from the left end to the right end of the above graph, you will find that only 34 percent of men and 29 percent of women claimed to have heavy drinking habits: less than half of light drinkers.

Preventive paradox in alcohol-related deaths

They further looked at alcohol-related deaths and found out a similar pattern; the majority who died reported to have light drinking habits earlier – the researchers linked previous survey data to hospital records.

Prevention paradox in alcohol-related deaths The graph was created by Prasantha De Silva based on data available in the Kari Poikilonein et al. paper appeared in the Addiction journal

Preventive paradox in 23 European countries

Much later, another group of researchers analyzed 38,370 alcohol-consuming 16 -year old student data from 23 European countries. Again, they also found similar results with regard to mean levels of alcohol consumption and heavy episodic drinking measure although the countries varied with drinking levels – a very robust, impressive finding. However, they emphasized a limitation of the concept: a minority – frequent heavy episodic drinkers – three or more heavy episodic drinkers a month – were the majority.

In other words, the existence of the prevention paradox in alcohol-related problems depends on the indicator used to measure consumption.

Author: Prasantha De Silva

A specialist in Community Medicine board-certified in Sri Lanka and a research analyst in Canada

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