Prevention paradox in alcohol-related problems

Does the Rose’s prevention paradox apply in alcohol-related problems?

In 1986, a year after the Rose’s paper, Norman Kreitman found an answer affirmatively to the above question. He published his findings in the British Journal of Addiction.

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

Kreitman’s paper

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

  1. 1986 British study

This study has conducted by Wilson with 2000 adult participants. The following graph summarises their key findings.

As we see in the above graph, of all drinkers who reported alcohol-related problems, as many as 66 per cent, reported drinking below the risk limit at that time.

Three Areas study

Kreitman used data from another study to support his argument. In this study, the researchers used three drinking levels with increasing severity – a more detailed assessment than the previous one.

As we can see, this study too follows a similar pattern; as many as 54 per cent of problem drinkers arise from light drinkes who self-reported drinking 1 – 20 units of ethanol. In contrast, among all drinkers who reported problems, only 12 per cent reported drinking heavily: 51 and more units of ethanol.

2007 Finnish study: A paradox in alcohol-related hospital admissions

The previous studies that I discussed suffer quite a formidable limitation; all were based on self-reports. In 2007, Kari Poikilonein addressed this limitation to a certain extent by looking at alcohol-related hospital admissions. Based on the data available in their published paper, I created the following graph which resembled the alcohol-related hospital admissions.

The above graph illustrates that of all alcohol-related hospital admissions, 71 per cent of men and 64 per cent of women reported light drinking habits. In contrast, men and women, who reported heavy spisodic drinking habits constituted only 29 per cent and 34 per cent respectively.

Now we look at alcohol-related deaths.

Prevention paradox in alcohol-related deaths

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

Again, this data add more evidence convincingly to support the prevention paradox; 63 per cent and 93 per cent of all deaths occured among men and women, who previously reported light drinking habits. In contrast, only 36 per cent and 7 per cent of all deaths occured among men and women respectively, who reported heavy drinking habits.

Prevention 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 in 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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