Academic journal article Alcohol Research

Defining Risk Drinking

Academic journal article Alcohol Research

Defining Risk Drinking

Article excerpt

Preventing alcohol-related harm does not necessarily require that risk drinking be defined. At the population level, harm reduction can be achieved through numerous broad measures that determine the price or availability of beverage alcohol (Babor et al. 2003). Measures such as these affect drinkers at all consumption levels. Although there is inconsistent evidence as to whether their impact is greater among heavy or light-to-moderate drinkers (Farrell et al. 2003; Gmel et al. 2008; Heeb et al. 2003; Makela et al. 2008; Manning et al. 1995; Wagenaar et al. 2009), such measures have proven to be effective in reducing problems associated with heavy or problem drinking (Wagenaar et al. 2009, 2010). In contrast to such global approaches, targeted approaches focus on preventing, identifying, and modifying risk drinking (i.e., drinking at levels or in patterns that increase the risk of alcohol-related harm). The development and dissemination of drinking guidelines that define the limits of low-risk alcohol consumption are one example of this type of prevention effort. Defining risk drinking may seem simple compared with preventing it, but in fact there are many conceptual and methodological challenges to arriving at a definition of risk drinking.

Perhaps the most essential challenge lies in determining the threshold that discriminates "low-risk" and "risk" drinking. Is risk drinking any consumption that corresponds to a significantly higher level of harm than that experienced by lifetime abstainers, or does the harm have to be of a specified magnitude? Given a linear relationship between consumption and harm, where is the appropriate cutoff point? Beyond this basic question, one must also ask what types of harms should be considered. Excessive use of alcohol is associated with a wide range of harmful outcomes, including alcohol use disorders; mortality and morbidity from chronic medical conditions, such as alcoholic liver disease, and acute causes, such as vehicular crashes and accidental and intentional injury; and a host of social and legal problems. Should risk-drinking definitions be keyed more closely to those types of harm most strongly attributable to alcohol use, or to the most severe harms (i.e., mortality or years of life lost) regardless of the strength of their association with drinking?

What aspects of alcohol consumption should be used to define risk drinking? Should these vary according to the type of harm (e.g., drinking volume in relation to chronic conditions, and drinking pattern in relation to acute alcohol-related harm)? Should risk drinking be defined in terms of consumption that reflects current alcohol-related problems, as is the case with screening for alcohol use disorders and emergency-department studies of drinking in relation to the risk of injury? Or should it be defined in terms of consumption that increases the risk of developing alcohol-related harm in the long term, as is the case with prospective studies of alcohol-related mortality and morbidity?

What types of studies are most appropriate for assessing associations between different aspects of alcohol consumption and alcohol-related harm? To what extent should we account for the quality of the consumption data upon which evidence of alcohol-related harm is based? Many of the large prospective studies used to assess mortality risk collect data on numerous putative risk factors, and they often contain too few questions on alcohol use to yield estimates of consumption that fully capture the contribution of heavy drinking days or multiple beverage types. If it is likely that associations of consumption with the risk of harm are based on underestimates of consumption, how should we account for that fact when using the data to inform definitions of risk drinking?

Finally, what is the appropriate cutoff between enough information and too much? Should definitions of risk drinking, or, conversely, low-risk drinking guidelines, be complex enough to include volume- and pattern-related risks and their variation across population subgroups or should they be simple enough so that drinkers can easily recall them and clinicians can easily identify risk drinkers based on a single metric? …

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