Abstract
BackgroundAccording to the prevention paradox, the majority of alcohol-related harms in the population occur among low-to-moderate risk drinkers, simply because they are more numerous in the population, although high-risk drinkers have a higher individual risk of experiencing alcohol-related harms. In this study we explored the prevention paradox in the Irish population by comparing alcohol-dependent drinkers (high-risk) to low-risk drinkers and non-dependent drinkers who engage in heavy episodic drinking (HED).MethodsData were generated from the 2013 National Alcohol Diary Survey (NADS), a nationally representative cross-sectional survey of Irish adults aged 18–75. Data were available for 4338 drinkers. Respondents dependent on alcohol (as measured by DSM-IV criteria), respondents who engaged in monthly HED or occasional HED (1–11 times a year) and low-risk drinkers were compared for distribution of eight alcohol-related harms.ResultsRespondents who were dependent on alcohol had a greater individual risk of experiencing each harm (p < .0001). The majority of the harms in the population were accounted for by drinkers who were not dependent on alcohol. Together, monthly and occasional HED drinkers accounted for 62% of all drinkers, consumed 70% of alcohol and accounted for 59% of alcohol-related harms.ConclusionsOur results indicate that the majority of alcohol consumption and related harms in the Irish population are accounted for by low- and moderate-risk drinkers, and specifically by those who engage in heavy episodic drinking. A population-based approach to reducing alcohol-related harm is most appropriate in the Irish context. Immediate implementation of the measures in the Public Health (Alcohol) Act (2018) is necessary to reduce alcohol-related harm in Ireland.
Highlights
Alcohol use is the seventh leading risk factor for both deaths and disability-adjusted life years globally and is the leading risk factor among those aged 15–49 [1]
Of the 4338 respondents included in the analyses, there was a relatively even breakdown of low-risk (31.0%), occasional heavy episodic drinking (HED) (30.6%), and monthly HED (31.5%) drinkers
The majority of alcohol-related harms in Ireland occurred among drinkers who engage in heavy episodic drinking
Summary
Alcohol use is the seventh leading risk factor for both deaths and disability-adjusted life years globally and is the leading risk factor among those aged 15–49 [1]. Social harms arising from alcohol consumption, such as damage to work and home life, may constitute a significant burden to drinkers [2,3,4]. The selection of an appropriate target population represents a significant challenge to the design and implementation of polices aimed at reducing alcohol consumption and related harms. Not mutually exclusive, policy approaches are generally taken in order to reduce alcohol-related harm [4, 6]. A high-risk approach targets a small number of high-risk drinkers, while a population-based strategy aims to reduce alcohol-related harms through interventions targeted at the whole population. In this study we explored the prevention paradox in the Irish population by comparing alcohol-dependent drinkers (high-risk) to low-risk drinkers and non-dependent drinkers who engage in heavy episodic drinking (HED)
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