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Revising the preventive paradox: the Swiss case.
G Gmel1, S Klingemann, R Müller
1Swiss Institute for the Prevention of Alcohol and Drug Problems, PO Box 870, CH-1001 Lausanne, Switzerland. ggmel@sfa-ispa.ch
Addiction (Abingdon, England)
|February 22, 2001
Summary
Moderate drinkers who binge drink reported more alcohol-related social harm than hazardous drinkers. Most binge drinkers are moderate consumers, suggesting prevention should target drinking occasions, not just volume.
Area of Science:
- Public Health
- Epidemiology
- Alcohol Research
Background:
- Kreitman's preventive paradox suggests reducing average alcohol consumption may increase harm if lower-volume drinkers increase binge drinking.
- Revisions by Stockwell and Skog highlight the role of binge drinking and its distribution within the population.
- Understanding alcohol-related social harm in different drinking patterns is crucial for effective public health interventions in Switzerland.
Purpose of the Study:
- To examine the preventive paradox of alcohol consumption and its revisions concerning alcohol-related social harm in Switzerland.
- To investigate the reporting of social harm in low-volume, non-binging drinking subpopulations.
- To compare the occurrence and severity of social harm across subgroups defined by average consumption (volume) and binge drinking patterns.
Main Methods:
- Conducted telephone interviews with 1256 current drinkers in a probabilistic sample of the Swiss general population.
- Defined moderate and hazardous consumption using a quantity-frequency instrument (20g/day for women, 30g/day for men).
- Defined binge drinking as ≥4 drinks/occasion for women, ≥5 drinks/occasion for men; used structural equation modeling for harm severity and factor analysis for stages of change.
Main Results:
- Moderate-volume drinkers reported more problems than hazardous drinkers, supporting Kreitman's paradox.
- Binge drinkers reported more problems than non-binge drinkers, supporting Stockwell's revisions.
- Binge drinkers were more prevalent in the moderate-drinking group, aligning with Skog's findings; harm severity did not differ significantly between binge drinkers in moderate vs. hazardous groups.
Conclusions:
- The preventive paradox of binge drinking reappeared, with most binge drinkers found in the low-average consumption group.
- Findings suggest that preventive strategies targeting the majority population should focus on heavy-drinking occasions rather than solely on mean consumption.
- Approximately 40% of moderate-volume, non-binge drinkers reporting harm indicated it related to a previous drinking pattern, suggesting a dynamic in harm reporting.