Male at-risk drinkers with heavy episodic drinking: a subclinical diagnosis?

The aim of this study was to examine to what extent general hospital inpatients with risky drinking patterns differ regarding alcohol-associated characteristics. In particular, we tested whether persons with at-risk and heavy episodic drinking (ARHE) differ from those persons with at-risk drinking only (AR) and heavy episodic drinking only (HE).

The participants were recruited using a two-stage sampling process: (1) screening and (2) diagnostic. All in-patients from four general hospitals, ages 18-64 years (N = 14,332), were systematically screened for alcohol use. For this study, men with AR, HE, or ARHE (n = 425) were used, and men with current alcohol dependence or alcohol abuse were excluded. The severity of the alcohol problem was assessed by the number of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria met. Among the participants' diseases, those that were 100% attributable to alcohol (assigned an alcohol-attributable fraction of 1 [AAF = 1]) were analyzed.

Of the sample, 35.3% of the persons were identified with AR, 22.6% with HE, and 42.1% with ARHE. Multinomial logistic regression revealed that, when controlling for age, ARHE was associated with increased odds of having a more severe alcohol problem (odds ratio [OR] = 2.06, confidence interval [CI]: 1.23-3.45), using formal help (OR = 2.21, CI: 1.02-4.79), and having diseases with AAF = 1 (OR = 3.43, CI: 1.58-7.43), compared with AR.

Among at-risk drinkers, persons with ARHE are a special subgroup because there appears to be an indication of a subclinical diagnosis. To provide adequate intervention, future research and clinical practice should distinguish between different risky drinking patterns.