Risky Single Occasion Drinking Research: The Four Stages of Enlightenment

Abstract

the WHO international study with the two Australian studies available at the time and concluded that: 'all studies show(ed) a greater increase in risk of injury after four standard drinks (40 g) on a single occasion than after lower numbers of drinks ' (p. 53) and 'having four drinks on a single occasion more than doubles the relative risk of an injury in the six hours afterwards . . . the relative risk rises more rapidly above the level of four drinks on an occasion ' (p. 56). (I understand that Professor Rehm was consulted regarding the analyses underpinning the new Australian drinking guidelines.)However, based on cross-country comparisons, Gmel et al. reasonably conclude 'harmonization' of RSOD at 60-70 g for males and 40-60 g for females. What can we make, then, of the disparity between the Australian analysis (which is based on international evidence) and what appears to be international consensus? The former, concluding RSOD at a level at least one-third lower for males than the latter? Given the problems described by Gmel et al. for RISKY SINGLE OCCASION DRINKING RESEARCH: THE FOUR STAGES OF ENLIGHTENMENTWe are grateful for the comments of our highly esteemed colleagues. First, they raise concerns about the name and definition of the underlying concept [1,2]. While the sociology of research of binge drinking is interesting [2], our aim was much more modest: we have been trying to clarify a concept which could help research to better interpret the myriad of empirical findings. With this objective in mind and to avoid confusion, we prefer the term risky single occasion drinking (RSOD) in order to separate it from more chronic heavy drinking.Second, to define the cut-off for RSOD may be difficult in terms of a fixed number of drinks (e.g. five drinks or more) due to different concentrations of ethanol of drinks across countries. Our focus was not on promoting a particular cut-off as may have been understood by Dr Chikritzhs [3]; instead, we tried to review the literature by focusing on articles where single occasion alcohol consumption was between 60-70 grams for men, and 40-60 grams for women. Cut-offs for research must be defined based on the research question and the scientific evidence, and should not be confused at all with normative cut-offs such as those used in drinking guidelines, for example. Our aim was not to translate research into understandable and evidence-based public health guidelines or measures, but to raise awareness for research needed to feed into correct public health messages. In terms of measurement via blood alcohol concentrations [1,2]: although such an operationalization is feasible in some studies, it seems to be difficult for the majority of studies in alcohol epidemiology, which have to rely on self-report, if only for budgetary considerations.Third, we agree there is a risk of problem amplifying of RSOD [2], which could lead to stigmatizing some behavior. For instance, problem amplifying may occur in longitudinal research where a baseline measure of RSOD is used as a pre...

A narrative review of alcohol consumption as a risk factor for global burden of disease

“…As indicated above, currently the only triangulation is between average level of alcohol consumption and per capita consumption [110, 112]. For irregular heavy drinking occasions [130, 131], we accept self-reports from surveys as true, even if we know, that they usually underestimate true frequency and number of drinks per occasion. In the future, we need to develop ways to triangulate self-report and objective measurement for irregular heavy drinking occasions.…”