Unravelling the preventive paradox for acute alcohol problems

Abstract

Kreitman's discussion of the preventive paradox in relation to the prevention of alcohol problems has had profound implications for alcohol policy and has generated considerable controversy [1]. It is argued here that although Kreitman should be credited with the important observation that alcohol-related harm is not confined to a few dependent drinkers, none the less an apparent paradox is not an ideal platform from which to recommend policy. Furthermore, Kreitman's own data and data from an Australian survey of drinking are used to demonstrate that a commonplace truth underlies his apparently paradoxical findings. It is shown that the preventive paradox disappears when consideration is given to the amount of alcohol consumed on either (i) the day of highest alcohol intake out of the last four, or (ii) the day on which acute alcohol-related harm occurred. Episodic heavy consumption by people whose average alcohol intake can be classified as 'low' or 'medium' risk contributes to the bulk of such experiences of harm. It is suggested that the importance of intoxication as a public health and safety issue has been neglected. This neglect is compounded when public education campaigns and prevention policy are only based on average rates of alcohol consumption. Advice regarding the low risk levels of consumption for different types of harm should form one component of a comprehensive harm reduction policy. Other elements of such a policy should include a variety of other measures of proven effectiveness in relation to reducing levels of intoxication and related problems.

Alcohol-Related Injuries: Evidence for the Prevention Paradox

“…In an Australian population-based survey, Stockwell and colleagues 6 also found support for the prevention paradox, with only 25% of the 67 individuals who reported intoxicationrelated harm exceeding the threshold for hazardous drinking on average. But the phrase "on average" here is key.…”

Impacts of Alcoholism in Public Health: A Systematic Review

“…It is showed, too, that the probabilities of being a victim of predatory crime for females who are weekly or more frequent drinkers are higher than those for males, which could reflect the fact that females, especially those who drink frequently, are more likely to be victims of various crimes [22]. Analyses have shown that the majority of problems may occur in relation to heavy drinking occasions, and that the number of people with heavy drinking occasions is larger among low-moderate consumers than among heavy consumers [28,29,30,144].…”

The Challenge of Distinguishing High‐volume and Frequent Risky Drinking

“…This redefinition also shifts the focus of control from individual deviants towards a deviant generation of young bingers. It offers an easy explanation of numerous problems emerging among youngsters: growing discontent, violence, including among young women, football hooliganism and so on [3]. It satisfies cultural demand to explain the alienation of a substantial segment of the young generation in contemporary societies, in particular in individualized societies in the United Kingdom or the United States.…”

“…Typically, the focus is on distinguishing low-volume (or moderate-volume) drinkers who do and do not engage in RSOD. This distinction was critical for analyses that probed the preventive paradox with respect to alcohol-related problems [2][3][4][5], demonstrating that most problems associated with low and moderate volumes of consumption occurred among drinkers with occasional episodes of RSOD. Less often compared are relatively high-volume drinkers who do and do not engage in RSOD, in part because there are few highvolume drinkers with no RSOD.…”