The extent of the 'prevention paradox' in alcohol problems as a function of population drinking patterns

Aims To assess to what extent use of various criteria for high-risk groups and analyses from subpopulations with different drinking patterns may affect the extent of the prevention paradox (that most alcohol-related harm in populations arises within the drinkers at low risk). Data sets Two national surveys of Norwegian adult samples (n = 4321 current drinkers) and one register linkage of Swedish armed forces conscripts (n = 45 839 current drinkers) with inpatient hospital data. Measures High-risk groups were categorized as the upper 10% of drinkers by annual alcohol intake or by intoxication frequency. Acute alcohol-related harms comprised number of quarrels and fights in the Norwegian surveys and number of hospital admissions for attempted suicide and violent injuries over a follow-up period (3 and 25 years) in the Swedish conscript study. Results The majority of acute alcohol problems were found among the majority of drinkers with low or moderate risk (the lower 90%) by drinking volume, suggesting empirical support for the prevention paradox. By applying frequency of intoxication rather than annual volume of consumption to determine the high-risk group, a somewhat larger proportion of acute alcohol-related harms was found within the high-risk group, and the number of alcohol-related harms tended to be distributed more evenly between high-risk drinkers and other drinkers. The proportion of alcohol-related harms within the risk groups was significantly lower in the younger age group, where the majority drinks to intoxication compared with other drinkers. Conclusion The extent of the prevention paradox with respect to acute alcohol problems may be more prominent in drinking in subpopulations where intoxication is a common part of the drinking pattern compared with those where intoxication occurs less frequently and among a smaller fraction of the drinkers.