Prevalence and Determinants of Alcohol-Related Problems

Abstract

In this study, we sought to determine what factors, in addition to alcohol consumption, were the best predictors of social and physical alcohol-related problems. Variables examined as possible predictors of problems included circumstances under which people drink, feelings of alienation, and religious affiliation. Data for this study were collected continually from 1984 to 1989 using a random telephone survey of 2094 New York State residents aged 18 or older; the study sample was comprised of the 1076 who had consumed alcohol in the previous 30 days. Stepwise regression analyses examined the main effects of all possible predictors of problems while controlling for alcohol consumption. Forced-entry regressions examined interaction effects of problem predictors while controlling for basic demographics. Drinking with breakfast, smoking marijuana, and drinking in bars alone were all significant predictors of more problems. This suggests that problems are associated with an aberrant lifestyle (i.e., different from a typical lifestyle), although it makes no assumption about motivations. Further investigation of this subject area is warranted to ascertain which population subgroups are the most vulnerable to alcohol-related problems and to guide the design of prevention programs.

The fact that alcohol consumption is the primary contributor to social and physical alcohol-related problems has prompted researchers to study both alcohol consumption and the problems emanating from it; therefore, demographic distributions of each are fairly well understood. This body of research has revealed that distributions of drinking problems match distributions of heavy drinking in the United States . For example, lower socioeconomic status members, males, urbanites, and those who are young and/or single tend to drink more than their counterparts and to experience more problems from their drinking as a result .

In contrast to this wealth of research is the relatively small number of studies focused on whether the traditional problem-experiencing groups continue to have the highest problem rates when alcohol consumption is held constant. Identification of those most at risk of experiencing negative consequences from their drinking requires more than knowing who drinks more and assuming that they will experience more problems as a result; an adequate understanding of alcohol’s untoward effects requires specification of the contexts in which the effects of alcohol are the greatest.

Despite Babor, Kranzler, and Lauerman’s findings that social, moderate, and heavy drinkers are all at risk of experiencing serious health hazards and psychosocial consequences, it is generally reasonable to assume that studies focusing mainly on severe alcohol-related consequences are likely to miss lighter drinkers who experience less severe, yet potentially dangerous, repercussions from their drinking. Since, at most, about 10% of the drinking population in the United States can be classified as chronic, heavy drinkers , studying only people with severe alcohol-related problems would result in missing what is occurring across a broad cross section of the population . Conversely, studying only those with less serious alcohol-related problems (e.g., keeping one’s drinking secret versus developing cirrhosis) would still include heavy drinkers, who are more likely than moderate and social drinkers to experience all problems. In the present study, alcohol-related problems of a less serious nature were analyzed.

Babor et al. found that risk of experiencing social and physical alcohol-related problems is not always a direct function of amount consumed, but may instead reflect complex interactions among many variables. They asserted that occurrence of such problems can be predicted better when those interactions are taken into account. Hilton found that, holding alcohol consumption constant, occurrence of alcohol-related problems had no strong association with frequent binges, gender, age, marital status, income, education, region, or urbanicity. Makela and Simpura found in Finland that physical alcohol-related problems are less responsive than social problems to increased alcohol consumption. They also found that differences in problem rates between the sexes vanished when alcohol consumption was held constant. Knupfer found that, among those who drink enough to get high or drunk, women seem to experience slightly more alcohol-related problems than men, and young men and married men had slightly more problems than older men and single men. Wilsnack, Wilsnack, and Klassen found that, in their category of highest consumption (2 ounces per day or more), women exceeded men in rates of problem consequences, but not in rates of dependence symptoms. Grant and Harford found that the relationship between absolute alcohol intake and alcohol dependence was stronger among younger than among older adults. Herd’s review points out that national survey data suggest black men are more likely to experience alcohol-related problems than white men, even though they have similar alcohol consumption rates. Park’s review suggests that rates of drunkenness among the social classes are more a reflection of police attitudes toward those social classes than of actual differential alcoholism rates among them.

While these past studies are not completely comparable (because definitions of alcohol-related problems vary from study to study) or consistent, it is clear that very different results were obtained from investigations in which alcohol consumption was held constant when compared with those in which it was not. Thus, one of the purposes of this study was to investigate whether chosen groups experience more problems than their counterparts with alcohol consumption held constant. We also sought to identify factors that, in addition to amount of alcohol consumed, were the best predictors of alcohol-related problems. A better understanding of these predictive factors may enhance our capability to identify correctly those individuals most at risk of experiencing alcohol-related problems and to help them through improved design and application of screening, prevention, intervention, and treatment programs.