Saturday, January 27, 2007

Study: Alcoholics a minority of excessive drinkers

The public perception that most people who drink too much and cause harm are alcoholics may be far off the mark, a study published in the February issue of Alcoholism: Clinical and Experimental Research suggests.

Researchers led by Sandra Woerle of the National Institute of Justice and Michael G. Landen of the New Mexico Department of Health analyzed results from an annual telephone poll of nearly 5,000 adults in New Mexico and found that about one in six was an "excessive drinker," defined as drinking five or more drinks in a sitting. But fewer than two per cent could be classified as "alcohol dependent" or "alcoholic."

Tim Naimi, a physician at the Centers for Disease Prevention, commented on the study:
"In order to prevent most alcohol-related problems, including alcoholism itself, we need to focus on excessive drinking, not just alcoholism. Focusing exclusively on alcoholism will identify only a small percentage of those at risk of causing or incurring alcohol-related harms, precludes the possibility of prevention, and is very costly, at least on a per-person basis."
Study Abstract. Press release. Science Daily rewrite of press release.

Comment: This research deserves repeating with larger populations and other methods. If it can be widely replicated -- as seems probable -- it has important policy implications. As Dr. Naimi and other commentators on this study point out, a public policy focusing exclusively on alcoholics (people with alcohol dependence) misses nine tenths of the iceberg. What are some of the policy implications?
  • Courts that routinely sentence intoxicated drivers to treatment programs and support groups designed for alcoholics are not fitting the solution to the problem.
  • Most people who are court-mandated into treatment programs and support groups designed for alcoholics are not alcoholics and don't belong there.
  • Treatment programs and support groups that require court-mandated clients/members to declare themselves alcoholics are frequently pushing a misdiagnosis.
  • Treatment programs and support groups that focus on alcoholism, even when they are effective in palliating that disorder, may have only a minimal impact on the over-all public damage that excessive alcohol consumption causes.
Note that the very name of an organization, if it requires participants to label themselves as alcoholics, can present policy problems. On the one hand, insofar as the organization includes large numbers of mandated participants, the "alcoholics" nomenclature misrepresents the diagnosis of large portion of its members. On the other hand, the "alcoholic" label in the organization's name virtually guarantees that its work, even when successful, will have only a minimal impact on public health and safety issues connected with alcohol.

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