Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?
Article first published online: 21 SEP 2011
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 107, Issue 1, pages 71–80, January 2012
How to Cite
Danielsson, A.-K., Wennberg, P., Hibell, B. and Romelsjö, A. (2012), Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?. Addiction, 107: 71–80. doi: 10.1111/j.1360-0443.2011.03537.x
- Issue published online: 12 DEC 2011
- Article first published online: 21 SEP 2011
- Accepted manuscript online: 14 JUN 2011 07:34AM EST
- Submitted 26 October 2010; initial review completed 24 January 2011; final version accepted 6 June 2011
- alcohol problems;
- heavy episodic drinking;
- prevention paradox
Aims According to the prevention paradox, a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems among adolescents in 23 European countries.
Design and setting Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed.
Participants A total of 38 370 alcohol-consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included.
Measurements The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems.
Findings Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems.
Conclusions The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.