The shifting sands of alcohol prevention: rethinking population control approaches

This paper identifies seven major conceptual and perceptual shifts which have occurred in the alcohol field in recent years and which influence approaches to the prevention of alcohol–related problems. The paper highlights the shift away from measures of mean consumption, as the principal indicator of use and problems, towards an incorporation of temporal patterns of use. No longer is the traditional parameter of mean per capita consumption seen to be the predominant measure by which alcohol and its associated problems are assessed. Also examined are the relative merits of prevention strategies that include the whole population and those aimed at people at high risk. The key shifts identified are: 1. acceptance that there is no single distribution theory that adequately accounts for alcohol consumption; 2. alcohol may represent an exception to the population health models based on mean distributions (for example, as found in the relationship between salt and hypertension); 3. there is no prevention paradox if episodes of intoxication are examined instead of mean consumption levels; 4. population control measures to reduce overall alcohol consumption may deprive some people of the protective cardiovascular effects of moderate alcohol consumption; 5. it is more useful to focus on at–risk drinking than attempt to locate groups of at–risk drinkers; 6. alcohol–consumption guidelines are meaningful only when defined on the basis of daily consumption, and then with further caveats; and 7. harm minimisation offers a constructive conceptual vehicle by which to shift the focus from consumption to consequences of use. (Aust N Z J Public Health 1997; 21: 621–5)