Current diagnostic guides divide alcohol-use disorders into two categories: alcohol abuse/harmful use and alcohol dependence. Some researchers and clinicians believe this is insufficient, that there should be a third, preceding diagnosis known as "hazardous drinking," defined as drinking more than guidelines recommend. A Finnish study has found that hazardous drinking is quite common.
"This is an issue that needs to be debated," said Mauri Aalto, chief physician at the National Public Health Institute and corresponding author for the study. "Current tools -- the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, and the International Statistical Classification of Diseases - 10 -- do not allow for a phenomenon like hazardous drinking, when a person drinks too much and is at risk but is not alcohol dependent."
Aalto and his colleagues examined data collected on 4,477 Finns (2,341 females, 2,136 males), 30 to 64 years of age, through the nation's Health 2000 Survey. They analyzed quantity and frequency of alcohol consumption, as well as socio-demographic characteristics.
Results showed the prevalence of hazardous drinking at 5.8 percent of the population examined.
"I think 5.8 percent is a high number, because we used rather high limits for hazardous drinking," said Aalto. Men were defined as hazardous drinkers if they reported drinking 24 Finnish standard drinks or more per week during the preceding year. The corresponding limit for women was 16 standard drinks or more per week.
"A hazardous drinker may see many other people around him or her drinking as much as him or herself," said Aalto. "This, together with not yet experiencing any alcohol-related harm, may lead the individual to wrongly think that there is no need to reduce drinking. However, hazardous drinkers do not include alcohol dependents, who usually drink a lot more. Alcohol-dependent drinkers already have significant alcohol-related harms and it is more difficult for them to change their drinking habits."
Results also showed that hazardous drinking was more of a problem for males, those older than 40 years of age, those who were unemployed versus employed, and those who were cohabiting, divorced/separated or unmarried versus those who were married.
"I think it is interesting to notice that almost 80 percent of hazardous drinkers in our study were employed," said Aalto. "Yet the probability of being divorced or unemployed, which might be inferred as 'adverse social consequences' of alcohol use, increases on the continuum from moderate drinking via hazardous drinking to alcohol dependence."
Aalto said these results support viewing hazardous drinking as a genuine public-health concern. "The important point is that there is such a phenomenon like hazardous drinking and it is quite common," he added.
Co-authors of the paper were: Jukka T. Halme of the Department of Mental Health and Alcohol Research at the National Public Health Institute; Kaija Seppä of Medical School at the University of Tampere, and the Department of Psychiatry at Tampere University Hospital; Hannu Alho of the Department of Mental Health and Alcohol Research at the National Public Health Institute, and the Research Unit of Substance Abuse Medicine at the University of Helsinki; Sami Pirkola of the Department of Psychiatry at Helsinki University Central Hospital; Kari Poikolainen of the Department of Mental Health and Alcohol Research at the National Public Health Institute, and the Finnish Foundation for Alcohol Studies; and Jouko Lönnqvist of the Department of Mental Health and Alcohol Research at the National Public Health Institute, and the Department of Psychiatry at Helsinki University Central Hospital -- all in Finland. The study was funded by the National Public Health Institute.
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