The distribution of consumption model of prevention of alcohol problems. A critical assessment.

Abstract

The distribution of alcohol consumption theory and its implications for the prevention of alcohol problems is gaining acceptance, as indicated by the recent change in the prevention policies of the National Institute on Alcohol Abuse and Alcoholism, from a focus on responsible drinking to one on limiting the availability of alcohol. The theory (based on Ledermann''s work) proposes that the distribution of alcohol consumption is lognormal in all populations, that there is a constant relationship between consumption and the prevalence of heavy drinking, and that the incidence of alcohol problems can be reduced by lowering per-capita consumption through limiting the availability of alcoholic beverages. The samples used by Ledermann were poorly selected and inconsistent, and his constants are variable or inaccurate. The lognormal assumption can only apply to homogeneous populations since others show considerable systematic deviations. An aggregate distribution obscures age and sex differences in drinking patterns, and thus will mislead a program of prevention. The only health problem which consistently correlates with heavy drinking is liver cirrhosis; reducing the mean consumption could result in changes toward more damaging drinking patterns. The proposition that consumption can be lowered by increasing the price of alcohol is refuted by evidence showing that heavy drinking is most prevalent among the lower social classes, and that alcohol consumption is not consistently related to its availability. The distribution model is incomplete and more information about the other factors involved in the genesis of alcohol problems is needed to construct a more valid model for use in a prevention program.