Medical net cost of low alcohol consumption - a cause to reconsider improved health as the link between alcohol and wage?

BACKGROUND: Studies have found a positive effect of low/moderate alcohol consumption on wages. This has often been explained by referring to epidemiological research showing that alcohol has protective effects on certain diseases, i.e., the health link is normally justified using selected epidemiological information. Few papers have tested this link between alcohol and health explicitly, including all diseases where alcohol has been shown to have either a protective or a detrimental effect. AIM: Based on the full epidemiological information, we study the effect of low alcohol consumption on health, in order to determine if it is reasonable to explain the positive effect of low consumption on wages using the epidemiological literature. METHODS: We apply a non-econometrical cost-of-illness approach to calculate the medical care cost and episodes attributable to low alcohol consumption. RESULTS: Low alcohol consumption carries a net cost for medical care and there is a net benefit only for the oldest age group (80+). Low alcohol consumption also causes more episodes in medical care then what is saved, although inpatient care for women and older men show savings. CONCLUSION: Using health as an explanation in the alcohol-wage literature appears invalid when applying the full epidemiological information instead of selected information.

Criticism of drinking as informal social control: a study in 18 countries.

The focus of this paper is on informal control of drinking, indicated by criticism of people in the social network on someone's alcohol consumption. It studies country and gender differences in the extent drinkers suffering from typical symptoms of heavy or prolonged alcohol use report informal control from others (reactive informal control), and country and gender differences in the extent comments on someone's drinking are (also) directed at those who do not suffer from these symptoms (pro-active informal control). The data come from eighteen general population surveys, selected from an integrated dataset on drinking and drinking-related factors including more than 35 countries. The criteria for inclusion were that data for both men and women were available and that at least 3 items about symptoms of severe physiological consequences and about criticism of drinking had valid responses. The results show that men suffering from typical symptoms of heavy or prolonged alcohol use are more likely to be criticized than equivalent women (reactive control). Irrespective of gender, reactive informal control is more prevalent in poorer countries and in countries with a high proportion of abstainers. Concerning pro-active control, among women a larger part of criticism appeared to be directed at those who (as yet) do not suffer from symptoms typical for heavy or prolonged alcohol use. There is a lot of variation between countries in pro-active informal control. This variation is only weakly related to prosperity of a country but not to its proportion of abstainers.

Informal social control of drinking in intimate relationships - a comparative analysis.

A number of studies have shown that pressure from others is an important element in decision making concerning entering treatment and that the pressure most often comes from one's partner. Is has also been found that, besides actual drinking habits, togetherness of drinking, i.e. proportion of drinking occasions spent together with partner, is reversely connected to pressure from partner to drink less. The purpose of this paper was to examine these relationships in a comparative perspective, using GENACIS survey data from 16 countries. The results confirmed that on both individual and aggregated level, there is a relationship between drinking and pressure from partner. There is more pressure reported in 'dry' cultures and heavy drinking individuals are more often the object than others - in all cultures studied. In only a few countries with rather different drinking culture, drinking together prevents the pressure, also when controlled for actual consumption. Except for Uganda and UK, men are generally more exposed to pressure to drink less exerted by their female partners and this cannot only be explained by the fact that they actually drink more.

The societal cost of alcohol consumption: an estimation of the economic and human cost including health effects in Sweden, 2002.

This article estimates the societal cost of alcohol consumption in Sweden in 2002, as well as the effects on health and quality of life. The estimation includes direct costs, indirect costs and intangible costs. Relevant cost-of-illness methods are applied using the human capital method and prevalence-based estimates, as suggested in existing international guidelines, allowing cautious comparison with prior studies. The results show that the net cost (i.e. including protective effects of alcohol consumption) is 20.3 billion Swedish kronor (SEK) and the gross cost (counting only detrimental effects) is 29.4 billion (0.9 and 1.3% of GDP). Alcohol consumption is estimated to cause a net loss of 121,800 QALYs. The results are within the range found in prior studies, although at the low end. A large number of sensitivity analyses are performed, indicating a sensitivity range of 50%.

Alcohol Use Disorder Identification Test (AUDIT): what does it screen? Performance of the AUDIT against four different criteria in a Swedish population sample.

The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000-01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.

Test-retest reliability of the alcohol use disorder identification test in a general population sample.

BACKGROUND: A number of different screening tests are frequently used in alcohol research, but our knowledge about the reliability of many of them is quite limited. Recently, this problem has received more attention. This article examines the test-retest reliability of one of these instruments-the Alcohol Use Disorder Identification Test (AUDIT)-in a general population sample. METHODS: A general population sample (n = 457) was tested and, after approximately 1 month, was retested by using the AUDIT. Correlation between the two tests has been examined with the intraclass correlation coefficient and the kappa coefficient in analysis of dichotomous variables. Specificity and sensitivity at a number of different cutoff scores have also been analyzed by using the first test as a criterion. RESULTS: On the item level, the correlations ranged between 0.6 and 0.8. The overall reliability of total AUDIT scores was 0.84. When stratified by gender, age, and consumer status, the total score reliability approximated 0.80 for all the categories except low alcohol consumers (0.51). Agreement using the recommended cutoff score of 8+ was also examined. The reliability (kappa) observed in the whole sample was 0.691, which was interpreted as a substantial agreement. By this cutoff, 91% were correctly classified at retest compared with the first test. AUDIT 8+ showed higher reliability for males, young people, and moderate consumers and low reliability among low consumers. In terms of reliability, the most optimal cutoff for women turned out to be 6 or more. CONCLUSIONS: According to these results, the test-retest reliability of AUDIT is high. The next step might be to examine to what extent the findings apply within health-care settings, which is what the test originally was designed for.