BackgroundAccording to the prevention paradox, the majority of alcohol-related harms in the population occur among low-to-moderate risk drinkers, simply because they are more numerous in the population, although high-risk drinkers have a higher individual risk of experiencing alcohol-related harms. In this study we explored the prevention paradox in the Irish population by comparing alcohol-dependent drinkers (high-risk) to low-risk drinkers and non-dependent drinkers who engage in heavy episodic drinking (HED).MethodsData were generated from the 2013 National Alcohol Diary Survey (NADS), a nationally representative cross-sectional survey of Irish adults aged 18–75. Data were available for 4338 drinkers. Respondents dependent on alcohol (as measured by DSM-IV criteria), respondents who engaged in monthly HED or occasional HED (1–11 times a year) and low-risk drinkers were compared for distribution of eight alcohol-related harms.ResultsRespondents who were dependent on alcohol had a greater individual risk of experiencing each harm (p < .0001). The majority of the harms in the population were accounted for by drinkers who were not dependent on alcohol. Together, monthly and occasional HED drinkers accounted for 62% of all drinkers, consumed 70% of alcohol and accounted for 59% of alcohol-related harms.ConclusionsOur results indicate that the majority of alcohol consumption and related harms in the Irish population are accounted for by low- and moderate-risk drinkers, and specifically by those who engage in heavy episodic drinking. A population-based approach to reducing alcohol-related harm is most appropriate in the Irish context. Immediate implementation of the measures in the Public Health (Alcohol) Act (2018) is necessary to reduce alcohol-related harm in Ireland.
ObjectivesIreland has high per capita alcohol consumption and also has high levels of problematic drinking patterns. While it is accepted that patterns of alcohol consumption in Ireland are a cause for concern, it is not clear if Irish people are actually aware of the extent of their hazardous or harmful pattern of drinking. The aim of this study was to determine awareness of drinking pattern in an Irish population using a representative random sample and to identify characteristics associated with self-awareness of hazardous or harmful drinking.MethodsWe analysed data from Ireland’s 2014/2015 Drug Prevalence Survey which recruited a stratified clustered sample of 7005 individuals aged 15 years and over living in private households. Logistic regression analysis was used to determine characteristics associated with self-awareness of hazardous or harmful drinking.ResultsAlmost one half of drinkers had a hazardous or harmful pattern of drinking; 38% engaged in monthly risky single occasion drinking (RSOD) and 10.5% met Diagnostic and Statistical Manual version IV (DSM-IV) criteria for alcohol dependence. Of the 2420 respondents who had a hazardous or harmful pattern of drinking, 67% were unaware of this and misclassified themselves as being either a light or moderate drinker who did not engage in RSOD. An adjusted logistic regression model identified that hazardous and harmful drinkers were more likely to be aware of their drinking pattern if they had completed third level education (OR=1.80, 95% CI: 1.30 to 2.49) while older drinkers (aged 65 and over) were less likely to be aware of their drinking pattern (OR=0.30, 95% CI: 0.14 to 0.65). Subjects who engaged in risk taking behaviours such as illicit drug use and gambling were also significantly more likely to be aware of their drinking pattern.ConclusionsThe results of this study suggest that patterns of alcohol use in Ireland are problematic. Older respondents and those with lower educational attainment are less likely to be aware of their hazardous or harmful drinking pattern. There is also a population of younger, more-educated drinkers who engage in potentially risk-taking behaviours and these subjects are aware of their harmful drinking pattern. Initiatives to reduce overall alcohol consumption and raise awareness around drinking patterns are required.
Background From a secondary prevention perspective, it is useful to know who is at greatest risk of progressing from substance initiation to riskier patterns of future use. Therefore, the aim of this study was to determine relationships between age at first use of alcohol, tobacco and cannabis and patterns of cannabis use, frequency of use and whether age of substance use onset is related to having a cannabis use disorder (CUD). Methods We analysed data from Ireland’s 2010/11 and 2014/15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years and over, living in private households. We included only those people who reported lifetime cannabis use. Multinomial, linear and binary logistic regression analyses were used to determine relationships between age of substance use onset and patterns of cannabis use, frequency of use and having a CUD. Results When compared to former users, the odds of being a current cannabis user were found to be reduced by 11% (OR = 0.89; 95% CI: 0.83, 0.95) and 4% (OR = 0.96; 95% CI: 0.92, 1.00) for each year of delayed alcohol and cannabis use onset, respectively. Among current users, significant inverse linear relationships were noted, with increasing age of first use of tobacco (β = − 0.547; P < .001) and cannabis (β = − 0.634; P < .001) being associated with a decreased frequency of cannabis use within the last 30 days. The odds of having a CUD were found to be reduced by 14% (OR = 0.86; 95% CI: 0.78, 0.94) and 11% (OR = 0.89; 95% CI: 0.82, 0.98) for each year of delayed tobacco and cannabis use onset respectively in analyses which examined survey participants aged 15–34 years. Conclusions Among people who report past cannabis use, it is those with a more precocious pattern of early use of substances, including alcohol, and especially tobacco and cannabis, who are more likely to report ongoing, heavy and problematic cannabis use. Secondary prevention initiatives should prioritise people with a pattern of very early onset substance use.
Background Knowledge of factors relating to patterns of cannabis use is important for informing drug policy. This study determined factors associated with recent and current cannabis use. In addition, we explored factors related to having a cannabis use disorder (CUD)—defined using the Diagnostic and Statistical Manual of Psychiatric Disorders—among current users. Methods We analyzed data from Ireland’s 2010–11 and 2014–15 National Drug Prevalence Surveys, which recruited 5134 and 7005 individuals respectively, aged 15 years or more, living in private households. Multinomial logistic regression was used to identify factors associated with recent (last year) and current (last month) cannabis use compared to experiential use. Binary logistic regression was used to determine factors related to CUD among current users. Results The weighted prevalence of experiential cannabis use was 18.3%, with 3.0% and 3.3% of participants indicating recent or current use, respectively; 41.3% of current users indicated having a CUD. Factors associated with both recent or current cannabis use included younger age, not being married or cohabiting, having no dependent children and current use of tobacco or alcohol. Male gender, younger age and lower educational levels were significantly related to CUD among current users. Conclusions Males, adolescents/young adults and individuals with lower educational levels are more likely to be current users of cannabis and are at a greater risk of having a CUD. Health professionals should be aware of these factors to improve detection and prevention of CUD.
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