Surveying the range and magnitude of alcohol's harm to others in Australia

Aims This study aims to document the adverse effects of drinkers in Australia on people other than the drinker. Design Cross‐sectional survey. Setting In a national survey of Australia, respondents described the harmful effects they experienced from drinkers in their households, family and friendship networks, as well as work‐place and community settings. Participants A randomly selected sample of 2649 adult Australians. Measurements Problems experienced because of others' drinking were ascertained via computer‐assisted telephone interviews. Respondent and drinker socio‐demographic and drinking pattern data were recorded. Findings A total of 70% of respondents were affected by strangers' drinking and experienced nuisance, fear or abuse, and 30% reported that the drinking of someone close to them had negative effects, although only 11% were affected by such a person ‘a lot’. Women were more affected by someone they knew in the household or family, while men were more affected by strangers, friends and co‐workers. Young adults were consistently the most negatively affected across the majority of types of harm. Conclusions Substantial proportions of Australians are affected by other people's drinking, including that of their families, friends, co‐workers and strangers. These harms range in magnitude from noise and fear to physical abuse, sexual coercion and social isolation.     

The self‐reported personal wellbeing of a sample of Australian injecting drug users

Aims To examine the self‐reported personal wellbeing of a sample of Australian injecting drug users (IDU) using a standardized instrument and determine the key correlates of variations in self‐reported personal wellbeing. Design, setting and participants Cross‐sectional survey of 881 Australian IDU. Measurements Self‐reported personal wellbeing collected using the Personal Wellbeing Index (PWI). Findings IDU scored significantly lower than the general Australian population on the PWI and all subscales. Lower PWI scores were associated with a range of socio‐demographic, drug use and other health and social characteristics. Across all PWI subscales, lower personal wellbeing scores were associated with unemployment, past 6‐month mental health problems and more frequent injecting (all P < 0.05). Conclusions The PWI is sufficiently sensitive to distinguish between IDU and the general population, and to identify key correlates of PWI among IDU. Some domains canvassed within the scale, such as health, standard of living and life achievements, are well within the scope of current intervention strategies, such as pharmacotherapy maintenance treatment and housing and employment support services. This suggests that the PWI could be useful in clinical settings by allowing structured identification of the areas of a person's life to be addressed as a part of a treatment regimen. In order to inform targeted prevention and intervention efforts, longitudinal studies of PWI and its correlates among IDU are required.     

Revising the preventive paradox: the Swiss case

Aims. To examine Kreitman's preventive paradox of alcohol consumption and its revisions by Stockwell and colleagues and by Skog, with regard to alcohol‐related social harm in Switzerland, and to shed light on the reporting of alcohol‐related social harm in the low‐volume drinking, non‐bingeing subpopulation. The paper compares occurrence and severity of social harm in four subgroups defined by average consumption (volume) and binge drinking. Stage‐of‐change membership was used to further distinguish low‐risk drinkers who might have changed their drinking patterns from those who had not. Design, setting, and participants. Telephone interviews were conducted with 1256 current drinkers of a probabilistic two‐stage sample of the general population of Switzerland. Moderate and hazardous mean consumption (volume) was defined by means of a quantity‐frequency instrument. Daily average consumption of 20 g was set as the cut‐off point for women, and 30 g for men. Binge drinking was defined as taking four or more drinks on an occasion for women, and five or more for men. Structural equation modelling was used to construct a severity scale of six alcohol‐related consequences: work problems, accidents and problems with the police, with friends, with a partner or with the family. Explanatory factor analysis was used to assign drinkers to motivational stages of change. Findings. Moderate drinkers in terms of volume reported more problems than hazardous drinkers, which confirms Kreitman's view. Binge drinkers reported more problems than non‐binge drinkers, confirming the view of Stockwell and colleagues. Binge drinkers were more numerous in the moderate drinking group, which constituted the majority of drinkers, in accordance with Skog's view. Binge drinkers in the moderate‐volume and hazardous‐volume drinking groups did not differ significantly as to either severity or number of problems. Approximately 40% of moderate‐volume, non‐binge drinkers who reported alcohol‐related social harm had already changed their consumption pattern, which indicated that reported harm was related to an earlier drinking pattern. Conclusions. As Skog has pointed out, the second‐order preventive paradox of binge drinking reappeared, in that most binge drinkers were found to occur in the drinker group with low average consumption. Findings also indicate that, with respect to social harm, a preventive strategy aimed at the majority of the population, but on heavy‐drinking occasions rather than on mean consumption, may be valuable.     

The Shetland Islands: Drinking Patterns in the Community

General population drinking patterns in the Shetland Islands and their demographic correlates are described. A total of 533 individuals comprising a stratified random sample of the Island's population were interviewed, yielding a response rate of 78 per cent; 35 questionnaires were rejected as incomplete having 498 questionnaires to be utilized in this analysis. Weekly per capita consumption among male drinkers is 17 drinks, and among female drinkers is 2.5 drinks. Approximately 14 per cent of the women and 3 per cent of the men are abstainers. The predominant drinking pattern among women is occasional drinking (50%), and among men moderate drinking (40%). Also 33 per cent of the men are heavy drinkers. The associations between drinking patterns and social and demographic variables do not follow a pattern; the direction of the associations may change according to sex. Of all the demographic variables sex is the best predictor of drinking behaviour, accounting for 42 per cent of the variance explained out of a total of 49 per cent. The relationship of the findings to previous research done in Scotland and England and their implications for prevention are discussed.     

Types of drinkers and drinking settings: an application of a mathematical model

Aims US college drinking data and a simple population model of alcohol consumption are used to explore the impact of social and contextual parameters on the distribution of light, moderate and heavy drinkers. Light drinkers become moderate drinkers under social influence, moderate drinkers may change environments and become heavy drinkers. We estimate the drinking reproduction number, R_d, the average number of individual transitions from light to moderate drinking that result from the introduction of a moderate drinker in a population of light drinkers. Design and Settings Ways of assessing and ranking progression of drinking risks and data‐driven definitions of high‐ and low‐risk drinking environments are introduced. Uncertainty and sensitivity analyses, via a novel statistical approach, are conducted to assess R_d variability and to analyze the role of context on drinking dynamics. Findings Our estimates show R_d well above the critical value of 1. R_d estimates correlate positively with the proportion of time spent by moderate drinkers in high‐risk drinking environments. R_d is most sensitive to variations in local social mixing contact rates within low‐risk environments. The parameterized model with college data suggests that high residence times of moderate drinkers in low‐risk environments maintain heavy drinking. Conclusions With regard to alcohol consumption in US college students, drinking places, the connectivity (traffic) between drinking venues and the strength of socialization in local environments are important determinants in transitions between light, moderate and heavy drinking as well as in long‐term prediction of the drinking dynamics.     

Associations between self-reported illness and non-drinking in young adults

Aims This study investigated associations between self‐reported illness, social factors and health behaviours and non‐drinking among young people aged 18–34 years. Design Logistic regression analysis of cross‐sectional national survey data, collected from the Health Survey for England 2006 and 2008. Data were collected through face‐to‐face interviews and are self‐reported. Participants and settings A total of 2826 male and 3618 females aged 18–34 years drawn from a nationally representative multi‐stage stratified probability sampling design across England. Measurements Non‐drinkers were based on those who reported ‘no’ to drinking alcohol currently. Exposure measures included self‐reports of having a limiting long‐standing illness, long‐standing illness or self‐reported poor health. We adjusted for ethnicity, income, education, general physical activity and other factors. Findings Having a limiting long‐standing illness during early adulthood increased the odds of being a non‐drinker 1.74 times for men (P < 0.01) and 1.45 times for women (P < 0.01). In both men and women belonging to the lowest income quintile or having no qualifications was associated with increased odds of being a non‐drinker (P < 0.001), indicating that the social gradient in non‐drinking begins at an early age. Men and women aged 18–34 years with the lowest activity levels were also more likely to be non‐drinkers (P < 0.01). Conclusion Young adults who have a limiting long‐standing illness are more likely not to drink alcohol even after adjusting for a range of social and demographic measures. Studies on the putative health benefits of moderate alcohol consumption later in life need to take account of early life history.     

A prospective study of the association between smoking and later alcohol drinking in the general population

Aims To address the possible prospective association between smoking habits and risk of later heavy drinking in the adult population. Design Pooled population‐based long‐term cohort studies with repeated assessments of smoking and alcohol habits. Setting Copenhagen, Denmark. Participants A total of 14 130 non‐ to moderate drinkers at baseline, who attended re‐examination. Measurements Among the non‐ to moderate drinkers we addressed the relation between smoking habits at first examination and the risk of becoming a heavy and excessive drinker at follow‐up. Findings Level of tobacco consumption at first examination predicted an increased risk of becoming a heavy and excessive drinker in a dose‐dependent manner. Men who smoked more than 25 g of tobacco per day had adjusted odds ratios of 2.12 (95% confidence interval (CI): 1.44–3.11) and 3.95 (95% CI: 1.93–8.95) for becoming heavy and excessive drinkers, compared to participants who had never smoked. Equivalent estimates among women were 1.76 (95% CI: 1.02–3.04) and 2.21 (95% CI: 1.00–4.58), respectively. Conclusions This study suggests that tobacco use is associated quantitatively with later risk of heavier drinking.     

Binge Drinking and Suboptimal Self‐Rated Health Among Adult Drinkers

Background: Binge drinking accounts for more than half of the 79,000 annual deaths in the United States that are owing to excessive drinking. The overall objective of our study was to examine the prevalence of binge drinking and consumption levels associated with suboptimal self‐rated health among the general population of adult drinkers in all 50 states and territories in the United States. Methods: The study included a total of 200,587 current drinkers who participated in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey. We estimated the prevalence of binge drinking (i.e., ≥5 drinks on 1 occasion for men or ≥4 drinks on 1 occasion for women) and heavy drinking (i.e., an average of >14 drinks per week for men or >7 drinks per week for women), as well as the average number of binge episodes per person during a 30‐day period. Odds ratios were produced with multivariate logistic regression models using binge‐drinking levels as a predictor; status of suboptimal self‐rated health was used as an outcome variable while controlling for sociodemographic, health, and behavioral risk factors. Results: We estimate that 34.7 million adult drinkers in the United States engaged in binge drinking in 2008, including an estimated 42.2% who reported either heavy drinking or at least 4 binge‐drinking episodes in a 30‐day period. Binge drinking with such levels was associated with a 13–23% increased likelihood of reporting suboptimal self‐rated health, when compared to the nonbinge drinkers. Conclusions: Binge drinking continues to be a serious public health concern. Frequent binge drinkers or binge drinkers who consume alcohol heavily are especially at risk of suboptimal self‐rated health. Our findings underscore the importance of broad‐based implementation in health care settings of screening for and brief interventions to address alcohol misuse, as well as the continuing need to implement effective population‐based prevention strategies to reduce alcohol‐related morbidity and mortality.     

The use of acute and preventative medical services by a general population: relationship to alcohol consumption

Aims. To investigate the hypothesis that increasing alcohol consumption is accompanied by increasing use of acute, but decreasing use of preventative, medical services among the general population. Design and participants. Health and life-style survey of 41 000 randomly-sampled adults in SE England who self-completed a validated questionnaire covering socio-demographics, alcohol and tobacco usage and use of acute (A&E department and general practitioner) and preventative (dental, optician, mammography and cervical cytology) services: the response rate was 60%. Measurements. Comparative use of acute and preventative health care services by patients with varying consumption of alcoholic beverages. This was estimated by the odds ratio for service use, after correcting for the following confounding variables; age, social class, ethnic group, employment status, whether lives with children or with other adults, whether is a carer, limiting long-term illness, depression status, smoking habit and use of private health insurance. Findings. There was increased use of accident and emergency services by the harmful and intermediate drinking groups compared with the safe drinking group. Male abstainers attended their A&E departments more frequently than 'safe limit' drinkers. With respect to preventative services, both male and female abstainers and harmful drinkers used dental services less than safe limit drinkers. For females, mammography and cervical cytology services were less frequently used by abstainers and by harmful drinkers. Conclusions. This study supports the generally held view that heavy alcohol consumers are disproportionate users of acute medical services but they are relative under-users of preventative medical care services. Alcohol abstainers are also over-users of acute services, but under-users of preventative services. These latter observations are relevant to the claims that moderate alcohol consumers have lower apparent morbidity and mortality rates compared to abstainers.     

The Social Victims of Drinking *

The social consequences of drinking from the perspective of the drinker's victims, rather than from the drinker him/herself, are assessed in a general population survey of Berkeley, California (N= 1, 0222). Social victimization is assessed using an array of drinking-related consequences, including crime and accidents. The degree to which respondents experience alcohol-related social victimization and the context is reported. Demographic characteristics and drinking characteristics of the victims are found to be moderately related to the degree to which they are victimized. Social victims tend to resemble problem drinkers found in general population studies, particularly in terms of their own drinking and drinking-related problems. Women are at higher risk for victimization than men, particularly women who are heavy-frequent or problem drinkers. The results suggest the need for research which more boldly takes the interaction of perpetrator and victim into account in alcohol-related problems.     

Prevalence and correlates of alcohol use: a population-based study in Hong Kong

Objective To estimate the prevalence and pattern of alcohol use and to analyse the socio‐demographic and biological correlates of alcohol drinking in Hong Kong Chinese. Design A population‐based cross‐sectional study conducted from December 1994 to October 1996. Setting and participants 2900 randomly selected subjects age 25–74 years who participated in the Cardiovascular Risk Factor Prevalence Study in Hong Kong. Results Alcohol consumers comprised 55.4% (95% CI: 52.8–58.0) of men and 19.4% (95% CI: 17.4–21.4) of women. The median weekly ethanol consumed by male and female drinkers were 9.6 g and 3.6 g, respectively. Beer was the main source of alcohol; 61.5% of drinkers consumed beer as their main drink. In stepwise multiple regression among drinkers, male sex, smoking, high density lipoprotein cholesterol, primary or below education, diastolic blood pressure and separated or widowed marital status were associated positively with weekly ethanol consumption. Conclusion In this representative sample of Hong Kong adults, the majority were either non‐drinkers or very light drinkers, which can be used as a benchmark to measure changes in drinking pattern in the future. The putative protective effect of alcohol on heart disease could be due to the higher level of HDL in moderate drinkers.     

Unhealthy drinking patterns in older adults: prevalence and associated characteristics

OBJECTIVES: To examine the prevalence of unhealthy drinking patterns in community-dwelling older adults and its association with sociodemographic and health characteristics.
DESIGN: Cross-sectional analysis of nationally representative survey data.
SETTING: The data source was the 2003 Access to Care file of the Medicare Current Beneficiary Survey, which represents the continuously enrolled Medicare population.
PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 65 and older (N=12,413).
MEASUREMENTS: The prevalence of unhealthy alcohol use by older adults defined in relation to two parameters of recommended limits: monthly use exceeding 30 drinks per typical month and "heavy episodic" drinking of four or more drinks in any single day during a typical month in the previous year. Sociodemographic and health status variables were also included.
RESULTS: Nine percent of elderly Medicare beneficiaries reported unhealthy drinking, with higher prevalence in men (16%) than women (4%). In logistic regression analyses with the full sample, higher education and income; better health status; male sex; younger age; smoking; being white; and being divorced, separated, or single were associated with higher likelihood of unhealthy drinking. Among drinkers, in addition to sociodemographic variables, self-reported depressive symptoms were positively associated with unhealthy drinking. Among unhealthy drinkers, race and ethnicity variables were associated with likelihood of heavy episodic drinking.
CONCLUSION: Almost one in 10 elderly Medicare beneficiaries report exceeding recommended drinking limits. Several distinct unhealthy drinking patterns were identified and associated with sociodemographic and health characteristics, suggesting the value of additional targeted approaches within the context of universal screening to reduce alcohol misuse by older adults.     

The risk of harm to oneself from drinking, Canada 1989

In a national sample of 11 634 Canadians aged IS years and above, risk curves for harm to six life-areas from one's own drinking and for assault by another drinker rose steadily with the respondent's volume of alcohol consumption. While drinking five or more drinks on an occasion at least once a month substantially raised the risk at a given volume of drinking, the risk rose with volume even among those not regularly drinking Jive or more drinks. These relationships remained in logistic regressions which controlled for gender, age and educational level. Younger respondents, those without higher education and men reported more harm for a given level of their own drinking although differences by gender disappeared above one-third of one drink per day. Three sets of guidelines for low-risk drinking—two from Canada, and one generally used in Britain—were compared in terms of the proportions of respondents reporting harm from their own drinking among those who had kept within the guideline in the previous 7 days' drinking. More restrictiveness in the guidelines was associated with substantial reductions in reported drinking-related harm     

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

Aims This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all‐cause mortality. Design, participants and measurement Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES‐D) scale and an eight‐item social isolation scale. Findings The J‐shaped risk curve for all‐cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life‐time abstainer. Conclusions The relationship of alcohol consumption to 11‐year all‐cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex‐drinkers.     

The effects of drinking-driving laws: a test of the differential deterrence hypothesis

Aims Ontario introduced an Administrative Driver's Licence Suspension (ADLS) law in 1996, whereby a person with a blood alcohol level over the legal limit of 80 mg%, or who refused to provide a breath sample, would have his or her driver's licence suspended immediately for a period of 90 days. We test the differential deterrence hypothesis which would predict that social or lighter drinkers would be more affected by the Administrative Driver's License Suspension law than heavier drinkers. Design Data from the 1996 and 1997 cycles of the Ontario Drug Monitor, a general population survey of Ontario adults (monthly cross‐sectional surveys), were employed (response rate 64–67%). Analyses were restricted to drivers who reported at least some drinking during the last year (n = 3827). The total number of drinks consumed during the past 12 months was analysed with analysis of variance. Findings We found that the mean alcohol consumption of those who reported drinking‐driving increased significantly after the ADLS was introduced, whereas the alcohol consumption of those who did not drive after drinking remained the same. Conclusions The limits of this study include a lack of comparison data from regions without ADLS, a reliance on self‐report measures, possible age restrictions of the findings and the fact that only an inferential test of the differential deterrence hypothesis is permitted by the data. Despite these limitations, these findings are consistent with the prediction that lighter or more moderate drinkers will tend to stop driving after drinking completely, and thus drop out of the drinking‐driving population when the ADLS law was introduced, leaving heavier drinkers in this population. It will be important to continue to examine the dynamics of differential deterrence over a longer interval.     

Deliberate induction of alcohol tolerance: empirical introduction to a novel health risk

Aims Alcohol tolerance is a hallmark indicator of alcohol dependence. Even so, the allure of peers' admiration for having the ability to drink heavily may lead some adolescents and young adults to practice, or ‘train’, to increase their tolerance (particularly at US colleges, where heavy drinking is highly prevalent and central to the social culture). This is a potential health hazard that has not been documented empirically. Thus, we initiated a study of tolerance ‘training’ and its association to risky and heavy drinking. Design, setting and participants A cross‐sectional online survey of 990 college student life‐time drinkers at a large Midwestern US university. Findings Of the sample, 9.9% (n = 97) reported deliberately ‘training’ to increase tolerance. On average, they reported increasing from approximately seven to 10 US standard drinks in a night prior to ‘training’ to 12–15 drinks at the end of ‘training,’ over approximately 2–3 weeks' duration. Although the proportion of frequent binge drinking among ‘non‐trainers’ (34.4%) was similar to national rates, ‘trainers’ were much more likely to be frequent bingers (76.3%; OR = 6.15). Conclusions A number of students report deliberately inducing alcohol tolerance, probably directly increasing the risk for alcohol poisoning and other acute harms and/or dependence. This phenomenon might additionally be applicable to other populations, and deserves further study and attention as a potential personal and public health risk. Prevention efforts might aim to reduce the perceived importance of heavy‐drinking abilities.     

Predictors of help-seeking and the temporal relationship of help to recovery among treated and untreated recovered problem drinkers

This study investigated variables predicting different help-seeking patterns (no treatment, AA participation only, or treatment plus AA participation) by problem drinkers who had maintained stable abstinence (n = 57). Collaterals verified subjects' help-seeking and drinking status. Help-seeking was predicted by greater alcohol-related psycho-social problems, especially in interpersonal relationships, but was not associated with heavier drinking practices or demographic characteristics. Subjects' belief that they could solve their own problem deterred help-seeking, whereas relationship problems and being unable to quit on one's own facilitated help-seeking. Additional incentives specific to AA were its privacy, anonymity, spiritual aspects, opportunities to help other problem drinkers, and the convenient meetings held at times typically spent drinking. Many subjects became abstinent before they sought help, especially from treatment programs. These findings implicate interpersonal factors as primary incentives for help-seeking and suggest that interventions often consolidate, rather than initiate, positive changes in drinking practices.     

Psychological Correlates of Drinking Behavior in Social Drinker College Students

Psychological adjustment, cognitive functioning, and drinking behaviors have been shown to discriminate between alcoholic and control populations. Few data exist on the discriminatory power of such measures among social drinkers differing on alcohol intake level. The purpose of this study was to assess the relationship between alcohol consumption and psychological/cognitive functioning in a group of social drinker college students made up of equal numbers of males and females, matched on age and education, and varying on amount of alcohol consumed per drinking episode. Results indicate no relationship between alcohol consumption and cognitive functioning in this group of social drinkers. Drinking and psychological profiles of heavy social drinkers were very similar to those of diagnosed alcoholics and very dissimilar to light social drinkers. Such a finding suggests that these types of profiles may have predictive value for identifying at-risk social drinkers in the general population.     

Superior Outcome of Females Over Males After Brief Treatment for the Reduction of Heavy Drinking

Problem drinkers (52 males, 38 females) recruited through advertisements were randomly assigned to one of three treatments: Guidelines: three sessions of advice using a pamphlet outlining basic steps for achieving abstinence or moderate drinking. Manual: three sessions of instruction in the use of a 'self-help’manual presenting a step-by-step approach for attaining abstinence or moderate drinking. Therapist: six or more sessions of instruction in the methods outlined in the 'self-help’manual. At 3, 6 and 12 months follow-up, no significant differences were found among the groups in reduction of heavy drinking days (i.e. days when consumption exceeded four drinks, each containing 13.6 g/ethanol). Overall, the number of heavy days were reduced from an average of 43 at intake, to 20 over the 1-year follow-up period. Females, however, had significantly greater reductions than males (75% versus 35%). Three months after treatment the rate of successful moderate drinkers was significantly higher for females than males in the Guidelines (60% versus 33%) and the Manual condition (63% versus 18%), but not in the Therapist condition (25% versus 35%). At 1-year follow-up, females were more successful than males in all conditions. Mean changes in GGT and MCV levels lended support to the change in drinking status (from heavy drinker at intake to moderate drinker at follow-up), based on clients’self-reports.     

Drinking habits and prevalence of heavy drinking among primary health care outpatients and general population

Aims. To identify the target group for brief alcohol intervention in primary health care and to compare the prevalence of heavy drinking in two different primary health care populations and the general population in the same geographical area. Design. Drinking data were collected from outpatients of primary health care by a questionnaire containing the CAGE test and quantity-frequency alcohol consumption questions and from a sample of the general population by a telephone survey, including the CAGE. The index of heavy drinking was for men three, and for women two, affirmative answers in CAGE which though not specifically a consumption questionnaire is a good marker of heavy drinking. Setting. Two different primary health care populations (primary health care clinic and occupational health care clinic) and the general population in a Finnish health care area. Participants. Consecutive 1861 primary health care clinic and 2942 occupational health care clinic outpatients and 544 randomly selected adults in the general population, contacted by telephone. Findings. The primary health care clinic patients drank significantly more per occasion than the patients of the occupational health care clinic (75 vs. 66 g. in men; 33 vs. 27 g. in women) and fewer times per week (0.8 vs. 0.9 in men; 0.5 vs. 0.6 in women). The patients in the primary health care clinic also reported drinking more per week (76 vs. 67 g. in men; 23 vs. 19 g. in women); among women the difference was significant. Among men the prevalences of heavy drinking in the primary health care clinic, occupational health care clinic and general population were 20%, 17% and 16%, respectively ( p 0.05). Among women the corresponding figures were 9%, 6% and 13% ( p 0.05). Conclusions. The high prevalence of heavy drinking found in the study confirms the importance of brief intervention by general practitioners. The study also indicates that prevalence and drinking habits depend on the type of clinic and heavy drinkers in general may not be over-represented in primary health care. This study raises the question, especially among women, of how to reach and to provide health advice to those heavy drinkers who do not attend primary health care facilities.