BINGE DRINKING Catch it early
A survey of South Africans’ habits highlights the need for early interventions to address the growing scourge of alcohol abuse, KARL PELTZER, ALICIA DAVIDS and PETER NJUHO maintain.
In South Africa the burden of disease attributable to alcohol use in 2000 was estimated at 7.1% of all deaths and 7% of total disability-adjusted life-years (DALYs). In terms of alcohol-attributable disability, alcohol-use disorders ranked first (44.6%), interpersonal violence second (23.2%), and foetal alcohol syndrome third (18.1%).
As there is a need for accurate recent national prevalence data on adolescent and adult alcohol use in South Africa, the aim of this secondary analysis of the South African National HIV, Incidence, Behaviour and Communication 2008 survey was to provide current data to develop and implement effective alcohol-use policies and intervention programmes. However, future impact studies are needed to assess the impact of problem drinking.
How do we drink?
The drinking pattern in a country or within a group is an important determinant of types and levels of problems associated with consumption.
In much of the developing world, the predominant pattern is of infrequent heavy drinking, particularly by men. This includes binge drinking (five or more drinks on the same occasion for men and four or more for women), hazardous drinking (quantity or pattern of consumption that place the user at risk for adverse health events) and harmful drinking (intake that causes adverse events, for instance, physical or psychological harm).
A multi-stage random population sample of 15 828 persons ages 15 or older (56.3% women) was included in the survey in South Africa in 2008.
Current (past-month) consumption was reported by 41.5% of men and 17.1% of women. White men (69.8%) were most likely and Indian or Asian women (15.2%) least likely to be current drinkers. Urban residents (33.4 %) were more likely than rural dwellers (18.3%) to report current drinking.
Binge and hazardous or harmful drinking was highest in men among coloureds (31.9% and 31.6%, respectively) and in women also among coloureds (10.4% and 9.7%, respectively), followed by white men for binge drinking (19.9%) and black and white men for hazardous or harmful drinking (15.5% and 15.2%, respectively). Hazardous or harmful alcohol use was significantly higher in men (17%) than women (2.9%). For both men and women, higher rates of alcohol use (current use, binge drinking and hazardous or harmful drinking) were recorded in urban than rural areas. For both men and women, the highest current drinking, binge and hazardous or harmful drinking levels were reported in two provinces (Western Cape and Northern Cape). Current drinkers among men and women were higher in higher educational groups of Grade 12 and higher (more than 50%) than lower educational groups from no education to Grade 11 (below 33%). Likewise the proportion of current drinkers and binge drinkers increased with increasing income (from not employed 25.3% and 6.7%, respectively, to more than R48 001 a year income 55.2% and 14.4%, respectively).
Overall 9.6% said they had engaged in past-month binge drinking, which is a slight increase from the SABSSM II 2005 survey overall 7.4% (men, 14.3% and women, 3.2%). Risky or hazardous or harmful drinking was reported by 9%, significantly up from 6.2% reported in the 2005 survey.
The study’s limitations included a 10.9% survey non-response rate from the total sample of 15 828. Also, because the household survey on consumption is self-reported, it may under-report the true consumption rate.
Diagnosis and treatment
For populations with high rates of hazardous alcohol use, both population-wide measures (‘sin’ tax, for instance) and individual-based interventions, such as brief healthcare-provider advice, have been shown to have a notable impact on reducing the global burden of alcohol misuse.
Most alcohol-related harm is attributable to hazardous/harmful drinkers, who also make disproportionate use of primary healthcare systems, even though brief, easily delivered interventions are effective in this group of people. And with our health-care system currently providing tertiary care services to treat dependence – often with a poor outcome – this focus needs to shift towards providing brief interventions for early alcohol-use disorders. Effective evidence-based combinations of psychosocial and pharmacological treatments for alcohol-use disorders are available, but costly.
Summary of an article published in the African Journal of Psychiatry (2010), Alcohol use and problem drinking in South Africa: Findings from a 2008 national population-based survey. Professor Karl Peltzer, research director, HIV/AIDS, STIs and TB (HAST) research programme; Dr Peter Njuho, senior research specialist, HAST; Alicia Davids, senior researcher, HAST.