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The abuse of alcohol is more common than any other form of drug abuse throughout the world. The consequences of alcohol use are pervasive in society. From a public health perspective, alcohol use presents a unique dilemma, referred to as the “prevention paradox.”1 This paradox stems from the observation that health and economic consequences resulting from alcohol use are far greater due to hazardous drinking than drinking patterns that constitute a formal diagnosis of alcohol dependence.2 This paradox is further complicated by findings that suggest that low to moderate levels of alcohol use may play a role in reducing mortality for certain disorders, such as cardiovascular disease.3 To better understand this paradox and the risk of alcohol use, it is helpful to stratify alcohol use and risk along a continuum. This continuum stretches from abstinence to alcohol dependence.
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CATEGORIES OF ALCOHOL USE ALONG THE DRINKING CONTINUUM
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Safe (Low-Risk) Drinking
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Based on the concept of a continuum of risk, some organizations have proposed guidelines for “safe” (low-risk) drinking, some of which include both the characteristics and circumstances of the drinker as well as levels of consumption. American guidelines for safe drinking generally recommend no more than 2 drinks per day for men, and 1 drink per day for nonpregnant females.4 Slightly higher limits are proposed by U.K. authorities.5
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One example of safe drinking guidelines, which also include characteristics of the drinker as well as levels of consumption, is contained in the report of the Australian National Health and Medical Research Council (NHMRC).6 “Is there a safe level of daily consumption of alcohol for men and women?” Recommendations regarding responsible drinking behavior, in which it is recommended that responsible drinking be considered as the consumption of the least amount of alcohol that will meet an individual's personal and social needs and in any case:
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a. that men should not exceed 4 units or 40 g of absolute alcohol per day on a regular basis, or 28 units per week; that 4–6 units per day or 28–42 units per week be considered as hazardous and that greater than 6 units per day or 42 units per week be regarded as harmful
b. that women should not exceed 2 units or 20 g of absolute alcohol per day on a regular basis, or 14 units per week; that 2–4 units per day or 14–28 units per week be considered as hazardous and that greater than 4 units per day or 28 units per week be regarded as harmful because of the biological differences between men and women
c. that abstinence be promoted as highly desirable during pregnancy
d. that persons who intend to drive, operate machinery, or undertake activities in hazardous or potentially hazardous situations should not drink
e. that in any given situation it is difficult to say that ...