UNRAVELING THE PREVENTIVE PARADOX FOR ACUTE ALCOHOL-PROBLEMS

Kreitman's discussion of the preventive paradox in relation to the pre vention of alcohol problems has had profound implications for alcohol policy and has generated considerable controversy [1]. It is argued he re that although Kreitman should be credited with the important observ ation that alcohol-related harm is not confined to a few dependent dri nkers, none the less an apparent paradox is not an ideal platform from which to recommend policy. Furthermore, Kreitman's own data and data from an Australian survey of drinking are used to demonstrate that a c ommonplace truth underlies his apparently paradoxical findings, It is shown that the preventive paradox disappears when consideration is giv en to the amount of alcohol consumed on either (i) the day of highest alcohol intake out of the last four, or (ii) the day on which acute al cohol-related harm occurred. Episodic heavy consumption by people whos e average alcohol intake can be classified as 'low' or 'medium' risk c ontributes to the bulk of such experiences of harm, It is suggested th at the importance of intoxication as a public health and safety issue has been neglected. This neglect is compounded when public education c ampaigns and prevention policy are only based on average rates of alco hol consumption, Advice regarding the low risk levels of consumption f or different types of harm should form one component of a comprehensiv e harm reduction policy. Other elements of such a policy should includ e a variety of other measures of proven effectiveness in relation to r educing levels of intoxication and related problems.