Abstract
Many drinkers globally are at risk of developing an alcohol use disorder (AUD). The study aimed to identify the extent of AUDs and associated individual and societal-level risk factors or vulnerabilities among adult drinkers in a country with high levels of heavy episodic drinking. A household survey was conducted in the Tshwane Metro, South Africa, using multistage stratified cluster random sampling. Complete data were available on 949 adult drinkers. Half (49%) reported symptoms of alcohol problems, as a proxy for AUDs, as measured using the RAPS4. Gender and age were not associated with symptoms of alcohol problems. White persons had 74% lower odds of symptoms of alcohol problems compared to Black Africans, and persons who reported stressful life events in the past 6 months were four times more likely to report symptoms of alcohol problems. Persons whose primary drinking location was a pub/bar/tavern and “other club” were more than twice as likely to have symptoms of alcohol problems than persons who drank at home, and persons whose primary beverage was wine were 74% less likely to have symptoms of alcohol problems compared to beer drinkers. The findings raise important implications regarding particular vulnerabilities experienced by Black Africans; the sale of alcoholic beverages, and especially beer, in locations such as pubs/bars/taverns; and the need for more comprehensive epidemiological research to assess the nature and extent of AUDs in South Africa together with focused contextual research on particular groups at risk.
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References
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.
Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The alcohol use disorders identification test: guidelines for use in primary care. Geneva: World Health Organization, Department of Mental Health and Substance Abuse Dependence.
Boden, J. M., Fergusson, D. M., & Horwood, L. J. (2014). Associations between exposure to stressful life events and alcohol use disorder in a longitudinal birth cohort studied to age 30. Drug & Alcohol Dependence, 142, 154–160.
Casswell, S., Meier, P. F., MacKintosh, A. M., Brown, A. F., Hastings, G. F., Thamarangsi, T. F., et al. (2012). The International Alcohol Control (IAC) study-evaluating the impact of alcohol policies. Alcohol Clinical & Experimental Research, 36, 1462–1467.
Cherpitel, C. J. (2000). A brief screening instrument for problem drinking in the emergency room: the RAPS4. Journal of Studies on Alcohol, 61, 447–449.
Cherpitel, C. J. (2002). Screening for alcohol problems in the US general population: comparison of the CAGE, RAPS4, and RAPS4-QF by gender, ethnicity, and service utilization. Alcohol Clinical & Experimental Research, 26, 1686–1691.
Cherpitel, C. J., Ye, Y., Bond, J., Borges, G., Cremonte, M., Marais, S., et al. (2005). Cross-national performance of the RAPS4/RAPS4-QF for tolerance and heavy drinking: data from 13 countries. Journal of Studies on Alcohol, 66, 428–432.
Cousins, G., Mongamn, D., Barry, J., Smyth, B., Rackard, M., & Long, J. (2016). Estimating risk of alcohol dependence using empirically validated ordinal risk zones verses recommended binary risk zones of the RAPS4: a validation study using stratus-specigic likelihood ratio analysis. Alcohol Clinical & Experimental Research, 40, 1700–1706.
Dawson, D. A. (2000). Drinking patterns among individuals with and without DSM-IV alcohol use disorders. Journal of Studies on Alcohol, 61, 111–120.
Econometrix (Pty) Ltd. (2013). Economic impact of an advertising ban on alcoholic beverages. Johannesburg: Industry Association for Responsible Alcohol Use.
Ewing, J. A. (1984). Detecting alcoholism. The CAGE questionnaire. Journal of the American Medical Association, 252, 1905–1907.
Grant, B. F., Chou, P., Saha, T. D., Pickering, R. P., Kerridge, B. T., Ruan, W. J., Huang, B., Jung, J., Zhang, H., Fan, A., & Hasin, D. S. (2017). Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry, 74, 911–923.
Holmes, T. H., & Rahe, R. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213–218.
Kalinowski, A., & Humphreys, K. (2016). Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries. Addiction, 111, 1293–1298.
Kessler, R. C., & Ustun, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121.
Martin-Moreno, J. M., Harris, M. E., Breda, J., Møller, L., Alfonso-Sanchez, J. L., & Gorgojo, L. (2013). Evidence labelling on alcoholic drinks: reviewing the evidence to guide alcohol policy. European Journal of Public Health, 23, 1082–1087.
McLoughlin, J.-A., Little, F., Mazok, C., Parry, C., & London, L. (2013). Prevalence of and associations with papsak wine consumption among arm workers in the Western Cape province, South Africa. Journal of Studies on Alcohol and Drugs, 74, 879–888.
National Department of Health (NDoH), Statistics South Africa (StatsSA), South African Medical Research Council (SAMRC), and ICF. (2017). South Africa demographic and health survey 2016: key indicators. Pretoria and Rockville: StatsSA, SAMRC, and ICD.
Parry, C. D. H., Plüddemann, A., Steyn, K., Bradshaw, D., Norman, R., & Laubscher, R. (2005). Alcohol use in South Africa: findings from the first demographic and health survey (1998). Journal of Studies on Alcohol, 66, 91–97.
Parry, C. D. H., Morojele, N. K., Petersen, P., Nel, E., & Burnhams, N. (2014). International Alcohol Control (IAC) study: alcohol environment protocol (South Africa). Tygerberg: South African Medical Research Council.
Parry, C., Trangenstein, P., Lombard, C., Jernigan, D., & Morojele, N. (2017). Support for alcohol policies from drinkers in the City of Tshwane, South Africa: data from the International Alcohol Control study. Drug & Alcohol Review. https://doi.org/10.1111/dar.12554.
Pechey, R., Couturier, D.-L., Hollands, G. J., Mantzari, E., Munafo, M. R., & Marteau, T. M. (2016). Does wine glass size influence sales for on-site consumption? A multiple treatment reversal design. BMC Public Health, 16, 390.
Peltzer, K., Davids, A., & Njuho, P. (2011). Alcohol use and problem drinking in South Africa: findings from a national population-based survey. African Journal of Psychiatry, 14, 30–37.
Probst, C., Shuper, P. A., & Rehm, J. (2017). Coverage of alcohol consumption by national surveys in South Africa. Addiction, 112, 705–710.
Rehm, J., Baliunas, D., Borges, G. L. G., Graham, K., Irving, H. M., Kehoe, T., Parry, C. D., Patra, J., Popova, S., Poznyak, V., Roerecke, M., Room, R., Samokhvalov, A. V., & Taylor, B. (2010). The relation between different dimensions of alcohol consumption and burden of disease—an overview. Addiction, 105, 817–843.
Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., & Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373, 2223–2233.
Rumpf, H. J., Hapke, U., Meyer, C., & John, U. (2002). Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questions. Alcohol, 37, 261–268.
Russell, C., & van Walbeek, C. (2016). How does a change in the excise tax on beer impact beer retail prices in South Africa? South African Journal of Economics, 84, 555–573.
Schmidt, L. A., Mälelä, P., Rehm, J., & Room, R. (2010). Alcohol: equity and social determinants. In E. Blas & A. S. Kurup (Eds.), Equity, social determinants and public health programmes. Geneva: World Health Organization.
StataCorp. (2015). Stata Statistical Software: Release 14. College Station: StataCorp LP.
StatsSA. (2017). Community Survey 2016. http://cs2016.statssa.gov.za/ (Accessed 7 July 2017).
Stein, D. J., Seedat, S., Herman, A., Moomal, H., Heeringa, S. G., Kessler, R. C., & Williams, D. R. (2008). Lifetime prevalence of psychiatric disorders in South Africa. British Journal of Psychiatry, 192, 112–117.
Studer, J., Baggio, S., Deline, S., N’Goran, A. A., Hemchoz, Y., Moler-Kuo, M., et al. (2015). Drinking locations and alcohol-related harm: cross-sectional and longitudinal associations in a sample of young Swiss men. International Journal of Drug Policy, 26, 653–661.
Sustainable Energy Africa. (2006). State of energy in south African cities 2006: setting a baseline. Cape Town: Author.
World Health Organization (WHO). (2010). Global strategy to reduce the harmful use of alcohol. Geneva: Author.
World Health Organization (WHO). (2014). Global status report on alcohol and health 2014. Geneva: Author.
Acknowledgements
This study was supported by the International Development Research Centre (IDRC) Canada (grant number 107198-001) and the South African Medical Research Council. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the IDRC. We thank the Research Coordinator (Elmarie Nel), the project assistants (Naledi Kitleli, Frans Masango, Shirley Hlope, and Chantal Graca-Correia), as well as all the field supervisors and interviewers for their role in data collection for the survey. In addition, we are grateful to Natasha Morris and Ndabezitha Shezi for preparing the maps for sampling purposes, Mukhethwa Londani for data management, and Kirsten Stenius for her comments on an earlier draft of this manuscript. Finally, we express our appreciation to all the participants who gave of their time to take part in this research.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1975 Declaration of Helsinki, as revised in 2000. Informed consent was obtained from all participants for being included in the study.
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Parry, C.D.H., Trangenstein, P., Lombard, C. et al. Identifying Alcohol Problems and Selected Individual and Contextual Risk Factors Among Adults in South Africa: Findings from the International Alcohol Control Study. Int J Ment Health Addiction 17, 56–72 (2019). https://doi.org/10.1007/s11469-017-9865-5
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DOI: https://doi.org/10.1007/s11469-017-9865-5