Drinking alcoholic beverages is widely permitted and tolerated in Spain. In industrialized countries, drink-related disorders have become an important health problem, and this in turn has generated a number of different areas of research, as well as increasing interest in the search for effective lines of action.
On a social level there is also interest in identifying health issues related with drinking--both its benefits and its drawbacks. Despite the widespread assumption that moderate drinking can have beneficial health effects, especially for the cardiovascular system,1,2 knowledge and awareness of the health risks of alcohol abuse are also increasing. This is consistent with reports of declining alcohol consumption in Spain (both in excess and day-to-day drinking) and decreasing rates of alcohol intoxication. Meanwhile moderate or light drinking appears to be on the increase.3
The perceived risk associated with drinking is lower in men, younger persons and risk drinkers.3 This is also consistent with the results of the study by Teruel et al4 of primary care center users, published in this issue of Atención Primaria. In general, the dangers of daily drinking appear to be greater and this type of drinking is seen as less desirable than weekend drinking, a behavior that the general public often tends to view with less concern.3
Studies that investigate the public's knowledge of harmful levels of alcohol consumption and the damage excess drinking can have on health are of interest to determine which preventive measures are most likely to work in primary care.
In addition, drinking habits (type, frequency and amount of alcohol consumed) have frequently been found to be underestimated or inaccurately noted in medical records, a fact that may be related with the still widespread acceptance (even among health professionals) of drinking as part of our culture and way of life. In this connection the findings of Teruel et al indicate that alcohol consumption is recorded more frequently in medical records at their center than in other parts of Spain, although the data may be incomplete or not up to date.5 The importance of correctly entering information about drinking in the patient's chart at primary care centers cannot be overemphasized, as this will help care providers to evaluate the extent of the problem in Spain and identify risk groups in need of specific interventions.
Members of the public appear to be aware of the limits for daily drinking, but downplay the risk of occasional abuse. They know excess alcohol is harmful, but their knowledge is partial and superficial. Perhaps lines of action should be directed toward defining the limits more clearly and communicating the real risks.
Unlike smoking and the use of other toxic substances, the problem with drinking may be that the message that we transmit regarding alcohol is not clear enough. On one hand there is a constant stream of contradictory information regarding the benefits of moderate drinking, whereas health professionals do not actively promote abstinence but instead recommend reducing alcohol consumption. This leaves the door open to subjective interpretation, self-deception and rationalization.
However, this may also be a result of health professionals' lack of a clear idea of what lines of action to use. Many studies have found larger numbers of excess drinkers in populations in which larger amounts of alcohol are habitually consumed.6 Other studies, in contrast, report moderate drinking to be more beneficial than abstinence with regard to cardiovascular disease.1,2 As health professionals, where should we focus our attention? Is it right to recommend abstinence when moderate drinkers may benefit from drinking? Nevertheless, if we recommend only that drinking be reduced, are we sending an unclear message about the importance of the problem and leaving the way open to subjectivity and rationalization? This issue is particularly important, as we know that for this type of problem the self-perceived threshold of risk is so low.
Within this context, studies of users' awareness of and attitudes regarding hazardous levels of drinking and the damage to health caused by excess drinking become increasingly relevant. The study by Teruel et al shows that up to 24% of the users at their health center (and often the younger users) are unaware of the limits of hazardous drinking, and that a large percentage of the population are still unclear about the potential consequences of this habit.
The efficacy of brief counseling as a preventive measure that can be provided through primary care has been clearly established.7 A profound awareness of our shortcomings and those of the population we serve is the way toward improving this type of intervention and making it more effective.
Key points
* Studies of the public's knowledge of nonhazardous limits of drinking and the damage this can cause can help to increase the efficacy of brief counseling.
* It is important to increase and improve quality and update practices for recording alcohol consumption in primary care services.
