SynthesisAddiction (Abingdon, England)2022
Causal mechanisms proposed for the alcohol harm paradox-a systematic review.
Synthesis in Addiction (Abingdon, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 75 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
75 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review of the association between alcohol-related deaths and area-level socioeconomic deprivation and other geographic characteristics in high-income countries.BMC public health · 2026Pooled it
- Prevalence and Correlates of Non-Alcoholic Beverage Consumption Among People Living with HIV: A Potential Alcohol Reduction Strategy.AIDS and behavior · 2026Article
- Treatment Needs of Patients With Severe Alcohol Use Disorders.Indian journal of psychological medicine · 2026Article
- Socioeconomic Status, Alcohol Use, and Mortality: Results From a Prospective Cohort Study.Alcohol, clinical & experimental research · 2026Article
- A Data-Driven Exploratory Analysis of the Alcohol-Harm Paradox in South-East Wales.International journal of environmental research and public health · 2026Article
- Expanded Alcohol Screening and Brief Intervention to Address Premature Mortality.JAMA health forum · 2026Article
- Alcohol-attributable cancer risk and burden estimates for Australia's updated alcohol consumption guidelines.British journal of cancer · 2026Article
- Representation of Substance Use Issues in Old Age Within Norwegian Policy Frameworks.Nordisk alkohol- & narkotikatidskrift : NAT · 2026Article
- The relationship between food insecurity and tobacco or alcohol use in Great Britain: A representative population-based survey.Addictive behaviors reports · 2026Article
- Does educational attainment modify the relationship between alcohol use and ischemic heart disease mortality? Evidence from the UK biobank.Nutrition, metabolism, and cardiovascular diseases : NMCD · 2026Article
- Do the Reasons People Drink Alcohol Aid Our Understanding of Sociodemographic Differences in Alcohol-Free and Low-Alcohol Consumption? A Path Analysis on a Cross-Sectional Study of Adult Alcohol Drinkers in Great Britain.Drug and alcohol review · 2026Article
- Exploring Motives for Reducing Alcohol Consumption Among Users of an Alcohol Reduction App: Content Analysis.JMIR public health and surveillance · 2026Article
- Alcohol use disorder: an Australian perspective on screening, diagnosis, treatment and prevention.Internal medicine journal · 2026Review
- Associations between life course socioeconomic circumstances and drinking patterns among young and early midlife Finnish public sector employees.Alcohol and alcoholism (Oxford, Oxfordshire) · 2026Article
- Health's influence on alcohol use-a longitudinal study of working adults in Sweden.European journal of public health · 2026Article
- Mind the Gap: Exploring Social Inequalities in Alcohol Consumption using Nationally Representative Data from the 2019 and 2021 Health Survey for England.BMC public health · 2026Article
- Socio-economic differences in the effectiveness of pharmacotherapy use in alcohol use disorder: A cohort study of 148 626 individuals in Sweden.Addiction (Abingdon, England) · 2026Article
- A spatial analysis of the associations between housing eviction and alcohol-related hospitalizations in Pennsylvania.Health & place · 2026Article
- Describing the alcohol harm paradox: 20 years of data from Victoria, Australia.Addiction (Abingdon, England) · 2026Article
- Public health professionals' perspectives on alcohol public health interventions: a qualitative interview study.BMC public health · 2026Article
15 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
BACKGROUND AND
aimsThe alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another.
methodsThis was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations.
resultsSeventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21).
conclusionsWhile there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.