Exploring the motives for drinking less alcohol and attitudes towards abstinence in individuals with low-to-moderate alcohol use - a mixed-methods study.

backgroundExtensive evidence links alcohol to increased morbidity and mortality, leading to recommendations to reduce drinking, regardless of the amount consumed. We aimed to explore the motives for (not) drinking alcohol in low-to-moderate drinkers because of their relevance for prevention strategies.

methodsUsing a mixed-methods design, we first analyzed longitudinal self-report data from 540 low-to-moderate drinkers from general population in Germany who participated in a randomized controlled trial. Over a period of three years, trajectories of alcohol use were examined using latent class analysis, resulting in the identification of three distinct classes with similar patterns of change. To gain deeper insights in (non-)drinking motives, we conducted qualitative interviews with 22 individuals sampled from these classes (55% female, mean age = 36 years, SD = 13.2). Interview transcripts were analyzed using content-structuring qualitative content analysis.

resultsSocial motives dominated across all trajectory classes. Enhancement and conformity motives were also present, coping motives appeared rarely. Several participants offered fragmented, hesitant, or contradictory reasons for drinking, which illustrated their habitual and automated drinking patterns or unreflective routines. Impression management, as well as health-related beliefs, appeared as additional motivational dimensions. Situational abstinence was common, yet sustained abstinence faced barriers such as the cultural normalization of drinking, the low perceived health risks of light drinking, and the avoidance of the social costs of abstinence. Participants with the lowest consumption in our sample highlighted autonomy-related motives for abstaining, while higher-consuming groups described conformity and social adjustment more frequently.

conclusionsEven within a narrow range of low-to-moderate drinking patterns, motives, resources, and barriers differ meaningfully. These findings highlight the need for prevention strategies that acknowledge cultural norms, social contexts, and motivational heterogeneity beyond heavy drinking populations.

trial registrationThe study was preregistered on the Open Science Framework, reviewed and approved by the ethics committee of the University Medicine Greifswald (BB 034/22), and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to participation, including consent for the anonymized publication of their data.