International Comparisons of Adult Alcohol Consumption Patterns

by National Institute of Health

(Page 2 of 6)

Drinking alcohol is a social behavior in the sense that it is something young people learn and practice with other members of their culture. Drinking patterns among adolescents and young adults in any country or culture consequently are related in many ways to the drinking patterns of the entire population. Therefore, a global review of per capita alcohol consumption and general drinking patterns also gives a first rough description of the differences in the amounts and patterns of adolescent and young adult drinking in different parts of the world. Adolescent and young adult drinking behaviors may show some systematic deviation from adult drinking behaviors in a given culture, however, because of differences in living conditions between adolescents/ young adults and the adult population and because of the influences of international youth culture and mass media.

One source of information on alcohol consumption and its consequences in various areas of the world is the World Health Organization. For surveying purposes (e.g., to estimate the global burden of disease), WHO has divided the world into 15 geographical areas based on adult and infant mortality. WHO also has used these areas to estimate the levels of alcohol consumption and proportions of drinkers around the globe.1 (1 These data are derived primarily from population-weighted averages of country estimates, but in many cases the figures include a substantial element of extrapolation and expert judgment.) However, countries within these 15 areas are not always uniform with regard to alcohol consumption and drinking habits. For example, Iceland and Norway, with a total alcohol consumption of about 7 liters per person age 15 and older, belong to the area "Europe A," where the average alcohol consumption is 13 liters. Despite these kinds of problems, the WHO data help to broadly characterize the levels and trends in alcohol consumption and drinking patterns in different parts of the world.

General Trends in Total Alcohol Consumption

Rehm and colleagues conducted an international comparison of average alcohol consumption in people age 15 and older around the world using the WHO data. These analyses found the following: average alcohol consumption was highest in Europe, the Americas, and established market economies such as Australia, Japan, and New Zealand, although there were exceptions (e.g., the Muslim countries of the former Soviet Union and Yugoslavia and the least developed countries in South and Central America). Average alcohol consumption generally was lower in Africa and Asia. Alcohol consumption was particularly low in the Muslim countries in the eastern Mediterranean region and on the Indian subcontinent.

Other studies have examined changes in per capita or per adult alcohol consumption since the mid-1970s and have found that: alcohol consumption appears to have declined in many countries with previously high alcohol consumption, particularly in the traditional wine-producing and wine-drinking countries of Europe but also in the wine-producing countries of South America. In many other established market economies, such as Canada and the United States, a smaller but still significant decrease in total alcohol consumption has occurred over the same period. In most countries of the Americas and Africa and in the eastern Mediterranean countries, alcohol consumption has been constant or slightly decreasing during recent decades. Alcohol consumption appears to have increased the most in Asian countries. Some developed countries have countered the trend toward decreasing alcohol consumption; in fact, consumption there has increased.

Proportions of Drinkers

The proportion of people who drink any alcohol varies greatly among different countries. In general, the highest proportion of drinkers is found in Europe, Australia, and New Zealand, where 80 to 90 percent of all adults are drinkers. In the Western Pacific, 80 to 90 percent of all men are drinkers. In the Americas, about two-thirds of adults are drinkers. For instance, the share of drinkers is 73 percent in Canada and 65 percent in the United States. In African countries, around half of the men and one-third of the women drink alcohol. In the rest of the world, only a minority of adults are drinkers.

In all countries, men are more likely to drink alcohol than are women. The differences between men and women in the proportion of drinkers are particularly marked in China and Southeast Asia. Women are especially likely to be abstainers in the Indian subcontinent and Indonesia as well as in the Middle East.

Differences in Drinking Patterns

Many studies (primarily based on survey data) have analyzed drinking patterns around the world. These studies consistently have found significant differences in drinking patterns between men and women, between younger and older people, and often among ethnic or religious groups. For example, Ahlström and colleagues found that, on average, men drink significantly more than women do. In many countries, men account for 70 to 80 percent or more of the total alcohol consumption, and in some developing countries, men's share of overall alcohol consumption is even greater. For instance, survey data from China indicate that men consume about 95 percent of all alcohol.

Alcohol consumption also is unevenly distributed among the drinking population in any country - that is, in all societies, most of the alcohol is consumed by a relatively small proportion of drinkers. For example, in the United States, the top 20 percent of drinkers consume almost 90 percent of all alcohol. And in China, the top 12.5 percent of the drinkers have been estimated to account for 60 percent of total alcohol consumption. In general, the proportion of drinkers who account for most of the alcohol consumption probably is smaller in countries with low per capita alcohol consumption - that is, in these countries alcohol consumption is more concentrated.

Intoxication and Harmful Drinking

Countries also vary in how often people drink to intoxication, how intoxicated people get, and how people behave while intoxicated. Generally, men are more likely than women to consume large quantities of alcoholic beverages or drink to intoxication. Also, the proportion of heavy drinkers and the frequency of heavy-drinking occasions are higher among men than among women. Consequently, patterns of harmful drinking2 are more common in men than in women. (2 Harmful drinking refers to any drinking pattern where drinking causes immediate harm to the drinker or others, including physical harm [e.g., resulting from alcohol-related unintended injuries and car crashes], social harm [e.g., arguments with family members or others], economic harm [e.g., lost property], or legal harm.) Some evidence suggests that this phenomenon may be even more pronounced in developing countries.

According to WHO's data on the global burden of disease, people in the former socialist countries of Eastern Europe, in Middle and South America, and in parts of Africa exhibit the most detrimental drinking patterns. For example, in these countries, drinking to intoxication is a characteristic mediator between alcohol consumption and alcohol-related morbidity, mortality, and social harms. Conversely, drinking patterns appear to be least detrimental in Western Europe, as represented by the patterns found in the wine-producing countries of southern Europe, where people primarily consume wine with meals and do not drink to intoxication.

About the Author

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