Background

The Alcohol Programme in the Health Service Executive (HSE) was established in 2016 to address the impact of alcohol-related harm on individuals, families, and children. The programme aims to decrease per capita alcohol use to 9.1% (10.2 litres in 2022), in accordance with the Healthy Ireland Framework 2013–2025.1,2 The work of the HSE Alcohol Programme involves collaborating with the Department of Health, Alcohol Health Alliance Ireland, and other stakeholders to actively support the Public Health (Alcohol) Act 2018. This involves identifying national priority areas, supporting effective policies, and advocating for evidence-based interventions and community action as well as informing and supporting the public in reducing alcohol use and signposting to support services through the AskAboutAlcohol campaign and website.3

AskAboutAlcohol website

The HSE AskAboutAlcohol website is a resource available to the public to seek impartial advice about alcohol use and alcohol-related harms. Users of the website can access a drinks calculator to determine how much alcohol they are drinking and how much money they are spending on alcohol per week. By entering this information, users receive feedback on whether they are exceeding the HSE low-risk alcohol guidelines or not, as well as advice about the harms associated with alcohol and a link to further advice on how to reduce alcohol use and the benefits of doing so.4

Information is provided on alcohol use and pregnancy, alcohol dependency, information for parents, advice for reducing alcohol use, and a list of services that can support individuals and their families who are impacted by alcohol. The website also contains a self-assessment tool, where visitors can complete an effective, brief screening test to identify potential problem drinking.

AskAboutAlcohol self-assessment tool

At total of 24,205 people filled out the AskAboutAlcohol.ie online self-assessment tool between 1 December 2022 and 30 November 2023 inclusive. The self-assessment tool is based on the World Health Organization (WHO) Alcohol Use Disorders Identification Test (AUDIT), a 10-item tool used to screen for alcohol problems.5 AUDIT scores can range from 0 to 40, where a score of 0–7 represents low-risk drinking; 8–15 increasing risk drinking; 16–19 high-risk drinking; and a score of 20 or greater indicates possible dependence.

Methods

Data were screened for anomalies and outliers. Ten respondents were removed as they reported an age of 100 years or greater. The age range of remaining respondents was 18–98 years. One respondent who reported drinking 477 standard drinks in the last week was identified as an outlier and also removed from the analyses, while 99 cases were removed as they did not enter a number of drinks despite stating that they drink alcohol regularly. Following the removal of these 110 cases, a total of 24,095 cases were included in the analyses.

Respondents were grouped into the following six age brackets: 15–24 years; 25–34 years; 35–44 years; 45–54 years; 55–64 years; 65 years and older. Statistical analyses were carried out using SPSS Version 29. Chi-squared tests were carried out to test for statistical significance between AUDIT scores and demographic variables of age, gender, and region. An alpha level of p <0.05 indicated statistical significance.

Findings

Profile of respondents using the online assessment tool

Table 1 provides a breakdown of the demographics of those who completed the online assessment tool. More females (53.7%) than males (46.3%) completed the self-assessment tool. Those aged between 35 and 54 years represented 44.8% of all respondents. Demographic data collected by the site identified users from all 26 counties in the Republic of Ireland, with the highest number of responses coming from the most populated counties, Dublin (13.9%) and Cork (9.8%).

Drinking classification of respondents

The mean score of respondents (n=24,095) on AUDIT was 13.9 (SD=8.8). Such a score indicates hazardous alcohol use or ‘increasing risk’ alcohol use. Table 1 indicates that 31.2% of drinkers were classified as low risk according to AUDIT; 29.5% were classified as hazardous or increasing risk drinkers; 13.0% as high-risk or harmful drinkers; and over one-quarter of those who completed the online assessment tool were classified as having probable alcohol dependence (26.3%).

There were significantly more males than females in the harmful drinking and probable dependence groups. Of males who completed the self-assessment tool, one-third (33.7%) were classified as having probable alcohol dependence, with one-fifth of women (20.0%) meeting these criteria.

Those in the 15–24 years age group (35.4%) and the 25–34 years age group (35.6%) were the most likely to score as probable dependence category. There was no statistically significant difference in scores across the five regions.

Table 1: Demographic profile of respondents, by drinker type

a Gender missing for 258 respondents. b Age missing for 755 respondents.

c Province missing for 1638 respondents. d Excluding Dublin.

Conclusion

The analyses indicate that almost two-fifths of the users of the AskAboutAlcohol.ie online self-assessment tool met the AUDIT criteria for harmful drinking or probable dependence (scoring 16 or greater), with rates highest among males and young people. Upon completion of the self-assessment tool, users are informed if their drinking is within low-risk limits or if their drinking is considered to be placing them at risk of harm and the potential impact of such drinking patterns. Further information is available on how to seek support for themselves or family members.

It is important to note that these results are not representative of the Irish population, as those who are conscious about their health are more inclined to seek out health-related information.6 Or the high number of hazardous and possible dependent drinkers may be due to higher numbers of people who are already concerned about their drinking completing the test. The online format may restrict certain groups such as older people and may have been completed by the same individual multiple times or have been completed on someone else’s behalf by a concerned friend or relative.

Finally, it is important to note that AUDIT is intended as a screening tool for harmful or hazardous patterns of drinking, not as a diagnostic tool for alcohol dependence. Those meeting the criteria for possible dependence should therefore not be taken as having the equivalent diagnosis of alcohol dependence, but rather an indication of a potentially harmful or dependent pattern of drinking. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is considered more accurate in measuring for an alcohol use disorder (AUD).7 DSM-5 was used in the National Drug and Alcohol Survey, which is based on a representative sample of the Irish population, and found that 14.8% of the general population in Ireland aged 15 years and older had an AUD, from mild (11.6%), moderate (5.4%) to severe AUD (3.1%).8

1    Revenue, Irish Tax and Customs (2022) Revenue quarterly excise receipts and volumes. Dublin: Revenue, Irish Tax and Customs. Available from:
https://www.revenue.ie/en/corporate/information-about-revenue/statistics/excise/receipts-volume-and-price/quarterly-update.aspx

2    Department of Health (2013) Healthy Ireland: a framework for improved health and wellbeing 2013–2025. Dublin: Department of Health. Available from: https://www.drugsandalcohol.ie/19628/

3    Health Service Executive (HSE) (2021) AskAboutAlcohol. HSE our health service. Dublin: HSE. Available from:
https://www2.hse.ie/alcohol/

4    Health Service Executive (2022) HSE weekly low-risk alcohol guidelines. Dublin: HSE. Available from:
https://www2.hse.ie/wellbeing/alcohol/improve-your-health/weekly-low-risk-alcohol-guidelines.html

5    Babor TF, Higgins-Biddle JC, Saunders JB and Monteiro MG (2001) AUDIT: The Alcohol Use Disorders Identification Test – guidelines for use in primary care. 2nd edn. Geneva: Department of Mental Health and Substance Abuse, World Health Organization. Available from: https://www.drugsandalcohol.ie/14104/

6    Dutta-Bergman MJ (2004) Primary sources of health information: comparisons in the domain of health attitudes, health cognitions, and health behaviors. Health Commun, 16(3): 273–288.

7    American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM–5). 5th edn. Arlington, VA: American Psychiatric Association.

8    Mongan D, Millar SR and Galvin B (2021) The 2019–20 Irish National Drug and Alcohol Survey: main findings. Dublin: Health Research Board. Available from: https://www.drugsandalcohol.ie/34287/