Understanding the Alcohol Harm Paradox

More alcohol-related health problems are found among people with a low socioeconomic status compared to those with high socioeconomic status, even though these two groups drink similar amounts of alcohol. In this overview, of what is known as ‘the alcohol harm paradox’, we cover the following issues:

Socioeconomic status

An individual’s economic and social standing can be measured in different ways, but usually through a combination of education, income and occupation.1 Generally, the higher someone’s socioeconomic status, the more affluent they are.

The Alcohol Harm Paradox explained

In the UK, less affluent people experience a higher rate of alcohol-related health problems, despite people in different socioeconomic groups having similar alcohol consumption levels.2 It is quite a significant difference too.

A study from Scotland shows that less affluent, moderate alcohol drinkers have a higher risk of harm than more affluent, heavy drinkers.3 It is a complicated relationship to understand and measure, but there are a few popular suggestions as to why this is the case.

Reasons for the Alcohol Harm Paradox

1. Drinking and other unhealthy behaviours

Drinking combined with other health-challenging behaviours, such as smoking or having a poor diet, has been found to multiply your risk of developing things like alcoholic liver disease and some cancers, compared to doing them separately or not at all. In 2016, a paper came out that showed how less affluent drinkers are more likely to do more health-challenging behaviours at the same time, compared to their more affluent counterparts2. This multiplied risk might explain the difference in harm, despite the different groups drinking similar amounts

2. Consumption patterns

Another explanation could be that people living in less well-off areas drink alcohol in more harmful ways, for example, bingeing. Less affluent people tend to be more likely to drink lots of alcohol in one session (‘binge drinking’, defined as 8 units or more for men and 6 units or more for women4) compared to lighter drinking over several sessions. This might explain the findings that they suffer more injury from alcohol than more affluent people.

3. Access to health-care resources

People with a lower socioeconomic status have to deal with more barriers in accessing health services than people with a higher socioeconomic status, for example transport costs and being on waiting lists (not affording quick access through private healthcare). On top of that, stigma around alcohol dependence seems to be particularly high for less affluent people. Together, these barriers mean that less affluent drinkers are less likely to receive, or look for, professional help with alcohol-related diseases and disorders.5

Widening our understanding of alcohol harm

The research suggests that health risks from alcohol is multiplied when people smoke, have a poor diet and low levels of physical activity. Given the importance of not just looking at alcohol harm in isolation, but together with other health behaviours, it is a core part of Drinkaware’s strategy for 2017-2022 to be working with partners to promote healthier lifestyles and wellbeing more broadly. Read the Drinkaware strategy


(1) Winters-Miner L. A. et al. (2015) Chapter 13 – Personalised medicine In: Practical predictive analytics and decisioning systems for medicine. Pages: 176-2014.


(2) Bellis, M. A., Highes, K., Nicholls, J., Sheron, N., Gilmore, I. and Jones, L. (2016) The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals,  BMC Public Health, 16:111 https://doi.org/10.1186/s12889-016-2766-x


(3) Katikireddi, S. V., Whitley, E. Lewsey, J., Gray, L. Leyland, A. (2017) Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data. The Lancet: public health. 2(6): 267-276. Available at: http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30078-6/abstract


(4) Great Britain, HM Government (2012) The Government’s Alcohol Strategy. [Online]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224075/alcohol-strategy.pdf [Accessed 20/12/17]


(5) Probst, C. et al. (2014) Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis. International journal of Epidemiology. 43(4): 1314-1327. Available at: https://academic.oup.com/ije/article/43/4/1314/740212/Socioeconomic-differences-in-alcohol-attributable