Drinking patterns and drinking behaviors: theoretical models of risky acts

Successful models linking drinking to subsequent injury require the complementary development of theories of drinking patterns and theories of drinking behaviors. Theories of drinking patterns characterize the primary dimensions of drinking that augment risks for injury, and theories of drinking behaviors characterize activities in which individuals participate during and after drinking and that expose drinkers to risk. This paper presents a theoretical approach to understanding these two aspects of risk for alcohol-involved injuries. In developing this approach, traditional methods of characterizing drinking patterns are reviewed, and their applicability to the prediction of drinking risks is evaluated (i.e., measures of total consumption, quantity/frequency measures, and measures of heavy drinking). The current approach provides a means of representing drinking risks in terms of three drinking measures-frequency, average drinks per occasion, and variance-and provides a mathematical representation of how injury risks can be predicted from drinking patterns. As a complement to the work on drinking patterns, the rather limited literature regarding drinking behaviors is reviewed with the objective of indicating the major components of human activities around alcohol. A skeletal framework for theoretically conceptualizing drinking behaviors is constructed around the idea that drinkers tend to maximize beverage quality and the amenity value of drinking locations within economic and time-energy budget constraints and outcome risks. That is, drinkers prefer to drink higher-quality beverages at locations where some form of entertainment is available (i.e., bars and restaurants). Yet drinkers must minimize costs in terms of time, money, and the possible risks associated with drinking. A lot of things happen to people who drink. Among them are the pleasures of intoxication, the relaxation that comes from the sedating effects of alcohol, and the social camaraderie of drinking groups. Also among them are some rather unfortunate consequences: alcohol-related car crashes caused by impaired driving performance (Perrine et al., 1989), injuries arising from impaired judgment in using pedestrian walkways at busy intersections (Solnick and Hemenway, 1994; Holubowycz, 1995), increased risks of suicide and other forms of aggression related to the effects of alcohol on the neurochemical and perceptual-attentive bases of behavior (summarized in Giancola and Zeichner, 1995), and a number of other social consequences such as domestic disputes, lost work, and, not surprisingly, the occasional hangover affecting job performance (Clark and Hilton, 1991). The involvement of a particular individual in these outcomes depends, of course, on how much and how often he or she drinks alcohol. It also depends upon his or her participation in certain activities (i.e., driving, walking, latently aggressive interactions, and work). All of these outcomes require participation in certain patterns of drinking. All of them require context. One must drive and drink in order to drink and drive. It is obvious that drinking patterns and drinking contexts, along with their interactions, form the basis for individual drinking problems. One must drive a car after drinking to be driving while under the influence of alcohol. At the individual level the behaviors of interest are well understood. Less well understood are the associations between drinking patterns and drinking behaviors aggregated over time. Here we have a different theoretical problem. In this case, patterns of alcohol use (e.g., drinking frequencies) and changes in routine human activities (e.g., the use of public transportation) may or may not alter the rates at which drinking driving occurs. The effects of drinking patterns and routine human activities on drinking and driving are conditional uvon their linkage in time and space. Thus one may increase frequencies of drinking at home, leaving likelihoods of drinking and driving unaffected. …