Aims: Alcohol-related harm occurs at lower levels than previously recognized, warranting a need to identify mediators to reduce alcohol-associated risk in increased-risk drinkers. Stages of change (SOC) have been used to assess motivation for health behaviour alteration. The primary aim was to explore distribution on SOC among medical inpatients when comparing low-risk, increased-risk, and high-risk consumers as defined by Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). Our secondary aim was to assess the distribution of SOC when consumption was stratified with a biomarker of alcohol use-phospatidylethanol 16:0/18:1.
Methods: Cross-sectional study with three participating hospitals. Recruiting consecutive medical inpatients ≥18 years with regular alcohol consumption as screened by score ≥2 on the first question in AUDIT-C (N = 888). AUDIT-C score and SOC were assessed by questionnaires, and phospatidylethanol concentration in a blood sample. Odds ratios and the 95% confidence intervals were calculated through a univariate logistic regression analysis for each variable, and multivariable logistic regression models were then fit to calculate the adjusted odds ratio and 95% confidence interval.
Results: Distributions of SOC differed between the three risk-groups. Distribution of SOC was comparable whether assessed by phospatidylethanol or AUDIT-C.
Conclusions: Increased-risk consumers constitute the majority of those in action-the only stage associated with consecutive reduction in drinking. Potentially, these results can aid in reducing perceived barriers among health care professionals in screening and offering health advice to those with increased-risk consumption and inform further research on mediators in this subgroup.
Keywords: AUDIT-C; alcohol consumption; increased-risk drinkers; phospatidylethanol; prevention paradox; stages of change.
© The Author(s) 2025. Published by Oxford University Press on behalf of the Medical Council on Alcohol and Oxford University Press.