The collectivity of drinking cultures: is the theory applicable to African settings?

AIMS: Skog's theory of collective drinking behaviour implies that countries with a strict informal social control of drinking alcohol would not exhibit 'collective displacement' of consumption (a linear association between population mean consumption and percentile values across the full range of the distribution), as do countries with less informal social control. This paper aimed to test this hypothesis by examining the alcohol consumption distributions in African countries with a strong informal control of alcohol. DESIGN SETTING, PARTICIPANTS AND MEASUREMENTS: Data on alcohol consumption from the World Health Organization's general population surveys in 15 African countries were aggregated and analysed with respect to skewedness and collective displacement of the distribution.
FINDINGS: The distribution of consumption was strongly positively skewed, with 10-15% of the drinkers consuming more than twice the mean consumption. There was also clear evidence of a collective displacement of the consumption distribution, and the consumption mean was a strong predictor of the distribution percentile values across the full range of the distribution. Correspondingly, consumption mean predicted the prevalence of heavy drinkers.
CONCLUSION: The distribution patterns of alcohol consumption in African countries are consistent with those observed previously in industrialized countries. These findings seem to counter Skog's theory of collective drinking behaviour and support the universality of the observation that the prevalence of problem drinking is linked closely to mean consumption.