I have read with interest the recent paper by Liang & Chikritzhs in Addiction[1] and venture to make some comment on it, as it is an area of the alcohol story in which I have a long-standing interest through the British Regional Heart Study (BRHS; http://www.ucl.ac.uk/primcare-popsci/brhs) [2].
The term ‘sick quitters’[3] is unfortunate, in that it carries the unintended implication that the person who has quit drinking or reduced their alcohol intake has done so for reasons associated with alcohol usage. Although it is usually made clear that being a ‘sick quitter’ need not be due to alcohol, most readers still assume this to be so. Any study of ex-drinkers or those who have markedly reduced their alcohol intake will show that only a minority have done so through an illness associated directly with the use of alcohol. Most ex-drinkers and most of those who make significant reductions in their intake usually do so as they age and because of physical or mental ill health, medication, economic factors or other changes in life-style conducive to a reduction in alcohol consumption [4,5]. Abandoning this term would be a useful starter in fresh thinking about alcohol usage and health.
There is an assumption, rather too easily made, that most modern epidemiological studies are careful not to include ‘sick quitters’ within the non-drinking category and will use life-long abstainers or light drinkers as their baseline. The problem with this assumption is that different authors vary in their definition of ‘sick quitters’; few studies use regular (i.e. with repeated measurements) light drinkers as the baseline and the use of life-long abstainers has other problems (vide infra).
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