Fat Words or Useful Concepts?: Consensus and Variation in Conceptions of Problematic Drinking in Contemporary Sweden

Abstract

The aim of this study was to bring to light the meanings attributed to four concepts denoting problematic drinking—“alcoholism,” “alcohol dependence,” “alcohol misuse,” and “risky drinking”—and to investigate whether individuals’ preferences for using these concepts vary depending on their demographic characteristics, their stakeholder group membership, and their own drinking habits. These questions were examined by means of a vignette experiment, in which Swedish social workers, health care staff, journalists, researchers, and the general public ( n = 863) read a series of 10 randomly constructed fictitious cases (vignettes; n = 8,630) and made judgments about which of the four concepts best portrayed the case descriptions. Results based on multilevel multinomial logistic regression showed that alcoholism was the concept chosen for the “heaviest” and most problematic drinking, whereas risky drinking was most often employed to describe moderate drinking habits that resulted in few negative consequences. The concepts alcohol misuse and alcohol dependence were positioned between alcoholism and risky drinking, and while misuse was linked to drinking large quantities and to more negative consequences, dependence was more frequently used to describe vignettes that involved depictions of craving. Moreover, the respondents’ conceptual choices were affected by their own gender, age, drinking habits, and stakeholder group membership. Taken together, the study’s findings reveal both consensus and variation in the respondents’ choice of concepts, indicating that while these concepts may to some extent be employed for making meaningful distinctions between different types of problematic drinking, there is substantial variation in the way the concepts are employed.