A qualitative exploration of the Alcohol Harm Paradox – understanding experiences of alcohol-related harm among Australians of different socio-economic status

Background People living in disadvantaged areas experience disproportionately more harms from alcohol compared to those in advantaged areas, despite equivalent or less alcohol consumption. This is known as the ‘alcohol harm paradox’. This study explores how people who drink alcohol from areas of different socio-economic status (SES) describe and perceive the harms they experience from drinking to garner a deeper understanding of the mechanisms that underpin the alcohol harm paradox. Methods The study draws on 45 semi-structured interviews with people who consume alcohol in Victoria, Australia. Participants were recruited in 2023-2024 from neighbourhoods with different levels of SES. Drawing on the Social Ecological Model as an analytical lens, thematic and comparative analysis was used to explore how socio-economic conditions influenced alcohol-related harms among those from different SES areas. Results Concerns about physical, mental and work-related harms from alcohol were more common among those living in areas of higher SES, with broader life concerns more immediate for those in areas of lower SES. Participants from middle and higher SES areas often reported compensating drinking practices with healthy activities such as fitness, and moderating consumption before work days. Those from the lowest SES areas described feeling less autonomy over their consumption and reported fewer resources to address potential alcohol-related problems. Conclusion Our findings support calls for a social ecological model perspective and approaches that consider multiple contextual factors to better understand alcohol-related health inequity. Policies that most effectively tackle the alcohol harm paradox may be those that improve social conditions for the whole population, subsequently reducing alcohol-related inequity.