Identifying Alcohol Problems and Selected Individual and Contextual Risk Factors Among Adults in South Africa: Findings from the International Alcohol Control Study

Many drinkers globally are at risk of developing an alcohol use disorder (AUD). The study aimed to identify the extent of AUDs and associated individual and societal-level risk factors or vulnerabilities among adult drinkers in a country with high levels of heavy episodic drinking. A household survey was conducted in the Tshwane Metro, South Africa, using multistage stratified cluster random sampling. Complete data were available on 949 adult drinkers. Half (49%) reported symptoms of alcohol problems, as a proxy for AUDs, as measured using the RAPS4. Gender and age were not associated with symptoms of alcohol problems. White persons had 74% lower odds of symptoms of alcohol problems compared to Black Africans, and persons who reported stressful life events in the past 6 months were four times more likely to report symptoms of alcohol problems. Persons whose primary drinking location was a pub/bar/tavern and “other club” were more than twice as likely to have symptoms of alcohol problems than persons who drank at home, and persons whose primary beverage was wine were 74% less likely to have symptoms of alcohol problems compared to beer drinkers. The findings raise important implications regarding particular vulnerabilities experienced by Black Africans; the sale of alcoholic beverages, and especially beer, in locations such as pubs/bars/taverns; and the need for more comprehensive epidemiological research to assess the nature and extent of AUDs in South Africa together with focused contextual research on particular groups at risk.