Measuring lifetime alcohol exposure: A scoping review and implications for translational research and alcohol-related harm.

Abstract

Understanding lifetime alcohol exposure is fundamental to appreciating the risks of alcohol dependence and the multiplicity of alcohol-related harms, such as cirrhosis. However, most research relies on self-reported alcohol use measures that rarely extend beyond recent consumption. This represents a critical limitation in assessing the relationship between alcohol exposure and biological or psychological outcomes. Concerns about recall bias may be overstated and risk obstructing translational research into long-term effects of alcohol, including treatment engagement. This scoping review examined the evidence for the reliability and validity of self-reported measures of lifetime alcohol consumption. We searched the MEDLINE, EMBASE and PsycINFO databases in June 2024 for English-language articles published since 1970. We included studies that performed at least one of the following psychometric assessments on a lifetime alcohol exposure measure: test-retest reliability, internal consistency, concurrent validity or construct validity. The search identified 1607 unique records. After title and abstract screening, 24 studies underwent full-text review, with nine meeting the inclusion criteria. Most studies were conducted in North America (78%). The most frequently used instrument was the Lifetime Drinking History (LDH) (67%). Across all studies, there were 6010 participants (3478 male, 2532 female), with sample sizes ranging from 49 to 3255. In 78% of studies, alcohol exposure data were collected via face-to-face interview. Eight studies assessed test-retest reliability, with retest intervals ranging from 14 days to 13 years; none assessed internal consistency. Three studies (33%) formally assessed validity. Where assessed, test-retest reliability and concurrent and construct validity were moderate to strong. Test-retest reliability ranged from 0.67 to 0.92, and concurrent and construct validity with external reference measures ranged from 0.40 to 0.80, indicating generally acceptable performance. Existing instruments for measuring lifetime alcohol exposure appear to be valid and reliable and can overcome concerns regarding biases; however, these instruments vary in structure, lack standardisation and may fail to capture binge or episodic drinking, highlighting important gaps for refinement.