Self-perceived alcohol dependence often clashes with screening scores in Lebanese adults

A cross-sectional study of 460 adults in Lebanon has found that roughly one in five participants showed a mismatch between how they perceived their own alcohol dependence and what their AUDIT screening score indicated. The research, published in Archives of Public Health, examined this discordance alongside self-reported drinking status, religious prohibition of alcohol, and social desirability bias.

The study was conducted between February and March 2025 using snowball sampling, a non-probability method. Participants completed validated instruments covering alcohol use through the AUDIT, cigarette dependence through the LCD, waterpipe dependence through the LWDS-11, and social desirability through the LSDS. The researchers applied Benjamini–Hochberg false discovery rate correction to their statistical analyses.

Among the 460 participants, 23.5% had a non-zero AUDIT score.

Overall, 100 participants, representing 21.74% of the sample, met the study’s definition of discordance between perceived alcohol dependence and AUDIT score, abbreviated DPADAS. The pattern varied sharply by how participants described their own drinking. DPADAS was observed in 86.7% of occasional drinkers, 66.7% of previous drinkers, and 58.8% of regular drinkers, compared with only 8.6% of participants who described themselves as non-drinkers.

A striking detail emerged among self-described non-drinkers: 33 of them recorded a non-zero AUDIT score, and 32 of those 33 met the DPADAS definition. This suggests that some people who deny drinking altogether still produce screening responses that register at least some alcohol-related items, creating a gap between their self-image and their questionnaire results.

In multivariable analyses, self-reported religious prohibition of alcohol was associated with substantially lower odds of DPADAS, with an adjusted odds ratio of 0.040 and a 95% confidence interval of 0.019 to 0.084, yielding a corrected q value below 0.002. By contrast, consuming alcohol while smoking and higher LWDS-11 waterpipe dependence scores were associated with higher odds of the discordance. Associations involving the social desirability scale factors were inconsistent across the models.

The authors caution that these findings are hypothesis-generating and should not be read as evidence of alcohol underreporting, causality, or population-level prevalence. Because the sample was recruited through snowball sampling rather than a probability design, it cannot represent the general adult population of Lebanon. The study’s conclusion also notes that the link between religious prohibition and lower discordance may largely reflect lower alcohol use itself rather than a direct psychological effect of religious belief.

The study’s background explains that accurate assessment of substance use, particularly alcohol, can be complicated by social desirability bias and religious injunctions, which motivated the focus on these factors. The research team was led by Rana Hatem and included Clara Gerges, Hala Sacre, Chadia Haddad, Aline Hajj, Sandrella Bou Malhab and Pascale Salameh, among other collaborators from Lebanese institutions.

Looking ahead, the researchers call for further studies using more representative sampling, direct measures of alcohol consumption and religiosity, and longitudinal designs. Until such work is done, the study stands as a snapshot of how self-perception, screening scores and self-reported drinking status can diverge in a convenience sample of Lebanese adults, and of how religious and behavioral factors may pattern that divergence.

Subject of Research: Discordance between self-perceived alcohol dependence and AUDIT screening scores among adults in Lebanon

Article Title: Discordance between perceived alcohol dependence and AUDIT scores in a sample of adults in Lebanon: correlates and focus on religious prohibition and social desirability

Article References: Hatem, R., Gerges, C., Eid, R., Chkayban, G., Sacre, H., Haddad, C., Sakr, F., Hajj, A., Karam, D., Youssef, D., Ghostin, M., Bou Malhab, S., & Salameh, P. (2026). Discordance between perceived alcohol dependence and AUDIT scores in a sample of adults in Lebanon: correlates and focus on religious prohibition and social desirability. Archives of Public Health. https://doi.org/10.1186/s13690-026-02126-4

Image Credits: AI Generated

DOI: 10.1186/s13690-026-02126-4

Keywords: alcohol use, AUDIT, Lebanon, cross-sectional study, religious prohibition, social desirability, self-perception, drinking status, waterpipe dependence, screening discordance, public health, Discordance