Alcohol Harm Reduction Strategy Research Articles

Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

Background People who use alcohol and/or drugs (PWUAD) are at higher risk of infectious disease, experiencing stigma, and recurrent hospitalization. Further, they have a higher likelihood of death once hospitalized when compared to people who do not use drugs and/or alcohol. The use of harm reduction strategies within acute care settings has shown promise in alleviating some of the harms experienced by PWUAD. This review aimed to identify and synthesize evidence related to the implementation of harm reduction strategies in acute care settings. Methods A scoping review investigating harm reduction strategies implemented in acute care settings for PWUAD was conducted. A search strategy developed by a JBI-trained specialist was used to search five databases (Medline, Embase, CINAHL, PsychInfo and Scopus). Screening of titles, abstracts and full texts, and data extraction was done in duplicate by two independent reviewers. Discrepancies were resolved by consensus or with a third reviewer. Results were reported narratively and in tables. Both patients and healthcare decision makers contributing to the development of the protocol, article screening, synthesis and feedback of results, and the identification of gaps in the literature. Findings The database search identified 14,580 titles, with 59 studies included in this review. A variety of intervention modalities including pharmacological, decision support, safer consumption, early overdose detection and turning a blind eye were identified. Reported outcome measures related to safer use, managed use, and conditions of use. Reported barriers and enablers to implementation related to system and organizational factors, patient-provider communication, and patient and provider perspectives. Conclusion This review outlines the types of alcohol and/or drug harm reduction strategies, which have been evaluated and/or implemented in acute care settings, the type of outcome measures used in these evaluations and summarizes key barriers and enablers to implementation. This review has the potential to serve as a resource for future harm reduction evaluation and implementation efforts in the context of acute care settings.

75 Examining the Role of Executive Functions on the Intention-Behavior Gap of Alcohol Harm Reduction Strategy Use

Objective:The Temporal Self-Regulation Theory (Hall and Fong, 2007) proposes that initiation and maintenance of effortful health behaviors relies on executive functions (EF: cognitive abilities associated with goal-directed behavior). Alcohol harm reduction strategies are health behaviors that aim to minimize the likelihood or severity of consequences associated with alcohol use. Some drinkers have the intention to drink safely but lack the ability to effectively initiate and execute the harm reduction behaviors. Executive functions may be one mechanism that helps explain the gap between safe drinking intentions and behavior. Specific components of EF may be differentially associated with alcohol harm reduction strategy use; working memory and set-shifting may be especially important in planning and following through with alcohol harm reduction strategies, and individuals with greater working memory capacity and set-shifting abilities may be more successful in implementing strategies that require preplanning and have a focus on altering typical the manner of drinking (e.g., not mixing types of alcohol). Inhibition may be important for resisting temptations that are inconsistent with safe drinking goals, and those with stronger inhibitory control may be more likely to follow through with strategies that require withholding responses despite desire to engage in the behavior, such as stopping or limiting drinking (e.g., not exceeding a predetermined number of drinks).Participants and Methods:Using ecological momentary assessment, the current study explored the extent to which an intention-behavior gap in harm reduction strategy use exists among college student drinkers (n=77), and investigated how potential individual differences in EF (i.e., working memory, set-shifting, and inhibition) were associated with translating intentions of drinking safely into action. Daily monitoring assessments contained brief measures of intention to use harm reduction strategies, actual strategy use, and alcohol-related behaviors, and were assessed daily for twenty-one days.Results:Multilevel model analyses revealed that although intention to use strategies predicted actual strategy use, measures of EF did not significantly moderate the relationship. Exploratory analyses indicated that set-shifting significantly moderated the intention-behavior gap for a subset of harm reduction strategies that relies more heavily on modifying behavior during a drinking event. Set-shifting did not significantly moderate the intention-behavior gap for a subset of strategies that relies more heavily on pre-planning before the drinking event.Conclusions:Findings from the current study suggests that those who plan to use strategies typically follow through regardless of individual differences in EF. Efforts to increase intention to drink safely can be incorporated into existing alcohol prevention and intervention programs, which would likely lead to increased use of harm reduction strategies and decreased alcohol-related consequences.

Evaluating an alcohol harm-reduction campaign advising drinkers of the alcohol-cancer link

IntroductionPublic awareness of the alcohol-cancer link is low. Provision of this information could reduce alcohol consumption and related harms. The Spread campaign is a multi-media education campaign implemented in Western Australia to inform people about the carcinogenic properties of alcohol and associated harms. The aims of the present study were to (i) examine attitudinal and behavioural outcomes of the Spread campaign and (ii) identify demographic and drinking status factors associated with enactment of harm-reduction behaviours resulting from exposure. MethodA cross sectional survey of Western Australian drinkers (consumed alcohol at least a few times in the previous 12 months, n = 760) examined campaign recognition, campaign perceptions, and behaviours resulting from campaign exposure. Chi-square analyses and a generalised linear model were used to identify demographic and alcohol-related factors associated with behavioural outcomes. ResultsAround two-thirds of respondents recognised the campaign (65%), and of these, 22% reported successfully reducing how often or how much they drank due to seeing the campaign. Three quarters (73%) of all respondents considered the campaign message about the alcohol-cancer link to be believable. Respondents drinking at levels above the Australian guideline were less likely to have positive perceptions of the campaign than those complying with the guideline, but were more likely to report enacting the assessed harm-reduction behaviours as a result of campaign exposure. Discussion and ConclusionThe results suggest that provision of information about the alcohol-cancer link has the potential to motivate reduced alcohol consumption. Implementing such campaigns could constitute an effective alcohol harm-reduction strategy.

Estimating the changing burden of disease attributable to alcohol use in South Africa for 2000, 2006 and 2012.

Alcohol use was one of the leading contributors to South Africa (SA)'s disease burden in 2000, accounting for 7% of deaths and disability-adjusted life years (DALYs) in the first South African Comparative Risk Assessment Study (SACRA1). Since then, patterns of alcohol use have changed, as has the epidemiological evidence pertaining to the role of alcohol as a risk factor for infectious diseases, most notably HIV/AIDS and tuberculosis (TB). To estimate the burden of disease attributable to alcohol use by sex and age group in SA in 2000, 2006 and 2012. The analysis follows the World Health Organization (WHO)'s comparative risk assessment methodology. Population attributable fractions (PAFs) were calculated from modelled exposure estimated from a systematic assessment and synthesis of 17 nationally representative surveys and relative risks based on the global review by the International Model of Alcohol Harms and Policies. PAFs were applied to the burden of disease estimates from the revised second South African National Burden of Disease Study (SANBD2) to calculate the alcohol-attributable burden for deaths and DALYs for 2000, 2006 and 2012. We quantified the uncertainty by observing the posterior distribution of the estimated prevalence of drinkers and mean use among adult drinkers (≥15 years old) in a Bayesian model. We assumed no uncertainty in the outcome measures. The alcohol-attributable disease burden decreased from 2000 to 2012 after peaking in 2006, owing to shifts in the disease burden, particularly infectious disease and injuries, and changes in drinking patterns. In 2012, alcohol-attributable harm accounted for an estimated 7.1% (95% uncertainty interval (UI) 6.6 - 7.6) of all deaths and 5.6% (95% UI 5.3 - 6.0) of all DALYs. Attributable deaths were split three ways fairly evenly across major disease categories: infectious diseases (36.4%), non-communicable diseases (32.4%) and injuries (31.2%). Top rankings for alcohol-attributable DALYs for specific causes were TB (22.6%), HIV/AIDS (16.0%), road traffic injuries (15.9%), interpersonal violence (12.8%), cardiovascular disease (11.1%), cancer and cirrhosis (both 4%). Alcohol remains an important contributor to the overall disease burden, ranking fifth in terms of deaths and DALYs. Although reducing overall alcohol use will decrease the burden of disease at a societal level, alcohol harm reduction strategies in SA should prioritise evidence-based interventions to change drinking patterns. Frequent heavy episodic (i.e. binge) drinking accounts for the unusually large share of injuries and infectious diseases in the alcohol-attributable burden of disease profile. Interventions should focus on the distal causes of heavy drinking by focusing on strategies recommended by the WHO's SAFER initiative.

Drinking Expectancies among Chinese Young Adults: A Qualitative Study from Hong Kong.

Background: Alcohol expectancies, i.e., the perceived consequences of drinking, have been reported to be important factor in predicting drinking behaviors. However, studies in the Asia region were largely limited to school-based samples. This study aimed to be the first to explore drinking expectancies among urban Chinese young adults. Methods: In 2020, eight focus group discussions were conducted with Hong Kong Chinese young adults aged 18–34 (n = 53). The participants included heavy drinkers, light drinkers, and non-drinkers from a wide range of occupations and educational backgrounds. Thematic analysis was conducted to uncover common alcohol expectancies. Results: Six themes emerged from this study. Four themes that were commonly reported in the literature were the negative consequences of drinking, social bonding, confidence enhancement, and tension reduction. The study also uncovered two culturally relevant alcohol expectancies: health benefits and business drinking expectancies. In contrast to Western samples, Chinese young adults did not report drinking expectancies related to cognitive enhancement or increased sexual interest. Conclusion: Alcohol harm reduction strategies will need to address the positive drinking expectancies uncovered in this study. Future policy discussions in this emerging alcohol market region should consider greater scrutiny of the role of alcohol marketing in the propagation of positive drinking expectancies.

PRACT: a pragmatic randomized adaptive clinical trial protocol to investigate a culturally adapted brief negotiational intervention for alcohol use in the emergency department in Tanzania

BackgroundAlcohol use in resource-limited settings results in significant morbidity and mortality. These settings lack the necessary specialty-trained personnel and infrastructure. Therefore, implementing evidence-based interventions from high-income settings, like a brief negotiational intervention (BNI) for alcohol, will require rapid production of evidence of effectiveness to guide implementation priorities. Thus, this study describes a clinical trial protocol to rapidly optimize and evaluate the impact of a culturally adapted BNI to reduce alcohol-related harms and alcohol consumption among injury patients.MethodsOur pragmatic, adaptive, randomized controlled trial (PRACT) is designed to determine the most effective intervention approach to reduce hazardous alcohol use among adult (≥18 years old) in acute (< 24 h) injury patients. Our culturally adapted, nurse-delivered, intervention (PPKAY) has been augmented with evidence-based, culturally appropriate standards and will be evaluated as follows. Stage 1 of the trial will determine if PPKAY, either with a standard short-message-service (SMS) booster or with a personalized SMS booster is more effective than usual care (UC). While optimizing statistical efficiency, Stage 2 drops the UC arm to compare the PPKAY with a standard SMS booster to PPKAY with a personalized SMS booster. Finally, in Stage 3, the more effective arm in Stage 2 is compared to PPKAY without an SMS booster. The study population is acute injury patients who present to Kilimanjaro Christian Medical Centre, Tanzania, who (1) test alcohol positive by breathalyzer upon arrival; (2) have an Alcohol Use Disorder Identification Test of 8 or above; and/or (3) have reported drinking alcohol prior to their injury. Outcome measures will be evaluated for all arms at 3, 6, 9, 12, and 24 months. The primary outcome for the study is the reduction of the number of binge drinking days in the 4 weeks prior to follow-up. Secondary outcomes include alcohol-related consequences, measured by the Drinker Inventory of Consequences.DiscussionThe findings from this study will be critically important to identify alcohol harm reduction strategies where alcohol research and interventions are scarce. Our innovative and adaptive trial design can transform behavior change research and identify the most effective nurse-driven intervention to be targeted for integration into standard care.Trial registrationClinicalTrials.govNCT04535011. Registered on September 1, 2020.

Estimating the Burden of Disease from Alcohol Use in South Africa in 2000, 2006, 2012

Background: Alcohol use was one of the leading contributors to South Africa (SA)’s disease burden in 2000, accounting for 7% of deaths and disability-adjusted life years (DALYs) in the first SA Comparative Risk Assessment (CRA) study. Since then, patterns of alcohol use have changed, as well as the epidemiological evidence pertaining to the role of alcohol as a risk for infectious diseases, most notably HIV/AIDS and tuberculosis (TB). Objectives: To estimate the burden of disease attributable to alcohol use by sex and age group in SA in 2000, 2006 and 2012. Methods: The analysis follows the World Health Organization (WHO)’s CRA methodology. Population attributable fractions (PAFs) were calculated from modelled exposure estimated from a systematic assessment and synthesis of 17 nationally representative surveys and relative risks based on the global review by the International Model of Alcohol Harms and Policies (interMAHP). PAFs were applied to the burden of disease estimates from the revised second SA National Burden of Disease study to calculate the alcohol-attributable burden for deaths and DALYs for 2000, 2006 and 2012. We quantified the uncertainty by observing the posterior distribution of the estimated prevalence of drinkers and mean use among adult drinkers (15+ years old) in a Bayesian model. We assumed no uncertainty in the outcome measures. Results: The alcohol-attributable disease burden decreased from 2000 to 2012 after peaking in 2006, owing to shifts in the disease burden, particularly infectious disease and injuries, and changes in drinking patterns. In 2012, alcohol-attributable harm accounted for an estimated 7.1% (95% uncertainty interval (UI): 6.6 - 7.6) of all deaths and 6.2% (95% UI 5.9 - 6.6) of all DALYs. Attributable deaths were split three ways fairly evenly across major disease categories: infectious diseases (36.4%), non-communicable diseases (32.4%) and injuries (31.2%). Top rankings for alcohol-attributable DALYs for specific causes were: TB (22.6%), HIV/AIDS (16.0%), road traffic injuries (15.9%), interpersonal violence (12.8%), cardiovascular disease (11.1%), cancer and cirrhosis (both 4%). Conclusions: Although reducing overall alcohol use will decrease the burden of disease at a societal level, alcohol harm reduction strategies in SA should prioritise evidence-based interventions to change drinking patterns. Frequent heavy episodic (i.e. binge) drinking accounts for the unusually large share of injuries and infectious diseases in the alcohol-attributable burden of disease profile. Interventions should focus on the distal causes of heavy drinking by focusing on strategies recommended by WHO’s SAFER initiative. Funding: This research and its publication have been funded by the South African Medical Research Council’s Flagships Awards Project (SAMRC-RFA-IFSP-01-2013/SA CRA 2). RM, AC and CDHP acknowledge funding support from SAMRC. Declaration of Interest: Nothing to declare.

Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: A mixed methods evaluation study.

Screening, brief intervention, and referral to treatment (SBIRT) for risky substance use is infrequently included in routine healthcare in low-resourced settings. A SBIRT programme, adopted by the Western Cape provincial government within an alcohol harm reduction strategy, employed various implementation strategies executed by a diverse team to translate an evidence-based intervention into services at three demonstration sites before broader programme scale-up. This paper evaluates the implementation of this programme delivered by facility-based counsellors in South African emergency centres. Guided by the Consolidated Framework for Implementation Research, this mixed methods study evaluated the feasibility, acceptability, appropriateness and adoption of this task-shared SBIRT programme. Quantitative data were extracted from routinely collected health information. Qualitative interviews were conducted with 40 stakeholders in the programme's second year. In the first year, 13 136 patients were screened and 4 847 (37%) patients met criteria for risky substance use. Of these patients, 83% received the intervention, indicating programme feasibility. The programme was adopted into routine services and found to be acceptable and appropriate, particularly by stakeholders familiar with the emergency environment. These stakeholders highlighted the burden of substance-related harm in emergency centres and favourable patient responses to SBIRT. However, some stakeholders expressed scepticism of the behaviour change approach and programme compatibility with emergency centre operations. Furthermore, adoption was both facilitated and hampered by a top-down directive from provincial leadership to implement SBIRT, while rapid implementation limited effective engagement with a diverse stakeholder group. This is one of the first studies to address SBIRT implementation in low-resourced settings. The results show that SBIRT implementation and adoption was largely successful, and provide valuable insights that should be considered prior to implementation scale-up. Recommendations include ensuring ongoing monitoring and evaluation, and early stakeholder engagement to improve implementation readiness and programme compatibility in the emergency setting.

Building a social marketing Strategy to reduce alcohol-related harm in France

Abstract Background Alcohol use ranks among the top three risk factors in France, leading to about 40 000 deaths annually. French health authorities wished to renew the public health message about alcohol consumption and build a social marketing Strategy to lower the social and health consequences of alcohol consumption in France. Objectives Two main steps were followed: 1) gathering a group of experts to provide up-to-date low-risk drinking guidelines, 2) building, testing and implementing a social marketing Strategy based on this expertise. Results In 2017, the group of experts established low-risk drinking Guidelines based on both scientific evidence and socially acceptable risks for the French population. They suggested to increase awareness on alcohol-related harm as well as on the new Guidelines. In 2018, a social marketing Strategy was set up by Santé publique France, the French national public health Agency. Qualitative and quantitative pretests allowed to develop understandable and potentially effective communication materials consisting of the following message: “To protect your health, no more than 2 alcoholic drinks a day, and not every day”. A web-based brief intervention to assess a person’s alcohol consumption was developed, based on a previous tool whose effectiveness had been demonstrated. In 2019, the Campaign was launched: health professionals were informed at first, followed by a national mass media Campaign that was broadcasted for 3 weeks, targeting the general population (TV, radio, press, the Internet). Conclusions It is the first time in France that such a global Strategy is set up to promote an alcohol harm reduction message. A robust evaluation is in progress but this structured approach seems feasible and reproducible abroad. Key messages In France, an alcohol harm reduction Strategy has been built up and implemented, based on scientifically-established Guidelines. The social marketing campaign is rigorously evaluated to assess its impact and portability.

Effect of a text message intervention to reduce hazardous drinking among injured patients discharged from a trauma ward: a randomized controlled trial

Screening and brief intervention for hazardous alcohol use in trauma care settings is known to reduce alcohol intake and injury recidivism, but is often not implemented due to resource constraints. Brief interventions delivered by mobile phone could overcome this challenge. This study aimed to evaluate the effect of a mobile phone text message intervention (YourCallTM) on hazardous drinkers admitted for an injury. The parallel two-group, single-blind, randomised controlled trial enrolled 598 injured patients aged 16–69 years identified as medium-risk drinkers at recruitment. The intervention group (n = 299) received 16 text messages incorporating brief intervention principles in the 4 weeks following discharge from hospital. Controls (n = 299) received usual care and one text message acknowledging participation in the trial. The primary outcome was the difference in hazardous alcohol use (assessed using AUDIT-C) between study groups at 3 months, with the maintenance of effect examined at 6 and 12 months’ follow-up. Data were analysed using a mixed-effects model for repeated measures. Both groups had similar baseline features. Compared to controls, hazardous drinking was significantly lower in the intervention group at 3 months and maintained over the 12-month follow-up period (least squares mean difference in AUDIT-C scores: −0.322; 95% CI: −0.636, −0.008; p = 0.04). The intervention effect was similar among Māori (New Zealand’s indigenous population) and non-Māori (interaction p = 0.59), and among younger (16–29 years) and older (30–69 years) patients (p = 0.77). The effectiveness of this intervention reflects the potential of low cost, scalable mobile health technologies to overcome common barriers in implementing alcohol harm reduction strategies following injury.

Drink wisely Australians, but keep drinking: does the alcohol industry in Australia frame the discourse on alcohol to maintain hegemony?

Public health literature proposes that the Australian alcohol industry–funded organisation DrinkWise is a Social Aspects Public Relations Organisation (SAPRO) that favours industry over public interests by deploying ineffective alcohol harm reduction strategies. This research addresses a gap in the critical public relations literature by investigating these claims through an examination of DrinkWise’s source media content. Content and rhetorical framing analysis revealed how the organisation framed the alcohol issue, as well as identifying the messages and message audiences of their media releases. Results supported extant research suggesting that DrinkWise is insulating the alcohol industry against evidence-based public health harm reduction strategies, by engaging in agenda building through industry-friendly framing of the alcohol issue, and dissemination of information subsidies to elites and policy-makers. We discuss the conclusions through a lens of hegemony and develop an argument that DrinkWise media relations is a strategy to maintain a hegemonic individual responsibility ideology.

Alcohol-related crime in city entertainment precincts: Public perception and experience of alcohol-related crime and support for strategies to reduce such crime.

Introduction and AimsBars, pubs and taverns in cities are often concentrated in entertainment precincts that are associated with higher rates of alcohol‐related crime. This study assessed public perception and experiences of such crime in two city entertainment precincts, and support for alcohol‐related crime reduction strategies.Design and MethodsA cross‐sectional household telephone survey in two Australian regions assessed: perception and experiences of crime; support for crime reduction strategies; and differences in such perceptions and support.ResultsSix hundred ninety‐four people completed the survey (32%). Most agreed that alcohol was a problem in their entertainment precinct (90%) with violence the most common alcohol‐related problem reported (97%). Almost all crime reduction strategies were supported by more than 50% of participants, including visitors to the entertainment precincts, with the latter being slightly less likely to support earlier closing and restrictions on premises density. Participants in one region were more likely to support earlier closing and lock‐out times. Those at‐risk of acute alcohol harm were less likely to support more restrictive policies.Discussion and ConclusionsHigh levels of community concern and support for alcohol harm‐reduction strategies, including restrictive strategies, provide policy makers with a basis for implementing evidence‐based strategies to reduce such harms in city entertainment precincts. [Tindall J, Groombridge D, Wiggers J, Gillham K, Palmer D, Clinton‐McHarg T, Lecathelinais C, Miller P. Alcohol‐related crime in city entertainment precincts: Public perception and experience of alcohol‐related crime and support for strategies to reduce such crime. Drug Alcohol Rev 2016;35:263–272]

“I always stop before I get sick”: a qualitative study on French adolescents alcohol use

Objective: This study aimed to examine French adolescents’ experiences and perception of alcohol use.Method: Individual interviews and focus groups were conducted with a total of 57 adolescents ranging from 12 to 18 years old.Measures: All interviews were conducted according to a similar discussion grid. Coding and analysis were carried out with N’vivo software. The coding grid was drawn up according to team consensus, using a cross-reference approach, based on phenomenology and discourse analysis.Results: Adolescents are mostly introduced to alcohol consumption in family contexts while peer-influence usually increases this to regular or even excessive consumption. Consuming alcohol in this way is often seen as a means of fostering and strengthening friendships as well as of assuming one’s identity. Adolescents tend to play down their alcohol use, deeming it to be a transitory phase. They limit their consumption according to the effects it induces rather than to the number of drinks.Recommendations: Specific alcohol harm-reduction strategies for adolescents appear to be a promising way to prevent alcohol misuse and an innovative technique could be to focus on setting limits on alcohol consumption based on adolescents’ proprioceptive sensations.

Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs.

BackgroundExcessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.MethodsA cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.ResultsMembers of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted ‘happy hour’ promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.ConclusionsThe findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.

“Everyone can loosen up and get a bit of a buzz on”: Young adults, alcohol and friendship practices

In countries with liberalised alcohol policies, alcohol harm reduction strategies predominantly focus on young adults’ excessive drinking harms and risks. However, research shows such risks are largely irrelevant for young adults, who emphasise the sociability, release, pleasure and fun of drinking. Friendship is a central part of their lives and an integral part of their drinking experiences. This study aimed to explore everyday friendship practices, drinking, and pleasure in young people's routine and shared social lives. Twelve friendship discussion groups were conducted in urban and non-urban New Zealand, with 26 women and 25 men aged 18–25 years. Our Foucauldian discursive analysis enabled us to identify how the young adults drew on drinking as ‘friendship fun’ and ‘friends with a buzz’ discourses to construct drinking as a pleasurable and socially embodied friendship practice. Yet the young adults also drew on ‘good always outweighs bad experiences’ and friendship ‘caring and protection’ discourses to smooth over disruptive negative drinking experiences. Together these discourses function to justify young adults’ drinking as friendship pleasure, minimising alcohol harms, and setting up powerful resistances to individualised risk-based alcohol-harm reduction campaigns. These findings are discussed in terms of new insights and implications for alcohol harm reduction strategies that target young adults.

The role of social drinking motives in the relationship between social norms and alcohol consumption

Social norms are key predictors of college student drinking. Additionally, the social reasons for consumption (i.e. social drinking motives) are important to understanding drinking behaviour. This study investigated the effects of social norms and social motives on alcohol consumption. A total of 229 college students completed an online questionnaire assessing their drinking behaviour, social drinking motives and their perceived drinking social norms. Drinking social norms were assessed as descriptive norms (i.e. the individual's perceived prevalence of alcohol consumption), and injunctive norms (i.e. the individual's perceived approval of drinking by their peers). Additionally, injunctive norms were further separated into distal (socially distant peers) and proximal (socially close peers). Hierarchical regression analyses revealed descriptive norms, proximal injunctive norms and social motives all independently predicted alcohol consumption. Additionally, the relationship between proximal injunctive norms and consumption, and descriptive norms and consumption was mediated by social motives. Lastly, there was a significant three-way interaction between descriptive norms, distal injunctive norms and social motives on drinking. Consideration of both the individual factors and the complex interplay between social norms and social motives on alcohol consumption is necessary to further understand drinking behaviour, and to develop more effective alcohol harm-reduction strategies.

Impact of alcohol harm reduction strategies in community sports clubs: Pilot evaluation of the Good Sports program.

Approximately 4.5 million Australians are involved in community sports clubs. A high level of alcohol consumption tends to be commonplace in this setting. The only program of its type in the world, the Good Sports program was designed to reduce harmful alcohol consumption in these Australian community sports clubs. The program offers a staged accreditation process to encourage the implementation of alcohol harm-reduction strategies. We conducted a postintervention adoption study to evaluate whether community sports club accreditation through the Good Sports program was associated with lower rates of alcohol consumption. We examined alcohol consumption rates in 113 clubs (N = 1,968 participants) and compared these to consumption rates in the general community. We hypothesized that members of clubs with more advanced implementation of the Good Sports accreditation program (Stage Two) would consume less alcohol than those with less advanced implementation (Stage One). Multilevel modeling (MLM) indicated that on days when teams competed, Stage Two club members consumed 19% less alcohol than Stage One club members. MLM also indicated that the length of time a club had been in the Good Sports program was associated with reduced rates of weekly drinking that exceeded Australian short-term risky drinking guidelines. However consumption rates for all clubs were still higher than the general community. Higher accreditation stage also predicted reduced long-term risky drinking by club members. Our findings suggest that community sports clubs show evidence of higher levels of alcohol consumption and higher rates of risky consumption than the general community. Implementation of the Good Sports accreditation strategy was associated with lower alcohol consumption in these settings.

A qualitative investigation into key cultural factors that support abstinence or responsible drinking amongst some Pacific youth living in New Zealand

BackgroundAbstinence and responsible drinking are not typically associated with youth drinking culture. Amongst Pacific youth in New Zealand there are high numbers, compared to the general New Zealand population, who choose not to consume alcohol. The Pacific youth population is made up of several ethnic groups; their ethno-cultural values are largely Polynesian and heavily influenced by the socio-economic realities of living in New Zealand. This paper explores factors that support abstinence or responsible drinking amongst Pacific youth living in Auckland.MethodsA qualitative study comprised of a series of ethnically-, age-, and gender-matched semi-structured focus group discussions with 69 Pacific youth, aged 15-25 years from a university and selected high-schools. Participants were purposively sampled.ResultsKey cultural factors that contributed to whether Pacific youth participants were abstinent or responsible drinkers were: significant experiences within Pacific family environments (e.g. young person directly links their decision about alcohol consumption to a positive or negative role model); awareness of the belief that their actions as children of Pacific parents affects the reputation and standing of their Pacific family and community (e.g. church); awareness of traditional Pacific values of respect, reciprocity and cultural taboos (e.g. male–female socialising); commitment to no-alcohol teachings of church or religious faith; having peer support and experiences that force them to consider negative effects of excessive alcohol consumption; and personal awareness that being part of an (excessive) drinking culture may seriously affect health or impede career aspirations.ConclusionsThe narratives offered by Pacific young people highlighted three key communities of influence: family (immediate and extended, but especially siblings), peers and church. Young people negotiated through these communities of influence their decisions whether to drink alcohol, drink excessively or not at all. For each young person the way in which those three communities came together to support their decisions depended on the specificities of their lived contexts. Pacific young people live lives that share some things in common with other New Zealand youth and others which are more specific to a Pacific ethnic group, especially in relation to the traditional beliefs of their Pacific parents and community. In the development of alcohol harm reduction strategies seeking active Pacific young person and family compliance, it is these “other ethnic things” that requires careful and more qualitative consideration.

Evaluation of an Internet-Based Alcohol Misuse Prevention Course for College Freshmen: Findings of a Randomized Multi-Campus Trial

Internet-based alcohol misuse prevention programs are now used by many universities. One popular 2- to 3-hour online course known as AlcoholEdu for College is typically required for all incoming freshmen and thus constitutes a campus-level strategy to reduce student alcohol misuse. Multi-campus study to evaluate the effectiveness of an Internet-based alcohol misuse prevention course. RCT with 30 universities: 21 entered the study in Fall 2007, nine in Fall 2008. Fifteen were randomly assigned to receive the online course and the other 15 were assigned to the control condition. The course was implemented by intervention schools during the late summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university, beginning prior to the intervention in Spring 2008-2009; post-intervention surveys were administered in Fall 2008-2009 and Spring 2009-2010. Public and private universities of varying sizes across the U.S. Random samples of 200 freshmen per campus were invited to participate in online surveys for the evaluation. Overall survey response rates ranged from 44% to 48% (M ≈ 90 participants per campus). The online course includes five modules; the first four (Part I) are typically offered in the late summer before matriculation, and the fifth (Part II) in early fall. Course content includes defining a standard drink, physiologic effects of alcohol, the need to monitor blood alcohol level, social influences on alcohol use, alcohol laws, personalized normative feedback, and alcohol harm-reduction strategies. Students must pass an exam after Part I to advance to Part II. Past-30-day alcohol use, average number of drinks per occasion, and binge drinking. Multilevel intent-to-treat analyses indicated significant reductions in the frequency of past-30-day alcohol use (beta = -0.64, p<0.05) and binge drinking (beta = -0.26, p<0.05) during the fall semester immediately after completion of the course. However, these effects did not persist when assessed in the spring semester. Post hoc comparisons suggested stronger course effects on these outcomes at colleges with higher rates of student course completion. No course effects were observed for average number of drinks per occasion or prevalence of binge drinking, regardless of the campus course completion rate. This study provides initial evidence that the Internet-based alcohol misuse prevention course has beneficial short-term effects on hazardous drinking behavior among first-year college students, which should be reinforced through effective environmental prevention strategies.

Screening and Brief Intervention of Detainees for Alcohol Use: A Social Crime Prevention Approach to Combating Alcohol‐Related Crime?

Abstract: Irresponsible and excessive consumption of alcohol and the associated problems it carries in its wake have become one of the key concerns for central government in terms of community safety, especially in the night‐time economy. In response to the Alcohol Harm Reduction Strategy for England (Department of Health 2007), the Department of Health (DoH) has announced a series of measures of which one is to pilot screening and intervention for alcohol use in a variety of locations, including criminal justice settings. This article reports on the findings of a project that pre‐empts the DoH initiatives, thus providing the opening comments in what will be sure to be a debate about a new strategic and evidence‐based approach to dealing with alcohol‐related crime and disorder. The article provides data and discussions on the Screening and Brief Intervention (SBI) project that screened 3,900 detainees in a busy custody suite in the south of England during the period March 2007 to March 2008.