Tackling Alcohol Misuse Research Articles

‘We shall drink until Lake Victoria dries up’: Drivers of heavy drinking and illicit drug use among young Ugandans in fishing communities

ABSTRACT We investigated patterns and drivers of alcohol misuse and illicit drug use among young fisherfolk. We undertook this study in fishing communities on Koome Island, Lake Victoria, Uganda, from December 2017–July 2018. We conducted six group discussions with men (3) and women (3) and 33 in-depth interviews with: young people [users (n = 10); non-users (n = 2)], local leaders (n = 3), health workers (n = 2), parents (n = 5), alcohol/illicit drugs sellers/distributors (n = 5), law enforcement officers (n = 5). We sampled participants using purposive and snowball strategies. Interview themes included: knowledge, experiences and perceptions of alcohol use/illicit drug use, HIV risk behaviour and harm reduction. We mapped alcohol/illicit drug use outlets using a Geographic Information System to capture density, distribution and proximity to young people’s homes. We coded and analysed qualitative data using thematic content analysis. Motivations for heavy drinking and illicit drug use were multifaceted and largely beyond individual control. Key contextual determinants included social norms around consumption (acceptability), price (affordability), and ease of purchase (availability). Prevention and harm reduction interventions to tackle alcohol misuse and illicit drug use should be aimed at the structural rather than individual level and must be conducted in tandem with strategies to control poverty and HIV.

Co-production with young people to tackle alcohol misuse

PurposeThe purpose of this paper is to present the learning gained from undertaking research activities in co-production with young people in order to tackle alcohol misuse in local communities.Design/methodology/approachThe findings are drawn from an evaluation of an alcohol misuse change programme in which opportunities to learn about and conduct research were provided to young people through co-production. The evaluation was guided by a theory of change, and a portfolio of evidence collected which included feedback from the young people and project staff about their experiences.FindingsThis paper demonstrates that young people can be empowered to take on roles as agents of change in their own communities by learning more about research processes. However, the empowerment does not come from undertaking research training per se, but by being able to work co-productively with researchers on issues and questions that are of direct relevance to themselves and which are framed within a change agenda. Shared values, strong relationships and reciprocal knowledge exchange enabling flexible and relevant responses to real-world problems and questions are needed.Originality/valueThe paper suggests a reflexive and co-productive learning, design and delivery approach to involving young people in research. It challenges notions of young people as a problem in terms of alcohol misuse, and rather situates them as part of a solution that is aiming at longer-term transformational community change. This is significant in that much of the existing evidence concentrates on individual intervention.

Injury resulting from targeted violence: An emergency department perspective.

Hate crimes - those perpetrated because of perceived difference, including disability, race, religion, sexual orientation or transgender status - have not been studied at the point of the victim's hospital emergency department (ED) use. To investigate the frequency, levels of physical harm and circumstances of targeted violence in those seeking treatment at EDs in three UK cities. In a multimethods study, face-to-face semi-structured interviews were conducted with 124 adult ED attenders with violent injuries. Victim and perpetrator socio-demographics were recorded. Patient narratives about perceived motives and circumstances were transcribed, uploaded onto NVivo for thematic analysis. Nearly a fifth (23, 18.5%) of the injured patients considered themselves to have been attacked by others motivated by hostility or prejudice to their 'difference' (targeted violence). Thematic analyses suggested these prejudices were to appearance (7 cases), racial tension (5 cases), territorial association (3 cases) and race, religious or sexual orientation (8 cases). According to victims, alcohol intoxication was particularly relevant in targeted violence (estimated reported frequency 90% and 56% for targeted and non-targeted violence, respectively). Our findings support a broader concept of hate victimisation and suggest that emergency room violence surveys could act as a community tension sensor and early warning system in this regard. Tackling alcohol misuse seems as important in this as in other forms of violence perpetration. Copyright © 2017 John Wiley & Sons, Ltd.

What are the Implications for Policy Makers? A Systematic Review of the Cost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care.

Introduction: The efficacy of screening and brief interventions (SBIs) for excessive alcohol use in primary care is well established; however, evidence on their cost-effectiveness is limited. A small number of previous reviews have concluded that SBI programs are likely to be cost-effective but these results are equivocal and important questions around the cost-effectiveness implications of key policy decisions such as staffing choices for delivery of SBIs and the intervention duration remain unanswered.Methods: Studies reporting both the costs and a measure of health outcomes of programs combining SBIs in primary care were identified by searching MEDLINE, EMBASE, Econlit, the Cochrane Library Database (including NHS EED), CINAHL, PsycINFO, Assia and the Social Science Citation Index, and Science Citation Index via Web of Knowledge. Included studies have been stratified both by delivery staff and intervention duration and assessed for quality using the Drummond checklist for economic evaluations.Results: The search yielded a total of 23 papers reporting the results of 22 distinct studies. There was significant heterogeneity in methods and outcome measures between studies; however, almost all studies reported SBI programs to be cost-effective. There was no clear evidence that either the duration of the intervention or the delivery staff used had a substantial impact on this result.Conclusion: This review provides strong evidence that SBI programs in primary care are a cost-effective option for tackling alcohol misuse.

Should people who are drunk pay for urgent treatment?

Nurses at RCN congress to debate how emergency department staff can help to tackle alcohol misuse among patients. Erin Dean reports

Tackling the traits of teen alcoholism

After taking part in a pilot project to tackle alcohol misuse using targeted interventions with students grouped by personality traits and individual tendencies, Corelli College saw a real impact. Jon Kelly explains how.

Tackling alcohol misuse in the community

Jay Mannhart details his work on a drinking awareness scheme in Liverpool

Quantifying the contribution of leading causes of death to mortality decline among older people in England, 1991–2005

This paper quantifies the contribution of leading causes of death to mortality change between 1991 and 2005 for people aged 50 years and over in England. Between 1971 and 2005 the life expectancy of men aged 50 years increased by more than in the whole of the rest of the 20(th) century. The ageing population has not only had an important impact on health and social services, but was responsible for sparking the pensions crisis affecting both the public and commercial sector. A cross-sectional analysis was used to quantify trends in cause-specific mortality in terms of absolute and relative change between 1991 and 2005 in the population aged 50 and over. Absolute change is quantified in terms of the numbers of deaths prevented or postponed (or conversely, increased or brought-forward) in a year compared to deaths in the baseline year. The percentage change in age-standardised rates was used to identify relative change in causes of death. Between 1991 and 2005 there was a continuous decline in overall all-cause death rates for people aged 50 and over. Age-standardised mortality declined by 30 per cent for men, from 3,216 per 100,000 men to 2,267 per 100,000. This resulted in 86,477 fewer male deaths in 2005 than would have occurred had 1991 rates persisted. For women the age-standardised mortality rate declined by 20 per cent from 2,032 per 100,000 to 1,626 per 100,000, resulting in 48,406 deaths postponed (or fewer deaths) in 2005.Of the total numbers of deaths postponed in 2005, ischaemic heart disease contributed the largest share for both men (45,244 deaths - 52.3 per cent) and women (33,601 - 69.4 per cent).The greatest decline in the mortality rate was observed for influenza, for which age-standardised rates fell by 89 per cent for men and 93 per cent for women. However the proportion of deaths in which influenza was the underlying cause was extremely small and so did not contribute a large proportion in terms of the total fall in numbers of deaths.Mortality rates from some conditions increased. Liver disease rates demonstrated some of the largest increases for both men and women aged 50 and over. For men the age-standardised mortality rate from liver disease increased by 104 per cent, resulting in 1,434 more deaths in 2005 than in 1991. The trends of decreasing mortality rates from ischaemic heart disease and stroke have continued into the 21(st) century, however both causes continue to be the biggest killers in England. They are projected to remain so, and consequently, to contribute significantly to the burden of disease in the population.The steady increase in liver disease mortality identified highlights the importance of tackling alcohol misuse as a public health priority.

Healthcare and Medical Graduates of 2009: Their Reactions to Four Key Proposals in the Scottish Government's Strategy for Tackling Alcohol Misuse

This study compares the views of final year medical, and nursing and allied health professional (NAHP) students in relation to four governmental proposals impacting on the sale and purchase of alcohol. Against a background of political will to address alcohol abuse in Scotland and moves within the National Health Service promoting a shifting of professional roles, self-completed questionnaires were administered in spring 2009 through course websites and lectures to final year medical and NAHP students. Questionnaires were returned by 406 NAHPs and 121 medical students. Over three quarters of all students agreed with the proposed change to reduce the drink driving limit to 50 mg/100 ml blood. Less support was evident for the raising of the minimum legal purchase age for off-sales (37%), the banning of below cost price promotions of alcohol (47%) and minimum retail pricing (37%). However, there were differences between the NAHP and medical students in the case of the final two proposals; over 60% of the medical students agreed they would have a positive impact. For NAHPs, figures were 41% and 31%, respectively. Support for four key proposals outlined by the Scottish Government to address alcohol misuse varied. Only the suggestion to lower the drink driving limit received backing overall and within students in these professions. Effectiveness of proposed restrictions on the price of alcohol was less well regarded except by medical students. Evident gaps in knowledge around health guidelines, and the finding that almost half of NAHPs disagreed that they had the appropriate knowledge to advise patients about responsible drinking advice and alcohol misuse problems, suggest a need for improved undergraduate education and continued professional development with respect to public health aspects of alcohol use.

London Assembly issues recommendations on tackling alcohol misuse by young people

A major report on alcohol misuse issue along young people in London has revealed some alarming statistics.

Partnership working in community alcohol prevention programmes

The National Alcohol Harm Reduction Strategy for England places much emphasis on creating partnerships at both national and local levels between government, the drinks industry, health services, police, individuals and communities to tackle alcohol misuse and associated harm and disorder. This article describes the characteristic structures and dynamics of community partnerships to reduce alcohol-related harm at three sites in the UK, all influenced by an approach championed by Holder in the USA. It illustrates both the attributes of a good partner and the importance of the relationship between partners, as well as the benefits and challenges inherent in local partnerships’ working.

ABC of Alcohol (4th edn)

This classic is a tribute to the long-standing dedication of physician Alex Paton. He introduces co-editor, Professor Robin Touquet, who has pioneered the treatment of alcohol misuse in Accident & Emergency at St Mary's Hospital in London. Expert contributors ensure a true multidisciplinary approach. Although essentially a primer to alcohol, the book's length has virtually doubled to 57 pages. Interestingly, while the previous front cover shows a young male drinking, this fourth edition silhouettes what could be either a young man or a woman. Their wine glass clearly exceeds one unit, reflecting concern about binge drinking in young adults. Concepts are clearly defined and will inform health professionals, lay people and government, hopefully enhancing confidence in tackling alcohol misuse. Eric Appleby of Alcohol Concern highlights changing patterns of consumption, the powerful advertising lobby and binge drinking, particularly in young women and northern regions. The protective effects of alcohol in coronary heart and cerebrovascular disease are soon overtaken by all-cause mortality, when people exceed sensible recommendations. Successive governments have been ambivalent since alcohol generates taxes and employment. Hence, the National Alcohol Harm Reduction Strategy was delayed until 2004. Little wonder, since ten different government departments have an interest in alcohol policy with many in direct conflict. Paton describes absorption, metabolism, distribution and tolerance to alcohol and explains why women are more susceptible than men. Apparently, on average, six people are affected by each problem drinker. Genetic, familial, constitutional and environmental factors influence drinking patterns. Alcohol misuse is also often missed in older people. The Paddington Alcohol Test is a 1-min questionnaire for recognising alcohol misuse in A&E. Touquet describes the ‘teachable moment’, that window when the patient may be amenable to a brief intervention. He references the excellent Royal College of Physicians' report Alcohol, can the NHS afford it? – Recommendations for a coherent alcohol strategy for hospitals. Touquet highlights the recognition of Wernicke's encephalopathy and its prompt treatment with intravenous Pabrinex. Paton tables the litany of medical conditions associated with heavy drinking, and surgical problems, especially trauma, are highlighted. People who drink more than eight units per day have a 3-fold higher risk of postoperative morbidity, considerably reduced by pre-operative abstinence. John Henry gives a practical guide to interactions between alcohol and drugs, both legal and illicit, while Geoffrey Smerdon describes alcohol misuse in primary care. A GP can appreciate the perspective of the whole family. Currently, 98% of excessive drinkers who visit GPs' surgeries are not identified; sadly, the specification for essential services under the new General Medical Services Contract omits alcohol. Bruce Ritson succinctly reviews advice and counselling, treatment and resources. Two-thirds of excessive drinkers respond well to treatment, the long-term prognosis being surprisingly good with relapses forming part of recovery. Brief intervention should be offered when hazardous or harmful drinking is first identified. This comprises ten minutes' discussion and explanation, provision of a self-help booklet, and offering a further appointment in one or two weeks. He describes shared care, particularly with alcohol specialist nurses in hospital or the community, awareness of specialist services and the tremendous contribution of Alcoholics Anonymous, Al-Anon and Alateen. The illustrations and graphs, bullet points, boxes and index are excellent. I strongly recommend this book, both professionally and personally, especially to all alcohol healthcare professionals, hospital doctors, particularly A&E staff, students, lay people interested in alcohol, including politicians and Department of Health strategists. ABC of Alcohol, fourth edition, brings the subject right up to date. In 1994, I bought three copies of the third edition to loan to junior doctors and students writing articles or projects. Only one copy survives. I will not be lending my fourth edition to anybody!

Battling the bottle

Hospitals may bear the brunt of alcohol-related emergencies, but primary care nurses have a major role in tackling alcohol misuse.

Commentary on the alcohol harm reduction strategy for England for drugs: education, prevention and policy

The major UK producers of alcoholic drinks woke up to their social responsibilities when they established The Portman Group (TPG) in 1989. Now widely seen as a model for how an industry should set and maintain the highest standards of social responsibility, TPG’s success lies in the way it combines the role of industry regulator of marketing and promotion of alcoholic drinks with a forthright and proactive role in educating the public about responsible drinking. TPG is extremely effective in getting the industry to raise its game at the same time as running innovative campaigns which break the mould of the kind of traditional health education that can switch people off rather than engage their attention. TPG welcomes the long-overdue Alcohol Harm Reduction Strategy for England. We believe that it provides a good policy framework for tackling alcohol misuse and see it as an important opportunity for the industry to make a positive contribution towards helping to combat binge drinking and reduce the serious and growing problems associated with alcohol misuse in this country. Although some commentators have criticized the Strategy for being short on detail, we understand that many of the proposals are deliberately in outline at this stage because the Government rightly wishes to involve key stakeholders in negotiating the detail. We are pleased at the commitment in principle to ‘‘start the process of change in the culture of drinking to get drunk’’. For the past three years TPG has been the only organisation campaigning nationally against drunkenness. In light of the Strategy’s emphasis on working in partnership to target binge drinking, we now look forward to discussing with Government ways in which we can expand our campaigning work with their help. None of us should be under the illusion, however, that change will happen overnight. If the Government is serious about changing attitudes and behaviour – and let’s not forget what has been achieved with drink-driving and wearing seat belts – it needs to commit serious resources over a considerable period of time. TPG is delighted to see reflected in the Strategy its recommendation that education providers should include a compulsory element of the curriculum dealing with alcohol use and misuse for student doctors, nurses, midwives and health visitors. However, we would like to have seen a higher profile given to increasing the profile of alcohol within drugs education in schools. Although the Drugs: education, prevention and policy ISSN 0968–7637 print/ISSN 1465–3370 online # 2004 Taylor & Francis Ltd

Who in the primary health care team can tackle alcohol misuse?

The aim of this study was to compare, for the first time, the attitudes and role of general practitioners and practice nurses towards patients who misuse alcohol. Postal surveys of all GPs and practice nurses in a health authority area outside London were undertaken. Four mailings resulted in response rates of 50.5% and 50.6% for the 264 GPs and 196 practice nurses, respectively. Data collected consisted of replies to 12 attitude statements along a five-point Likert scale, from'strongly agree’, through ‘uncertain’, to ‘strongly disagree'. Respondents mostly perceived the alcohol misuser negatively, whilst simultaneously acknowledging the appropriateness of the primary care setting for treating the misuser. An explanation for this paradox appears to lie in the lack of training and specialist support available to these professional groups. This study indicates that, although primary care staff are willing to work with patients who misuse alcohol, they do not feel sufficiently trained and supported to do so. Two possible solutions to providing better primary care service for alcohol-misusing patients are: (I) appropriate training for the primary care team; and (2) the provision of support for the team from specialist services.