Following Davies and Stacey's investigation (1972, Teenagers and Alcohol , HMSO, London) into perceptions of drinking and abstaining among Scottish teenagers, this study extended their general method to an investigation of the perceptions of 239 Scottish adults. Results showed that the stereotypes of the heavy drinker as ‘tough and rebellious’ and the abstainer as ‘weak and cissy’ persist into adulthood. Heavy drinkers were seen as low on ‘sociability’ and ‘sexual attractiveness’ and abstainers were seen as less ‘sociable’ than moderate drinkers. There was also some evidence of a ‘double standard’ in perceptions of male and female drinking roles. Other findings concerning the effects on perceptions of subjects sex and drinking behaviour are compared to those reported in the earlier study and implications for the treatment of alcohol problems are discussed. It is concluded that the dimensions described by Davies and Stacey represent a relatively stable structure within future research where fresh initiatives in alcohol education may be located.
The purpose of this study was to report the "Outcome Reporting in Brief Intervention Trials: Alcohol" (ORBITAL) recommended core outcome set (COS) to improve efficacy and effectiveness trials/evaluations for alcohol brief interventions (ABIs).A systematic review identified 2,641 outcomes in 401 ABI articles measured by 1,560 different approaches. These outcomes were classified into outcome categories, and 150 participants from 19 countries participated in a two-round e-Delphi outcome prioritization exercise. This process prioritized 15 of 93 outcome categories for discussion at a consensus meeting of key stakeholders to decide the COS. A psychometric evaluation determined how to measure the outcomes.Ten outcomes were voted into the COS at the consensus meeting: (a) typical frequency, (b) typical quantity, (c) frequency of heavy episodic drinking, (d) combined consumption measure summarizing alcohol use, (e) hazardous or harmful drinking (average consumption), (f) standard drinks consumed in the past week (recent, current consumption), (g) alcohol-related consequences, (h) alcohol-related injury, (i) use of emergency health care services (impact of alcohol use), and (j) quality of life.The ORBITAL COS is an international consensus standard for future ABI trials and evaluations. It can improve the synthesis of new findings, reduce redundant/selective reporting (i.e., reporting only some, usually significant outcomes), improve between-study comparisons, and enhance the relevance of trial and evaluation findings to decision makers. The COS is the recommended minimum and does not exclude other, additional outcomes.
To determine whether treatment outcomes are mediated by therapist behaviors consistent with the theoretical postulates on which two contrasting treatments are based.We used data from the U.K. Alcohol Treatment Trial (UKATT), a pragmatic, multicenter, randomized controlled trial comparing the effectiveness of Motivational Enhancement Therapy (MET) and Social Behavior and Network Therapy (SBNT) in the treatment of alcohol problems. N = 376 clients (mean age 42.5, 74.5% male) had 12-month follow-up data and one treatment session recorded and coded using the UKATT Process Rating Scale, a reliable manual-based assessment of treatment fidelity including frequency and quality ratings of treatment-specific therapist tasks and therapist styles. Analyses were conducted using a mediation framework.Analysis of individual paths from treatment condition to treatment process indices (a path) and from treatment process indices to alcohol outcomes (b path) showed that (a) SBNT therapists more often used SBNT-specific behaviors, and did so with overall higher quality; (b) MET therapists more often used MET-specific behaviors, but there was no evidence that they performed these behaviors with higher quality than SBNT therapists; (c) only the quality of MET behaviors significantly predicted 12-month alcohol outcomes, irrespective of treatment condition. Consistently, there were no significant indirect effects. Multiple component analysis indicated that therapist quality of specific tasks influenced outcomes.The quality of delivery of the same treatment tasks in both treatments studied transcended the impact of delivering treatments according to different theoretical underpinnings in UKATT. (PsycINFO Database Record
The purpose of this study was to provide new knowledge about the temporal and contextual aspects of the alcohol–sport relationship. Eight U.K. student-athletes completed the Alcohol Use Disorders Identification Test in their final year at university, 18 months, and 30 months after graduation. They also completed semistructured interviews about their drinking motives, behaviors, and life circumstances. Results showed that participants reduced their alcohol consumption after leaving university, but despite the onset of some adult responsibilities, most were still drinking at hazardous levels. After university, drinking took place with old friends, new colleagues, and new sporting teammates. At all time points, social drinking motives were the most prevalent. Findings demonstrate a relationship between alcohol and sport that is cemented at university but continues beyond it. Targeted interventions to reduce the role of alcohol in the social experience of sport are needed to support long-term athlete health.
In times of information overload, researchers have found ways to synthesise a large amount of data from numerous studies bearing on the effectiveness of treatment for alcohol problems. Two of these ways are discussed: formal meta‐analysis and the box‐score ‘mesa grande’. It is concluded that meta‐analysis cannot answer questions regarding which treatments give the best results in the alcohol field. The mesa grande has certain limitations, which are described, but is useful for the formation of treatment policies when a clear summary of the research evidence on treatment effectiveness is needed. By contrast, large multi‐centre randomised controlled trials with enough statistical power to detect small effects of treatment should normally be preferred when a decision has to be made as to which of two or more specified treatments should be implemented in practice. Unfortunately, two multi‐centre trials, one in the USA and one in the UK, have given rise to the ‘dodo bird’ verdict of equivalent effectiveness of four treatment modalities. The findings of the UK Alcohol Treatment Trial cannot be used to advise treatment providers and practitioners which one of two treatments, MET or SBNT, should be preferred in practice. In the absence of relevant research findings, four possible ways of making this decision are outlined, including the suggestion that MET should serve as the first step in a stepped‐care model of treatment provision.
Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials.A pre-specified search strategy was used to search all relevant electronic databases up to 2006. We also hand-searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, subgroup and sensitivity analyses and meta-regression were conducted.The primary meta-analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: -38 g week(-1), 95%CI (confidence interval): -54 to -23], although there was substantial heterogeneity between trials (I(2) = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non-significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials.Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care.
Aim: The aim of this study was to argue that recommendations to the general public on daily amounts for low-risk alcohol consumption must retain the word ‘regular’ in order to avoid being rejected. Method: Narrative review of the evidence-base for daily limits to alcohol consumption, the guidance the public actually receives in the UK and media reactions to this guidance. Results: Evidence for daily limits (not more than 3–4 units for men and 2–3 units for women) rests on epidemiological surveys that enquire about ‘average’ or ‘usual’ amounts of consumption and this is reflected by the use of ‘regular’ or ‘consistent’ in the UK Government's Sensible Drinking report in 1995 and in guidance currently issued by the English Department of Health. In contrast, guidance the public actually receives often omits the word ‘regular’ and implies that the limits in question are maximum daily amounts. Media reactions to this inaccurate information suggest that the general public is likely to find these recommendations incredible and to reject them. Conclusion: If guidance to the public on daily drinking amounts is to stand any chance of being credible and effective, it must be accurate and must therefore retain the word ‘regular’.
We begin our concluding comments by thanking all the contributors who have produced original chapters for this volume, as well as those who permitted us to reprint their earlier works to ensure a balanced presentation of the key issues and perspectives on the BDMA. Taken together, we are sure the reader will agree, these contributions represent a powerful and challenging exploration of the complex issues that surround the deceptively simple question: should addiction be seen as a brain disease? We have made no secret of our perspective on this question, and equally we are aware that there are strong arguments articulated in Section I against our skeptical position with regard to the BDMA. And, as we saw in Section III, there are some good reasons to conclude that uncertainty may be a reasonable position to adopt in this important debate.
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