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Introduction. Drug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on-site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on-site drug testing technologies. Methods. Paper spray mass spectrometry was used to provide on-site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2-day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components. Results. During the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4-anilino-N-phenethyl-piperidine (4-ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co-measured with fentanyl, and in seven cases it was detected alone. Discussion and Conclusions. The quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on-site drug checking methods and harm reduction services. This work was supported by the Natural Science and Engineering Research Council of Canada Discovery Grant Program funding (RGPIN-2016-05380), Vancouver Island University and the Health Canada Drug Checking Technology Challenge. This article was originally published as: Borden, S.A., Saatchi, A., Vandergrift, G.W., Palaty, J., Lysyshyn, M., & Gill, C.G. (2021). A new quantitative drug checking technology for harm reduction: Pilot study in Vancouver, Canada using paper spray mass spectrometry. Drug and Alcohol Review, 1-8. https://doi.org/10.1111/dar.13370 This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. https://viurrspace.ca/bitstream/handle/10613/24515/Gill2021.pdf?sequence=3

A critique is offered of the Distilled Spirits Industry Council position paper ‘Alcohol Availability’. It is argued that this position paper presents a simple-minded analysis of the complex relationship between the availability of alcohol and its consumption which pays no attention to the importance of price in determining consumption. As a consequence, it misconstrues the lessons to be drawn from the Victorian experiment in liberalization and fails to consider its implications for the incidence of alcohol related problems.

Introduction:\ud The closure of licensed venues during the COVID-19 pandemic meant that most alcohol has been consumed at home during lockdown periods in the UK, a phenomenon which remains under-researched despite the public health implications. \ud \ud Methods:\ud This paper draws on a study consisting of online semi-structured interviews and focus groups with 20 UK drinkers, conducted between the first and second 2020 UK lockdowns. The study aimed to explore changing and enduring UK drinking practices within home spaces during the pandemic. \ud \ud Results:\ud Our findings illuminate specific ways in which assemblages and contextual factors may come together to encourage or mitigate against the consumption of any (or excessive) volumes of alcohol at home during lockdown. For example, the physical presence of alcohol bottles may both encourage consumption (e.g., compulsion to finish an open bottle of wine) and cue reflection on one’s drinking (through the potentially confronting presence of empty bottles after domestic drinking). We also highlight the significance of the home as a space separate from – and different to – public drinking spaces. \ud \ud Discussion and conclusions:\ud With the increasing normalisation of domestic drinking during a global pandemic, this paper illuminates several factors that may encourage or curtail domestic alcohol consumption and invites us to consider the importance of assemblages, space and context. Such findings have wider applicability; for example consideration of specific (and perhaps unique) push and pull factors of home spaces could inform future alcohol policy, health promotion messages and how guidance around ‘moderation’ or risky drinking is communicated.

Introduction and Aims The Northern Territory Government has recently planned and implemented an extensive suite of alcohol harm minimisation policies, including the reintroduction of the Banned Drinker Register (BDR). It is an explicit alcohol supply reduction measure that places persons who consume alcohol at harmful levels onto a register, prohibiting the purchase of alcohol from take‐away liquor outlets. This paper explores industry stakeholders' perspectives regarding the extent to which the BDR is meeting its objectives to improve community health and safety by reducing alcohol‐related harms. Design and Methods Interviews and one focus group were conducted with 66 alcohol industry stakeholders from urban and remote locations. Focusing on outcomes both central (crime and safety) and peripheral (health and therapeutic support) to the stakeholders' interest, the authors used inductive thematic analysis to examine participants' perceptions about the effectiveness of the BDR. Results Analysis revealed mixed views about the effectiveness of the BDR. There is a tension between the objective to address public amenity and decrease crime, as expressed by the participants, compared to the health‐focused approach to therapeutic services and referrals identified in other sources. Discussion and Conclusions Drawing on these findings, alongside other relevant sources, the authors argue there is a need for a more effective communication strategy to the public and professional community to enhance the capacity of the BDR to meet its goals. The authors recognise the limitations of alcohol industry stakeholder views and identify the need for a comprehensive evaluation approach that includes multiple stakeholder perspectives.

Introduction The objective of this study was to examine the relationship between trauma volume and alcohol prohibition during the COVID‐19 lockdown in South Africa. Methods This was a retrospective analysis of trauma volume from Worcester Regional Hospital in South Africa from 1 January to 28 December 2020. We compared total volume and incidence rates during five calendar periods; one when alcohol sales were allowed as per normal and four when alcohol sales were completely or partially banned. Poisson regression was used to model differences between alcohol ban and non‐ban periods. Results During the first period (pre‐COVID‐19, no ban), the trauma admission rate was 95 per 100 days, compared to 39 during the second period (complete ban 1), 74 during the third period (partial ban 1), 40 during the fourth period (complete ban 2) and 105 during the fifth period (partial ban 2). There was a 59–69% decrease in trauma volume between the no ban and complete ban 1 periods. When alcohol sales were partially reinstated, trauma volume significantly increased by 83–90% then dropped again by 39–46% with complete ban 2. By the second half of 2020, when alcohol sales were partially allowed again (partial ban 2), trauma volume increased by 163–250%, thus returning to pre‐COVID‐19 levels. Discussion and Conclusions Our study demonstrates a clear trend of decreased trauma volume during periods of complete alcohol prohibition compared to non‐ and partial alcohol bans. This finding suggests that temporary alcohol bans can be used to decrease health facility traffic during national emergencies.

Introduction To examine changes in drinking patterns and to assess factors associated with reported increases in frequency of drinking, units consumed and frequency of heavy episodic drinking (HED) during the UK lockdown. Methods Online cross‐sectional survey of 2777 self‐selected UK adults. Results Thirty percent of participants reported drinking more frequently in lockdown, 16% reported drinking more units per drinking occasion and 14% reported more frequent HED. For men and women, increased frequency of drinking was associated with being less likely to believe alcohol drinking would lead to greater chance of catching COVID‐19 (men: OR = 0.99, 95% CI = 0.98, 1.00; women: OR = 0.99, 95% CI = 0.99, 1.00) and deterioration in psychological wellbeing (OR = 1.27, 95% CI = 1.04, 1.54; OR = 1.29, 95% CI = 1.11, 1.51); increased unit consumption was associated with deterioration in financial situation (OR = 1.50, 95% CI = 1.21, 1.86; OR = 1.31, 95% CI = 1.05, 1.64) and physical health (OR = 1.31, 95% CI = 1.03, 1.67; OR = 1.66, 95% CI = 1.31, 2.10). Finally, increases in the frequency of HED were associated with deterioration in psychological wellbeing (OR = 1.65, 95% CI = 1.25, 2.18; OR = 1.46, 95% CI = 1.17, 1.82) and being furloughed (OR = 3.25, 95% CI = 1.80, 5.86; OR = 2.06, 95% CI = 1.19, 3.56). Other gender differences were detected, for example, living with children was associated with an increase in units consumed (OR = 1.72, 95% CI = 1.09, 2.73) and the frequency of HED (OR = 2.40, 95% CI = 1.44, 3.99) for men, but not women. Discussion and Conclusions In this self‐selected UK sample, a significant proportion of individuals reported drinking more frequently in lockdown, drinking more units per drinking occasion and more frequent HED. There were consistent predictors of increased consumption across men and women, but other gender differences were detected. This study identifies groups that may require targeted support in future lockdowns.

Introduction Despite the association of alcohol use with recurrent suicidal acts, individuals attempting suicide after drinking alcohol face barriers accessing crisis care following emergency assessment, demonstrated by higher odds of inpatient admission for those whose suicide attempt did not feature alcohol. This disparity may be due to suicidality dissipating more rapidly after a suicide attempt involving alcohol. We investigated the effect of acute alcohol use and ongoing suicidality on onward care decisions after emergency assessment. Methods We analysed electronic health records of 650 suicidal adults detained under Section 136 of the Mental Health Act (1983, amended 2007) for up to 36 h at a London psychiatric emergency care centre. We used logistic regression to estimate the association of acute alcohol use and ongoing suicidality (including their interaction) with admission to psychiatric hospital. Results Fifteen percent of previously intoxicated detainees expressed suicidal intent at detention end, compared to 24% of detainees who had not used alcohol prior to detention. Compared to those who were not previously intoxicated and not suicidal at detention end, acute alcohol use was associated with reduced odds of admission amongst those no longer suicidal (AOR 0.4, 95% CI 0.2, 0.6). Where suicidality persisted, odds of admission rose; however, the magnitude of increase when in combination with prior alcohol use (AOR 3.6, 95% CI 1.9, 7.1) was under half that of when alcohol was not involved (AOR 8.2, 95% CI 3.5, 19.1). Discussion and Conclusions Acute alcohol use is associated with transient suicidality, but this only partially accounts for disparities in care following suicide attempts.

Introduction The ageing of baby boomers is expected to confront addiction care with new challenges. This cohort had greater exposure to psychoactive substances in youth than earlier cohorts. In this study, we aimed to investigate whether Berlin addiction care is confronted with a sustained change in its clientele initiated by the baby boomers. Methods Using data from Berlin outpatient addiction care facilities, we contrasted type of primary substance use disorder and number of comorbid substance use disorders in baby boomers with an earlier and a later cohort. To isolate cohort effects, two‐level random intercept regression models were applied in the overlapping age groups of the baby boomer cohort with each of the other cohorts. Results Compared with the earlier cohort, alcohol use disorder lost importance whereas illicit substance use disorder gained importance in the baby boomers. Baby boomers presented a higher number of comorbid substance use disorders than the earlier cohort. Comparing baby boomers with the later cohort, these relationships pointed in the opposite direction. Discussion and Conclusions Outpatient addiction care faces a sustained change to more illicit and comorbid substance use disorders. With increasing life expectancy and the ageing of baby boomers marked by higher substance use than previous cohorts, older clients, who had been under‐represented in outpatient addiction care, will gain relevance. Hence, addiction care has to adapt its offers to appropriately meet the changing needs of its clientele.

Introduction and Aims In 2008 additional licensing restrictions were imposed on ‘high‐risk’ licensed premises in the entertainment precinct of Newcastle (Australia) including earlier closing, a ‘lock‐out’ and additional responsible service of alcohol restrictions. A study was conducted to assess community perceptions, experiences of crime and support for the restrictions, 2 and 5 years following implementation. Design and Methods Telephone surveys were conducted with random samples of Newcastle community members (≥18 years) in 2010 and 2013. Change over time in perceptions and experiences of crime, and awareness and support of the conditions was analysed using logistic regression analyses for all participants, and separately for night‐time visitors. Results Among all participants (2010: n = 376; 2013: n = 314) the perception that alcohol misuse was a problem declined between 2010 and 2013 for all participants (90% to 85%; P = 0.02), and specifically among night‐time visitors (87% to 75%; P = 0.06). Awareness of the restrictions was high among all participants and sub‐groups, and remained constant over time. Support for the restrictions was also high, with drink restrictions being the most popular. More night‐time visitors reported that conditions made the streets safer in 2013 (62%) than 2010 (47%; P = 0.05). Support for applying restrictions to all licensed premises in the Newcastle entertainment precinct (83%) and across New South Wales was high in 2013 (86%). Discussion and Conclusions At 2 years and 5 years following implementation of additional licensing restrictions, significant improvements in public perceptions of the occurrence of alcohol‐related harm and crime were evident, as were high levels of support for the restrictions.

Introduction and Aims We aimed to explore UK‐based Punjabi‐Sikh men's views on: (i) alcohol consumption within the community; (ii) available support for alcohol reduction; and (iii) an evidence‐informed alcohol reduction app. Design and Methods Semi‐structured interviews and a think aloud method were employed. Participants (n = 15) were male, aged 18–27 years, identified as Punjabi‐Sikh, were hazardous or harmful drinkers (i.e. had an Alcohol Use Disorders Identification Test‐Consumption score of ≥5) and interested in using an app to reduce drinking. Interviews were audio‐recorded, transcribed verbatim and analysed with inductive thematic analysis. Results Six themes were developed: (i) fear of drinking to cope; (ii) clash between religious and cultural norms (i.e. an internal conflict between important values); (iii) stigmatisation of mental health issues and lack of knowledge as barriers to help seeking; (iv) perceived usefulness of goal setting, monitoring and feedback (i.e. beliefs about the utility of the app's components for reducing drinking); (v) concerns about accessibility of the app within the Punjabi‐Sikh community; and (vi) desire for human support for continued app engagement. Discussion and Conclusions Among UK‐based, Punjabi‐Sikh men, clashing religious and cultural norms give rise to internal conflict about drinking. Stigmatisation of mental health issues and lack of knowledge of available support leads to reduced help seeking. Respondents believed an evidence‐informed alcohol reduction app could be useful, but were concerned about accessibility within the wider community and wanted an element of human support. The potential for a combination of digital and face‐to‐face support should be explored.

Introduction and Aims: \ud Reducing the legal drink‐drive limit from 0.08% to 0.05% blood alcohol concentration (BAC) can reduce road traffic accidents and deaths if properly enforced. Reduced limits may be opposed by alcohol retail and manufacturing industries on the basis of commercial impact. Our aim was to qualitatively explore how a reduction in the drink‐drive limit from 0.08% to 0.05% BAC in Scotland, was experienced by bar owners or managers, including any resultant changes in customer drinking or business practice. This is the first study of this type.\ud \ud Design and Methods: \ud Semi‐structured interviews were conducted with 16 owners and managers of on‐trade premises in Scotland in 2018, approximately three years after the drink‐drive limit was reduced. Data were analysed using thematic analysis.\ud \ud Results: \ud Most participants reported no long‐term financial impact on their business, but a few, mainly from rural areas, reported some reduction in alcohol sales. Observed drinking changes included fewer people drinking after work or leaving premises earlier on weekdays. Adaptations to businesses included improving the range of no/low‐alcohol drinks and food offered. Changes such as these were seen as key to minimising economic impact.\ud \ud Discussion and Conclusions: \ud Opposition to legislative measures that impact on commercial interests is often strong and receives significant public attention. This study found that Scottish businesses that adapted to the drink‐drive limit change reported little long‐term economic impact. These findings are of international relevance as potential BAC limit reductions in several other jurisdictions remain the subject of debate, including regarding the impact on business.

Contains fulltext : 203443.pdf (Publisher’s version ) (Open Access) Introduction and Aims: Cognitive impairments in substance use disorder predict treatment outcome and are assumed to differ between substances. They often go undetected, thus the current study focuses on the prevalence of and differences in cognitive functioning across substances by means of a cognitive screen at the early stage of addiction treatment. Design and Methods: The Montreal Cognitive Assessment was administered to outpatients seeking treatment for substance use disorder. Patient characteristics (age, years of regular use, polysubstance use, severity of dependence/abuse, depression, anxiety and stress) were also taken into account. Results: A total of 656 patients were included (n = 391 used alcohol, n = 123 used cannabis, n = 100 used stimulants and n = 26 used opioids). The prevalence of cognitive impairments was 31%. Patients using alcohol had a lower total- and memory domain score than those using cannabis. Patients using opioids scored lower on visuospatial abilities than those using cannabis or stimulants. Younger patients scored higher than older patients. No effect was found for the other investigated characteristics. Discussion and Conclusions: Given the high prevalence of cognitive impairments, standard screening at an early stage of treatment is important to determine the course of treatment and maximise treatment outcome. Caution is needed in interpreting results about opioids due to an underrepresentation of this patient group, and more research is needed on the effect of age on Montreal Cognitive Assessment performance. 8 p.

Introduction: SMART Recovery is a popular mutual support group program. Little is known about its suitability or perceived helpfulness for Indigenous peoples. This study explored the cultural utility of SMART Recovery in an Australian Aboriginal context. Methods: An Indigenous-lensed, multi-methods, exploratory study design was used to develop initial evidence of: (i) attributes of Aboriginal SMART Recovery facilitators and group members; (ii) characteristics of Aboriginal-led SMART Recovery groups; (iii) perceived acceptability and helpfulness of SMART Recovery; and (iv) areas for potential improvement. Data were collected by synthesising Indigenous qualitative methods (research topic and social yarning) with western qualitative and quantitative methods (participant surveys, program adherence rating scale, group observations and field notes). Data were analysed using thematic analysis. Results: Participants were a culturally diverse sample of male and female Aboriginal facilitators (n = 10) and group members (n = 11), aged 22���65 years. Aboriginal-led SMART Recovery groups were culturally customised to suit local contexts. Program tools ���goal setting��� and ���problem solving��� were viewed as the most helpful. Suggested ways SMART Recovery could enhance its cultural utility included: integration of Aboriginal perspectives into facilitator training; creation of Aboriginal-specific program and marketing materials; and greater community engagement and networking. Participants proposed an Aboriginal-specific SMART Recovery program. Discussion and Conclusions: This study offers insights into Aboriginal peoples' experiences of SMART Recovery. Culturally-informed modifications to the program were identified that could enhance cultural utility. Future research is needed to obtain diverse community perspectives and measure health outcomes associated with group attendance.

Introduction To explore whether Skog's theory of collectivity of drinking cultures is valid across groups with different socioeconomic position (SEP). Methods Individual‐level information on alcohol consumption and SEP for the years 2004–2014 were retrieved from the Monitoring Project; a nationally representative monthly alcohol use survey. The analytical sample consisted of 162 369 respondents aged 25–79 years. SEP was measured by education level. Alcohol use was measured by yearly volume of consumption and frequency of heavy episodic drinking (HED). Respondents were divided into six SEP‐groups based on their education level and sex. Mean yearly volume consumption and prevalence of monthly HED was calculated for each group and graphically plotted against the overall mean volume of consumption. Results The yearly changes in overall mean consumption during the study period reflected a collective shift in drinking across groups with basic, intermediate and high education. There were also indications that changes in overall mean consumption reflected collective shifts in the prevalence of HED across the SEP‐groups. Moreover, while the magnitude of the associations for both average volume and HED differed somewhat in strength across the SEP‐groups, they were clearly in the same, positive, direction. Discussion and Conclusions Our findings add support for including a socioeconomic dimension to Skog's theory of collectivity of drinking cultures. Future studies should replicate our analyses on cases and periods with more tangible changes in the price and availability of alcohol.

Introduction and Aims Aboriginal residential rehabilitation services provide healing for Aboriginal people who misuse substances. There is limited available research that empirically describes client characteristics of these services. This study examined 5 years of data of a remote Aboriginal residential rehabilitation service. Design and Methods Retrospective analysis of 329 client admissions to Orana Haven Drug and Alcohol Rehabilitation Centre from 2011 to 2016. Multinomial and binary logistic regressions were conducted to identify trends in the data. Results There were 66 admissions recorded annually, of which most identified as Aboriginal (85%). Mean length of stay was 56 days, with one in three (36%) discharging within the first month. A third (32%) completed, 47% self‐discharged and 20% house‐discharged from the program. Client age significantly increased over time (P = 0.03), with most aged from 26 to 35. Older clients were significantly more likely to readmit (P < 0.002) and stay longer than 90 days (P = 0.02). Most clients were referred from the criminal justice system, significantly increasing from 79% (2011–2012) to 96% (2015–2016) (P < 0.001) and these clients were more likely to self‐discharge (P < 0.01). Among a subset of clients, most (69%) reported concerns with polysubstance use and half (51%) reported mental illness. Discussion and Conclusions The current study makes a unique contribution to the literature by empirically describing the characteristics of clients of a remote Aboriginal residential rehabilitation service to more accurately tailor the service to the client's needs. Key recommendations include integrating these empirical observations with staff and client perceptions to co‐design a model of care, standardise data collection, and routinely following‐up clients to monitor treatment effectiveness.

Introduction Taxation is increasingly being used as an effective means of influencing behaviour in relation to harmful products. In this paper we use data from six participating countries of the International Alcohol Control Study to examine and evaluate their comparative prices and tax regimes. Methods We calculate taxes and prices for three high‐income and three middle‐income countries. The data are drawn from the International Alcohol Control survey and from the Alcohol Environment Protocol. Tax systems are described and then the rates of tax on key products presented. Comparisons are made using the Purchasing Power Parity rates. The price and purchase data from each country's International Alcohol Control survey is then used to calculate the mean percentage of retail price paid in tax weighted by actual consumption. Results Both ad valorem and specific per unit of alcohol taxation systems are represented among the six countries. The prices differ widely between countries even though presented in terms of Purchasing Power Parity. The percentage of tax in the final price also varies widely but is much lower than the 75% set by the World Health Organization as a goal for tobacco tax. Conclusion There is considerable variation in tax systems and prices across countries. There is scope to increase taxation and this analysis provides comparable data, including the percentage of tax in final price, from some middle and high‐income countries for consideration in policy discussion.

Introduction and Aims To investigate behaviours related to four alcohol policy variables (policy‐relevant behaviours) and demographic variables in relation to typical quantities of alcohol consumed on‐premise in six International Alcohol Control study countries. Design and Methods General population surveys with drinkers using a comparable survey instrument and data analysed using path analysis in an overall model and for each country. Measures: typical quantities per occasion consumed on‐premise; gender, age; years of education, prices paid, time of purchase, time to access alcohol and liking for alcohol advertisements. Results In the overall model younger people, males and those with fewer years of education consumed larger typical quantities. Overall lower prices paid, later time of purchase and liking for alcohol ads predicted consuming larger typical quantities; this was found in the high‐income countries, less consistently in the high‐middle‐income countries and not in the low middle‐income country. Three policy‐relevant behaviours (prices paid, time of purchase, liking for alcohol ads) mediated the relationships between age, gender, education and consumption in high‐income countries. Discussion and Conclusions International Alcohol Control survey data showed a relationship between policy‐relevant behaviours and typical quantities consumed and support the likely effect of policy change (trading hours, price and restrictions on marketing) on heavier drinking. The path analysis also revealed policy‐relevant behaviours were significant mediating variables between the effect of age, gender and educational status on consumption. However, this relationship is clearest in high‐income countries. Further research is required to understand better how circumstances in low‐middle‐income countries impact effects of policies.

Introduction and Aims This study examines the proportion of alcohol markets consumed in harmful drinking occasions in a range of high‐, middle‐income countries and assesses the implications of these findings for conflict of interest between alcohol producers and public health and the appropriate role of the alcohol industry in alcohol policy space. Design and Methods Cross‐sectional surveys were conducted in 10 countries as part of the International Alcohol Control study. Alcohol consumption was measured using location‐ and beverage‐specific measures. A level of consumption defined as harmful use of alcohol was chosen and the proportion of the total market consumed in these drinking occasions was calculated for both commercial and informal alcohol. Results In all countries, sizeable proportions of the alcohol market were consumed during harmful drinking occasions. In general, a higher proportion of alcohol was consumed in harmful drinking occasions by respondents in the middle‐income countries than respondents in the high‐income countries. The proportion of informal alcohol consumed in harmful drinking occasions was lower than commercial alcohol. Discussion and Conclusions Informal alcohol is less likely to be consumed in harmful drinking occasions compared with commercial alcohol. The proportion of commercial alcohol consumed in harmful drinking occasions in a range of alcohol markets shows the reliance of the transnational alcohol corporations on harmful alcohol use. This reliance underpins industry lobbying against effective policy and support for ineffective approaches. The conflict of interest between the alcohol industry and public health requires their exclusion from the alcohol policy space.

Introduction and Aims A 2010 World Health Assembly resolution called on member states to intensify efforts to address alcohol‐related harm. Progress has been slow. This study aims to determine the magnitude of public support for 12 alcohol policies and whether it differs by country, demographic factors and drinking risk (volume consumed). Design and Methods Data are drawn from seven countries participating in the International Alcohol Control Study which used country‐specific sampling methods designed to obtain random, representative samples. The weighted total sample comprised 11 494 drinkers aged 16–65 years. Results Drinking risk was substantial (24% ‘increased’ risk and 16% ‘high’ risk) and was particularly high in South Africa. Support varied by alcohol policy, ranging from 12% to 96%, but was above 50% for 79% of the possible country/policy combinations. Across countries, policy support was generally higher for policies addressing drink driving and increasing the alcohol purchase age. There was less support for policies increasing the price of alcohol, especially when funds were not earmarked. Policy support differed by country, and was generally higher in the five middle‐income countries than in New Zealand. It also differed by age, gender, education, quantity/frequency of drinking, risk category and country income level. Discussion and Conclusions We found a trend in policy support, generally being highest in the low–middle‐income countries, followed by high–middle‐income countries and then high‐income countries. Support from drinkers for a range of alcohol policies is extensive across all countries and could be used as a catalyst for further policy action.

Introduction and Aim To report data on the implementation of alcohol policies regarding availability and marketing, and drink driving, along with ratings of enforcement from two small high‐income to three high‐middle income countries, and one low‐middle income country. Method This study uses the Alcohol Environment Protocol, an International Alcohol Control study research tool, which documents the alcohol policy environment by standardised collection of data from administrative sources, observational studies and interviews with key informants to allow for cross‐country comparison and change over time. Results All countries showed adoption to varying extents of key effective policy approaches outlined in the World Health Organization Global Strategy to Reduce the Harmful Use of Alcohol (2010). High‐income countries were more likely to allocate resources to enforcement. However, where enforcement and implementation were high, policy on availability was fairly liberal. Key Informants judged alcohol to be very available in both high‐ and middle‐income countries, reflecting liberal policy in the former and less implementation and enforcement and informal (unlicensed) sale of alcohol in the latter. Marketing was largely unrestricted in all countries and while drink‐driving legislation was in place, it was less well enforced in middle‐income countries. Conclusion In countries with fewer resources, alcohol policies are less effective because of lack of implementation and enforcement and, in the case of marketing, lack of regulation. This has implications for the increase in consumption taking place as a result of the expanding distribution and marketing of commercial alcohol and consequent increases in alcohol‐related harm.

Introduction and Aims Alcohol use is a leading risk factor for disease and injury in Pacific Island countries and territories (PICT). This paper examines drinking patterns across 20 PICTs. Design and Methods We synthesised published data from the STEPwise approach to surveillance or similar surveys for adults 25–64 years, and from the Global School‐Based Student Health surveys and Youth Risk Behavior Surveillance System (YRBSS) for youth. We examined current and heavy drinking, and for adults also frequency of consumption. Using YRBSS, we studied trends in youth alcohol use in US‐affiliated PICTs between 2001 and 2013. Results Alcohol consumption in adults and youth varied considerably across PICTs. In eight PICT populations, over 60% of male adults were current drinkers. Male adults consumed alcohol more frequently and engaged in heavy drinking more than female adults. Similar gender differences occurred in current and heavy drinking among youth. Across 10 PICTs, current drinking prevalence in males 13–15 years ranged from 10% to over 40%. Declines in alcohol use among grade 9–12 students were observed in YRBSS, although the magnitude differed by island and sex. Discussion and Conclusions Alcohol consumption varies widely between PICTs. There are marked gender differences in use and abstention. There is scope in PICTs for implementation of best practice strategies to reduce alcohol‐related harm. These need to be gender responsive and cognisant of concerning patterns of youth drinking. Strengthening surveillance of alcohol use and its consequences is vital to inform and monitor the impact of national and regional policies. [Kessaram T, McKenzie J, Girin N, Roth A, Vivili P, Williams G, Hoy D. Alcohol use in the Pacific region: Results from the STEPwise approach to surveillance, Global School‐Based Student Health Survey and Youth Risk Behavior Surveillance System. Drug Alcohol Rev 2016;35:412–423]

Introduction and Aims Alcohol misuse and harm are more prevalent amongst sports people than non‐sports people. Few studies have trialled interventions to address alcohol misuse for this group. The study aimed to test the effectiveness of an intervention to reduce alcohol misuse and related harms amongst amateur sports people in Ireland. Design and Methods A controlled trial was conducted in two counties in Ireland. A random selection of sports clubs in one county received a 4 month multi‐faceted intervention. All sports clubs in a non‐adjacent county acted as control sites. Consumption of more than 21 units of alcohol per week and six or more standard drinks on a single occasion at least once per week was the primary study outcome. Alcohol Use Disorders Identification Test scores and number of alcohol‐related harms were also reported. Outcomes were assessed for cross‐sectional samples of players at pre‐intervention and post‐intervention and paired samples of players who completed surveys at both times. Generalised linear mixed model analysis was used. Results There was no evidence of effect for the primary outcomes or Alcohol Use Disorders Identification Test scores. There was a statistically significant difference in the median number of alcohol‐related harms reported by intervention group players compared with control group players at post‐intervention for the paired samples [intervention: 0; control: 3; incident rate ratio 0.56 (0.37, 0.84); P = 0.005]. Discussion and Conclusions Intervention in community sports clubs may be effective in reducing the number of alcohol‐related harms. Low levels of intervention participation and inadequate intervention dose are possible reasons for lack of a broader intervention effect. [O'Farrell A, Kingsland M, Kenny S, Eldin N, Wiggers J, Wolfenden L, Allwright S. A multi‐faceted intervention to reduce alcohol misuse and harm amongst sports people in Ireland: A controlled trial. Drug Alcohol Rev 2018;37:14–22]

Introduction and Aims Controlling behaviours are highly prevalent forms of non‐physical intimate partner violence (IPV). The prevalence of perpetrating controlling behaviours and technology‐facilitated abuse (TFA) was compared by men receiving substance use treatment in England (n = 223) and Brazil (n = 280). Factors associated with perpetrating these behaviours towards their current/most recent partner and their association with other types of IPV were explored. Design and Methods Secondary analysis from two cross‐sectional studies was performed. Data on socio‐demographic characteristics, infidelity, IPV perpetration and victimisation, adverse childhood experiences (ACE), attitudes towards gender relations and roles, substance use, depressive symptoms and anger expression were collected. Results Sixty‐four percent (143/223) and 33% (73/223) of participants in England and 65% (184/280) and 20% (57/280) in Brazil reported controlling behaviours and TFA, respectively, during their current/most recent relationship. Excluding IPV victimisation from the multivariate models; perpetrating controlling behaviours was associated with a higher number of ACE, higher anger expression (England) and severe physical IPV perpetration (Brazil), and perpetrating TFA was associated with younger age. Including both IPV victimisation and perpetration in the multivariate models; perpetrating controlling behaviour was associated with experiencing a higher number of ACE, higher anger expression (England), emotional IPV victimisation (England) and experiencing controlling behaviour from a partner (England). The perpetration of TFA was associated with younger age and experiencing TFA from a partner. Conclusions Technological progress provides opportunities for perpetrators to control and abuse their partners. Controlling behaviours and TFA should be addressed to reduce IPV perpetration by males in substance use treatment. [Gilchrist G, Canfield M,Radcliffe P, d'Oliveira AFPL. Controlling behaviours and technology‐facilitated abuse perpetrated by men receiving substance use treatment in England and Brazil: Prevalence and risk factors. Drug Alcohol Rev 2017;36:52–63]

Introduction and Aims Acute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms. Design and Methods We selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the ‘alcohol syndrome’) in the New South Wales, Australia, automatic syndromic surveillance system. The sample was selected from 68 public hospitals during 2014. Nursing triage free‐text fields were independently reviewed to confirm alcohol consumption and classify each presentation into either an ‘acute’ or ‘chronic’ harm. Positive predictive value (PPV) for acute harm was calculated, and predictors of acute harm presentations were estimated using logistic regression. Results The PPV of the alcohol syndrome for acute alcohol harm was 53.5%. Independent predictors of acute harm were ambulance arrival [adjusted odds ratio (aOR) = 3.4, 95% confidence interval (CI) 2.4–4.7], younger age (12–24 vs. 25–39 years: aOR = 3.4, 95% CI 2.2–5.3), not being admitted (aOR 2.2, 95% CI 1.5–3.2) and arriving between 10 pm and 5.59 am (aOR 2.1, 95% CI 1.5–2.8). PPV among 12 to 24‐year‐olds was 82%. Discussion and Conclusions The alcohol syndrome provides moderate precision as an indicator of acute alcohol harms presenting to the ED. Precision for monitoring acute harm in the population is improved by filtering the syndrome by the strongest independent predictors of acute alcohol harm presentations. [Whitlam G, Dinh M, Rodgers C, Muscatello DJ, McGuire R, Ryan T, Thackway S. Diagnosis‐based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level? Drug Alcohol Rev 2016;35:693–701]

Introduction and Aims Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin use by injection have a high risk of drug‐related death in the first weeks after prison‐release. The N‐ALIVE trial was planned as a large prison‐based randomised controlled trial (RCT) to test the effectiveness of naloxone‐on‐release in the prevention of fatal opiate overdoses soon after release. The N‐ALIVE pilot trial was conducted to test the main trial's assumptions on recruitment of prisons and prisoners, and the logistics for ensuring that participants received their N‐ALIVE pack on release. Design and Methods Adult prisoners who had ever injected heroin, were incarcerated for ≥7 days and were expected to be released within 3 months were eligible. Participants were randomised to receive, on liberation, a pack containing a single ‘rescue’ injection of naloxone or a control pack with no naloxone syringe. The trial was double‐blind prior to prison‐release. Results We randomised 1685 prisoners (842 naloxone; 843 control) across 16 prisons in England. We stopped randomisation on 8 December 2014 because only one‐third of administrations of naloxone‐on‐release were to the randomised ex‐prisoner; two‐thirds were to others whom we were not tracing. Discussion and Conclusions Prevention RCTs are seldom conducted within prisons; we demonstrated the feasibility of conducting a multi‐prison RCT to prevent fatality from opioid overdose in the outside community. We terminated the N‐ALIVE trial due to the infeasibility of individualised randomisation to naloxone‐on‐release. Large RCTs are feasible within prisons.

Introduction and Aims. South Africa is considering a range of alcohol policy reforms. This study aims to determine the magnitude of public support for 13 alcohol policies in the Tshwane Metropolitan Municipality and whether this varies by demographic factors and heavy drinking status. Design and Methods. Data are from the South African arm of the International Alcohol Control study, a household survey of adult drinkers using a multistage stratified cluster random sampling design. The sample included 1920 drinkers aged 18–65 years (62% men), with complete drinking data for 16 drinking locations on 955 persons (510 heavy and 445 not heavy drinkers). Results. Over half (53%) of the sample were found to be heavy drinkers. Support varied by alcohol policy, ranging from 31% to 77%, with support above 50% for 11 of the 13 policies. Policy support was higher for policies increasing the purchase age to 21 years (77%), addressing drink driving (58–76%) and restricting physical availability (60–66%). There was slightly less support for policies restricting alcohol marketing (59%) or for policies increasing the price of alcohol (34–58%), especially if no justification was given or the funds were not earmarked. Policy support differed by age, gender, heavy drinking status and income. Discussion and Conclusions. Public support from adult drinkers for a range of alcohol policies is extensive and, as found elsewhere, was strongest for raising the minimum drinking age and lowest for increasing prices. The support from drinkers to increasing controls on alcohol could be one lever to getting control measures implemented. [Parry CDH, Trangenstein P, Lombard C, Jernigan DH, Morojele NK. Support for alcohol policies from drinkers in the City of Tshwane, South Africa: Data from the International Alcohol Control study. Drug Alcohol Rev 2017;00:000‐000]

Introduction and Aims Bars, 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 Methods A 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. Results Six 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 Conclusions High 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]

Introduction and Aims Disadvantaged men suffer substantial harm from heavy drinking. This feasibility study developed and evaluated the methods for a trial of a brief intervention delivered by text messages to disadvantaged men. It aimed to test the methods for recruitment and retention, to monitor engagement with the intervention and assess the overall acceptability of study methods. Design and Methods Disadvantaged men aged 25–44 years who had ≥2 episodes of binge drinking (≥8 units in one session) in the preceding month were recruited. Two recruitment strategies were assessed: recruitment from general practice registers and by a community outreach strategy. Theoretically and empirically based text messages were tailored to the target group. Results The study recruited 67 disadvantaged men at high risk of alcohol‐related harm, exceeding the target of 60. Evaluation showed that 95% of text messages were delivered, and the men engaged enthusiastically with the intervention. Retention at follow up was 96%. Outcomes were successfully measured on all men followed up. This provided data for the sample size calculation for the full trial. Post‐study evaluation showed high levels of satisfaction with the study. Discussion and Conclusions This study has shown that disadvantaged men can be recruited and follow‐up data obtained in an alcohol intervention study. The study methods were acceptable to the participants. The men recruited were at high risk of alcohol‐related harms. It also clarified ways in which the recruitment strategy, the baseline questionnaire and the intervention could be improved. The full trial is currently underway. [Crombie IK, Irvine L, Falconer DW, Williams B, Ricketts IW, Jones C, Humphris G, Norrie J, Slane P, Rice P. Alcohol and disadvantaged men: A feasibility trial of an intervention delivered by mobile phone. Drug Alcohol Rev 2017;36:468‐476]

Issues: This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti-smoking health-information interventions (HII) among low-socioeconomic status (SES) adults in high-income countries. Approach: We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low-SES adults of anti-smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low-SES effects, equity effects, proposed explanations and whether these were studied empirically. Key Findings: Thirty-eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low-SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self-efficacy. Implications: Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti-smoking HIIs for low-SES adults. Conclusions: To our knowledge, this is the first review to explore the explanations proposed for why anti-smoking HIIs are (in)effective among low-SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti-smoking interventions.

Issues: Numerous studies have explored alcohol consumption in pregnancy, but less is known about women's drinking in the early parenting period (EPP, 0–5 years after childbirth). We synthesise research related to three questions: (i) How are women's drinking patterns and trajectories associated with socio-demographic and domestic circumstances?; (ii) What theoretical approaches are used to explain changes in consumption?; (iii) What meanings have been given to mothers' drinking? Approach: Three databases (Ovid-MEDLINE, Ovid-PsycINFO and CINAHL) were systematically searched. Citation tracking was conducted in Web of Science Citation Index and Google Scholar. Eligible papers explored mothers' alcohol consumption during the EPP, focusing on general population rather than clinical samples. Studies were critically appraised and their characteristics, methods and key findings extracted. Thematic narrative synthesis of findings was conducted. Key Findings: Fourteen quantitative and six qualitative studies were identified. The (sub)samples ranged from n = 77,137 to n = 21 women. Mothers' consumption levels were associated with older age, being White and employed, not being in a partnered relationship, higher education and income. Three theoretical approaches were employed to explain these consumption differences: social role, role deprivation, social practice theories. By drinking alcohol, mothers expressed numerous aspects of their identity (e.g., autonomous women and responsible mothers). Implications and Conclusion: Alcohol-related interventions and policies should consider demographic and cultural transformations of motherhood (e.g., delayed motherhood, changes in family structures). Mothers' drinking should be contextualised carefully in relation to socio-economic circumstances and gender inequalities in unpaid labour. The focus on peer-reviewed academic papers in English language may limit the evidence.

Issues Drug consumptions rooms (DCR) and supervised injecting facilities (SIF) are expanding internationally. Previous reviews have not systematically addressed evaluation methodologies. Approach Results from systematic searches of scientific databases in English until June 2017 were coded for paper type, country and year of publication. For evaluation papers, study outcome, methodology/study design and main indicators of DCR/SIF 'exposure' were recorded. Key findings Two hundred and nineteen eligible peer-reviewed papers were published since 1999: the majority from Canada (n = 117 papers), Europe (n = 36) and Australia (n = 32). Fifty-six papers reported evaluation outcomes. Ecological study designs (n = 10) were used to assess the impact on overdose, public nuisance and crime; modelling techniques (n = 6) estimated impact on blood-borne diseases, overdose deaths and costs. Papers using individual-level data included four prospective cohorts (n = 28), cross-sectional surveys (n = 7) and service records (n = 5). Individual-level data were used to assess safer injecting practice, uptake into health and social services and all the other above outcomes except for impact on crime and costs. Four different indicators of DCR/SIF attendance were used to measure service 'exposure'. Implications Research around DCRs/SIFs has used ecological, modelling, cross-sectional and cohort study designs. Further research could involve systematic inclusion of a control group of people who are eligible but do not access SIFs, validation of self-reported proportion of injections at SIFs or a stepped-wedge or a cluster trial comparing localities. Conclusions Methodologies appropriate for DCR/SIF evaluation have been established and can be readily replicated from the existing literature. Research on operational aspects, implementation and transferability is also warranted.

Issues. Alcohol and other drug use among adolescents is a serious concern, and effective prevention is critical. Research indicates that expanding school-based prevention programs to include parenting components could increase prevention outcomes. This paper aims to identify and describe existing combined student- and parent-based programs for the prevention of alcohol and other drug use to evaluate the efficacy of existing programs. Approach. The PsycINFO, Medline, Central Register of Controlled trials and Cochrane databases were searched in April 2015 and additional articles were obtained from reference lists. Studies were included if they evaluated a combined universal intervention for students (aged 11–18 years old) and their parents designed to prevent alcohol and/or other drug use, and were delivered in a school-based setting. Risk of bias was assessed by two independent reviewers. Because of the heterogeneity of the included studies, it was not possible to conduct a meta-analysis and a qualitative description of the studies was provided. Key Findings. From a total of 1654 screened papers, 22 research papers met inclusion criteria, which included 13 trials of 10 programs. Of these, nine programs demonstrated significant intervention effects in terms of delaying or reducing adolescent alcohol and/or other drug use in at least one trial. Conclusion. This is the first review of combined student- and parent-based interventions to prevent and reduce alcohol and other drug use. Whilst existing combined student- and parent-based programs have shown promising results, key gaps in the literature have been identified and are discussed in the context of the development of future prevention programs. [Newton NC, Champion KE, Slade T, Chapman C, Stapinski L, Koning I, Tonks Z, Teesson M. A systematic review of combined student- and parent-based programs to prevent alcohol and other drug use among adolescents. Drug Alcohol Rev 2017;00:000-000]

Introduction and Aims The Self-Management and Recovery Training (SMART Recovery) program provides facilitated mutual aid for people with addictions. To date, little research has examined SMART Recovery. This paper examined participant and facilitator perceptions of the helpfulness of cognitive behaviour therapy tools in SMART Recovery groups. SMART Recovery's strengths and areas for improvement were also explored, as well as overall participant satisfaction with SMART Recovery. Design and Methods This exploratory study was conducted as part of the first national survey of SMART Recovery in Australia. Paper surveys were posted to all registered SMART Recovery groups for participants. SMART Recovery facilitators were emailed a link to an online survey. Results Overall, satisfaction with SMART Recovery was moderate to strong. Participants and facilitators perceived the cognitive behaviour therapy tools incorporated within SMART Recovery to be helpful. Participants and facilitators nominated the group experience and the SMART Recovery tools and strategies as helpful aspects of SMART Recovery. Participants and facilitators were concerned with improving public knowledge about SMART Recovery groups, updating the structure and content of SMART Recovery groups, and increasing training for facilitators. Discussion and Conclusions SMART Recovery displays strengths as communicated by those who utilise its services. However, there are opportunities to continue to improve SMART Recovery. Updating the training for facilitators and increasing communication between SMART Recovery Australia's head office and its facilitators may serve to improve service delivery. Future research should focus on examining the efficacy of SMART Recovery groups on participant outcomes.[Kelly PJ, Raftery D, Deane FP, Baker AL, Hunt D, Shakeshaft A. From both sides: Participant and facilitator perceptions of SMART Recovery groups. Drug Alcohol Rev 2017;36:325–332]

Introduction and Aims Alcohol pricing is an effective prevention policy. This paper compares the 10 Canadian provinces on three research-based alcohol pricing policies—minimum pricing, pricing by alcohol content and maintaining prices relative to inflation. Design and Methods The selection of these three policies was based on systematic reviews and seminal research papers. Provincial data for 2012 were obtained from Statistics Canada and relevant provincial ministries, subsequently sent to provincial authorities for verification, and then scored by team members. Results All provinces, except for Alberta, have minimum prices for at least one beverage type sold in off-premise outlets. All provinces, except for British Columbia and Quebec, have separate (and higher) minimum pricing for on-premise establishments. Regarding pricing on alcohol content, western and central provinces typically scored higher than provinces in Eastern Canada. Generally, minimum prices were lower than the recommended $1.50 per standard drink for off-premise outlets and $3.00 per standard drink in on-premise venues. Seven of 10 provinces scored 60% or higher compared to the ideal on indexing prices to inflation. Prices for a representative basket of alcohol products in Ontario and Quebec have lagged significantly behind inflation since 2006. Discussion and Conclusions While examples of evidence-based alcohol pricing policies can be found in every jurisdiction in Canada, significant inter-provincial variation leaves substantial unrealised potential for further reducing alcohol-related harm and costs. This comparative assessment of alcohol price policies provides clear indications of how individual provinces could adjust their pricing policies and practices to improve public health and safety. [Giesbrecht N, Wettlaufer A, Thomas G, Stockwell T, Thompson K, April N, Asbridge M, Cukier S, Mann R, McAllister J, Murie A, Pauley C, Plamondon L, Vallance K. Pricing of alcohol in Canada: A comparison of provincial policies and harm-reduction opportunities. Drug Alcohol Rev 2016;35:289–297]

Introduction and Aims ‘Changing drinking culture’ is a prominent goal in the Australian state of Victoria's current alcohol strategy—seeking a shift so that ‘excessive drinking isn't seen as the norm’. As a social activity, there is a strong collective aspect to drinking and associated behaviour: customs within the drinking group and at the level of social worlds of drinking operate both to increase and to control drinking patterns and associated behaviours. The paper considers how risky drinkers and those in social worlds of heavy drinking experience others' expectations about drinking. Design and Methods Using Victorian population survey responses (n = 2092 adults who had consumed alcohol in previous year) to identify those in a social world of group drinking, and a subcategory who are also risky drinkers, the paper explores pressures on those in these categories both to drink more and to drink less, whether from family members, from work colleagues, or from friends. Results Those who are both risky and social drinkers are much more likely than other drinkers to report pressures to drink more from friends and workmates, and even from family members, although they more often report pressures from family members to drink less than to drink more. Discussion and Conclusions Efforts to change a drinking culture, it is argued, must take account of the collective nature of drinking and of the interplay of influences at interpersonal and subcultural levels if they are to be effective in reducing rates of heavy drinking and alcohol problems. [Room R, Callinan S, Dietze P. Influences on the drinking of heavier drinkers: Interactional realities in seeking to ‘change drinking cultures’. Drug Alcohol Rev 2015]

INTRODUCTION AND AIMS: This paper examined whether recall of childhood trauma was associated with adult alcohol consumption in a sample of Australians with low housing security. The secondary aim was to examine whether risky alcohol consumption predicted subsequent housing instability. Sociodemographic factors were examined as potential moderators of these associations. DESIGN AND METHODS: This paper utilised data collected through the Journeys Home Study, a longitudinal study of a representative sample of individuals who were homeless or at risk of homelessness. This paper focused on 1224 participants aged 18 years and over. Data on alcohol use, childhood trauma and sociodemographic characteristics were collected through interviews at baseline. Homeless status at 6- to 12-month follow-up was assessed via interview. Logistic regression modelling was used to examine associations of alcohol consumption with childhood abuse, sociodemographic factors and changes in homelessness status. RESULTS: Self-reported recall of childhood experiences of violence was significantly associated with low-risk (odds ratio = 1.54, 95% confidence interval [1.01, 2.35]) and risky (odds ratio = 2.35, 95% confidence interval [1.41, 3.94]) drinking. Recall of childhood neglect was associated with a lower likelihood of risky drinking (odds ratio = 0.57, 95% confidence interval [0.34, 0.96]). Additionally, risky drinkers were significantly more likely to remain homeless at follow-up (odds ratio = 1.85, 95% confidence interval [1.16, 2.96]). Several effects varied significantly by indicators of socio-economic status. DISCUSSION AND CONCLUSIONS: These results demonstrate that traumatic experiences during childhood (particularly violence) are significantly associated with risky alcohol consumption in later life and may be most pronounced in those facing the greatest social disadvantage. Furthermore, risky consumption may contribute to subsequent housing instability. [Keane C, Magee CA, Lee JK. Childhood trauma and risky alcohol consumption: A study of Australian adults with low housing stability. Drug Alcohol Rev 2014]. Language: en

Issues. Impulsivity is a widely studied personality trait and research construct that has been implicated as a risk factor for substance use,including initiating and continuing use.However,relatively few studies have examined impulsivity as a predictor of treatment outcome. Because impulsivity has been operationalised in many different ways, cross-comparisons of empirical studies have been difficult. Approach. The PubMed database was searched in September 2013. Reference lists of papers retrieved from this search were also manually scanned for additional resources.Studies were included if they presented data that assessed impulsivity as a predictor of treatment outcomes. Key Findings.The body of literature reviewed in this paper suggests that higher pretreatment impulsivity, regardless of how it is measured, usually is associated with poorer treatment outcomes. Recent data indicate that some psychosocial and pharmacological treatments may directly impact impulsivity and thus represent an interesting avenue for further research. Conclusions.Impulsivity appears to be a key predictor of substance use treatment outcomes and warrants more attention in the improvement of treatment outcomes.Suggestions for future research on the role of impulsivity in substance use treatment are provided.[Amy M. Loree AM, Leslie H. Lundahl LH, David M. Ledgerwood DM. Impulsivity as a predictor of treatment outcome in substance use disorders: Review and synthesis. Drug Alcohol Rev 2014]

Introduction and Aims To review the results of five research projects commissioned to enhance alcohol treatment among Aboriginal Australians, and to highlight arising from them. Design and Methods Drafts of the papers were workshopped by project representatives, final papers reviewed and results summarised. Lessons arising were identified and described. Results While the impact of the projects varied, they highlight the feasibility of adapting mainstream interventions in Aboriginal Australian contexts. Outcomes include greater potential to: screen for those at risk; increase community awareness; build capacity and partnerships between organisations; and co-ordinate comprehensive referral networks and service provision. Discussion Results show a small investment can produce sustainable change and positive outcomes. However, to optimise and maintain investment, cultural difference needs to be recognised in both planning and delivery of alcohol interventions; resources and funding must be responsive to and realistic about the capacities of organisations; partnerships need to be formed voluntarily based on respect, equality and trust; and practices and procedures within organisations need to be formalised. Conclusions There is no simple way to reduce alcohol-related harm in Aboriginal communities. However, the papers reviewed show that with Aboriginal control, modest investment and respectful collaboration, service enhancements and improved outcomes can be achieved. Mainstream interventions need to be adapted to Aboriginal settings, not simply transferred. The lessons outlined provide important reflections for future research. [Gray D, Wilson M, Allsop S, Saggers S, Wilkes E, Ober C. Barriers and enablers to the provision of alcohol treatment among Aboriginal Australians: A thematic review of five research projects. Drug Alcohol Rev 2014;33:482-490]

Issues.Serious educational games (SEG) have been shown to be effective in educating young people about a range of topics, including languages and maths.This paper identifies the use of computerised SEGs in education about alcohol and other drugs and reviews their impact on the prevention of alcohol and drug use. Approach. The Cochrane Library, EMBASE, MEDLINE, ERIC, Scopus, psychINFO, pubMED and DRUG databases were searched in February 2013. Additional publications were obtained from the reference lists of the relevant papers. Studies were included if they described an evaluation of a computerised SEG that targeted alcohol and/or other drugs and had been trialled with adolescents. Key Findings.Eight SEGs were identified targeting tobacco, alcohol, cannabis, methamphetamine, ecstasy, inhalants, cocaine and opioids. Six reported positive outcomes in terms of increased content knowledge and two reported increased negative attitudes towards the targeted drugs. Only one reported a decrease in the frequency of drug use. Implications and Conclusion.This is the first review of the efficacy of computerised SEGs for alcohol and other drugs for adolescents.Results suggest that SEGs can increase content knowledge of alcohol and other drugs. Evidence concerning impacts on negative attitudes and alcohol and drug use is limited, with few studies examining these outcomes. [Rodriguez DM, Teesson M, Newton NC. A systematic review of computerised serious educational games about alcohol and other drugs for adolescents. Drug Alcohol Rev 2013]

Introduction and Aims Evidence of treatment effectiveness for alcohol use disorders (AUD) have emerged predominantly from Western studies, using highly controlled trials that may not reflect real-world settings. This paper examines treatment outcome and its predictors among Asian problem drinkers participating in a treatment outcome monitoring program at an addiction treatment centre in Singapore. Design and Methods Data were collected at intake and 3, 6 and 12 months, although the focus of this paper is on reliable change at 3 months among the 70% who were followed up. Five hundred and forty-one AUD-diagnosed outpatients presenting for treatment, over a 2-year period, were assessed on drinking behaviours and administered the Addiction Severity Index-Lite, Personal Wellbeing Index (PWI) and Treatment Perceptions Questionnaire. Results At 3 months, drinking days, alcohol units and alcohol use severity had more than halved and 69% were either abstinent or had reliably reduced their drinking days. Baseline drinking days and treatment satisfaction predicted 3-month drinking frequency but not severity. Positive alcohol outcomes observed at 3 months were sustained among those followed up until 12 months. Mean PWI score improved significantly and fell within the ‘normal’ range. Treatment satisfaction also emerged as the only significant predictor of reliable positive change in both drinking days and PWI score. Discussion and Conclusions Significant reductions in drinking frequency and severity are possible for Asian problem drinkers after 12 weeks of outpatient treatment. The identified predictors suggest that more frequent drinkers and patients with past/current psychiatric comorbidities may require a more intensive treatment approach to optimise treatment outcomes.

Issues The use of alcohol and drugs amongst young people is a serious concern and the need for effective prevention is clear. This paper identifies and describes current school-based alcohol and other drug prevention programs facilitated by computers or the Internet. Approach The Cochrane Library, PsycINFO and PubMed databases were searched in March 2012. Additional materials were obtained from reference lists of papers. Studies were included if they described an Internet- or computer-based prevention program for alcohol or other drugs delivered in schools. Key Findings Twelve trials of 10 programs were identified. Seven trials evaluated Internet-based programs and five delivered an intervention via CD-ROM. The interventions targeted alcohol, cannabis and tobacco. Data to calculate effect size and odds ratios were unavailable for three programs. Of the seven programs with available data, six achieved reductions in alcohol, cannabis or tobacco use at post intervention and/or follow up. Two interventions were associated with decreased intentions to use tobacco, and two significantly increased alcohol and drug-related knowledge. Conclusion This is the first study to review the efficacy of school-based drug and alcohol prevention programs delivered online or via computers. Findings indicate that existing computer- and Internet-based prevention programs in schools have the potential to reduce alcohol and other drug use as well as intentions to use substances in the future. These findings, together with the implementation advantages and high fidelity associated with new technology, suggest that programs facilitated by computers and the Internet offer a promising delivery method for school-based prevention.

Introduction and Aims Since 2010, members of the World Trade Organization (WTO), including Australia, have opposed Thailand's proposal for graphic warnings on alcohol containers. This paper aims to provide an account of the arguments for/against Thailand and to examine the arguments' legal and political validity. Design and Methods This paper reviews primary WTO records in relation to Thailand's proposal to reveal the arguments for/against Thailand's proposal. The paper analyses these arguments in light of WTO cases to identify the legal strengths and weaknesses of Thailand's position. The paper then considers whether the attacks on Thailand by Australia are justified in light of the Australian Government's position on (i) alcohol warning labels in Australia and (ii) tobacco plain packaging. Results The legal arguments against Thailand are: only harmful alcohol consumption should be prevented; there is no evidence that graphic warning labels can reduce alcohol-related harm; the labels unnecessarily restrict international trade. There are some legal weaknesses in Thailand's proposal. Yet, Australia's opposition to Thailand cannot be justified whilst Australia is (i) mandating pregnancy-related alcohol warnings in Australia and (ii) defending its plain packaging law against similar WTO attacks. Discussion No WTO member is obliged to challenge another member for being non-compliant. The case tests the willingness of WTO members like Australia to respect the autonomy of other countries to pursue their public health goals and trial novel interventions. Conclusions Australia's actions suggest it is willing to protect its alcohol industry at the expense of public health in Thailand.

Introduction and Aims. The purpose of this paper is to provide a per incident of crime cost measure for New South Wales that is suitable for the use within cost-effectiveness studies of interventions aimed at reducing the burden of alcohol. This paper seeks to quantify the individual cost of an assault, property damage, sexual offence and disorderly conduct in New South Wales. Design and Methods. Costs regarding the criminal act, police involvement, prosecution in criminal courts and incarceration are estimated and then using a four-stage probability analysis, the expected cost per incident is calculated. Results. It is found that expected cost per incident for assault, sexual offence, property damage and disorderly conduct (in 2006 dollar values) is $3982, $5976, $1166 and $501 respectively. Discussion and Conclusions. A large total cost figure is a powerful policy motivator; however, for the purpose of economic analysis it is often more useful to estimate the per incident cost. This research furthers the existing research on cost of crime estimates and facilitates future cost-effectiveness and other economic analysis of interventions that reduce alcohol-related crime.[Byrnes JM, Doran CM, Shakeshaft AP. Cost per incident of alcohol-related crime in New South Wales. Drug Alcohol Rev 2012]. Language: en

Issues. Only a limited amount of research has been conducted to explore whether there are socioeconomic status differences in responses to mass media. However, the methodological quality of this evidence has not been assessed, limiting confidence in conclusions that can be drawn regarding study outcomes. A systematic review of the effectiveness of anti-tobacco mass media campaigns with socially disadvantaged groups was conducted, and the methodological quality of included studies was assessed. Approach. Medline, The Cochrane Library, PsycInfo, Embase and Web of Science were searched using MeSH and keywords for quantitative studies conducted in Western countries prior to March 2012. A methodological quality assessment and narrative analysis of included studies was undertaken. Key Findings. Seventeen relevant studies (reported in 18 papers) were identified; however, weak study designs and selection bias were common characteristics, limiting strong conclusions about effectiveness. Using predominantly non-cessation related outcome measures reviewed papers indicated mixed results for mass media tobacco control campaign effectiveness among various social groups. Most studies assessed mass media impact on low socioeconomic status groups rather than highly socially disadvantaged groups. Implications. Methodological rigour of evaluations in this field must be improved to aid understanding regarding the effectiveness of mass media campaigns in driving cessation among disadvantaged groups. Conclusion. The results of this review indicate a gap in methodologically rigorous research into the effectiveness of mass media campaigns among socially disadvantaged groups, particularly the highly disadvantaged.[Guillaumier A, Bonevski B, Paul C. Anti-tobacco mass media and socially disadvantaged groups: A systematic and methodological review. Drug Alcohol Rev 2012;31:698–708]

Issue. The prevalence of smoking among prisoners is exceptionally high and is often comorbid with alcohol and drug problems, mental illness and other health problems. This review paper summarises the literature and available research related to smoking prevalence and smoking cessation initiatives among prisoners and identifies areas of need for further research and intervention. Approach. This paper highlights three studies conducted in the New South Wales prison system which attempt to address these high rates of smoking including a feasibility study, a focus group study and a randomised controlled trial. Key Findings. The challenges of making systems-level changes to address these high rates of smoking are discussed including a recent National Summit on Tobacco Smoking in Prisons. Implications. Dissemination of research findings has assisted in highlighting the importance of tobacco smoking among prisoners and the need to develop culturally and setting appropriate smoking cessation initiatives for prisoners. Conclusions. As one of the most marginalised and socially disadvantaged populations in Australia, prisoners represent an important population to target for smoking cessation programs and interventions. This paper highlights a number of initiatives undertaken to address this problem and suggests directions for the future.[Richmond RL, Butler TG, Indig D, Wilhelm KA, Archer VA, Wodak AD. The challenges of reducing tobacco use among prisoners. Drug Alcohol Rev 2012;31:625–630]

Introduction and Aims.This paper contrasts health-oriented low-risk drinking guidelines (LRDGs) with social drinking marketing and popular advice on the amount of alcohol to be provided for social occasions. The questions addressed include: What is the underlying evidence base and rationale for health-oriented versus socially oriented drinking guidelines? What are the recommended amounts of alcohol per person from the LRDGs and from popular advice? Design and Methods.This paper draws on existing research, archival data, websites, print media and key informant interviews. The focus is on recent information on LRDGs and social drinking indicators in Canada, the USA, Australia and the UK. Results.There is extensive epidemiological research indicating the associations between drinking pattern and risk for chronic disease and trauma as well as certain potential health benefits from drinking small amounts regularly. This body of evidence is one resource for government or medically sanctioned LRDGs in many jurisdictions. In contrast, for those planning social events where liquor is served, information is available from the hospitality industry, retailers and liquor control boards. While some overlap exists between these two sources of information, in some contexts normative recommendations support drinking at potentially dangerous levels. Discussion and Conclusions.The inconsistency among the different guidelines highlights one of the challenges of conveying health information on a drug that is integrated into social life and used extensively. It also reflects a siloed approach to alcohol policy—where retailing and harm reduction practices are managed by different sectors of government that seldom reflect a coordinated response.[Wettlaufer A, Cukier S, Giesbrecht N, Greenfield TK. The marketing of responsible drinking: Competing voices and interests. Drug Alcohol Rev 2012;31:231–239]

Introduction and Aims. Alcohol has consistently been demonstrated to increase levels of aggression and violence, particularly in late night licensed venues. Since August 2003, Ballarat (a regional city of approximately 95 000 inhabitants, in Victoria, Australia) has implemented a 3:00 am'lockout' with the goal of reducing alcohol-related harms. This paper is the first long-term analysis of the effect of this type of intervention on emergency department (ED) attendances. The aim of this paper is to examine the effectiveness of a lockout intervention within the city of Ballarat, Victoria on alcohol-related ED presentations. Design and Methods. This paper examines alcohol-related injury frequencies pre- to post-lockout intervention in Ballarat, Victoria, from 1999 to 2009, as indicated by ED International Classification of Diseases codes for acute alcohol intoxication and assault. These data are further compared with similar data from Geelong, Victoria, as a control. Results. A small reduction in alcohol-related assaults and intoxication rates within Ballarat occurred before and after the introduction of the lockout. However, after this decline these rates steadily increased, surpassing Geelong by 2005. Discussion and Conclusions. There is no discernible long-term impact on alcohol-related ED attendances of the lockout intervention in Ballarat. As such, other interventions may be more appropriate to reduce alcohol-related ED attendances.[Miller P, Coomber K, Sonderlund A, McKenzie S. The long-term effect of lockouts on alcohol-related emergency department attendances within Ballarat, Australia. Drug Alcohol Rev 2011]. Language: en

Introduction and Aims. This paper proposes an approach for evaluating the validity of alternative low-risk drinking guidelines. Design and Methods. Twenty-seven alternative guidelines were evaluated in terms of their ability to predict nine measures of concurrent and prospective alcohol-related harm, using longitudinal data from a nationally representative sample of US adults (n = 26 438 to 12 339 depending upon outcome). Parameters compared included sensitivity, specificity, adjusted odds ratios and measures of model fit. Results. Performance varied by harm. The guidelines that best predicted concurrent alcohol-related harm comprised daily-only limits of 4/3 drinks for men/women, but gender-invariant limits of 4/4 drinks also performed well. Adding weekly limits did little to improve the prediction of concurrent harm. The guidelines that best predicted prospective harm comprised daily limits of 4/4 drinks combined with weekly limits of 14 drinks for men and 7 drinks for women, with weekly limits of 14/14 drinks running second. When concurrent and incident harms were aggregated, daily-only limits of 4/3 drinks performed nearly on a par with the combination of 14/14 drinks per week and 4/3 drinks per day. Discussion and Conclusions. This paper supported gender-specific daily limits and suggested that optimal guidelines might take daily limits from analyses of concurrent harms and weekly limits from analyses of prospective harms. This paper illustrates a mechanism for validating the ability of low-risk drinking guidelines to accurately predict a range of alcohol-related harms, whereby countries could use their own data on consumption and its association with harm to evaluate their low-risk drinking guidelines.[Dawson DA, Smith SM, Pickering RP, Grant BF. An empirical approach to evaluating the validity of alternative low-risk drinking guidelines. Drug Alcohol Rev 2011]. Language: en

Alcohol-related violence causes substantial death, injury and health problems. The 2004 Global Burden of Disease project estimated that alcohol-attributable violence accounted for 248,000 deaths annually worldwide [1]. As noted by Bellis and Hughes in this issue [2], the link between alcohol and violence has been recognized as far back as the 4th century BC. However, understanding this link and especially how to prevent alcohol-fuelled violence continues to perplex contemporary scientists and policy-makers. Thus, in March 2010, researchers from 14 countries met in Melbourne to present recent research on this topic and discuss issues and solutions. This special issue includes 12 papers from that conference. Other papers from the conference are included in a companion issue published in Contemporary Drug Problems, Volume 38(2), 2011.