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New students arrive at university with pre-determined perceptions around how alcohol can be used as a tool to overcome anxieties and secure new friendships, which in turn influences students' drinking behaviors. From a health promotion perspective, the transition to university may present a unique yet understudied opportunity to challenge and reframe situated drinking norms. This paper explores prospective university students' perceptions of the role that alcohol plays at university and the influence that these perceptions have on behavior. Focus groups with 46 prospective university students (aged 16-20 years) recruited from colleges and sixth forms in the North West of England. Through various sources of information, new students arrive at university with pre-conceived perceptions of a heavy student drinking culture and knowledge around how alcohol can be used to aid successful integration with new peers. Alcohol was viewed by new students as a social lubricant which is key to accruing social capital. Cultural presentations of the student drinker identity led prospective students to formulate negative connotations of those students who transgress from the norms of drinking. The findings provide new insights into how young people conceptualize alcohol at university and the impact that these perceptions have on shaping ideology and influencing drinking behavior. Breaking down these norms presents real challenges for those trying to address excessive drinking in universities, therefore, early intervention which challenges, re-frames and modifies perceptions before students arrive on campus may help to reduce the pressure and expectations to drink in social situations. [ABSTRACT FROM AUTHOR]

Previous research has established that young people tend to operate with a sense of invulnerability when it comes to risk-taking behaviour. This paper initially investigates the possibility that this might be a product of their relative lack of exposure to situations or events which involve death or serious threats to health. It then considers the thesis that exposure to such ‘serious health-related incidents’ will act as ‘critical incidents’ affecting the health-related behaviour of young people. Findings are based on the ESRC-funded research project Critical Incidents and Risk-Taking Behaviour Among Schoolchildren (R000 22 1802) which has investigated perceptions of risk and the consumption of alcohol and tobacco by 15- to 16-year-olds in a central region of England. The research reveals a high level of exposure to ‘serious health-related incidents’ and the findings provide some modest support for this thesis that these act as ‘critical incidents’ shaping the willingness of the young people to take risks with their health. However, the findings also indicate significant limitations to the thesis. These limitations are discussed and it is concluded that they stem from the use of ‘expert opinion’ and ‘medical models’ of health as the bases for identifying critical incidents. [ABSTRACT FROM AUTHOR]

Background:Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method:Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results:Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions:This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support. [ABSTRACT FROM AUTHOR]

Background: Alcohol Use Disorders (AUD) in England have a prevalence rate of about 27% in the general population. There is good evidence to suggest that Alcohol Identification and Brief Advice (IBA) delivered in health-care settings reduces both consumption and related harms. Criminal Justice Settings offer opportunities for the identification of AUDs and afford a "teachable moment" where a link is made between alcohol use and consequence at which to deliver appropriate interventions. Objective: To identify areas in the English Criminal Justice System where the deployment of alcohol screening and brief interventions could reduce alcohol consumption and related harms. Methods: A rapid literature review for the prevalence of alcohol use disorders and the effectiveness of screening and brief interventions in criminal justice settings as well as conducting telephone interviews of key informant interviews. Conclusion: With young offenders, there is a lack of trials and none from the U.K. With AssestPlus screening it would appear more feasible to conduct a trial here than in other criminal justice settings which may offer an advantage than other settings. [ABSTRACT FROM AUTHOR]

Homelessness and heavy alcohol consumption are increasing global public health concerns. Homelessness is associated with poorer health outcomes, shorter life expectancy, and health risk behaviours. High levels of alcohol consumption intersect with the cause and effect of homelessness making this an important consideration for research. This is explored through a theoretical lens of recovery capital, referring to the resources required to initiate and maintain recovery, and is applied to both heavy alcohol consumption and homelessness. Life history calendars were utilised alongside semi-structured interviews to explore the impact that adverse life events had on alcohol consumption and living situations with 12 participants in contact with homelessness services in North-West England. The findings consider how social, health, and structural-related adverse life events were both a cause and effect of homelessness and increasing consumption of alcohol, which were further exacerbated by a lack of recovery capital. The authors argue for further consideration relating to the intersection of homelessness and high levels of alcohol consumption in relation to recovery capital. The findings have implications for policy and practice by demonstrating the need for relevant services to help individuals develop and maintain resources that will sustain recovery capital. [ABSTRACT FROM AUTHOR]

Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives' attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n = 7) and Örebro County, Sweden (n = 9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional's role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives' attitudes around risks with prenatal alcohol use. [ABSTRACT FROM AUTHOR]

Aim: To ascertain young adults’ experience of alcohol-related collateral harm (ARC harm).Methods: An online survey collected quantitative and qualitative data from a convenience sample of students (N = 450) aged 16–24 in Southern England. Questions and analyses focused on harms they had experienced as a result of alcohol consumption by other people in their family or social circle.Findings: Sixty-four percent of the participants experienced ARC harm, including 50% of non-drinkers. In logistic regression analysis, ARC harms were associated with being female (OR = 1.62, 95% CI 1.01–2.62) family members who drank every day (OR = 2.65, 95% CI 1.49–4.69) being influenced by others’ drinking (OR = 2.03, 95% CI 1.32–3.10) being older (OR = 2.61 95% CI 1.57–4.34). No significant associations were found with high or low self-reported levels of alcohol consumption. Using qualitative descriptors, the ARC harms reported were classified into a novel taxonomy comprising eight categories: nuisance/frustration/exasperation, tolerance/adjustment/accommodation, pressure into unwanted situations, unsought/inappropriate responsibility, psychological harm, physical harm/acute risk of physical harm, relationship harm, and undisclosed harm.Conclusions: A high level of ARC harm was reported and experience of ARC harm was linked to several predictors. Further work is required to validate the proposed taxonomy, and to promote consideration of the phenomenon of ARC harm in alcohol policy. [ABSTRACT FROM PUBLISHER]

Background: Intentional consumption of alcohol-based hand gels has been reported especially amongst non-UK national, alcohol dependent, homeless individuals in London. Whilst alcohol misuse is known to be associated with impaired cognitive functioning and mental health problems, the effects of additional ingestion of alcohol gel are unknown.Objectives: To explore cognitive and psychological functioning in users who intentionally ingest alcohol gel compared with ethyl-alcohol only misusers and controls.Methods: Male, Central and Eastern European alcohol only misusers, (n= 14; mean age 39 years), alcohol gel users (n= 14; mean age 43 years) and controls (n= 12; mean age 31 years) were recruited from a London Homeless Service during 2013/14. Alcohol misusers, alcohol gel users and controls were compared on the Forwards and Backwards Digit Span Test; Block Design test; Retrospective and Prospective Memory Questionnaire (PRMQ) and the Hospital and Anxiety Depression Scale (HADS).Results: Alcohol gel users performed significantly worse on the Block Design task (p< .01) and PRMQ (p< .01) relative to both alcohol only and control groups, and significantly worse on the digit span relative to controls (p= .01). Both alcohol misusing groups scored comparatively on digit span backwards (p< .01), with both groups performing significantly worse than controls. The alcohol gel group reported significantly higher levels of anxiety relative to controls (p= .02).Conclusions: Whilst there could be constitutional differences between alcohol misusers who additionally abuse alcohol gel, the findings suggest that alcohol gel ingestion may have a greater impact on psychological functioning than traditional alcohol misuse. [ABSTRACT FROM PUBLISHER]

Background: Worldwide alcohol consumption is involved in 2.5 million deaths annually. Worryingly, the age of alcohol initiation may be decreasing; evidence suggests an inverse correlation between initiation and prevalence of alcohol use. European data are limited. Methods: Data are from a survey (n = 2638) on alcohol consumption of ≥18 y in England. Univariate and multivariate associations are reported between demography, last year alcohol consumption, historic drinking including having regularly drank alcohol <18 y (drank at least monthly), and experience of at least one serious alcohol-related problem (self-defined). Results: Lifetime alcohol consumption was reported by 93.2% of participants. Of these, 36.1% reported regular consumption <18 y; 18–30 y had a threefold greater odds of reporting alcohol consumption <18 y than 61–75 y. In total, 5.2% reported at least one serious alcohol-related problem; those who had regularly consumed alcohol <18 y had a twofold greater odds of reporting this than those who had not. Conclusion: Our sample supports a potential increase in the proportion of those reporting underage alcohol initiation. As those who regularly consumed alcohol <18 y were at risk of experiencing alcohol-related problems, incidence of harm could increase over time as early initiators start to experience harms, supporting the need for interventions to delay alcohol consumption in underage groups. [ABSTRACT FROM PUBLISHER]

This article considers alcohol policy development in England and Wales under the coalition government after 2010. With a particular focus on minimum unit pricing, it examines why policy departures based on supply-side controls drawn from public health models were abandoned in favour of a restoration of policy equilibrium. This article adopts a historically informed political science perspective, drawing upon insights from John Kingdon's policy streams approach, with a focus on how the 'alcohol problem' is defined and framed by policy actors. It argues that while the restoration of policy equilibrium was significantly attributable to industry lobbying, also important were the inconsistent framing of policy proposals, lack of departmental synergy, ideological tensions and a lack of coherence in the communication of evidence. [ABSTRACT FROM AUTHOR]

Aims: There is a strong consensus that detoxification from alcohol should be planned. Six sessions of Group Cognitive Behavioral Therapy as structured preparation for detoxification for alcohol dependence have been developed and evaluated. To our knowledge this is the only structured preparation intervention reported in the literature. The aim of this study was to provide a client centered evaluation of this intervention to build upon initial quantitative evidence. Methods: Eleven telephone and two face to face qualitative interviews were conducted in four community alcohol teams in South England. Detailed inductive coding, and coding around CBT concepts, of all transcripts was undertaken. Participants were purposively sampled after completion of the six week group intervention. Results: Key benefits of group attendance from the participant perspective included not feeling 'alone', being supported by, and supporting peers. Participants demonstrated self-efficacy and coping strategies for reducing drinking and managing high-risk situations. Some reported pre-group anxiety, or difficult group experiences due to disruptive clients. Conclusions: Although the study has limitations, the intervention appears to be well accepted, and appears to prepare participants for detoxification. These exploratory findings suggest that both generic groups as well as theory specific factors are important. Effectiveness and cost-effectiveness of the intervention need to be further assessed. [ABSTRACT FROM AUTHOR]

Regional Alcohol Managers (RAMs) were employed in the nine English health regions over 2008-2011. Their mission was to impact on the 'hard target' of Alcohol-Related Hospital Admissions (AHRAs) through the 'soft methods' of persuasion and influence: working with local partners on evidence-based interventions. Drawing on a qualitative evaluation, this article shows how a central government policy imperative (ARHAs) led to 'government at a distance' responses, including the introduction of RAMs. The processes involved in shaping and delivering this function bore the hallmarks of a complex, interactive policy network model, involving individuals whose bearings and roles were flexible and sometimes ambiguous. While there were overlaps and blurring of boundaries, there were three levels of policy network: central government, regional and local. As the 'network in the middle', the RAMs were pulled in both directions by conflicting agendas but were also able to have an impact on central and local policy. [ABSTRACT FROM AUTHOR]

Efforts to discourage excessive alcohol use among young people can only be effective if the target audience is exposed to, attends to, and comprehends key messages. The aim of this study was to examine age and sex differences in drinking motives to better inform development of targeted interventions to reduce alcohol-related harm. Thirty individual interviews and 12 group interviews were conducted with English 13–25 year olds. Interviewees gave multiple motivations for drinking – especially those related to image and reputation, and played down the health implications of heavy drinking. Negative aspects of drinking – caring for drunk friends, being cared for when drunk and suffering through hangovers with friends – were considered to offer opportunities for closer interpersonal bonding than other social activities. Respondents distanced themselves from ‘problem’ drinkers, but disapproved of others’ problematic drinking or antisocial behaviour. Narrative messages demonstrating the social consequences of excessive consumption were preferred to single, static messages emphasising risk or harm. Interviewees noted that interventions must use an engaging tone or pitch: they considered many campaigns to be patronising or preaching. A lack of consensus between age and sex groups highlighted a need for multifaceted, multi-modal approaches that utilise mobile technologies and new media. [ABSTRACT FROM PUBLISHER]

Tackling alcohol-related harms crosses agency and professional boundaries, requiring collaboration between health, criminal justice, education and social welfare institutions. It is a key component of most multi-component programmes in the United States, Australia and Europe. Partnership working, already embedded in service delivery structures, is a core mechanism for delivery of the new UK Government Alcohol Strategy. This article reports findings from a study of alcohol partnerships across England. The findings are based on a mix of open discussion interviews with key informants and on semi-structured telephone interviews with 90 professionals with roles in local alcohol partnerships. Interviewees reported the challenges of working within a complex network of interlinked partnerships, often within hierarchies under an umbrella partnership, some of them having a formal duty of partnership. The new alcohol strategy has emerged at a time of extensive reorganisation within health, social care and criminal justice structures. Further development of a partnership model for policy implementation would benefit from consideration of the incompatibility arising from required collaboration and from tensions between institutional and professional cultures. A clearer analysis of which aspects of partnership working provide ‘added value’ is needed. [ABSTRACT FROM PUBLISHER]

Introduction and aims: The present study compared the types and severity of physical health problems among patients with drug or alcohol dependence. Design and methods: A total of 252 patients from one inpatient and two outpatient units were interviewed. Data were collected at the start of treatment using a structured research protocol to assess nine health domains, and ratings were made by a medically qualified physician following physical examination of the patient. Results: Physical health problems were common-76% of the sample had at least one problem and 51% had two or more problems. Health problems were often serious and required treatment with the overall level of severity significantly higher ( p < .001) in alcohol dependent patients and specifically for neurological, gastrointestinal and liver, and dermatological problems. Among alcohol dependent patients, both quantity of drinking prior to treatment and age ( p < .001) were associated with increased physical morbidity. For drug dependent patients, injection of drugs ( p < .001) and homelessness ( p = .037) were associated with poorer physical health. For both groups physical health was poorer among those treated in inpatient than in outpatient settings ( p < .001). Discussion and Conclusions: The high prevalence of physical health problems among patients who are dependent on alcohol or other drugs emphasizes the importance of a thorough health screening at admission to treatment with provision for, or referral to, appropriate treatment for any problems identified [ABSTRACT FROM AUTHOR]

In the late-Victorian period in England, attitudes towards suicide were complex. The existence of secular viewpoints encouraged compassionate attitudes to such deaths by characterising suicide as a result of mental illness or as a natural response to harsh socio-economic conditions. Yet, in contemporary society, traditional forms of cultural and moral condemnation continued to influence perceptions of self-destruction. This article examines attitudes to working-class suicide between 1870 and 1910 and maintains that the interaction between these traditional and secular outlooks was a highly complex phenomenon. Responses to suicidal deaths were multi-faceted. The extent of hostility or sympathy accorded to such deaths was dependent upon a wide range of factors that do not sit easily with either paradigm. I suggest that a dominant or homogenous attitude towards suicide did not exist. Instead, there existed different varieties of suicides and responses to them. The role of respectability, morality and gender will be portrayed as primary definers of what came to constitute a 'good' or 'bad' suicide. [ABSTRACT FROM AUTHOR]

A community survey using a structured questionnaire was used with 389 homeless 1 people currently or recently sleeping rough (on the streets)in London.Data were collected on respondents 'histories of homelessness and of substance use,and dependence on the main substance used in the last month was measured.In the month before the interview,83%(324)of the sample had used a drug,36%(139)were dependent on heroin and 25%(97)on alcohol.Sixty-three per cent (244)reported that their drug or alcohol use was one of the reasons they first became homeless,but the majority (80%,310)had used at least one additional drug since then.Overall,drug and alcohol use,injecting,daily use and dependency increased the longer the respon- dents had been homeless.A clear link exists between substance use and homelessness:initiatives to tackle homelessness must simultaneously tackle the drug use of homeless people. [ABSTRACT FROM AUTHOR]

Objectives. Ethnic minority groups are at a higher risk of stroke and heart disease. However, designing effective prevention strategies requires responding to the needs of different ethnic groups. The aims of this study were to estimate the prevalence of four behavioural risk factors (smoking, drinking, exercise and weight) for stroke among Black Caribbeans, Black Africans and Whites, and also to examined reported willingness to change these behaviours. Design. A random sample of 311 Black Caribbean, 300 White, and 105 Black Africans aged 45-74 registered with 16 practices in south London were surveyed in 1995. Information was obtained on smoking, drinking and exercise patterns, body mass index and perceptions of being at risk of stroke, and willingness to change risk behaviour. Results. White respondents (31% age and sex standardised prevalence) were more likely to smoke than Black Caribbeans (23%) and Black Africans (10%) (p < 0.001). Self-reported rates of drinking were higher than the government's 'sensible drinking levels' for 19% of Whites, 11% of Black Caribbeans and 4% Black Africans (p < 0.001). In contrast, fewer Whites (51%) were overweight (BMI > 27) than Black Caribbeans (60%) and Black Africans (68%) (p = 0.001). A high proportion of smokers wished to give up (89% Black African; 83% Black Caribbean; 74% White). A higher proportion of Black Caribbeans (35%) reported a willingness to reduce their alcohol intake compared to only 15% of Whites (p = 0.040). There was a difference between groups in attitudes to weight reduction with 69% Black Caribbean women expressing a desire to be thinner compared to 86% Whites and 82% Black Africans (p = 0.051). Conclusion. Strategies to reduce behavioural risk factors for heart attack and stroke need to emphasise different risk factors among ethnic groups, especially in relation to alcohol use in the White population and weight in the Black Caribbean population. Influencing the change of these behaviours requires working in partnership with local community groups. [ABSTRACT FROM AUTHOR]