Staying in the 'sweet spot': A resilience-based analysis of the lived experience of low-risk drinking and abstention among British youth

How is alcohol consumption and heavy episodic drinking spread across different types of drinking occasion in Great Britain: An event-level latent class analysis

BACKGROUND

This paper aimed to (i) update a previous typology of British alcohol drinking occasions using a more recent and expanded dataset and revised modelling procedure, and (ii) estimate the average consumption level, prevalence of heavy drinking, and distribution of all alcohol consumption and heavy drinking within and across occasion types.

METHODS

The paper uses a cross-sectional latent class analysis of event-level diary data that includes characteristics of 43,089 drinking occasions in 2019 reported by 17,821 adult drinkers in Great Britain. The latent class indicators are characteristics of off-trade only (e.g. home), on-trade only (e.g. bar) and mixed trade (e.g. home and bar) drinking occasions. These describe companions, locations, purpose, motivation, accompanying activities, timings, consumption volume in units (1 UK unit = 8g ethanol) and beverages consumed.

RESULTS

The analysis identified four off-trade only, eight on-trade only and three mixed-trade occasion types (i.e. latent classes). Mean consumption per occasion varied between 4.4 units in Family meals to 17.7 units in Big nights out with pre-loading. It exceeded ten units in all mixed-trade occasion types and in Off-trade get togethers, Big nights out and Male friends at the pub. Three off-trade types accounted for 50.8% of all alcohol consumed and 51.8% of heavy drinking occasions: Quiet drink at home alone, Evening at home with partner and Off-trade get togethers. For thirteen out of fifteen occasion types, more than 25% of occasions involved heavy drinking. Conversely, 41.7% of Big nights out and 16.4% of Big nights out with preloading were not heavy drinking occasions.

CONCLUSIONS

Alcohol consumption varies substantially across and within fifteen types of drinking occasion in Great Britain. Heavy drinking is common in most occasion types. However, moderate drinking is also common in occasion types often characterised as heavy drinking practices. Mixed-trade drinking occasions are particularly likely to involve heavy drinking.

Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS)

Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: "poly-behavioral" (19.4%), "smoking and depression" (21.7%), "illicit drug use" (13.8%), and "no conditions" (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.

How do people drink alcohol at a low-risk level?

Reducing the risks associated with drinking is an ongoing public health goal. Approximately two-fifths of Australian adults consume alcohol within low-risk guidelines, yet little is known about their drinking patterns or practices. In this paper, we use social practice theory to consider low-risk drinking at home as a routinised social practice with material, meaning and competence dimensions. We analysed open-text survey responses from 252 Australian adults (30-65, 89% female) who were considered low-risk drinkers. A low-risk drinking occasion was typically closely linked to other practices such as eating dinner or connecting with family or friends. Drinking alcohol, even in small amounts, was associated with enjoyment. Being attuned to bodily sensations and applying some self-imposed rules were competencies that allowed low-risk drinkers to avoid intoxication. Low-risk drinking practices entail some elements that can inform health promotion, including encouraging efforts to limit drinking to times of the day (e.g. during meals) and to attend to bodily feelings of sufficiency. The study also shows how low-risk drinking is entangled with gendered and age-related norms about drinking, and facilitated by rarely being in 'intoxigenic' environments. These factors are imbricated with individual decisions in our respondents' capacity to consume alcohol moderately.

"Drinkers Like Me": A Thematic Analysis of Comments Responding to an Online Article About Moderating Alcohol Consumption

Background

There has been media coverage surrounding the dangers of heavy drinking and benefits of moderation, with TV and radio presenter, Adrian Chiles, documenting his experience of moderating alcohol consumption in an online article for the Guardian. By analysing the comments in response to Chiles' article, this study aimed to explore (i) posters' (someone who has posted a comment in response to the article) attitudes or beliefs toward moderating alcohol and (ii) posters' experiences of moderating or abstaining from alcohol.

Method

A secondary qualitative analysis of online comments in response to an article about moderating alcohol consumption. Main outcome measures: Comments (n = 784) in response to a United Kingdom online news article about moderating alcohol consumption were extracted and inductive thematic analysis was used.

Results

For aim one, two themes were developed; "general attitudes toward drinking" and "general attitudes toward reducing consumption". These themes reflect negative perceptions of alcohol and issues around changing attitudes. For aim two, three themes were developed: "moderation vs. abstention", "reflection on past drinking behaviours", and "current drinking behaviours". These themes represent posters' experiences and implications changing their drinking habits.

Conclusion

Our analysis provides a novel insight into perceptions and experiences of moderating or abstaining from alcohol. Alcohol is embedded within United Kingdom culture, creating difficulties for those who choose to moderate or abstain from alcohol. Our analysis highlights the need for public health to focus on shifting the current drinking culture, through clearer drinking guidelines and a wider availability of alcohol-free alternatives.

Non-Drinkers' Experiences of Drinking Occasions: A Population-Based Study of Social Consequences of Abstaining from Alcohol

BACKGROUND

People should be able to quit or moderate their drinking without negative social consequences, but studies have shown how nondrinkers often face pressure and negative reactions. As previous research has mostly focused on youth, we conducted a population-level study of the ways adult nondrinkers encounter their drinking companions on drinking occasions and what kinds of reactions they perceive from their social environments.

METHOD

The data were based on the Finnish Drinking Habits Survey (FDHS), a general population survey of Finns aged 15-79 collected in 2016 (N = 2,285; 330 nondrinkers; response rate 60%). Characteristics of drinking occasions where nondrinkers participate ("non-drinking occasions") were measured through self-reports of frequency, time, purpose, and social companion on those occasions. Nondrinkers' experiences of non-drinking occasions and reactions from the social environment were measured by question batteries on social consequences.

RESULTS

Compared with drinking occasions, non-drinking occasions occurred more often at family events at home than on late-night drinking occasions. Accordingly, nondrinkers reported relatively low levels of negative consequences, and the reported consequences were least frequent in the oldest age group. Nondrinkers reported mostly positive feedback from people around them, more often from family members than from peers. However, negative consequences were reported in all studied groups, most commonly among youth and former drinkers.

CONCLUSIONS

The study indicates that nondrinkers' social environments may be more supportive than what has been suggested previously, yet coping mechanisms are required especially from youth and former drinkers. The positive social experiences of being a nondrinker should guide the promotion of moderate and non-drinking.

'You see the pictures the morning after and you're like I wish I was in them': an interpretative phenomenological analysis of university student's alcohol-related regrets

OBJECTIVES

University students report experiencing regrettable health and social outcomes following excessive alcohol consumption. Students also report experiencing regret when they are unable to attend drinking events. This study explored how such experiences influence risk appraisals and decisions about future alcohol consumption.

DESIGN AND MEASURES

Thirteen university students (69% female, 18-20 years old) discussed the interplay of regret with alcohol consumption, and nonattendance at drinking events, in one of three focus groups. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

IPA produced three super-ordinate themes: 'It's not something I would have done sober', 'Attitudes towards action regret' and 'Fear of Missing Out (FoMO)'. Participants reported regrettable experiences (e.g. alcohol poisoning, tattoos), and a gender difference in risk appraisals was apparent. Attitudes towards action regret affected risk appraisals and informed future drinking decisions. Participants reported experiencing FoMO when they were unable to attend drinking events.

CONCLUSION

Regrettable incidents following excessive consumption were seen as common but did not affect risk appraisals or future drinking decisions. Students' reported they preferred the regrettable experiences that follow excessive consumption than the FoMO experienced when they were unable to attend drinking events, suggesting FoMO may drive attendance at future drinking events.

Where and What You Drink Is Linked to How Much You Drink: An Exploratory Survey of Alcohol Use in 17 Countries

This paper aimed to explore the differences in subjective experiences of intoxication depending on drinking location and drink type. Methods: Data came from 32,194 respondents to The Global Drug Survey (GDS) 2015, an annual, cross-sectional, online survey. Respondents selected their usual drinking location (home alone: home with partner/family: house parties: pubs/bars or clubs) and usual drink (wine; beer/cider/lager; spirits or alcopops/coolers). They indicated how many drinks they required to reach three stages of intoxication (feeling the effects; an ideal stage of intoxication; and the tipping point) and how frequently they reached each stage. Results: Drink type affected grams of alcohol reported to reach the tipping point: 109 gm wine, 127 gm alcopops, 133 gm of beer, and 134 gm of spirts. Respondents who drank at home alone, or in clubs reached their tipping point more frequently compared to other locations. Conclusions: Where people drink, and the type of alcohol they drink, affected the amount of alcohol reported to reach different stages of intoxication. Understanding why different drinking locations, and drink types lead to a need for greater consumption to reach an ideal state of drunkenness, such as social cues from other people who drink, may enable people to reduce their drinking.

Peer pressure and alcohol consumption in adults living in the UK: a systematic qualitative review

Background

Peer pressure to drink alcohol may influence excessive alcohol consumption, which can have adverse impacts on health and wellbeing. While peer pressure to drink alcohol is extensively studied among youth, less examination exists among adults. This systematic review examined qualitative research studies which explored the role and concept of peer pressure within the context of alcohol consumption in adults living in the UK.

Methods

Qualitative studies which explored peer pressure within the context of alcohol consumption or alcohol related behaviours and views in adults (age range approximately 18–52 years) living in the UK were included. Systematic searches conducted in Medline, PsycINFO and Web of Science identified 1462 references, of which 13 studies met inclusion criteria. Thematic analysis was conducted.

Results

Five overarching themes were identified. Four of these themes directly address aspects of peer pressure, including: experiences of peer pressure; consequences of peer pressure; strategies to deal with peer pressure; and conditions perceived to affect peer pressure. The fifth overarching theme explains the wider social context influencing peer pressure. Pressure to drink alcohol affects individuals across the life span and can be experienced as overt and aggressive, or subtle and friendly. Those consuming little or no alcohol are more likely to feel overt forms of peer pressure. Some developed strategies to cope with pressure from drinkers. Peer pressure can result in feelings of social isolation, or giving in by consuming alcohol against ones wishes.

Conclusion

Peer pressure to drink alcohol is a complex and multifaceted phenomenon experienced across adulthood requiring better understanding to support initiatives to decrease the impact of pressure-inducing environments and develop strategies to deal with perceived pressure conditions.

Trial Registration

The protocol for this review is registered with PROSPERO (CRD42019122201). Registered 11 February 2019

Resilience-based alcohol education: developing an intervention, evaluating feasibility and barriers to implementation using mixed-methods

Alcohol education must ensure that young people have appropriate information, motivation and skills. This article describes the fifth phase in a program of intervention development based on principles of social marketing and intervention mapping. The aim was to enhance drink refusal self-efficacy (DRSE) and help develop skills for non-drinking or moderate drinking. We conducted a mixed-methods feasibility trial that measured intervention effects among 277 UK secondary school students aged 14-16, and used qualitative methods to explore four teachers' experiences of delivering the intervention. The intervention did not produce the desired changes in DRSE or alcohol use, but nor did it increase alcohol use. In the qualitative process evaluation, time constraints, pressure to prioritize other topics, awkwardness and embarrassment were identified as barriers to fidelitous delivery. A more intense and/or more prolonged intervention delivered with greater fidelity may have produced the desired changes in DRSE and alcohol use. This study illustrates how principles of social marketing and intervention mapping can aid development of resilience-based education designed to help students develop skills to drink moderately, or not drink. It also highlights the need to consider the constraints of micro-social (school) and macro-social (societal) cultures when designing alcohol education.

Voices of Temporary Sobriety - A Diary Study of an Alcohol-Free Month in Hungary

Background: Temporary abstinence from alcohol as a challenge could support self-knowledge, self-care, and health consciousness in several ways. Objectives: The present study explored Dry November participants' personal experiences and coping strategies during a one-month abstinence period. The research is embedded in the Hungarian context of drinking habits, culture, society, and alcohol policy. Methods: This qualitative study comprised the thematic analysis of 23 participants' diaries, reported twice a week for 30 days (in November 2017), to identify and understand the common experiences of temporary sobriety. Results: Three main themes emerged from the analysis: challenge, community, and relationship toward alcohol and abstinence. Results showed that there are no categorical differences between successful and non-successful participants. Conclusions: The present research demonstrated that during the challenge, rather than simply saying 'no' to alcohol, participants utilized other refusal strategies to avoid social confrontation.

My own personal hell: approaching and exceeding thresholds of too much alcohol

Objectives: Government guidelines aim to promote sensible alcohol consumption but such advice is disconnected from people's lived experiences. This research investigated how people construct personal thresholds of 'too much' alcohol. Design and measures: One hundred fifty drinkers completed an online survey (M_age = 23.29(5.51); 64.7% female). Participants were asked whether they had an intuitive sense of what constitutes too much alcohol. They wrote open-ended descriptions of how that threshold had been established and how it felt to approach/exceed it. These qualitative accounts were coded using thematic analysis and interpreted with an experiential theoretical framework. Results: Personal thresholds were based on previously experienced embodied states rather than guidelines, or health concerns. Describing the approach to their threshold, 75% of participants fell into two distinct groups. Group 1's approach was an entirely negative embodied experience (nausea/anxiety) and Group 2's approach was an entirely positive, embodied experience (relaxed/pleasurable). These groups differed significantly in awareness of alcohol's effects, agency and self-perceptions, but not on alcohol consumption. Exceeding their threshold was an entirely negative embodied experience for all. Conclusion: These findings illustrate that people are guided by experientially grounded conceptions of consumption. Interventions could target different groups of drinker according to their embodied experience during the approach to 'too much' alcohol.

Exploration of young adults' influences on, and consequences of, avoiding alcohol consumption

BACKGROUND

There is a wealth of research on motives for alcohol consumption among young people. However, little is known about motives to avoid alcohol in this population.

OBJECTIVES

The study purpose was to explore what influences young adults' decisions to avoid alcohol and their motives to avoid alcohol.

METHODS

Face-to-face, semi-structured, one-on-one interviews were conducted in 2015 with young adults (n = 30, M_age = 21.13 years, SD = 2.05) living in Australia who did not consume alcohol regularly. Interviews were analyzed using thematic content analysis.

RESULTS

Thematic analysis resulted in seven themes: being in control; avoiding negative health consequences; taste; socialization influences; being left out; peer pressure; strategies to curb excessive alcohol consumption. Conclusions/Importance: Findings from the present study contribute to the literature in identifying coping strategies that participants adopted when faced with questions concerning their abstinence. The data provide evidence that, even in a minority, strong identities and beliefs appear to be a robust means to counteract pressure to conform to the social norm to consume alcohol. Findings may inform the (1) development of youth-centered interventions that target values and social norms to help build resistance to pressures to consume alcohol from peers and the wider community and (2) creation of opportunities and promotion of activities that are fun and alcohol free.

I Am Quite Mellow But I Wouldn't Say Everyone Else Is": How UK Students Compare Their Drinking Behavior to Their Peers'

BACKGROUND

Excessive drinking is commonplace at UK Universities. Individuals may misperceive how much they drink compared to others and are less likely to think that they will suffer adverse consequences. Young people often distance themselves and their friends from 'problem drinkers'.

OBJECTIVES

The aim of the study was to explore how student drinkers compared their own drinking behaviors to the drinking behaviors of others.

METHODS

An online survey was completed by 416 students aged 18-30 (68.5% female). They were asked 'how do you think your drinking compares with other people like you?' and 'how do you think your behavior when you drink compares with other people like you?' Answers were subjected to thematic analysis.

RESULTS

The first main theme was about 'identification as a 'good' drinker'. Participants suggested their own behavior when drinking was similar to their sober behavior. Further, they viewed themselves as more able to maintain a balance between staying in control and having fun while drinking. The second main theme was about 'distancing from being a 'bad' drinker. Participants distanced themselves from negative prototypical drinkers, such compulsive or anti-social drinkers. They also attributed their own drinking behaviors to situational factors, but described other people as intentionally violent or aggressive. Conclusions/Importance: These findings may explain the failure of some health messages to change drinking behaviors. If drinkers perceive that their behavior when they drink is better than other people's then they may discount intervention messages. Targeting these biases could be incorporated into future interventions.

Benefits and drawbacks of social non-drinking identified by British university students

INTRODUCTION AND AIMS

Promoting the benefits of not drinking alcohol during social occasions where other peers may be drinking ('social non-drinking') may support more moderate drinking among young people. We analysed free-text responses from university students to gauge the frequency/focus of identified benefits of, and drawbacks to, social non-drinking. We also assessed whether/how identified benefits and drawbacks were associated with recent drinking behaviour and psychological correlates of harmful drinking.

DESIGN AND METHODS

Secondary data analyses were conducted on 511 free-text responses provided by students participating in a health intervention. Template analysis was used to identify potential benefits of social non-drinking. Links between responses relating to social non-drinking and behavioural/psychological measures were assessed.

RESULTS

46.2% of female students and 42.0% of male students had engaged in social non-drinking in the previous week. Overarching benefits of social non-drinking included: improved physical and psychological health; increased self-esteem/agency; a higher quality social life and having a more stable/productive life. Hostility/ambivalence to social non-drinking was evident in 26.6% of responses. Among women only, endorsing higher self-esteem and agency as a benefit of social non-drinking was associated with increased intention to heed government drinking recommendations (β = 0.10, P = 0.036).

DISCUSSION AND CONCLUSIONS

Focus on social non-drinking may help encourage more moderate drinking among young people by articulating positives of social non-drinking while raising awareness of a changing normative context in which non-drinking is increasingly more common among young people.