Students Who Limit Their Drinking, as Recommended by National Guidelines, Are Stigmatized, Ostracized, or the Subject of Peer Pressure: Limiting Consumption Is All But Prohibited in a Culture of Intoxication

Drinker's own drinking, experience of alcohol-related harms, and concern for drinking predict drinker's attitudes towards non-drinkers

OBJECTIVE

While the stigma experienced by non-drinkers is well-documented, little is known about the factors that influence it. This study aims to test a sequential mediation model in which the amount of alcohol consumed by a drinker, predicts their experienced alcohol-related harm, which in turn predicts the concern they have for drinking and their negative attitudes towards non-drinkers.

METHODS

A sample of 787 Australian drinkers (Mage = 38.4 years, SD = 11.4) completed online measures of alcohol consumption, alcohol-related harms, concern for drinking and the Cheers Attitudes towards Non-drinker Scale (CANS): a scale that measures the negative attitudes toward non-drinkers via three threats non-drinkers are perceived to pose to drinkers (Threat to Fun, Connection, and Self).

RESULTS

The model was shown to be a good fit and demonstrated a sequential mediation with significant indirect effects from alcohol consumption via experienced alcohol-related harms and concern, to each CANS subscale: Threat to Self (β = 0.402, p < 0.001), Fun (β = 0.096, p = 0.006) and Connection (β = 0.165, p < 0.001).

CONCLUSION

The findings suggest that the stigma directed at non-drinkers may be enacted as a defence against an unwanted self-reflection from a drinker's concern for their own drinking.

Development and Validation of the Cheers Attitudes towards Non-drinkers Scale (CANS)

Non-drinkers report experiencing stigma, which can act as a barrier to non-drinking. Two studies were undertaken to develop and test a new scale to measure attitudes towards non-drinkers. In Study 1, 29 items were presented to 426 Australian drinkers. In Study 2, the refined 12-item Cheers Attitudes to Non-drinkers Scale (CANS) was presented to 389 drinkers. Alcohol consumption, Harm and the Regan Attitudes towards Non-drinkers Scale (RANDS) were presented for scale validation. Exploratory factor analysis revealed three factors representing the Threats to Fun, Connection and Self that drinkers perceive non-drinkers to pose. Confirmatory factor analysis showed that the scale meets the required fit indices and had good reliability (α = 0.842). Evidence of validity was shown through significant correlations with Alcohol Consumption, Harm and the RANDS. These studies show the CANS to be a reliable and valid measure that could be utilised to understand and modify the stigma experienced by non-drinkers.

"Drunk People Are on a Different Level": A Qualitative Study of Reflections From Students About Transitioning and Adapting to United Kingdom University as a Person Who Drinks Little or No Alcohol

BACKGROUND

Though sobriety in young people is on the rise, students who drink little or no alcohol may experience social exclusion at University, impacting well-being. We aim to understand the social experiences of United Kingdom (UK) undergraduate students who drink little or no alcohol.

METHODS

A mixed-methods study using semi-structured, one-to-one interviews and the 24-Item Social Provisions Scale and Flourishing Scale with 15 undergraduate students who drink little or no alcohol. Descriptive statistics are presented for quantitative data and thematic analysis for qualitative.

RESULTS

Eight main themes and four subthemes were generated from thematic analysis summarised in two sections 'views of drinkers from non-drinkers' and 'how peer pressure feels and how people deal with it.' The initial transition to University represented a challenge, where participants struggled to find their 'true' friends. However, students generally had high levels of social provision, well-being and enjoyed close friendships with fewer casual acquaintances. All students experienced some kind of peer pressure (of a varying extremity) and developed coping strategies when in social situations involving alcohol. Fear of missing out on the 'typical' University experience heightened self-imposed expectations to drink. Despite participants acknowledging their counter-normative behaviour, some felt they were subject to stigmatisation by drinkers, doubting their non-drinker status, causing feelings of exclusion or being 'boring.' Their desire to 'be like everyone else' exposed some insight into the negative stereotypes of sobriety, including frustration behind alcohol's status elevation.

CONCLUSION

Students adopt strategies to minimise peer pressure and to fit in. Future research should interrogate drinkers' perceptions of their sober peers to deepen understanding, better break down 'us and them,' and mitigate future expectations within the University drinking culture.

Educational level and alcohol use in adolescence and early adulthood-The role of social causation and health-related selection-The TRAILS Study

Both social causation and health-related selection may influence educational gradients in alcohol use in adolescence and young adulthood. The social causation theory implies that the social environment (e.g. at school) influences adolescents' drinking behaviour. Conversely, the health-related selection hypothesis posits that alcohol use (along other health-related characteristics) predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as drinking may be both a cause and consequence of low educational attainment. Furthermore, educational gradients in alcohol use may reflect the impact of 'third variables' already present in childhood, such as parental socioeconomic status (SES), effortful control, and IQ. We investigated social causation and health-related selection in the development of educational gradients in alcohol use from adolescence to young adulthood in a selective educational system. We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level and drinking at ages around 14, 16, 19, 22, and 26 years (waves 2 to 6). First, we evaluated the directionality in longitudinal associations between education and drinking with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of childhood characteristics around age 11 (wave 1), i.e. IQ, effortful control, and parental SES, both as confounders in these associations, and as predictors of educational level and drinking around age 14 (wave 2). In fixed effects models, lower education around age 14 predicted increases in drinking around 16. From age 19 onward, we found a tendency towards opposite associations, with higher education predicting increases in alcohol use. Alcohol use was not associated with subsequent changes in education. Childhood characteristics strongly predicted education around age 14 and, to a lesser extent, early drinking. We mainly found evidence for the social causation theory in early adolescence, when lower education predicted increases in subsequent alcohol use. We found no evidence in support of the health-related selection hypothesis with respect to alcohol use. By determining initial educational level, childhood characteristics also predict subsequent trajectories in alcohol use.

A Revised Framework for the Investigation of Expectation Update Versus Maintenance in the Context of Expectation Violations: The ViolEx 2.0 Model

Expectations are probabilistic beliefs about the future that shape and influence our perception, affect, cognition, and behavior in many contexts. This makes expectations a highly relevant concept across basic and applied psychological disciplines. When expectations are confirmed or violated, individuals can respond by either updating or maintaining their prior expectations in light of the new evidence. Moreover, proactive and reactive behavior can change the probability with which individuals encounter expectation confirmations or violations. The investigation of predictors and mechanisms underlying expectation update and maintenance has been approached from many research perspectives. However, in many instances there has been little exchange between different research fields. To further advance research on expectations and expectation violations, collaborative efforts across different disciplines in psychology, cognitive (neuro)science, and other life sciences are warranted. For fostering and facilitating such efforts, we introduce the ViolEx 2.0 model, a revised framework for interdisciplinary research on cognitive and behavioral mechanisms of expectation update and maintenance in the context of expectation violations. To support different goals and stages in interdisciplinary exchange, the ViolEx 2.0 model features three model levels with varying degrees of specificity in order to address questions about the research synopsis, central concepts, or functional processes and relationships, respectively. The framework can be applied to different research fields and has high potential for guiding collaborative research efforts in expectation research.

Justifications for heavy alcohol use among gender and sexually diverse people

A range of research reports that many gender and sexually diverse people drink alcohol at heavy levels. This study used 24 focus groups to explore shared understandings of alcohol use among gender and sexually diverse people living in New Zealand. An inductive, data-driven thematic analysis was employed to identify explanations for heavy drinking among gender and sexually diverse people. Three key explanations were articulated: alcohol is needed for socialising; drinking helps coping with stress; alcohol and drug treatment services are inadequate. These results demonstrate justifications for heavy drinking in certain contexts. This behaviour runs counter to public health approaches and messages that highlight low-risk levels of drinking or not drinking as desirable. Public health interventions should continue to address alcohol use at a whole population level but should be supplemented by policy and interventions that take into account the sociocultural contexts and structural conditions that encourage drinking among gender and sexually diverse people.

"Have a little less, feel a lot better": Mixed-method evaluation of an alcohol intervention

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A multimedia campaign encouraging men to drink less produced changes in alcohol use.

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Men appreciated the straightforward message and friendly tone of the campaign.

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There is also a need to develop the necessary behavioural skills for behaviour change.

The aim of the mixed-methods study reported here was to evaluate the impact of a “gain-framed”, multimedia campaign to encourage heavier drinking men aged 45–64 years to drink less. Quantitative analyses were based on pre-intervention panel surveys of 3057 men in intervention regions and 500 in the control region, and post-intervention panel surveys of 1508 men in intervention regions and 219 in the control region. Qualitative analyses entailed thematic analysis of interviews with 14 men: five who had reduced their drinking after seeing the campaign, four who had considered reducing but did not, and five who did not consider changing. Interviews focused on men’s responses to the campaign, and their ideas for how to improve it. In quantitative analyses, the campaign was associated with significant changes in alcohol consumption, and significant increases in readiness to change and likelihood of using moderate drinking strategies. In qualitative analyses, men appreciated the friendly, non-threatening tone and that the message was straightforward, meaningful, achievable, and was gain-framed - i.e., emphasised the benefits of drinking less rather than the harms of drinking too much. However, the men who did not change their behaviour also identified several barriers to responding in ways encouraged by the message. It would be important to address their views of their drinking as not problematic, as pleasurable, and as socially expected, and also their sense of not feeling empowered to initiate or maintain behaviour change.

Control of Recreational Cannabis in a New Zealand University Sample: Perceptions of Informal and Formal Controls

An increasing number of countries have, or are moving towards, reforming cannabis policies. New Zealand is also moving in this direction and the government will hold a referendum on the legalization of recreational cannabis in September 2020. To inform imminent public and political discussions it is important to understand how current cannabis use is controlled. Research suggests that cannabis law has been ineffective in NZ. Internationally, informal controls, rather than the law, have been found to shape cannabis use by creating a threshold for normalization, but the attitudes shaping this threshold are unknown. This study aimed to examine drug acceptability attitudes, specifically students' attitudes towards the illegal use of cannabis and their attitudes towards peers who abstain, sometimes use, or are heavy users of cannabis, to identify the factors that control cannabis use. Using a mixed methods approach, university students recruited their peers (N = 535) to complete a pen and paper survey investigating perceptions towards 3 cannabis user prototypes (abstainers, moderate users, heavy users), concern for legality of cannabis use, and the integration of cannabis into the student culture (perceptions of peers' use, ease of acquisition, and availability). Perceptions of peers' lifetime and regular use were 82% and 38.5%, respectively. Participants rated cannabis as easy to acquire and likely to be available at a typical student social occasion. The majority stated that the law does not deter use (92.7%); participants perceived the law to be soft and that they are unlikely to get caught. Participants' descriptions of the 3 cannabis user prototypes revealed a threshold for normalization. For instance, abstaining was perceived to be associated with positive attributes (such as being studious), linked to being less sociable, and linked to being less likely to be judged. Moderate use of cannabis was perceived to be normal and sociable. Heavy use was perceived to be associated with having negative attributes, such as being addicted, unhealthy, and an underachiever, and negative drug labels. Our findings revealed that cannabis use is not controlled by the law, but by informal thresholds of control. Moderate cannabis use is accepted whereas heavy cannabis use is not. We extended research by identifying the attitudes shaping these thresholds, in particular that negative outcomes associated with heavy use deters the normalization of this behavior. We argue that policy must be informed by, and build on, these informal controls. The negative perceptions associated with heavy use also raise concerns regarding the well-being of heavy users, and coupled with the ineffectiveness of cannabis law, lend support towards a health model for regulating cannabis. Furthermore, insights into the negative perceptions associated with heavy use could inform health interventions on the types of concerns that will resonate with users.

The 'sober eye': examining attitudes towards non-drinkers in Australia

BACKGROUND

The proportion of Australians who choose not to drink alcohol has increased in recent years; yet, non-drinkers report experiences of stigma and judgement from peers for this choice. This study aimed to explore the attitudes that exist towards non-drinkers and examine what drives this stigma.

METHOD

Thematic analysis of four focus groups was undertaken, comprising 37 drinking and non-drinking Australian adults.

RESULTS

Three themes were identified that elucidate the stigma, with non-drinkers being perceived as a: (1) threat to fun, a judgemental 'sober eye' disrupting the desired hedonistic environment created by alcohol, (2) threat to connection, described as difficult to initiate and maintain a social connection with and (3) threat to self, with the presence of a non-drinker described by drinkers as encouraging an unwanted reflection on the problematic aspects of their own drinking. Participant responses also suggested that the gender of the non-drinker influenced these perceptions.

CONCLUSION

Through the lens of Integrated Threat Theory, this study proposes that the stigma experienced by non-drinkers may be understood as a response to threats non-drinkers are perceived to pose to drinkers' group values (e.g. hedonism) and self-esteem. This study offers new direction for health promotion efforts to challenge negative perceptions of non-drinkers.

Adult low-risk drinkers and abstainers are not the same

Background

Alcohol consumption, even at low-levels, can not be guaranteed as safe or risk free. Specifically, the 2009 Australian National Health and Medical Research Council drinking guidelines recommend that adults should not drink more than two standard drinks on any day on average, and no more than four drinks on a single occasion. Nearly 40% of Australians aged 12 years and older drink alcohol but don’t exceed these recommended limits, yet adult low-risk drinkers have been largely overlooked in Australian alcohol survey research, where they are usually grouped with abstainers. This paper examines the socio-demographic profile of low-risk drinking adults (18+ years old), compared to those who abstain.

Methods

Data from the 2013 National Drug Strategy Household Survey were used. In the past 12 months, 4796 Australians had not consumed alcohol and 8734 had consumed alcohol at low-risk levels, accounting for both average volume and episodic drinking (hereafter low-risk).

Results

Multivariate logistic regression results indicated that low-risk drinkers were more likely to be older, married, Australian-born, and reside in a less disadvantaged neighbourhood compared with abstainers. There was no significant difference by sex between low-risk drinkers and abstainers.

Conclusions

The socio-demographic profile of low-risk drinkers differed from that of abstainers. Combining low-risk drinkers and abstainers into a single group, which is often the practice in survey research, may mask important differences. The study may support improved targeting of health promotion initiatives that encourage low-risk drinkers not to increase consumption or, in view of increasing evidence that low-risk drinking is not risk free, to move towards abstinence.