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Morris J, Tattan-Birch H, Albery IP, Heather N, Moss AC. Look away now! Defensive processing and unrealistic optimism by level of alcohol consumption. Psychol Health 2024:1-19. [PMID: 38379336 DOI: 10.1080/08870446.2024.2316681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or 'defensive processing', may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption. DESIGN Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and demographics. RESULTS AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson's correlation r from.16 to .36), threat and susceptibility (r = .16) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = -0.48). CONCLUSION People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
| | | | - I P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - N Heather
- University of Northumbria, Newcastle upon Tyne, United Kingdom
| | - A C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, United Kingdom
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2
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Müller CP, Schumann G, Rehm J, Kornhuber J, Lenz B. Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment. Mol Psychiatry 2023; 28:2683-2696. [PMID: 37117460 PMCID: PMC10615763 DOI: 10.1038/s41380-023-02074-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/30/2023]
Abstract
Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.
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Affiliation(s)
- Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia.
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Gunter Schumann
- The Centre for Population Neuroscience and Stratified Medicine (PONS), ISTBI, Fudan University, Shanghai, China
- PONS Centre, Charite Mental Health, Department of Psychiatry and Psychotherapie, CCM, Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Bernd Lenz
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
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3
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Problem drinking recognition among UK military personnel: prevalence and associations. Soc Psychiatry Psychiatr Epidemiol 2023; 58:193-203. [PMID: 35661230 PMCID: PMC9922231 DOI: 10.1007/s00127-022-02306-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Despite the higher prevalence of problem drinking in the UK military compared to the general population, problem recognition appears to be low, and little is known about which groups are more likely to recognise a problem. This study examined prevalence of problem drinking recognition and its associations. METHODS We analysed data from 6400 regular serving and ex-serving personnel, collected in phase 3 (2014-2016) of the King's Centre for Military Health Research cohort study. MEASUREMENTS Participants provided sociodemographic, military, health and impairment, life experiences, problem drinking, and problem recognition information. Problem drinking was categorised as scores ≥ 16 in the AUDIT questionnaire. Associations with problem recognition were examined with weighted logistic regressions. FINDINGS Among personnel meeting criteria for problem drinking, 49% recognised the problem. Recognition was most strongly associated (ORs ≥ 2.50) with experiencing probable PTSD (AOR = 2.86, 95% CI = 1.64-5.07), social impairment due to physical or mental health problems (AOR = 2.69, 95% CI = 1.51-4.79), adverse life events (AOR = 2.84, 95% CI = 1.70-4.75), ever being arrested (AOR = 2.99, CI = 1.43-6.25) and reporting symptoms of alcohol dependence (AOR = 3.68, 95% CI = 2.33-5.82). To a lesser extent, recognition was also statistically significantly associated with experiencing psychosomatic symptoms, feeling less healthy, probable common mental health disorders, and increased scores on the AUDIT. CONCLUSION Half of UK military personnel experiencing problem drinking does not self-report their drinking behaviour as problematic. Greater problem drinking severity, poorer mental or physical health, and negative life experiences facilitate problem recognition.
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de Graaf L, Roelofs T, Janssen M, Luijkx K. Live and let live: Residents' perspectives on alcohol and tobacco (mis)use in residential care facilities. Int J Older People Nurs 2023; 18:e12508. [PMID: 36229901 PMCID: PMC10078196 DOI: 10.1111/opn.12508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/10/2022] [Accepted: 09/13/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Alcohol and tobacco use could cause health problems in older adults. Older adults who become in need of 24/7 care due to physical and/or neurological disabilities may need to move to a Residential Care Facility (RCF). RCFs aim to provide person-centred care (PCC) to enhance quality of life (QoL) of residents. OBJECTIVES This study aims to explore perspectives of residents on alcohol and tobacco use, which is essential to provide PCC. METHODS A qualitative research design was chosen, and semi-structured interviews were conducted. Residents who use alcohol and/or tobacco and those who do not use these substances were purposively selected in two organisations on two types of units: psychogeriatric units and units providing care for residents with mainly physical disabilities. The results were analysed using thematic analysis. RESULTS Thematic analysis resulted in five themes: Current use and self-reflection, knowledge and attitudes, addiction or habit, policies and availability, dependency versus autonomy. CONCLUSION Residents in this study value their autonomy regarding alcohol and tobacco use. They experience dependency on their (in)formal caregivers to use these substances and acknowledge that their use could cause a nuisance to others, challenging the ability of caregivers to implement PCC. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health and safety risks for all. IMPLICATIONS FOR PRACTICE This study could help care professionals to become aware of the habits and wishes of residents regarding alcohol and tobacco use and to discuss the possibilities and limitations within RCFs.
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Affiliation(s)
- Lisette de Graaf
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Mijzo, Waalwijk, The Netherlands
| | - Tineke Roelofs
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Mijzo, Waalwijk, The Netherlands
| | - Meriam Janssen
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Katrien Luijkx
- Department of Tranzo, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Larsen J, Christmas S, Souter A. Perceptions of alcohol health harm among midlife men in England: a qualitative interview study. HEALTH, RISK & SOCIETY 2022. [DOI: 10.1080/13698575.2022.2138833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- John Larsen
- Independent Researcher (Previously Director of Evidence and Impact at Drinkaware, UK)
| | - Simon Christmas
- Independent Researcher (Previously Director of Evidence and Impact at Drinkaware, UK)
| | - Amanda Souter
- Independent Researcher (Previously Director of Evidence and Impact at Drinkaware, UK)
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Social capital and alcohol risks among older adults (50 years and over): analysis from the Drink Wise Age Well Survey. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Although there has been significant research on the relationship between alcohol consumption and demographic and psychological influences, this does not consider the effect of social influence among older drinkers and if these effects differ between men and women. One aspect of social influence is social capital. The aim of this paper is to examine whether relational and cognitive social capital are associated with higher or lower risk of alcohol use among adults aged 50 years or older and to assess the extent to which this relationship differs between men and women. To investigate this, data were collected from a cross-sectional questionnaire survey of adults over the age of 50 in the United Kingdom who were recruited from general practitioners. The sample consisted of 9,984 individuals whose mean age was 63.87 years. From these data, we developed proxy measures of social capital and associate these with the respondent's level of alcohol consumption as measured on the Alcohol Use Disorders Identification Test (AUDIT-10) scale. In the sample, just over 20 per cent reported an increasing risk or dependency on alcohol. Using two expressions of social capital – relational (social relationships) and cognitive (knowledge acquisition and understanding) – we found that greater levels of both are associated with a reduced risk of higher drinking risk. Being female had no significant effect when combined with relational capital but did have a significant effect when combined with cognitive capital. It is argued that interventions to enhance social relations among older people and education to help understand alcohol risks would be helpful to protect older people from the damaging effects of excessive alcohol consumption.
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7
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Emiliussen J, Engelsen S, Christiansen R, Nielsen AS, Klausen SH. Alcohol in long-term care homes: A qualitative investigation with residents, relatives, care workers and managers. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:414-433. [PMID: 35308816 PMCID: PMC8900185 DOI: 10.1177/14550725211018113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 04/28/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Western societies are aging rapidly, and habitual use of alcohol is changing among older adults. Hence, care facilities are facing novel challenges regarding alcohol use. This pioneering qualitative study seeks to investigate the role of alcohol in care homes, as seen from the perspectives of residents, care workers, relatives, and institution management simultaneously. Method Five residents, four care workers, three relatives, and two care home managers participated in semi-structured interviews lasting 60 minutes maximum. An interpretative phenomenological analysis framework were utilised for the analysis. Results It seems that there is a positive attitude towards the use of alcohol in care homes across the four groups of participants. They find that the use of alcohol is presently low among the residents. Importantly there appears to be an important symbolic value in the rituals surrounding alcohol which is upheld by all four groups. Conclusion While experiences between the four groups seem to converge regarding the use of alcohol, there are still some important differences. Importantly, we suggest that these unique views be utilised in developing methods for handling alcohol use in care homes in the future.
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Affiliation(s)
- Jakob Emiliussen
- University of Southern Denmark, Odense, Denmark; Department of Psychiatry, Region of Southern Denmark, Odense, Denmark; and Odense University Hospital, Odense, Denmark
| | | | | | - Anette Søgaard Nielsen
- University of Southern Denmark, Odense, Denmark; and Department of Psychiatry, Region of Southern Denmark, Odense, Denmark
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8
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Kersey K, Lyons AC, Hutton F. Alcohol and drinking within the lives of midlife women: A meta-study systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103453. [PMID: 34653766 DOI: 10.1016/j.drugpo.2021.103453] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND A range of societal changes have created positive and encouraging environments for women's alcohol use. Within this context, in Western countries there is evidence of rising rates of alcohol consumption and related harms among midlife and older women. It is timely and important to explore the role of alcohol in the lives of midlife women to better understand observed data trends and to develop cohort specific policy responses. Focussing on Western countries and those with similar mixed market systems for alcohol regulation, this review aimed to identify 1) how women at midlife make sense of and account for their consumption of alcohol; 2) factors that play a role; and 3) the trends in theoretical underpinnings of qualitative research that explores women's drinking at midlife. METHODS A meta-study approach was undertaken. The review process involved extracting and analysing the data findings of eligible research, as well as reviewing the contextual factors and theoretical framing that actively shape research and findings. RESULTS Social meanings of alcohol were interwoven with alcohol's psycho-active qualities to create strong localised embodied experiences of pleasure, sociability, and respite from complicated lives and stressful circumstances in midlife women. Drinking was shaped by multiple and diverse aspects of social identity, such as sexuality, family status, membership of social and cultural groups, and associated responsibilities, underpinned by the social and material realities of their lives, societal and policy discourses around drinking, and how they physically experienced alcohol in the short and longer term. CONCLUSION For harm reduction strategies to be successful, further research effort should be undertaken to understand alcohol's diverse meanings and functions in women's lives and the individual, material, and socio-cultural factors that feed into these understandings. As well as broad policies that reduce overall consumption and "de-normalise" drinking in society, policy-makers could usefully work with cohorts of women to develop interventions that address the functional role of alcohol in their lives, as well as policies that address permissive regulatory environments and the overall social and economic position of women.
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Affiliation(s)
- Kate Kersey
- School of Health, Victoria University of Wellington, Kelburn Campus, Wellington, New Zealand.
| | - Antonia C Lyons
- School of Health, Victoria University of Wellington, Kelburn Campus, Wellington, New Zealand
| | - Fiona Hutton
- Institute of Criminology, Victoria University of Wellington, Kelburn Campus, Wellington, New Zealand
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9
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Bareham BK, Kaner E, Hanratty B. Managing older people's perceptions of alcohol-related risk: a qualitative exploration in Northern English primary care. Br J Gen Pract 2020; 70:e916-e926. [PMID: 33077511 PMCID: PMC7575405 DOI: 10.3399/bjgp20x713405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Risk of harm from drinking increases with age as alcohol affects health conditions and medications that are common in later life. Different types of information and experiences affect older people's perceptions of alcohol's effects, which must be navigated when supporting healthier decisions on alcohol consumption. AIM To explore how older people understand the effects of alcohol on their health; and how these perspectives are navigated in supportive discussions in primary care to promote healthier alcohol use. DESIGN AND SETTING A qualitative study consisting of semi-structured interviews and focus groups with older, non-dependent drinkers and primary care practitioners in Northern England. METHOD A total of 24 older adults aged ≥65 years and 35 primary care practitioners participated in interviews and focus groups. Data were analysed thematically, applying principles of constant comparison. RESULTS Older adults were motivated to make changes to their alcohol use when they experienced symptoms, and if they felt that limiting consumption would enable them to maintain their quality of life. The results of alcohol-related screening were useful in providing insights into potential effects for individuals. Primary care practitioners motivated older people to make healthier decisions by highlighting individual risks of drinking, and potential gains of limiting intake. CONCLUSION Later life is a time when older people may be open to making changes to their alcohol use, particularly when suggested by practitioners. Older people can struggle to recognise potential risks or perceive little gain in acting on perceived risks. Such perceptions may be challenging to navigate in supportive discussions.
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Affiliation(s)
- Bethany Kate Bareham
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Eileen Kaner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
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10
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Aubut V, Wagner V, Cousineau MM, Bertrand K. Problematic Substance Use, Help-Seeking, and Service Utilization Trajectories among Seniors: An Exploratory Qualitative Study. J Psychoactive Drugs 2020; 53:18-26. [PMID: 32990172 DOI: 10.1080/02791072.2020.1824045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Problematic substance use has a significant impact on the health of a large proportion of people aged 65 years and older. Along with population growth, there is an increase in seniors enrolling for treatment in Québec (Canada). This study explores the perspectives of older adults related to their substance use experiences, help-seeking and utilization of addiction treatment services. In-depth interviews were conducted with 11 seniors receiving addiction treatment in two area in Québec. Thematic analysis highlight that seniors' experiences, life contexts, and social participation influence their substance use. Help-seeking process can be triggered by realizing the extent of substance use, while barriers and facilitators shape this experience. Utilization of addiction treatment services was mainly perceived positively. Several characteristics and components of services enable seniors to have positive experiences. Substance use can be employed as an adaptation strategy to get through hardships or ease loneliness and boredom. Talking to people, such as family, friends or professionals, is important to older adults' developing trust and engaging in a process to change substance use habits. Based upon these results, clinical recommendations to take into account the complex needs of seniors seeking treatment and related to their social environment are formulated.
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Affiliation(s)
- Valérie Aubut
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC,Canada.,Recherche et intervention sur les substances psychoactives-Québec group, Université du Québec à Trois-Rivières - Centre universitaire de Québec, Trois-Rivières, QC, Canada
| | - Vincent Wagner
- Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC,Canada.,Recherche et intervention sur les substances psychoactives-Québec group, Université du Québec à Trois-Rivières - Centre universitaire de Québec, Trois-Rivières, QC, Canada.,Department of Community Health Sciences, Addiction Research Study Program, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Marthe Cousineau
- School of Criminology, Assistant Dean, Graduate Studies, Professional Training and Partners, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada
| | - Karine Bertrand
- Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC,Canada.,Recherche et intervention sur les substances psychoactives-Québec group, Université du Québec à Trois-Rivières - Centre universitaire de Québec, Trois-Rivières, QC, Canada.,Department of Community Health Sciences, Addiction Research Study Program, University of Sherbrooke, Sherbrooke, QC, Canada
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11
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Grossi A, Holmes A, Ibrahim JE. Use of Alcohol in Long Term Care Settings: A Comparative Analysis of Personal Choice, Public Health Advice and the Law. J Am Med Dir Assoc 2020; 22:9-14.e1. [PMID: 32980241 DOI: 10.1016/j.jamda.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 02/01/2023]
Abstract
Alcohol is one of the most widely available psychoactive substances globally. Many accept the risks associated with alcohol consumption for reasons such as social engagement and feelings of pleasure. Alcohol consumption in a nursing home (NH) setting highlights the moral and logistical challenges of balancing the need for a safe living and working environment with the dignity of risk (DoR) and personal autonomy of residents. This analysis explores public health, human rights, and legal frameworks in their approach to a NH resident's choice to drink alcohol. Key issues under the public health framework include the medical risks associated with alcohol consumption, whether residents with impaired cognitive functioning have the capacity to make a decision about alcohol consumption, and the practical and ethical implications of supplying alcohol to residents. Under a legal framework, NHs must consider the legal imperative to respect residents' rights, the possibility of liability in negligence, duties owed to employees, the existence of substitute decision-makers, and liquor licensing laws. Fundamental considerations under the human rights framework include the damaging psychological effects of risk-avoidance and the importance of inclusive risk assessment processes. Alcohol policies should incorporate elements from all 3 frameworks. There is limited data publicly available about alcohol policies in NHs. Further research is needed to establish current practice and to evaluate the merits and disadvantages of different policies. Establishing inclusive and thorough decision-making processes is key to achieving better consumer-directed care.
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Affiliation(s)
- Amelia Grossi
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Alice Holmes
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Joseph E Ibrahim
- Health Law and Aging Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.
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12
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Khadjesari Z, Stevenson F, Toner P, Linke S, Milward J, Murray E. 'I'm not a real boozer': a qualitative study of primary care patients' views on drinking and its consequences. J Public Health (Oxf) 2020; 41:e185-e191. [PMID: 29912419 DOI: 10.1093/pubmed/fdy067] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The public health message around alcohol is complex, with benefits versus harms, the confusing concept of risk and drinking guidance changing over time. This provides a difficult context for alcohol screening in primary care, with established barriers from the practitioner perspective, but less is known about the patients' perspective. This study explores patients' views on drinking. METHODS Eligible participants were recorded as drinking above low risk levels in primary care. Six practices in North London participated. Interviews were in-depth, semi-structured, transcribed verbatim and underwent detailed thematic analysis. FINDINGS Interviews were conducted with 8 women and 12 men, aged 26-83 years, mostly educated to undergraduate level and of 'White' ethnicity. UK drinking guidance was viewed as irrelevant for reasons related to life stage, lifestyle and absence of harm. Dependence, loss of functionality and control were perceived as key features of problematic drinking. Healthy lifestyles, in terms of diet, exercise and not smoking, were thought to mitigate potential problems associated with alcohol intake. CONCLUSION The findings suggest that public health messages and brief advice should focus on harm experienced at different life stages, among people with different lifestyles, to challenge the ubiquitous view that 'I'm not a real boozer'.
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Affiliation(s)
- Z Khadjesari
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK.,Centre for Implementation Science, Health Service and Population Research Department, King's College London, 16 De Crespigny Park, Camberwell, London, UK
| | - F Stevenson
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK
| | - P Toner
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, UK
| | - S Linke
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK.,Camden and Islington Mental Health Trust, 4 St Pancras Way, Kings Cross, London, UK
| | - J Milward
- Addictions Department, King's College London, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London, UK
| | - E Murray
- eHealth Unit, Primary Care and Population Health Research Department, University College London, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, UK
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13
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Morris J, Albery IP, Heather N, Moss AC. Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience. Addict Behav 2020; 105:106292. [PMID: 32007833 DOI: 10.1016/j.addbeh.2020.106292] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 11/18/2022]
Abstract
Low problem recognition may be an important barrier to opportunities for self-change or help-seeking in harmful drinkers. Little is known about how the beliefs harmful drinkers hold about the nature and causes of alcohol problems affect problem recognition and subsequent behaviour change processes. Participants (n = 597) recruited online were randomised to one of two conditions designed to promote beliefs according to (a) a continuum model of alcohol problems or (b) a binary disease model, or (c) a control condition. Participants completed measures of alcohol problem beliefs, problem recognition and other indices including the Alcohol Use Disorder Identification Test (AUDIT), addiction beliefs, addiction experience and demographics. Results showed that harmful drinkers without addiction experience exposed to the continuum condition had significantly higher problem recognition than those in binary disease model or control conditions. Continuum beliefs appear to offer self-evaluative benefits for harmful drinkers with low alcohol problem recognition, thus potentially facilitating help-seeking or self-change regarding alcohol use. Further research to understand the mechanisms by which continuum beliefs may promote more accurate drinking self-evaluation and its potential for behaviour change is warranted. The role of continuum beliefs may have important consequences for alcohol-related messaging and interventions seeking to promote self-change or help-seeking.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom.
| | - I P Albery
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - N Heather
- Faculty of Health & Life Sciences, Northumbria University, United Kingdom
| | - A C Moss
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
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Gough B, Madden M, Morris S, Atkin K, McCambridge J. How do older people normalise their drinking?: An analysis of interviewee accounts. Appetite 2020; 146:104513. [DOI: 10.1016/j.appet.2019.104513] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/15/2019] [Accepted: 11/09/2019] [Indexed: 11/15/2022]
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15
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Dare J, Wilkinson C, Traumer L, Kusk KH, McDermott ML, Uridge L, Grønkjaer M. "Women of my age tend to drink": the social construction of alcohol use by Australian and Danish women aged 50-70 years. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:35-49. [PMID: 31538364 DOI: 10.1111/1467-9566.12991] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In Australia and Denmark, women aged 50-70 years are more likely than younger women to consume alcohol at levels that exceed national low risk drinking guidelines. To explore and possibly help explain this sociocultural shift in patterns of alcohol use, this research investigated the social construction of alcohol use amongst 49 women (25 in Northern Denmark, 24 in Western Australia) aged 50-69 years. The women viewed drinking as normal and acceptable. While some women reported reducing their drinking due to health concerns, others neutralised alcohol-related health risks through compensatory behaviours including exercise. Such constructions arguably serve to sustain at-risk drinking amongst some women. Our research highlights that interventions to minimise alcohol-related health risks amongst middle-aged and young-old women should acknowledge that women's social construction of their drinking practices may prioritise subjective experiences of "being in control" while drinking, over biomedical understandings of the health impacts of alcohol.
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Affiliation(s)
- Julie Dare
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Celia Wilkinson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Curtin University, Bentley, WA, Australia
| | - Line Traumer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Kathrine H Kusk
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lynsey Uridge
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Mette Grønkjaer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Chapman J, Harrison N, Kostadinov V, Skinner N, Roche A. Older Australians' perceptions of alcohol-related harms and low-risk alcohol guidelines. Drug Alcohol Rev 2019; 39:44-54. [PMID: 31829473 DOI: 10.1111/dar.13022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/21/2019] [Accepted: 11/24/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND AIMS Australia has an ageing population. Given the concomitant increase in the numbers and proportion of risky drinkers among older adults, research examining contributory factors is a priority. The current study examined older adults' estimates of the NHMRC low-risk drinking guidelines, consumption patterns and associated harms and self-identification of drinking type. DESIGN AND METHODS Data from respondents aged 50+ years (N = 11 886) in the 2016 National Drug Strategy Household Survey were subjected to secondary analyses. Estimates of low-risk drinking levels, perceived level of harm from current drinking, self-identification of drinking type and awareness of standard drinks and labelling were included. Data were examined for those aged 50-59 years and 60+. RESULTS Seventeen percent of older Australians drank at both long-term and short-term risk levels. Approximately 39% of males and 11% of females overestimated the long-term low-risk levels and 54% of males and 20% of females overestimated the short-term low-risk levels. Overestimation was highest among risky drinkers. Most older risky drinkers were aware of standard drinks and labelling; however, less than half perceived their drinking as harmful, instead identifying as social drinkers. DISCUSSION AND CONCLUSIONS Although substantial gaps are evident in older respondents' estimates of low-risk drinking, additional public awareness campaigns are likely to be of limited use. Older peoples' engagement with the public health system presents 'windows of opportunity' to provide targeted, age-appropriate harm reduction strategies. Appropriate intervention and policy responses are required to direct resources to this emerging area of concern.
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Affiliation(s)
- Janine Chapman
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Nathan Harrison
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Victoria Kostadinov
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Natalie Skinner
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Ann Roche
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
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Madden M, Morris S, Stewart D, Atkin K, Gough B, McCambridge J. Conceptualising alcohol consumption in relation to long-term health conditions: Exploring risk in interviewee accounts of drinking and taking medications. PLoS One 2019; 14:e0224706. [PMID: 31697723 PMCID: PMC6837440 DOI: 10.1371/journal.pone.0224706] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/18/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Alcohol use is a major contributor to the burden of disease, including long-term non-communicable diseases. Alcohol can also interact with and counter the effects of medications. This study addresses how people with long term conditions, who take multiple medications, experience and understand their alcohol use. The study objective is to explore how people conceptualise the risks posed to their own health from their concurrent alcohol and medicines use. METHODS AND FINDINGS Semi-structured interviews were conducted with a sample of 24 people in the North of England taking medication for long term conditions who drank alcohol twice a week or more often. Transcripts were analysed using a modified framework method with a constructionist thematic analysis. Alcohol was consumed recreationally and to aid with symptoms of sleeplessness, stress and pain. Interviewees were concerned about the felt effects of concurrent alcohol and medicines use and sought ways to minimise the negative effects. Interviewees associated their own drinking with short-term reward, pleasure and relief. Risky drinking was located elsewhere, in the drinking of others. People made experiential, embodied sense of health harms and did not seem aware of, or convinced by, (or in some cases appeared resigned to) future harms to their own health from alcohol use. The study has limitations common to exploratory qualitative studies. CONCLUSIONS Health risk communication should be better informed about how people with long-term health conditions perceive health outcomes over time, and how they adopt experience-based safety strategies in contexts in which alcohol consumption is heavily promoted and weakly regulated, whilst medicines adherence is expected. Supporting people to make active and informed connections between medicines, alcohol and potential personal health harms requires more than a one-way style of risk communication if it is to be perceived as opening up rather than restricting choice.
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Affiliation(s)
- Mary Madden
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Stephanie Morris
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Duncan Stewart
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Karl Atkin
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
| | - Brendan Gough
- School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Jim McCambridge
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom
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18
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Parke H, Michalska M, Russell A, Moss AC, Holdsworth C, Ling J, Larsen J. Understanding drinking among midlife men in the United Kingdom: A systematic review of qualitative studies. Addict Behav Rep 2018; 8:85-94. [PMID: 30140728 PMCID: PMC6104518 DOI: 10.1016/j.abrep.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study reviews qualitative research into the sociocultural meanings and subjective experiences that midlife men in the United Kingdom (UK) associate with their drinking. In the UK, average weekly alcohol consumption is highest among midlife men, and they are disproportionately affected by alcohol harm. There is increasing recognition that public health messages to support behaviour change must be based on an in-depth understanding of drinking motivations and experiences. STUDY DESIGN AND METHODS Systematic literature review of studies exploring motivations for and experiences of drinking among UK men aged 45-60 using qualitative methodology. Medline, PsycINFO and the Social Science Citation Index were used, along with manual searches of key journals, Google searches and a call for evidence. The Critical Appraisal Skills Programme tool was used to quality-assess papers. Thematic synthesis was used to combine and analyse the data. RESULTS From 5172 titles and abstracts (1995-2018), 11 publications were included, representing 6 unique studies. Five themes were identified: 'Drinking Motivations'; 'Drinking Justifications'; 'Drinking Strategies and Control'; 'Social Norms and Identity' and 'Harm'. Motivations for drinking among midlife men were associated with relaxation, socialising and maintenance of male friendships. They justified drinking as a choice and emphasised their ability to meet responsibilities, which they contrasted with 'problem drinkers'. Social norms governed drinking behaviours as an expression of masculinity. CONCLUSION This review highlights the significance of the meanings and social importance of alcohol consumption among midlife men. Interventions using information and guidance should consider these when aiming to effectively influence the way this group drinks.
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Affiliation(s)
| | - Monika Michalska
- Centre for Addictive Behaviours Research, London South Bank University, London, United Kingdom
| | | | - Antony C. Moss
- School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Clare Holdsworth
- School of Physical and Geographical Sciences, Keele University, Keele, United Kingdom
| | - Jonathan Ling
- Department of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, United Kingdom
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Bliuc AM, Doan TN, Best D. Sober social networks: The role of online support groups in recovery from alcohol addiction. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1002/casp.2388] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ana-Maria Bliuc
- School of Social Sciences and Psychology; Western Sydney University; Sydney Australia
| | - Tuyet-Ngan Doan
- School of Social Sciences and Psychology; Western Sydney University; Sydney Australia
| | - David Best
- Centre for Regional Economic and Social Research; Sheffield Hallam University; Sheffield UK
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Haighton C, Kidd J, O’Donnell A, Wilson G, McCabe K, Ling J. 'I take my tablets with the whiskey': A qualitative study of alcohol and medication use in mid to later life. PLoS One 2018; 13:e0205956. [PMID: 30335835 PMCID: PMC6193697 DOI: 10.1371/journal.pone.0205956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 10/04/2018] [Indexed: 01/11/2023] Open
Abstract
Background Concurrent alcohol and medication use can result in significant problems especially in mid to later life. Alcohol is often used instead of medication for a number of health-related conditions. This novel qualitative study explored concurrent alcohol and medication use, as well as the use of alcohol for medicinal purposes, in a sample of individuals in mid to later life. Methods Twenty-four interviews (12 men/12 women, ages 51–90 years) and three focus groups (n = 27, 6 men/21 women, ages 50–95 years) from three branches of Age UK and two services for alcohol problems in North East England. Results Older people in this study often combined alcohol and medication, frequently without discussing this with their family doctor. However, being prescribed medication could act as a motivating factor to stop or reduce alcohol consumption. Participants also used alcohol to self-medicate, to numb pain, aid sleep or cope with stress and anxiety. Some participants used alcohol to deal with depression although alcohol was also reported as a cause of depression. Women in this study reported using alcohol to cope with mental health problems while men were more likely to describe reducing their alcohol consumption as a consequence of being prescribed medication. Conclusions As older people often combine alcohol and medication, health professionals such as family doctors, community nurses, and pharmacists should consider older patients’ alcohol consumption prior to prescribing or dispensing medication and should monitor subsequent drinking. In particular, older people should be informed of the dangers of concurrent alcohol and medication use.
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Affiliation(s)
- Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Jess Kidd
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amy O’Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Graeme Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Reid School of Music, University of Edinburgh, Edinburgh, United Kingdom
| | - Karen McCabe
- School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom
| | - Jonathan Ling
- School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom
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Herbert S, Stephens C, Forster M. Older Māori understandings of alcohol use in Aotearoa/New Zealand. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 54:123-129. [PMID: 29428887 DOI: 10.1016/j.drugpo.2018.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The predominant framing of indigenous people's alcohol use as problematic has resulted in narrow understandings of indigenous alcohol use in general. In particular, there has been little exploration of how Māori, those indigenous to Aotearoa/New Zealand, contextualise and understand their alcohol use. To build on current understandings of Māori alcohol use, this study explored the broader and socially shared meanings of alcohol use from the perspectives of older Māori. METHODS Hui (meeting/s) were held with five kaupapa whānau (groups with a common purpose) comprising older Māori (n = 19) who shared their perspectives on Māori alcohol use. Data were analysed using a master/counter discursive narrative analytical framework. RESULTS The results show that older Māori drew on a number of discursive strategies to construct three cultural narratives of Māori alcohol use. These were: 'Not all Māori are problem drinkers', 'There is good Māori alcohol use', and 'Alcohol is not the problem'. These narratives simultaneously supported and challenged the dominant narrative that problematises Māori alcohol use. CONCLUSION These findings can be used to inform future research to show Māori understandings of alcohol use. Such research will support the development of culturally responsive alcohol policy and health promotion initiatives aimed at addressing alcohol related issues among Māori and thereby improve Māori health and wellbeing.
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Affiliation(s)
- Sarah Herbert
- Ngatikahu ki Whangaroa, School of Interprofessional Health Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand.
| | - Christine Stephens
- School of Psychology, Massey University, Private Bag 11-222, Palmerston North 4442, New Zealand.
| | - Margaret Forster
- Te Pūtahi-a-Toi, The School of Māori Art, Knowledge & Education, Massey University, Private Bag 11-222, Palmerston North 4442, New Zealand.
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Alcohol and older people: A systematic review of barriers, facilitators and context of drinking in older people and implications for intervention design. PLoS One 2018; 13:e0191189. [PMID: 29370214 PMCID: PMC5784942 DOI: 10.1371/journal.pone.0191189] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/30/2017] [Indexed: 11/19/2022] Open
Abstract
Background Harmful alcohol consumption in older people has increased and effective approaches to understanding and addressing this societal concern are needed. Methods Systematic review of qualitative studies in older populations (55+ years) to identify barriers, facilitators or context of drinking in older people. Multiple databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, Social Sciences Citation Index, York Centre for Reviews and Dissemination, Cochrane database and grey literature) were searched from 2000 to February 2017 for studies in English, from OECD countries using MeSH terms and text words relating to alcohol combined with older age terms. Study quality was assessed using NICE methodology. The review is reported according to PRISMA. Results Drinking in older people is strongly linked to social engagement and there is scepticism about the health risks of alcohol. Drinking was also linked to difficulties such as social isolation, illness or bereavement. Alcohol can be related to routines and identity. However, older people often regulate their own drinking and strategies that emphasise the life experience of older people to drink wisely could be helpful. Conclusions To be effective societal approaches need to take into account contexts of risks for harmful drinking. The evidence supports a strong social role for drinking alcohol which should be taken into account in any policy development with the potential benefits of social participation for cognitive health. Approaches to reducing alcohol use in older people need to avoid paradoxical harm, with a need for approaches that reduce harm from drinking alcohol but retain the benefit of socialising.
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23
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Alcohol and healthy ageing: a challenge for alcohol policy. Public Health 2017; 148:13-18. [DOI: 10.1016/j.puhe.2017.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 11/24/2022]
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Beard E, Brown J, Kaner E, West R, Michie S. Predictors of and reasons for attempts to reduce alcohol intake: A population survey of adults in England. PLoS One 2017; 12:e0173458. [PMID: 28278218 PMCID: PMC5344396 DOI: 10.1371/journal.pone.0173458] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to assess the predictors among high-risk drinkers in England of attempts to reduce alcohol consumption, the reasons given for these attempts and the association between the various reasons and alcohol consumption. METHOD Data came from 2,800 high-risk drinkers taking part in the Alcohol Toolkit Study (ATS) between March 2014 and November 2016 who were attempting to reduce their alcohol consumption. Participants completed the Alcohol Use Disorders Identification Test (AUDIT) and were asked questions regarding their socio-demographic characteristics, attempts to cut down and reasons for doing so. RESULTS Those cutting down were significantly older (OR 1.01, p<0.001), were more likely to be female (OR 1.32, p<0.05), had higher AUDIT-C scores (OR 1.12, p<0. 001), were less likely to be of white ethnicity (OR 0.64, p<0. 001), and were more likely to reside in the South of England (OR 1.34, p<0. 001). They were also more likely to be of higher occupationally-based social-grades (p<0. 001). The main reported reasons for reducing consumption were: fitness (22.5%), weight loss (20.4%), future health (20.4%), advice from a health-care professional (7.9%) and cost (7.6%). Those reporting the followings reasons for cutting down had higher AUDIT-C scores than those who did not report these reasons: a concern about further health problems (β 0.20, p<0.05), advice from a doctor/health worker (β 0.38, p<0.05), that drinking was too expensive (β 0.42, p<0.01) and detoxification (β 0.42, p<0.01). Lower AUDIT-C scores were noted among those who reported that they knew someone who was cutting down (β -0.67, p<0.05), that there was no reason (β -0.36, p<0.05), or they didn't know why they were cutting down (β -0.25, p<0.05). CONCLUSIONS Around a fifth of high-risk drinkers in England report trying to reduce their drinking, particularly older, high-socioeconomic female drinkers from the south of England. Attempts to cut down appear to be driven by a desire to improve health, advice from others and cutting down on the cost of drinking.
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Affiliation(s)
- Emma Beard
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- Department of Epidemiology and Public Health, University College London, London, England
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England
- Department of Epidemiology and Public Health, University College London, London, England
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle, England
| | - Robert West
- Department of Epidemiology and Public Health, University College London, London, England
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England
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Abstract
Older people consume less alcohol than any other adult age group. However, in recent years survey data on alcohol consumption in the United Kingdom have shown that while younger age groups have experienced a decline in alcohol consumption, drinking behaviours among the elderly have not reduced in the same way. This paper uses data from the English Longitudinal Study of Ageing to analyse both the frequency and quantity of older adult's alcohol consumption using a lifecourse approach over a ten-year period. Overall drinking declined over time and the analysis examined how socio-economic characteristics, partnership, employment and health statuses were associated with differences in drinking behaviours and how these changed over time. Higher wealth and level of education were associated with drinking more and drinking more frequently for men and women. Poorer self-rated health was associated with less frequent consumption and older people with poor and deteriorating health reported a steeper decline in the frequency of alcohol consumption over time. Men who were not in a partnership drank more than other men. For women, loss of a partner was associated with a steeper decline in drinking behaviours. These findings have implications for programmes to promote responsible drinking among older adults as they suggest that, for the most part, characteristics associated with sustaining wellbeing in later life are also linked to consuming more alcohol.
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26
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Frings D, Melichar L, Albery IP. Implicit and explicit drinker identities interactively predict in-the-moment alcohol placebo consumption. Addict Behav Rep 2016. [PMID: 29532004 PMCID: PMC5845916 DOI: 10.1016/j.abrep.2016.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Having an identity as a ‘drinker’ has been linked to increased alcohol-related harm, self-reported consumption and self-reported intention to engage in risky drinking behavior. These effects have been observed when identities have been measured using explicit measures (e.g. via questionnaires) and implicitly (e.g. using Implicit Association Tests [IATs] adapted to measure identity). Little research has used actual behavioral measures to measure alcohol consumption in-the-moment, nor compared the effects of implicit and explicit identities directly. Methods Participants' (n = 40) implicit and explicit identities associated with being a drinker were measured. Attitudes towards one's own drinking were measured explicitly. Participants completed a Pouring Taste Preference Task [PTPT] involving the consumption and rating of non-alcoholic wine. This provided a behavioral measure of intention (pouring), a behavioral measure of consumption and a measure of the implementation of intention into behavior. Results Results showed an interactive effect of implicit and explicit identities on attitudes and behavior. Explicit identities predicted attitudes towards drinking, but not behavior. Neither identity predicted the amount poured. Implicit identities predicted the amount consumed. A greater proportion of wine poured was predicted by higher implicit identities when explicit identities were absent. Conclusion These results suggest that explicit identities may be associated more with those beliefs about drinking that one is aware of than behavioral intention. In addition, explicit identities may not predict behavioral enactment well. Implicit identity shows effects on actual behavior and not behavioral intention. Together this highlights the differential influence of reflective (explicit) and impulsive (implicit) identity in-the-moment behavior. Implicit drinker identity is linked with self-reported past usage and intentions. Study compares implicit/explicit identity effects on attitudes and actual behavior. Implicit identities predicted drinking behavior but not attitudes to own drinking. When explicit identities are low, behavior is predicted by implicit identity. Findings suggest that implicit/explicit identities may sometimes differ in their effects.
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Affiliation(s)
- Daniel Frings
- Division of Psychology, London South Bank University, United Kingdom
| | - Lucinda Melichar
- Division of Psychology, London South Bank University, United Kingdom
| | - Ian P Albery
- Division of Psychology, London South Bank University, United Kingdom
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27
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Haighton C, Wilson G, Ling J, McCabe K, Crosland A, Kaner E. A Qualitative Study of Service Provision for Alcohol Related Health Issues in Mid to Later Life. PLoS One 2016; 11:e0148601. [PMID: 26848583 PMCID: PMC4744048 DOI: 10.1371/journal.pone.0148601] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/21/2016] [Indexed: 11/18/2022] Open
Abstract
Aims Epidemiological surveys over the last 20 years show a steady increase in the amount of alcohol consumed by older age groups. Physiological changes and an increased likelihood of health problems and medication use make older people more likely than younger age groups to suffer negative consequences of alcohol consumption, often at lower levels. However, health services targeting excessive drinking tend to be aimed at younger age groups. The aim of this study was to gain an in-depth understanding of experiences of, and attitudes towards, support for alcohol related health issues in people aged 50 and over. Methods Qualitative interviews (n = 24, 12 male/12 female, ages 51–90 years) and focus groups (n = 27, 6 male/21 female, ages 50–95 years) were carried out with a purposive sample of participants who consumed alcohol or had been dependent. Findings Participants’ alcohol misuse was often covert, isolated and carefully regulated. Participants tended to look first to their General Practitioner for help with alcohol. Detoxification courses had been found effective for dependent participants but only in the short term; rehabilitation facilities were appreciated but seen as difficult to access. Activities, informal groups and drop-in centres were endorsed. It was seen as difficult to secure treatment for alcohol and mental health problems together. Barriers to seeking help included functioning at a high level, concern about losing positive aspects of drinking, perceived stigma, service orientation to younger people, and fatalistic attitudes to help-seeking. Facilitators included concern about risk of fatal illness or pressure from significant people. Conclusion Primary care professionals need training on improving the detection and treatment of alcohol problems among older people. There is also a compelling need to ensure that aftercare is in place to prevent relapse. Strong preferences were expressed for support to be provided by those who had experienced alcohol problems themselves.
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Affiliation(s)
- Catherine Haighton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Graeme Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jonathan Ling
- Department of Pharmacy, Health and Well-being, Sunderland University, Sunderland, United Kingdom
| | - Karen McCabe
- Department of Pharmacy, Health and Well-being, Sunderland University, Sunderland, United Kingdom
| | - Ann Crosland
- Department of Pharmacy, Health and Well-being, Sunderland University, Sunderland, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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28
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McCabe KE, Ling J, Wilson GB, Crosland A, Kaner EFS, Haighton CA. Alcohol service provision for older people in an area experiencing high alcohol use and health inequalities. Perspect Public Health 2015; 136:83-5. [PMID: 26265734 DOI: 10.1177/1757913915597259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND UK society is ageing. Older people who drink alcohol, drink more than those from previous generations, drink more frequently than other age groups and are more likely to drink at home and alone. Alcohol problems in later life however are often under-detected and under-reported meaning older people experiencing alcohol problems have high levels of unmet need. METHODS This study sought to identify existing services within South of Tyne, North East England to capture the extent of service provision for older drinkers and identify any gaps. The Age UK definition of 'older people' (aged 50 and over) was used. Services were contacted by telephone, managers or their deputy took part in semi-structured interviews. FINDINGS Forty six service providers were identified. Only one provided a specific intervention for older drinkers. Others typically provided services for age 18+. Among providers, there was no definitive definition of an older person. Data collection procedures within many organisations did not enable them to confirm whether older people were accessing services. Where alcohol was used alongside other drugs, alcohol use could remain unrecorded. CONCLUSION To enable alcohol services to meet the needs of older people, greater understanding is needed of the patterns of drinking in later life, the experiences of older people, the scale and scope of the issue and guidance as to the most appropriate action to take. An awareness of the issues related to alcohol use in later life also needs to be integrated into commissioning of other services that impact upon older people.
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Affiliation(s)
- Karen E McCabe
- Faculty of Applied Sciences, University of Sunderland, UK
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Frisher M, Mendonça M, Shelton N, Pikhart H, de Oliveira C, Holdsworth C. Is alcohol consumption in older adults associated with poor self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing. BMC Public Health 2015. [PMID: 26205898 PMCID: PMC4513636 DOI: 10.1186/s12889-015-1993-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increases in alcohol related mortality and morbidity have been reported among older people in England over the last decade. There is, however, evidence that drinking is protective for some health conditions. The validity of this evidence has been questioned due to residual confounding and selection bias. The aim of this study is to clarify which drinking profiles and other demographic characteristics are associated with poor self-rated health among a community-based sample of older adults in England. The study also examines whether drinking designated as being "increasing-risk" or "higher-risk" is associated with poorer self-rated health. METHOD This study used data from Wave 0, Wave 1 and Wave 5 of the English Longitudinal Study of Ageing [ELSA]. Logistic regression analysis, was used to examine the association between drinking profiles (based on quantity and frequency of drinking) and self-rated health, adjusting for gender, age, wealth, social class, education, household composition, smoking and body mass index [BMI]. RESULTS Twenty percent of the sample reported drinking above the recommended level at wave 0. Rates of poor self-rated health were highest among those who had stopped drinking, followed by those who never drank. The rates of poor self-rated health among non-drinkers were significantly higher than the rates of poor self-rated health for any of the groups who reported alcohol consumption. In the adjusted logistic regression models there were no drinking profiles associated with significantly higher rates of poor self-rated health relative to occasional drinkers. CONCLUSIONS Among those who drank alcohol, there was no evidence that any pattern of current alcohol consumption was associated with poor self-rated health, even after adjustment for a wide range of variables. The results associated with the stopped drinking profile indicate improvement in self-rated health can be associated with changes in drinking behaviour. Although several limitations of the study are noted, policy makers may wish to consider how these findings should be translated into drinking guidelines for older adults.
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Affiliation(s)
- Martin Frisher
- School of Pharmacy, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Marina Mendonça
- School of Physical and Geographical Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Nicola Shelton
- Department of Epidemiology and Public Health, University College, London, UK.
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College, London, UK.
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College, London, UK.
| | - Clare Holdsworth
- School of Physical and Geographical Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
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Adams J, Stamp E, Nettle D, Milne EMG, Jagger C. Anticipated survival and health behaviours in older English adults: cross sectional and longitudinal analysis of the English Longitudinal Study of Ageing. PLoS One 2015; 10:e0118782. [PMID: 25799199 PMCID: PMC4370669 DOI: 10.1371/journal.pone.0118782] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/22/2015] [Indexed: 11/27/2022] Open
Abstract
Background Individuals may make a rational decision not to engage in healthy behaviours based on their assessment of the benefits of such behaviours to them, compared to other uncontrollable threats to their health. Anticipated survival is one marker of perceived uncontrollable threats to health. We hypothesised that greater anticipated survival: a) is cross-sectionally associated with healthier patterns of behaviours; b) increases the probability that behaviours will be healthier at follow up than at baseline; and c) decreases the probability that behaviours will be ‘less healthy’ at follow than at baseline. Methods Data from waves 1 and 5 of the English Longitudinal Survey of Ageing provided 8 years of follow up. Perceptions of uncontrollable threats to health at baseline were measured using anticipated survival. Health behaviours considered were self-reported cigarette smoking, physical activity level, and frequency of alcohol consumption. A wide range of socio-economic, demographic, and health variables were adjusted for. Results Greater anticipated survival was cross-sectionally associated with lower likelihood of smoking, and higher physical activity levels, but was not associated with alcohol consumption. Lower anticipated survival was associated with decreased probability of adopting healthier patterns of physical activity, and increased probability of becoming a smoker at follow up. There were no associations between anticipated survival and change in alcohol consumption. Conclusions Our hypotheses were partially confirmed, though associations were inconsistent across behaviours and absent for alcohol consumption. Individual assessments of uncontrollable threats to health may be an important determinant of smoking and physical activity.
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Affiliation(s)
- Jean Adams
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Elaine Stamp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Daniel Nettle
- Centre for Behaviour & Evolution, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Eugene M. G. Milne
- Institute of Ageing & Health, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Carol Jagger
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Ageing & Health, Newcastle University, Newcastle upon Tyne, United Kingdom
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Britton A, Bell S. Reasons why people change their alcohol consumption in later life: findings from the Whitehall II Cohort Study. PLoS One 2015; 10:e0119421. [PMID: 25756213 PMCID: PMC4355077 DOI: 10.1371/journal.pone.0119421] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/13/2015] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Harmful alcohol consumption among the ageing population is an important public health issue. Very few studies ask drinkers why they change their consumption in later life. The aim of this paper was to determine whether a group of people aged over 60 years increased or decreased their alcohol consumption over the past decade and to determine the reasons for their change. We also examined whether the responses varied by age, sex and socio-economic position (SEP). SUBJECTS AND METHODS Data were taken from 6,011 participants (4,310 men, 1,701 women, age range 61 to 85 years) who completed questionnaires at phase 11 (2012-2013) of the Whitehall II Cohort Study. RESULTS Over half the study members reported a change in alcohol consumption over the past decade (40% decreased, 11% increased). The most common reasons given for decreases were as a health precaution and fewer social occasions. Common reasons for increases were more social occasions and fewer responsibilities. The lowest SEP group was less likely to increase consumption compared to high SEP (RR 0.57, 95% CI 0.40 to 0.81). Women were more likely to increase consumption in response to stress/depression than men (RR1.53, 95% CI 1.04 to 2.25). Compared to high SEP, the lowest SEP group was less likely to reduce as a health precaution (RR 0.61, 95% CI 0.38 to 0.76). CONCLUSIONS Alcohol consumption in late life is not fixed. Reasons for change vary by age, sex and SEP. Such information could be used to tailor intervention strategies to reduce harmful consumption.
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Affiliation(s)
- Annie Britton
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Steven Bell
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Abstract
The proportion of older people drinking alcohol above the recommended levels has been increasing in the UK. Alcohol dependency and misuse can lead to various physical and psychological problems for older people. A range of factors can influence alcohol dependency and misuse among older adults, which need careful consideration when interventions are being developed to reduce consumption. Interventions to reduce alcohol consumption among older people can include: home visits, telephone support, mentoring, one-to-one and group programmes, family and community engagement programmes, outreach programmes, and targeted support groups focused on education and social activities. There is a need for the training of community nurses focused on improving the detection (screening and assessment), treatment and service provision for older people.
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Affiliation(s)
- Savita Bakhshi
- Research Associate, Florence Nightingale School of Nursing and Midwifery, King's College London
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Understanding older adults' attitudes and beliefs about drinking: perspectives of residents in congregate living. AGEING & SOCIETY 2014. [DOI: 10.1017/s0144686x14000671] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTDrinking motives may change as adults age, yet few studies in the United States of America have examined older adults' perspectives about their own drinking habits. The current study explored beliefs and attitudes of alcohol use of retired adults residing in a congregate care setting in the Baltimore/Washington DC metro area. Individual interviews were conducted with a sub-sample of 11 individuals who participated in a daily diary study on alcohol use among older adults. All participants in the study were identified as regular drinkers, meaning they had an alcoholic beverage on at least six of the eight days prior to screening. The participants' mean age was 81.5 years with a majority being women (54.5%). Older adults reported alcohol use as a long-term habit or routine. Participants also recognised that their alcohol use was influenced by peer drinking and by the availability of alcohol at the congregate care setting. Participants normalised their drinking as a form of routine socialisation carried from earlier life stages. Participants did not report reactive drinking, suggesting that older drinkers do not see their alcohol use as driven by specific reactions to life stresses or losses associated with ageing. The study also indicates that drinking may provide older adults in congregate care with a sense of continuity from before retirement and preserve their identity and autonomy.
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