Dr Bob Patton

Background and aims Alcohol use increases throughout adolescence. Emergency department (ED) attendance is an opportunity for alcohol screening and brief intervention (ASBI), which is effective for adults. This trial evaluated the effectiveness and cost-effectiveness of ASBI compared with screening alone (SA) in high-risk adolescents. Design, Setting and Participants Multi-centre, three-group, single-blind, individually randomized trial with follow-ups after 6 and 12 months in 10 ED settings in England. From October 2014 to May 2015 we screened 3327 adolescents aged 14 to 18 years, of whom 756 (22.7%) scored at least 3 on the Alcohol Use Disorders Identification Test: consumption (AUDIT-C) and consented to participate in this trial. Mean age was 16.1 years; 50.2% were female and 84.9% were white. Interventions Interventions were personalized feedback and brief advice (PFBA), personalized feedback plus electronic brief intervention (eBI) and SA. Measures The primary outcome was the weekly alcohol consumed in standard UK units (8 g ethanol) at 12 months post-randomization, derived from extended AUDIT-C. Economic outcomes included quality of life and service use, from perspectives of both the National Health Service and personal social services (NHS&PSS) and society. Findings At 12 months, mean weekly consumption was 2.99 [95% confidence interval (CI) = 2.38–3.70] standard units for the SA group, 3.56 (95% CI = 2.90, 4.32) for PFBA and 3.18 (95% CI = 2.50, 3.97) for eBI, showing no significant differences. The PFBA group consumed mean 0.57 (−0.36, 1.70) units more than SA; and eBIs consumed 0.19 (−0.71, 1.30) more. Bayes factors suggested lack of effectiveness explained non-significance. From the NHS&PSS perspective, economic analysis showed that PFBA and eBI were not cost-effective compared with SA: PFBA yielded incremental cost-effectiveness ratio of £6213 (−£736 843, £812 884), with the intervention having 54% probability of being cost-effective compared with SA at the £20 000 WTP threshold. Conclusions In emergency departments in England, neither personalized feedback and brief advice nor personalized feedback plus electronic brief intervention showed evidence of being effective or cost-effective when compared with screening alone in reducing alcohol consumption among adolescents.

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

This study examined posttraumatic stress disorder (PTSD), complex PTSD, depression, and anxiety among U.K. rail workers. A cross-sectional survey examining exposure to seven psychosocial hazards (bullying/harassment; verbal abuse; physical and sexual assault; and hearing about, seeing the aftermath of, or witnessing a fatality), working conditions, physical health, and the impact of COVID-19 was administered to 3,912 participants. Outcome measures were the ITQ, PHQ-9, and GAD-7. Among trauma-exposed participants, 24.3% met the criteria for PTSD or CPTSD; 38.6% and 29.2% of all participants scored in the moderate-to-severe range on the PHQ-9 and GAD-7, respectively. Data were analyzed using logistic and linear regression. Bullying/harassment was positively associated with GAD-7 scores, f 2 = .001, and PTSD and CPTSD, ORs = 1.83–2.02. Hearing about and witnessing a fatality were associated with PTSD and CPTSD, ORs = 1.77–2.10. Poorer ergonomics at work were positively associated with PHQ-9 and GAD-7 scores, f 2 = .001. Higher job satisfaction was associated with lower odds of PTSD and CPTSD, ORs = 0.87–0.91, and negatively associated with PHQ-9 and GAD-7 scores, f 2 = .008–.01. Work intensity was associated with PTSD and CPTSD, ORs = 1.79–1.83, and positively associated with PHQ-9 and GAD-7 scores, f 2 = .02–.03. Reporting more physical health problems was associated with PTSD, OR = 1.07, and positively associated with GAD-7 and PHQ-9 scores, f 2 = .008–.01. The results suggest bullying/harassment and work intensity are important variables in employee mental health and could drive future research and industry initiatives.

This study compared volume, alcohol by volume (ABV), alcohol units, and health warnings on product labels of selected alcoholic beverages simultaneously produced in Nigeria and the UK. The volume, ABV, alcohol units, and health warnings in a total of 13 alcoholic beverage brands simultaneously produced in Nigeria and the UK were documented from product labels and compared. Alcohol units were calculated by multiplying ABV% with volume (milliliters), divided by 1000. There was variation in volume, ABV, alcohol units, and health warnings on product labels. Beer and stout brands produced in Nigeria were sold in 600 mL bottles containing higher ABV and alcohol units compared with similar brands in the UK sold in 400 mL bottles containing smaller ABV and alcohol units. Pregnancy and drink driving warnings were present on 18.2% of product labels of alcoholic beverages produced in Nigeria. The high ABV, alcohol unit, and absence of health warnings on product labels might explain the high level of alcohol consumed, drunk driving and road traffic accidents in Nigeria. Reducing the ABV and alcohol units in beers and stouts while displaying health warnings on product labels would have the potential for reducing harmful alcohol consumption and related harms in Nigeria and the UK.

Alcohol consumption and related harm increase rapidly from the age of 12 years. We evaluated whether alcohol screening and brief intervention is effective and cost-effective in delaying hazardous or harmful drinking amongst low-risk or abstaining adolescents attending Emergency Departments (EDs). This ten-centre, three-arm, parallel-group, single-blind, pragmatic, individually randomised trial screened ED attenders aged between 14 and 17 years for alcohol consumption. We sampled at random one third of those scoring at most 2 on AUDIT-C who had access to the internet and, if aged under 16, were Gillick competent or had informed consent from parent or guardian. We randomised them between: screening only (control intervention); one session of face-to-face Personalised Feedback and Brief Advice (PFBA); and PFBA plus an electronic brief intervention (eBI) on smartphone or web. We conducted follow-up after six and 12 months. The principal outcomes were alcohol consumed over the 3 months before 12-month follow up, measured by AUDIT-C; and quality-adjusted life-years. Between October 2014 and May 2015, we approached 5,016 eligible patients of whom 3,326 consented to be screened and participate in the trial; 2,571 of these were low-risk drinkers or abstainers, consuming an average 0.14 units per week. We randomised: 304 to screening only; 285 to PFBA; and 294 to PFBA and eBI. We found no significant difference between groups, notably in weekly alcohol consumption: those receiving screening only drank 0.10 units (95% confidence interval 0.05 to 0.18); PFBA 0.12 (0.06 to 0.21); PFBA and eBI 0.10 (0.05 to 0.19). While drinking levels remained low in this population, this trial found no evidence that PFBA with or without eBI was more effective than screening alone in reducing or delaying alcohol consumption.

Background: Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs). Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions. Design: The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs). Setting: Twelve EDs in England (London, North East, and Yorkshire and The Humber). Participants: A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female).Interventions: Personalised feedback and brief advice (PFBA) and personalised feedback plus electronic brief intervention (eBI), compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews. Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C). Results: In the prevalence study, 2112 participants (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found. In the RCT, the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial, the mean difference compared with control was 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost-effective than screening alone. Conclusions: The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol-related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study. The trials were feasible to implement and exceeded the recruitment target and minimum follow-up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14- to 17-year-olds attending EDs. Limitations and future work: Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes. Trial registration: Current Controlled Trials ISRCTN45300218. Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.

As of 2014, Internet Gaming Disorder (IGD) has been included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) as a condition for further study. There are questions about the validity of the current diagnostic criteria, particularly when distinguishing IGD from avid or professional gaming. This study aims to explore the validity of the DSM-5 criteria for IGD, establish prevalence rates, and identify predictive factors of IGD within the esports community. A sample of 147 esports players completed an online survey comprising of an IGD measure (Internet Gaming Disorder Scale 9—Short Form [IGDS9-SF]) based on the DSM-5 criteria, and a range of health, and demographic questions. The IGDS9-SF significantly correlated with psychological distress and disability (impairment in daily functioning). An exploratory factor analysis confirmed the IGDS9-SF criterion loaded onto a single factor. Using the 32-point cutoff for IGD on the IGDS9-SF, findings indicated that 11.64% of nonprofessional esports players and 5.26% of professional esports players met IGD cutoffs. Level of disability was the only significant predictor of reaching the IGD cutoff. These findings support the DSM-5 conceptualization of IGD within the esports community and identify a potential larger risk for nonprofessional players. The clinical implications and future directions for research as result of these findings are discussed.

Background Khat is a plant that is used for its amphetamine-like stimulant properties. However, although khat is very popular in Eastern Africa, Arabian Peninsula, and the Middle East, there is still a lack of studies researching the possible neurobehavioral impairment derived from khat use. Methods A systematic review was conducted to identify studies that assessed the effects of khat use on neurobehavioral functions. MedLine, Scopus, Cochrane, Web of Science and Open Grey literature were searched for relevant publications from inception to December 2020. Search terms included (a) khat and (b) several cognitive domains. References from relevant publications and grey literature were also reviewed to identify additional citations for inclusion. Results A total of 142 articles were reviewed, 14 of which met the inclusion criteria (nine human and five rodent studies). Available human studies suggest that long term khat use is associated with significant deficits in several cognitive domains, including learning, motor speed/coordination, set-shifting/response inhibition functions, cognitive flexibility, short term/working memory, and conflict resolution. In addition, rodent studies indicated daily administration of khat extract resulted in dose-related impairments in behavior such as motor hyperactivity and decreased cognition, mainly learning and memory. Conclusions The findings presented in this review indicates that long-term khat use may be contributing to an impairment of neurobehavioral functions. However, gaps in literature were detected that future studies could potentially address to better understand the health consequences of khat use.

Student evaluation of teaching content and delivery has been undertaken at the University of Surrey for many years. Typically students complete Module Evaluation Questions (MEQs) at the end of each teaching module. Feedback from the MEQs is provided to teaching staff and this contributes towards individuals’ assessment of their appraisal targets, and to course convenors to help the ongoing development of course materials and staff development. Trainees attending the PsychD Clinical Psychology Doctorate programme complete a “Feedback on Learning” questionnaire (based on the standard university MEQ) on a weekly basis for each lecture they attended. While the evidence base for student assessment of leaning is well founded, the university does not at present seek to understand lecturers own reflection on their delivery of teaching. By determining differences and commonalities between educators and students experiences of teaching, it is hoped that we may identify areas for further staff development and training, and to facilitate regular reflection of teaching performance from staff.

BACKGROUND: Shame has been associated with a range of maladaptive behaviours, including substance abuse. Young people may be particularly vulnerable to heightened shame sensitivity, and substance abuse is a significant problem amongst UK adolescents. Although there appears to be a relationship between shame and substance abuse, the direction of the relationship remains unclear. AIM: We reviewed the literature relating to shame and substance abuse amongst young people. METHOD: Five electronic databases were searched for articles containing terms related to ‘adolescence’, ‘shame’ and ‘substance abuse’. Of the two hundred and twelve articles identified in the first sweep, six were included in the final analyses. RESULTS: Sexual abuse is indicated as a predictor of shame-proneness. Substance abuse may be a mechanism by which individuals cope with negative feelings. In general, there is a lack of literature investigating the shame-substance abuse relationship among adolescents. The available literature associates shame-proneness with poorer functioning and suggests that this may lead to psychopathology and early-onset substance misuse. Scant attention has been paid to the cognitive and emotional processes implicated. Further research is required to ascertain the strength of the shame-substance abuse relationship in young people and to develop appropriate interventions for this population.

This paper reports on a survey of 39 Accident and Emergency departments (AED) in England regarding presentations over a three month time period before and after the changes in the Licensing Act (2003) which came into force in November 2005. The time periods reported are January – March 2005 (the PRE period) and January – March 2006 (the POST period). Our data indicated NO significant change in the number of attendances that could be related to alcohol consumption (hereafter referred to as ‘attendances’) in the first two months following increased availability. In the third month there was a significant decrease in ‘attendances’. There was considerable variation in the changes in ‘attendances’ between participating AEDs. The pattern of ‘attendances’ on weekdays (Monday – Thursday) was unchanged. Following increased availability ‘attendances’ on Saturday fell, but increased on Fridays and Sundays. There were no changes in the pattern of ‘attendances’ across the 24 hour period, with most patients presenting at around Midday. Rates of ‘attendances’ for Assault and Head Injury fell significantly following the change in availability. The number of ‘attendances’ where alcohol was specifically mentioned increased significantly during the POST period. Prior to the increase in availability, the number of ‘attendances’ where alcohol was specifically mentioned peaked sharply around Midnight. Following the change in the law, there was a general increase in such ‘attendances’ from 11PM through to 3AM. Although there was a general increase in alcohol specified ‘attendances’ across the week, there was a significant increase in such ‘attendances’ on a Sunday. Data from one Northern and one Southern Local Ambulance Service was provided to complement the data obtained from individual AEDs. The number of alcohol related ambulance call outs for the LAS and NEAS increased following the change in the law.

Introduction The proliferation of alcohol outlets has led to increased physical availability of alcohol, harmful alcohol consumption and related harm in Nigeria. This study explored alcohol licensing legislations and licensing systems across local government councils (LGC) in South-West, Nigeria. Method Twenty-four LGC across three states participated in the study. Data was generated from i) documents containing LGC liquor licensing legislations and ii) semi-structured interviews conducted with 50 LGC officials (16 legislative council (LC) clerks, and 34 finance officers (director of finance, rate officers and revenue collectors) were thematically analyzed using NVivo. Results Nine of the sampled LGC enacted liquor license byelaws. These mostly specified categories of liquor licenses issued and licensing fees. None of the liquor license byelaw contained regulations for controlling physical availability of alcohol and outlet density. Finance officials were licensing officers and there were no licensing committees across the LGCs. The LGC officials were unanimous in stating that generating revenue from licensing fees was the main objective for licensing alcohol outlets. The LGCs licensed alcohol outlets indiscriminately and failed to regulate outlet density. Discussion and Conclusion The absence of regulations for controlling outlet density has implications for physical availability of alcohol in Nigeria. Our findings strongly suggest the need to develop national liquor licensing legislation with public health objectives and implementing regulations for controlling temporal and spatial availability of alcohol. Each LGC should inaugurate a licensing committee with clearly defined roles and responsibilities for licensing stakeholders such as LGC health officials, law enforcement agencies and community members

s statement and the absence of guidelines on its implementation made some LGcouncils enact liquor license byelaws. However, most LG liquor license byelaws indicated the typeand amount of licenses issued but failed to specify how the physical availability of alcohol would beregulated and controlled. The absence of national and local licensing regulations and controlmechanisms on the physical availability of alcohol might be responsible for the proliferation of AOsin LGs. Licensing officers were unanimous in stating that generating revenue from liquor licensefees was the main objective of licensing AOs. The LG licensed AOs indiscriminately and failed toregulate AOD. Business owners could set up AOs and most rarely apply for a liquor license beforecommencing operations. ConclusionOur findings strongly suggest the need to develop a national liquor licensing legislation with publichealth objectives, and a licensing committee with clearly defined roles and responsibilities forlicensing stakeholders.Keywords: Alcohol, Licensing, Local Government, Policy, Nigeria

The Cognitive Behavioural Therapy (CBT) pathway enables trainees to develop their CBT competencies and to meet the BABCP Level 2 Minimum Training Standards upon qualification from doctoral training. The paper outlines trainees’ experiences of the pathway, including its strengths, challenges, and future recommendations.

Aim: The physical availability of alcohol is a modifiable determinant of alcohol consumption and related harm. However, Nigeria currently does not have national regulations restricting the physical availability of alcohol. The study measured alcohol outlet density and marketing in Abeokuta, Nigeria. Methods: A descriptive community design was employed. Seven wards in Abeokuta South local government were surveyed street by street for functional alcohol outlets and nearby public institutions (schools and worship centres). Outlet characteristics were documented, and the location of outlets and public institutions was geocoded using a global positioning system app. The density and proximity of outlets and public institutions were analysed using QGIS 3.22. Results: Four hundred and seventy-six alcohol outlets and 194 public institutions (82 schools, 87 churches, and 25 mosques) were sampled across the 7 wards. The most common type of alcohol premises and outlets was on/off-premises and liquor/non-alcoholic drinks stores. Alcohol banners on liquor store lintels were the most prevalent marketing item. Alcohol outlet density ranged from 8.06 to 200 per km2. The smallest average distance between alcohol outlets was 28 m in Sodeke, while Ago Egun/Ijesa had the highest number of outlets and on/off premises. The shortest distance from an outlet to a school was 18.77 m in Ijaiye and 44 (14.7%) schools were located within & LE;100 m of an outlet. Conclusions: Findings indicate high alcohol density, resulting in short distances between alcohol outlets and public institutions in Abeokuta South local government area. These results underscore the importance of implementing evidence-based alcohol availability policies in Nigeria. Abeokuta has a high alcohol outlet density. The average density between alcohol outlets was 28 m in Sodeke. The shortest distance from an alcohol outlet to a school was 18.77 m in Ijaiye. Forty-four (14.7%) schools (14.7%) were located within & LE;100 m of an alcohol outlet.

Stigma experienced by drug users by their healthcare professionals can be a barrier to treatment engagement, which in turn affects mortality and morbidity rates. Attribution theory suggests that stigma will be greatest whenever drug use is attributed to factors within personal control. Here, clients (n = 76) and healthcare professionals (n = 62) identified features that characterize good and bad clinical interactions, and responded to a vignette about a drug user who attributed his use to personal control or situational factors. Healthcare professionals completed the vignette and drug users gave their best guess of how healthcare professionals would react to this vignette. Clients and professionals held overlapping prototypes of clinical interactions. Clients overestimated both how negative healthcare professionals’ reactions would be, and the extent to which healthcare professionals’ reactions would accord with attribution theory. Despite healthcare professionals’ believing they are acting in nonstigmatizing ways, they may engender stigma in clinical situations more than they realize. Discrepancies between professionals’ hypothetical responses and clients’ anticipation of these responses are discussed in terms of the influence of self‐stigma and societal understandings of drug use and control. Attribution theory only offers a limited explanation for these discrepancies, because professionals’ beliefs about drug users are complex. Implications for theories of stigma and engagement with services are discussed, and the importance of clients’ anticipation of stigma is highlighted as a primary target for addressing treatment disengagement. Anti‐stigma campaigns may also benefit from changing their focus from individuals’ attributions to holistically addressing discrepant conceptions of treatment.

Globally, alcohol use is the leading cause of ill health and life years lost in adolescents, although its clinical impact is often overlooked, particularly in England where most research is based in schools. This study aims to examine the prevalence of alcohol consumption and the association between alcohol consumption and age of onset with health and social consequences among adolescents presenting to emergency departments (EDs). Methods Consecutive attenders (n = 5,576) aged 10–17 years at 10 EDs were included. Information was collected on general health and functioning, quality of life, alcohol use, and alcohol-related health and social consequences. Results Nearly 40% of adolescents reported the consumption of alcohol that was more than a sip in their lifetime. Age of the first alcohol consumption before the age of 15 years was associated with tobacco use (p < .001), lower quality of life (p = .003), and evidence of an alcohol use disorder (p = .002). It was also associated with general social functioning (problems with conduct p = .001 and hyperactivity p = .001) and alcohol-related health and social consequences (accident p = .046, problems with a parent p = .017, school p = .0117, or police p = .012). Conclusions Rates of alcohol consumption in adolescents presenting to the ED were similar to those reported in schools in England and globally. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed. The ED can offer an opportunity for the identification of hazardous alcohol use in adolescents.

Aims To explore adolescents’ experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care. Methods In-depth semi-structured interviews with 27 adolescents (16 males; aged 14–17 years (Mage = 15.7)) who had taken part in one of two linked brief alcohol intervention trials based in 10 accident and emergency departments in England. Interviews were transcribed verbatim and subject to thematic analysis. Results Research and intervention methods were generally found to be acceptable though confidentiality was important and parental presence could hinder truthful disclosures regarding alcohol use. Participants discussed the importance of being involved in research that was relevant to them and recognised alcohol consumption as a normative part of adolescence, highlighting the importance of having access to appropriate health information. Beyond this, they recognised the benefits and risks of trial participation for themselves and others with the majority showing a degree of altruism in considering longer term implications for others as well as themselves. Conclusions Alcohol screening and intervention in emergency care is both acceptable and relevant to adolescents but acceptability is reliant on confidentiality being assured and may be inhibited by parental presence.

Introduction: Alcohol misuse creates an immense burden for society, with problem drinkers too often constituting a neglected group. The Paddington Alcohol Test (PAT) is a useful screening tool in emergency departments. Methods: Using a questionnaire, we assessed the attitudes of 127 emergency department junior doctors over 5 years to misuse detection using the PAT, in a centre with a well-defined protocol for detection and referral. Results: The majority (99%) thought early detection important, and the emergency department an appropriate place for screening (98%). Most thought that treatment could be successful (98%), and the PAT a useful instrument for early detection (87%). However, 63% reported that they misuse alcohol at least once a month and 30% once or more a week. Discussion and Conclusions: Junior doctors trained in the detection of alcohol misuse have a very positive view of this work. However, this professional insight is in marked contrast to their personal misuse of alcohol. This paradox reflects the entrenched culture of alcohol use in the medical profession, perhaps learnt at medical school.

To identify factors that predict acceptance of brief advice among people consuming excessive alcohol in an accident and emergency (A&E) department.

Excessive alcohol consumption increases the likelihood of accidental injury. This pilot study reports on the prevalence of hazardous drinkers presenting to a minor injuries unit. The proportion of hazardous drinkers is broadly similar to that found in emergency departments, suggesting that such units could also host alcohol intervention and brief advice activities.

Aims In the Emergency Department (ED), alcohol identification and brief advice is an effective method of reducing consumption and related harms. Our objective was to conduct a national survey of English EDs to determine current practice regarding alcohol identification and provision of brief advice, and to compare changes in activity to a previous National Survey conducted in 2011. Methods This was a cross-sectional survey of all consultant led Emergency Departments in England. Results Of 180 departments, 147 (81.6%) responded. All departments may question adult patients about their alcohol consumption, with many (63.6%) asking all patients over 18 as part routine care, and using a formal screening tool (61.4%). The majority of departments asked young people (aged 11-17) about their consumption (83.8%), but only 11.6% did so as a part of routine practice. Compared to the 2011 survey, there have been significant increases in routine screening among adults (+15.9%, CI: 4.16-27.18, p=0.006), General Practitioners being informed about patients alcohol related presentations (+10.2%, CI: 0.64-19.58, p=0.028) and access to an Alcohol Health Worker or a Clinical Nurse Specialist (+13.4%, CI: 3.64-22.91, p=0.005). Modest (non-significant) changes were also found in access to training on brief advice (+9.7%) and the use of formal screening questions on adult patients (+9.7%). Conclusion Alcohol screening together with referral or intervention is becoming part of routine practice in England. Compared to our previous national survey, increases in alcohol screening and intervention activity are demonstrated, with improvements in routine questioning (among adults), the number of General Practitioners being informed about alcohol related attendances, provision of training, access to specialist services and the use of formal screening tools.

Hazardous levels of alcohol consumption are associated with presentations to the accident and emergency department. Although screening and brief interventions are effective at reducing levels of hazardous drinking, a low number of departments has implemented such a strategy. Time constraints upon clinical staff have been cited as one reason for this inertia. This pilot study demonstrates that self-completion of screening materials is possible before a patient is seen by clinical staff.

Objective To estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 alcohol abuse and alcohol dependence in adolescents attending ED in England. Design Opportunistic cross-sectional survey. Setting 10 emergency departments across England. Participants Adolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013. Measures Scores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID. Findings AUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%). Conclusions The 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence.

Background: Patients receiving methadone-maintenance therapy appear more likely to have other substance-use disorders than do people in the general population and often fail to receive treatment for these conditions. Coexisting substance-use disorders are associated with poor health outcomes amongst current or former heroin users. The aim of this study was to establish the prevalence of the use of tobacco, cocaine and alcohol amongst patients attending for community-based methadone-maintenance therapy. Methods: Cross-sectional survey of patients prescribed methadone as to treat opiate dependence. Results: Prevalence of tobacco, cocaine and alcohol use in the sample were 91.18%, 11.18% and 42.01%, respectively. Most respondents were found to be dependent upon tobacco. In contrast, most patients were found to have no dependence upon alcohol. In total, 145 patients (85.80%) had Alcohol Use Disorders Identification Test PC (AUDIT PC) scores below 5, indicating lower risk drinking, while the remaining 24 (14.20%) had AUDIT scores of 5 or above, indicating higher risk drinking. Conclusions: There are higher rates of self-reported tobacco, cocaine and alcohol use disorders amongst methadone-maintained individuals than those reported in individuals from the general population. The findings illustrate the importance of identifying coexisting tobacco, cocaine and alcohol use disorders in methadone-maintained patients, since these issues can significantly impair patients’ quality of life and affect treatment outcomes.

Aims The aim of the study was to explore the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use in a primary care population in the UK. Methods The study was a randomized evaluation of screening approach (targeted versus universal) for consecutive attendees at primary care aged 18 years or more. Targeted screening involved screening any patient attending with one of the targeted presentations, conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries or a new patient registration. In the universal arm of the study all presentations in the recruitment period were included. Universal screening included all patients presenting to allocated practices. Results A total of 3562 potential participants were approached. The odds ratio of being screen positive was higher for the targeted group versus the universal group. Yet the vast majority of those screening positive in the universal group of the study would have been missed by a targeted approach. A combination of age and gender was a more efficient approach than targeting by clinical condition or context. Conclusions While screening targeted by age and gender is more efficient than universal screening, targeting by clinical condition or presentation is not. Further universal screening is more effective in identifying the full range of patients who could benefit from brief alcohol interventions, and would therefore have greater public health impact.

Background: Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. Methods and Findings: Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n = 863) at six, and 67% (n = 810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. Conclusions: SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions. Trial Registration: Current Controlled Trials ISRCTN 93681536 © 2014 Drummond et al.

Electronic screening and brief intervention (eSBI) has been shown to reduce alcohol consumption, but its effectiveness over time has not been subject to meta-analysis.

To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling.

Aim Most published research utilizes an AUDIT score of >8 as the threshold for hazardous drinking. Recent research suggests that this limit should be amended for younger drinkers (aged 18–35 years). This study aimed to explore the effect of a revision to AUDIT cut scores. Method Applying Foxcroft et al.’s [(2015) Accuracy of Alcohol Use Disorders Identification Test for detecting problem drinking in 18–35 year-olds in England: method comparison study. Alcohol Alcohol50, 244–50] suggested cut off scores of nine for males and four for females to the most recent Adult Psychiatric Morbidity Survey (2007) data. Results This more than doubles the prevalence of female hazardous drinkers, and significantly increases the overall rate for that age group when compared with the standard threshold of >8. Conclusion The prevalence of hazardous drinking among females ages 18–30 may be significantly higher than current estimates.

The Paddington Alcohol Test, designed to screen for alcohol related problems amongst those attending Accident and Emergency Departments, is presented in a slightly modified form. It concords fairly well with the Alcohol Use Disorders Identification Test (AUDIT), but can be administered in about one fifth of the time taken to administer AUDIT. Its scoring of units is rapid and specific to the UK. PAT is recommended for use in UK Accident and Emergency Departments.

Objective Social and occupational functioning are important for psychological health. However, quantitative research has suggested that these areas can be adversely affected by multiple chemical sensitivity (MCS). This systematic review therefore sought to explore what qualitative research has suggested about how people with MCS perceive it to affect their social and occupational functioning. Method Journal articles were included if they were 1) peer reviewed 2) qualitative or mixed methods 3) published in English 4) reported qualitative findings relevant to the review. Studies were excluded if they were 1) descriptive only 2) primarily concerned with environmental intolerances other than chemicals or 3) focussed on specific populations such as veterans. Quality was assessed using the National Institute for Health and Care Excellence (NICE, 2018) qualitative quality criteria. However, quality was not used to determine eligibility for inclusion. Six databases (CINAHL, Medline, PsychArticles, PsychInfo, Scopus and Web of Science) were searched between the 24th of February 2019 and 2nd of March 2019. Results Having removed duplicates, database searches identified 388 potential articles. Thirteen of these articles were eligible for inclusion. Following review, no more articles were included from the reference lists of these studies. Meta-aggregation of the findings identified seven categories. These were synthesised into three themes; ‘limited access’, ‘loss & anxiety’ and ‘seeking engagement’. Conclusions The findings suggested that MCS limits some people's social and occupational functioning. The results warrant further research, and, the development of prevention and intervention strategies. Studies predominantly recruited United States and Canadian females and had several limitations.

Background. Shame has been associated with a range of maladaptive behaviours, including substance use. Young people may be particularly vulnerable to heightened shame sensitivity, and substance use is a significant problem amongst UK adolescents. Although there appears to be a relationship between shame and substance use, the direction of the relationship remains unclear. Aim. The purpose of this study was to undertake a systematic review of the literature relating to shame and substance use in young people. Method. Five electronic databases were searched for articles containing terms related to ‘adolescence,’ ‘shame’ and ‘substance use.’ Six articles were included in the final analyses. Results. Adverse early experiences, particularly sexual abuse, predict shame-proneness, and substance use is a mechanism by which some individuals cope with negative feelings. In general, there is a dearth of literature investigating the shame-substance use relationship in adolescent samples. The available literature associates shame-proneness with poorer functioning and suggests that it may potentially lead to psychopathology and early-onset substance use. Scant attention has been paid to the cognitive and emotional processes implicated. Further research is required to ascertain the strength of the shame-substance use relationship in young people and to develop appropriate interventions for this population.

The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities.

Internet based interventions can reach large numbers of those in need of help and advice about their drinking and reduce levels of consumption. While many systematic reviews suggest that this is an effective mechanism to promote behavioural change, the effective components are unclear. User involvement is needed for effective design.

To determine the extent to which the recommendations of the alcohol harm reduction strategy for England and the Choosing Health white paper for the provision of screening and brief interventions for hazardous and harmful drinkers have been adopted by accident and emergency departments.

Aims To characterize England’s alcohol assertive outreach treatment (AAOT) services for people who frequently attend hospital due to alcohol-related reasons according to their concordance with six core AAOT components. Methods A cross-sectional national survey using structured telephone interviews with health professionals examining 6 essential AAOT components. High-level AAOT services were those that delivered 5 or more components, mid-level 3 to 4 components, low-level AAOT services 2 or less. Results The analysis included 37 services that were classified according to their concordance with the 6 AAOT components. Six were identified as high-level AAOT services, 13 as mid-level AAOT services and 18 as low-level services. Extended support covering housing, mental and physical health over and above alcohol consumption was the most commonly delivered AAOT component provided. Having a multidisciplinary team was the least observed component, delivered in 33% high-level AAOT services and in 15% mid-level AAOT services. None of the low-level AAOT services had a multidisciplinary team. Conclusions Access to AAOT services developed to support high-cost and high-needs frequent hospital attenders varies across the nation. Further research, service evaluation and AAOT implementation should focus on essential AAOT components rather than self-defined labels of AAOT. Short summary The study investigated alcohol assertive outreach treatment (AAOT) services in England. The study found variability in service provision across AAOT services when measured against six essential AAOT components. Improvement of AAOT in England’s hospitals should focus on the implementation of essential AAOT components.

We present the cost and cost-effectiveness of referral to an alcohol health worker (AHW) and information only control in alcohol misusing patients. The study was a pragmatic randomised controlled trial conducted from April 2001 to March 2003 in an accident and emergency department (AED) in a general hospital in London, England. A total of 599 adults identified as drinking hazardously according to the Paddington Alcohol Test were randomised to referral to an alcohol health worker who delivered a brief intervention (n = 287) or to an information only control (n = 312). Total societal costs, including health and social services costs, criminal justice costs and productivity losses, and clinical measures of alcohol consumption were measured. Levels of drinking were observably lower in those referred to an AHW at 12 months follow-up and statistically significantly lower at 6 months follow-up. Total costs were not significantly different at either follow-up. Referral to AHWs in an AED produces favourable clinical outcomes and does not generate a significant increase in cost. A decision-making approach revealed that there is at least a 65% probability that referral to an AHW is more cost-effective than the information only control in reducing alcohol consumption among AED attendees with a hazardous level of drinking.

Harmful alcohol use is the leading casual factor in over 200 diseases and accounts for 3.3 million deaths annually. In recognition of the importance of alcohol control policies in reducing harmful alcohol use, the World Health Assembly enacted ‘the global strategy to reduce the harmful use of alcohol’ (WHO, 2010). Ten policy and intervention areas were provided to guide development, implementation and monitoring of alcohol control policies in WHO member states.

As part of an ongoing assessment of the physical health needs of injecting drug users during 2005, all 167 general practices in the Lambeth, Southwark & Lewisham (LSL) area were sent a questionnaire. The results indicate that the majority of IDUs visited the surgery because of DVT, pregnancy, chest infections or skin ulceration, and the GPs themselves opportunistically identified more serious problems such as BBV’s and Liver problems. Interestingly we found significant variation in the rate of opportunistic detection between PCTs. Many practices indicated that health promotion activity would benefit their IDU clients, in particular issues related to smoking and drinking, as well as dental health, diet and exercise needed to be addressed. In general it was felt that a nurse led resource integrated into existing services, such as that offered by the Drug and Alcohol Health Care Team, would be of greatest benefit to IDU clients.

Injecting drug use is highly prevalent in London and is associated with specific physical health problems. These problems are related to the toxicity of the substances, their mode of consumption and as a consequence of the drug taking lifestyle. Hepatitis B and C viral infections are common among drug users due to sharing of both needles and other drug taking paraphernalia. Hepatitis B infection can be prevented by immunisation. Hepatitis C infection can interact with alcohol consumption to accelerate liver damage. Sharing of drug injection equipment is high (up to 78%). Injecting drug users (IDUs) that live close to needle exchanges are significantly less likely to engage in sharing activities than those that live further away. Drug users are at particular risk of developing poor dental health, which is associated with morbidity and mortality, particularly cardio-vascular conditions and respiratory disease. Many female drug users have been involved with the commercial sex industry and are at risk of contracting blood borne viruses. Drug users who also use alcohol have an increased likelihood of physical morbidity and injury / trauma. Problem drug users have an increased likelihood of experiencing physical morbidity, but are less likely to engage with primary care services. Barriers to accessing primary care include convenience (access), apathy, procrastination and “self-medication”. Drug users are more likely to report physical health complications at an Accident & Emergency department (AED) than at a GP practice. Further investigation of local AEDs is required to ascertain their potential for assessing and referring drug users to specialist services and other primary care providers. Integration of primary care and drug treatment services may encourage drug users to engage in treatment for physical morbidity and promote retention within addictions services. Physical health of drug users may be assessed as part of a formal induction to treatment services, or opportunistically as appropriate. Drug users presenting to primary care services for prescriptions related to their addiction may not experience such an assessment. Increasing GPs knowledge and skills can lead to greater implementation of screening practices. The provision of primary care services to clients attending addiction treatment centres can lead to improvements in drug users’ physical health and enhanced treatment outcomes.

This paper reports on a survey of 39 Accident and Emergency departments (AED) in England regarding presentations over a three month time period before and after the changes in the Licensing Act (2003) which came into force in November 2005. The time periods reported are January – March 2005 (the PRE period) and January – March 2006 (the POST period). Our data indicated NO significant change in the number of attendances that could be related to alcohol consumption (hereafter referred to as ‘attendances’) in the first two months following increased availability. In the third month there was a significant decrease in ‘attendances’. There was considerable variation in the changes in ‘attendances’ between participating AEDs. The pattern of ‘attendances’ on weekdays (Monday – Thursday) was unchanged. Following increased availability ‘attendances’ on Saturday fell, but increased on Fridays and Sundays. There were no changes in the pattern of ‘attendances’ across the 24 hour period, with most patients presenting at around Midday. Rates of ‘attendances’ for Assault and Head Injury fell significantly following the change in availability. The number of ‘attendances’ where alcohol was specifically mentioned increased significantly during the POST period. Prior to the increase in availability, the number of ‘attendances’ where alcohol was specifically mentioned peaked sharply around Midnight. Following the change in the law, there was a general increase in such ‘attendances’ from 11PM through to 3AM. Although there was a general increase in alcohol specified ‘attendances’ across the week, there was a significant increase in such ‘attendances’ on a Sunday. Data from one Northern and one Southern Local Ambulance Service was provided to complement the data obtained from individual AEDs. The number of alcohol related ambulance call outs for the LAS and NEAS increased following the change in the law.

To estimate the relation between alcohol consumption and risk of death, the level of alcohol consumption at which risk is least, and how these vary with age and sex. Analysis using published systematic reviews and population data. England and Wales in 1997. Death from any of the following causes: cancer of lip, oral cavity, pharynx, oesophagus, colon, rectum, liver, larynx, and breast, essential hypertension, coronary heart disease, stroke, cirrhosis, non-cirrhotic chronic liver disease, chronic pancreatitis, and injuries. A direct dose-response relation exists between alcohol consumption and risk of death in women aged 16-54 and in men aged 16-34. At older ages the relation is U shaped. The level at which the risk is lowest increases with age, reaching 3 units a week in women aged over 65 and 8 units a week in men aged over 65. The level at which the risk is increased by 5% above this minimum is 8 units a week in women aged 16-24 and 5 units a week in men aged 16-24, increasing to 20 and 34 units a week in women and men aged over 65, respectively. Substantially increased risks of all cause mortality can occur even in people drinking lower than recommended limits, and especially among younger people.

Alcohol labeling raises consumers' awareness of a product's composition and the risks associated with alcohol consumption. We identified mandatory elements and health warnings in alcohol regulations in Nigeria and evaluated selected product labels on alcoholic beverages produced in Nigeria to determine their compliance with the requirements. A descriptive case study was used. Labeling requirements were extracted from two alcohol regulations and one related document retrieved from the website of the National Agency for Food and Drug Administration and Control (NAFDAC). The information on the product labels of 59 selected beers and spirit drinks produced in Nigeria was assessed based on six mandatory elements: list of ingredients, allergens, nutritional information, percentage of alcohol by volume (ABV), "drink responsibly" statement, and age restrictions. Five health warnings were also assessed: standard drinks per container, drinking guidelines, link to an alcohol education website, a "drinking during pregnancy" logo/text, and drink driving logo/text. Different regulations exist for beer and spirit drinks in Nigeria. Health warnings are not mandatory on labels of alcoholic beverages. No single product label included all six mandatory elements. Four mandatory elements--list of ingredients, ABV, drink responsibly statement, and age restrictions--were present on 61% of the product labels examined. The alcohol labeling regulations in Nigeria fall short of the World Health Organization labeling recommendations. The alcohol industry does not fully comply with labeling requirements in Nigeria. Enhanced labeling inclusive of health warnings should be mandatory as a strategy to create awareness of alcohol-related risks while monitoring industry-labeling practices to ensure compliance.

Background Meeting psychological needs for autonomy, competence and relatedness as described by Self-Determination Theory (SDT) has been associated with increased well-being and job satisfaction in mental health staff and improved care outcomes for patients. Aims The study investigated whether psychological need satisfaction predicted stress, turnover intention and job satisfaction in health care assistants (HCA) working in inpatient mental health hospitals in the United Kingdom including full time (FT) and temporary agency worker (TAW) staff. Methods A cross-sectional survey explored need satisfaction between FT (n = 63) and TAW (n = 39) staff using the Work-Related Basic Need Satisfaction Scale. Multiple regression was used to explore whether satisfaction of the needs for autonomy, competence and relatedness predicted scores on measures of stress, job satisfaction and turnover intention. Results Results were comparable between FT and TAW staff. Autonomy was the need least satisfied, a need which predicted self-reported job satisfaction, stress and turnover intention. Relatedness also predicted job satisfaction and turnover intention. Conclusions Recommendations are made to explore experiences of (and barriers to) autonomy and relatedness in inpatient HCA staff to target and improve autonomy and relatedness in this workforce. Implications of doing so are considered at a staffing, organisational and patient level.

• objectives – To conduct a survey of current alcohol identification and brief advice activity in English Emergency Departments, and to compare the results to the previous survey conducted in 2007. • methodology – Cross sectional survey of all 187 Emergency Departments in England • results – Significant increases (p

The UK’s new alcohol guidelines advise that men and women shouldn’t drink more than 14 units of alcohol a week. Previous advice for the British drinker presented a higher threshold for men, so this represents a considerable change. So what was the evidence that the limits should not take gender into account?

Background: The SIPS Jr. Research programme (1) is funded by the NIHR to screen for alcohol use and deliver effective brief interventions to 14-17yr olds presenting to Emergency departments. Ongoing Patient & Public Involvement (PPI) work has identified a need for paperless screening / baseline data collection and an enthusiasm for interventions based on mobile technologies. Two recent systematic reviews by the research team (Patton et al, 2014; Donovan et al, 2014) support the use of such technology to identify and intervene with adolescent drinkers (2, 3). Description: Together with a specialist software development company we have developed a bespoke data collection / participant management tool for the iPad which is currently being used as part of an ongoing RCT (4), with data being collected from 10 Emergency Departments in England (London, Hull and the North East). This method of data collection has already demonstrated considerable cost savings and is popular with participants and research staff (over 6000 participants recruited to date in the current trial and earlier prevalence study). We have developed an interactive WebApp to reduce alcohol consumption and related harm among adolescents. This works in conjunction with the data collection tool to provide personalised feedback to users, to record ongoing consumption and to provide access to information and advice presented in an engaging and age appropriate format. Conclusion: Both the Research Tool and e-intervention have been developed and refined by the research team working collaboratively with the Web Developer, PPI groups and local youth organisations. The use of this technology is effective and cost effective.

Sir, we agree that the proportion of older persons in the UK who consume alcohol at a hazardous or harmful level is set to increase. Clearly the identification of such persons and the subsequent offer of an intervention to reduce harms and/or consumption should be a priority for clinicians. Although the Royal College of Physicians report (1) recommends that General Practitioners adopt the Geriatric version of the Short Michigan Alcohol Screening Test, our own experience of integrating alcohol screening into the new patient registration process (2) suggest that such changes to routine practice are difficult to implement. Recent guidance from the Department of Health (3) offers local commissioners an incentive based opportunity to encourage General Practitioners to increase their alcohol screening activity, with the AUDIT (both short and full versions) stated as the screening tool to be applied to all new patient registrations. Many GP practices offer a “health check-up” to all their registered patients upon the occasion of their 65th birthday. We suggest that this could also be an ideal opportunity to assess the alcohol consumption of these patients, and that as practices may well be familiar with the AUDIT, that this is the screening tool employed. The AUDIT is not specifically designed for use on a population of older drinkers. We know that both physiological changes and concurrent medication use by this population can interact with alcohol consumption (even at lower dosages than recommended by the Department of Health (4)), and as such the AUDIT may not reliably identify older hazardous and harmful drinkers. Specialist screening tools such as the ShARPS (5) have been specifically designed for use in an older population, however the addition of yet another questionnaire may not be well received by the busy practitioner. We suggest that some modification to the cut-off points for the AUDIT may offer a useful method to improve the detection of alcohol misuse among older people. We recently conducted a pilot study to determine the optimal AUDIT score that had the best concordance in terms of sensitivity and specificity with the ShARPS. From a small sample of 32 patients aged over 65 years, who completed both instruments in the waiting area of a London clinic, we found that using a cut-off of 4+ on the AUDIT (rather than the 8+ recommended for the wider population) had a sensitivity of 0.80 and specificity of 0.93. Clearly these results are based on a small sample and need to be replicated as part of a larger study, however they do suggest that by lowering the cut-off for older patients the AUDIT can be used to effectively identify hazardous and harmful drinkers who would otherwise have not been detected.

Objectives: To examine the effect of referral to an alcohol health worker (AHW) on levels of alcohol consumption, A&E attendance, psychiatric morbidity and quality of life among patients identified as hazardous drinkers Design: Single Blind Pragmatic Randomised Controlled Trial. Methods: 5240 patients attending the accident and emergency department (AED) over a oneyear period were screened using the Paddington Alcohol Test (PAT). Participants randomised to the Treatment condition were given an AHW appointment and the HEA leaflet ‘Think about drink’. Control participants were given the leaflet, but no appointment. At six months alcohol consumption (PAT and Form 90 AQ) and psychiatric morbidity (GHQ-12); at 12 months alcohol consumption and quality of life (EQ-5D) were assessed. Hospital data was used to determine re-attendance. An analysis of costs associated with screening patients, attending an AHW session and AED attendance was undertaken. Analysis: 599 of 1167 hazardous drinkers met inclusion criteria and were randomised. Thirty-six per cent were lost to follow-up. Data was analysed on an intention to treat basis. Participants in the Treatment condition had significantly lower levels of consumption than Controls at six-month follow-up. Treatment participants attended the AED significantly less often than Controls; a number needed to treat analysis found that every two patients referred to the AHW prompted one less re-attendance. There were no significant differences between groups on the GHQ-12 or EQ-5D. Conclusions: Screening and brief intervention for alcohol misuse in the AED is feasible and results in lower levels of alcohol consumption over the following 12 months. Reduced alcohol consumption is associated with lower levels of reattendance in the AED, which in turn offsets the costs of screening and providing brief intervention.

Men are more likely to abuse alcohol than women and it is a significant cause of morbidity and mortality in men. In this article, the authors describe how simple interventions are particularly effective in men and how drinking is often a defence mechanism against psychological distress.

The results of the 2015 National Emergency Department survey of alcohol identification and brief advice activity indicate that, in comparison to the previous 2011 survey (Patton and O'Hara, 2013), the number of Emergency Departments informing patients’ GPs about alcohol-related attendance, routinely asking questions about alcohol use (in adults) and having access to Alcohol Health Worker or Clinical Nurse Specialist services have all significantly increased. The provision of training on alcohol screening and brief advice, and the use of a formal alcohol screening tool have also demonstrated modest increases. Nearly half of all departments are now implementing strategies to tackle reattenders. Improved communication with GPs highlights a move towards multidisciplinary care and integration across primary and secondary care services. While routine questioning about alcohol use is fairly high among adults (aged 18-65 years), the limited routine questioning among under 18’s marks room for improvement, particularly since those aged 15-24 years provide the greatest volume of A&E attendances (Currie et al., 2015).

Objectives: To examine the effects at one year of referral for brief intervention by an alcohol health worker (AHW) on levels of alcohol consumption, psychiatric morbidity and quality of life among patients attending an accident and emergency department (AED) with alcohol related problems. Design: Randomised controlled trial. Methods: An AED doctor using the Paddington Alcohol Test (PAT) screened patients who presented to the AED. All those identified as misusing alcohol and meeting the inclusion criteria were asked if they would accept help aimed at assisting them to reduce their alcohol intake. Those randomised to Treatment were given a card which detailed the time and place of an appointment to discuss alcohol consumption with an AHW. Participants were also given a copy of a leaflet ‘Think About Drink’ Those randomised to Control were given the leaflet but no appointment. At baseline demographic details were collected together with details of current level of alcohol consumption. At six months a telephone interview was conducted in order to assess alcohol consumption and psychiatric morbidity (GHQ-12). At 12 months alcohol consumption (using PAT and Form 90), psychiatric morbidity and quality of life using Euroqol EQ-5D were measured. Results: 5242 patients screened, 1159 identified as hazardous drinkers (22 per cent), 659 consented and randomised. Data collection at six-months completed (77 per cent). Data collection at 12 months is ongoing. Conclusions: This pragmatic study should provide evidence of the worth of screening and brief interventions for alcohol misuse applied in the AED and offer guidance on the conduct of psychological research within busy hospital settings.

The addition of information regarding calorific content to alcohol packaging should afford the consumer greater awareness of the content, facilitate informed choice and hopefully promote appropriate behavioural change. Should the provision of such information become mandated it would be interesting to explore how consumer choice and drinking behaviours may be moderated. Those in clinical practice should, as a matter of routine, ask questions about alcohol use in addition to diet and exercise, and from this the additional calories can be estimated (1 UK unit of alcohol contains 56 kcal), however the nature of the drink itself will add to the overall calorie counts (a 50ml measure of cream liqueur contains just under 1 unit of alcohol, but 121 kcal). Given that almost one in five junior doctors remain unaware of what a unit of alcohol actually is (1;2) there is a clear need to raise address these issues as part of the undergraduate medical school curriculum.

Proceedings of the 14th annual conference of INEBRIA

An interactive online learning module

Addiction: Psychology and Treatment brings together leading psychologists to provide a comprehensive overview of the psychology of addictions and their treatment across specialities and types of services. Emphasises the use of several approaches including CBT, psychodynamic and systemic and family treatments, and consideration of the wider picture of addictions As well as the theories, gives a clear overview of the application of these models Reflects the very latest developments in the role played by psychological perspectives and interventions in the recovery agenda for problem drug and alcohol users

While I am broadly in agreement with the authors that young people should not be exposed to e-cigarette advertising (1), we should not forget that these nicotine delivery systems may be of benefit in mitigating the harm of combustible tobacco products, or their potential effectiveness at helping smokers transition to non-smoker (2). It is unclear what proportion of current smokers or ex-smokers in this sample were now users of e-cigarettes, as these groups group appear excluded from the survey. The data reported is based on a population of non-smokers, with 0.3% overall admitting to current use of e-cigarettes, and 2.6% 'other' combustible tobacco products. proportion of young people doing both is not clear, but this could have a significant impact on the reported intention to smoke cigarettes. It would be interesting to explore the data for those young people who were tobacco naive.

The alcohol harm reduction strategy for England and subsequent White Paper highlight the problems associated with excessive alcohol consumption, and emphasise the role that A&E should play in the identification and management of such patients. Kings College Hospital is a busy inner-city A&E with a turnover of 105,000 patients per year. Based on the data from the alcohol strategy, at least 40,000 of these patients are hazardous drinkers and would benefit from some intervention to reduce their alcohol consumption. Following the example of good practice set at St Mary’s Hospital, Paddington described by Crawford et al (Lancet, 2004), we have started to implement an alcohol screening policy in our department. In a department that has no previous history of targeting alcohol related presentations, we wanted to explore how best to introduce such a policy. Our aim is to develop a set of guidelines that will inform other departments seeking to introduce such policies themselves. Data on screening has been collected using the A&E computer system and the impact of teaching sessions for clinical staff (Drs and Nurse Practitioners) as well as the introduction of a paper-based system has been assessed. Interviews with clinical staff illustrate the barriers and facilitators to implementing this policy. Additionally our substantive baseline data also allow for a rapid review of the impact of changes to licensing hours on alcohol related attendances.

While agreeing that alcohol screening should be undertaken as a matter of routine among adolescents, it is important to note that hazardous and harmful levels of consumption are less common among those under 16 years of age. In England the proportion of young people aged 11-15 years who admit to having ever consumed alcohol fell from 62% to 45% from 1998 - 2011, while the average number of units consumed by those who do drink has almost doubled across the same time period, from 6.4 to 10.4 units per week (1). Our recent review paper on alcohol identification and brief advice (IBA) for adolescents, recommends the use of AUDIT or CRAFT for the identification of those who may benefit from help or advice about their drinking, noting that motivational interventions based in health care or education settings are most effective at reducing consumption and related harms (2). Preliminary data from our survey of alcohol use among 10-17 year olds indicated a steep transition in drinking prevalence occurring at around 14 years; we are currently undertaking two linked trials of face 2 face vs. a Web based intervention for high and low risk drinkers aged 14-17 who present to Emergency Departments (3). The 2012 survey of alcohol IBA in English EDs (4) noted that just 9% of departments routinely ask young people about their alcohol consumption, despite NICE (2007) recommendations that highlighted the need to identify alcohol use and provide appropriate interventions (5). Clearly there needs to be an increase in IBA activity to address the potential harm that even moderate levels of consumption can cause to young people.

The SIPS Jr. Research programme1 is funded by the NIHR to screen for alcohol use and deliver effective brief interventions to 14-17yr olds presenting to Emergency departments. Ongoing Patient & Public Involvement work has identified a need for paperless screening / baseline data collection and an enthusiasm for interventions based on mobile technologies. Two recent systematic reviews support the use of this technology to identify and intervene with adolescent drinkers2,3. Working with a specialist software development company (CodeFace Ltd.) we have developed a bespoke data collection / participant management tool for the iPad which is currently being used as part of an ongoing RCT4, with data being collected from 10 Emergency Departments across England (London, Hull and the North East). This paperless method of study management has already demonstrated considerable cost savings and is popular with patients and research staff (over 6500 participants recruited to date in the current trial and an earlier prevalence study). Both the Management Tool and e-intervention have been developed and refined by the research team working collaboratively with the Web Developer, PPI groups and local youth organisations.

Educational interventions are designed to increase knowledge about alcohol and in doing so to change an individual’s attitude and behaviour. Providing information about health risks and brief advice emphasising strategies to reduce consumption are the only interventions that have been recommended for both hazardous and harmful consumption of alcohol. Education may be usefully employed as part of more complex (brief) interventions; however in this section we shall evaluate the ‘stand alone’ application of this form of treatment.