Patton R, Crawford M, Touquet R (2004) Brief intervention for hazardous drinking among people attending an accident and emergency department, Proceedings of the British Psychological Society12(2)pp. 181-181
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
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
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
Patton R (2009) Dr Bob Patton CSci,
Patton R (2010) Binge Drinking,
Patton R, Touquet R (2002) The Paddington Alcohol Test, British Journal of General Practice52(474)pp. 59-59
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.
Patton R, Crawford M, Touquet R (2004) Hazardous drinkers in the accident and emergency department--who accepts advice?, Emerg Med J21(4)pp. 491-492
To identify factors that predict acceptance of brief advice among people consuming excessive alcohol in an accident and emergency (A&E) department.
Crawford MJ, Patton R, Touquet R, Drummond C, Byford S, Barrett B, Reece B, Brown A, Henry JA (2004) Screening and referral for brief intervention of alcohol-misusing patients in an emergency department: a pragmatic randomised controlled trial., Lancet364(9442)pp. 1334-1339
Alcohol misuse is highly prevalent among people attending emergency departments, but the effect of intervention by staff working in these departments is unclear. We investigated the effect of screening and referral of patients found to be misusing alcohol while attending an emergency department.
Magazine (2011) Who, What, Why: Why are Indians dying from alcohol poisoning?, BBC
More than 100 people have died after drinking toxic alcohol in the Indian state of West Bengal, in the latest example of fatal poisoning in the country. So why does it happen?
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.
Patton R, Drummond C, Deluca P (2010) Training Programme for Primary Care Staff in the London Borough of Newham on alcohol Identification and Brief Advice,
Patton R, Ihezue N (2011) Alcohol and drug problems in older people, BMJ: British Medical Journal
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.
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.
Deluca P, Coulton S, Alam F, Cohen D, Donoghue K, Gilvary E, Kaner E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton Bob, Phliips C, Phillips T, Russell I, Strang J, Drummond C (2015) Linked randomised controlled trials of face-to-face and electronic brief intervention methods to prevent alcohol related harm in young people aged 14-17 years presenting to Emergency Departments (SIPS junior),BMC Public Health345
BACKGROUND: Alcohol is a major global threat to public health. Although the main burden of chronic alcohol-related disease is in adults, its foundations often lie in adolescence. Alcohol consumption and related harm increase steeply from the age of 12 until 20 years. Several trials focusing upon young people have reported significant positive effects of brief interventions on a range of alcohol consumption outcomes. A recent review of reviews also suggests that electronic brief interventions (eBIs) using internet and smartphone technologies may markedly reduce alcohol consumption compared with minimal or no intervention controls. Interventions that target non-drinking youth are known to delay the onset of drinking behaviours. Web based alcohol interventions for adolescents also demonstrate significantly greater reductions in consumption and harm among 'high-risk' drinkers; however changes in risk status at follow-up for non-drinkers or low-risk drinkers have not been assessed in controlled trials of brief alcohol interventions. DESIGN AND METHODS: The study design comprises two linked randomised controlled trials to evaluate the effectiveness and cost-effectiveness of two intervention strategies compared with screening alone. One trial will focus on high-risk adolescent drinkers attending Emergency Departments (Eds) and the other will focus on those identified as low-risk drinkers or abstinent from alcohol but attending the same ED. Our primary (null) hypothesis is similar for both trials: Personalised Feedback and Brief Advice (PFBA) and Personalised Feedback plus electronic Brief Intervention (eBI) are no more effective than screening alone in alcohol consumed at 12 months after randomisation as measured by the Time-Line Follow-Back 28-day version. Our secondary (null) hypothesis relating to economics states that PFBA and eBI are no more cost-effective than screening alone. In total 1,500 participants will be recruited into the trials, 750 high-risk drinkers and 750 low-risk drinkers or abstainers. Participants will be randomised with equal probability, stratified by centre, to either a screening only control group or one of the two interventions: single session of PFBA or eBI. All participants will be eligible to receive treatment as usual in addition to any trial intervention. Individual participants will be followed up at 6 and 12 months after randomisation. DISCUSSION: The protocol represents an ambitious innovative programme of work addressing alcoh
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.
Patton R (2009) Alcohol Training implementation and outcomes,
Patton R, Henriquez-Gonzalez O (2012) Prevalence of tobacco, cocaine and alcohol use amongst patients attending for Methadone-Maintenance Therapy in a rural setting, Journal of Substance Use: for nursing, health and social care
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.
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.
Mohiddin A, Devall A, Hicyilmaz M, McCormick G, Crompton J, Patton R (2012) STI clinic demonstrates potential as a location to provide education to parents, Sexually Transmitted Infections88(1)pp. 69-70
Patton R (2009) Alcohol problems in A&E,
Patton R (2012) The 2nd National Emergency Department Survey of Alcohol IBA Activity,
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.
Lofthouse K (2015) HERE?S WHY YOU GET THAT WEIRD ANXIETY WHEN YOU?RE HUNGOVER, Campus Society
Booze blues, beer fear, hangxiety. The crushing dread that threatens to wipe all the joy out of the world after a heavy session ? it goes by many names. At best it?s a taunting reminder that you?re alive when you?d much rather be otherwise, at worst it can be akin to a full-blown panic attack.
Hangxiety ? a term that?s seen a recent renaissance ? happens because your body thinks it?s going into panic mode. Dr Bob (as he likes to be known), lecturer in Clinical Psychology at the University of Surrey and general alcohol Yoda, explained to me how it happens. Because you?re already experiencing anxiety-like symptoms (shakes, nausea, headache, elevated heart rate, sweating) caused by a drop in your brain?s happy-chemicals, alongside dehydration, your body gets all confused and has a hard time differentiating between the hangover and naturally occurring anxiety.
Patton R, Thompson P, Marshall EJ (2005) Integrating alcohol screening and intervention in an inner-city accident & emergency department ? from theory to practice,
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.
Patton R, McCormick R (2005) Alcohol Screening and Brief Interventions, BMJ Learning
An interactive online learning module
Patton R, Donoghue K (2015) Web-delivered personalised normative feedback for college students on alcohol consumption and sexual situations reduces alcohol-related risky sexual behaviour., Evid Based Nurs18(3)pp. 84-84
Alcohol use is associated with an increase in RSB among young adults. University students who engage in these activities overestimate the prevalence of RSB and alcohol use among their peers. PNF is an effective intervention known to reduce alcohol consumption and consequences, and may also reduce RSB. While there is evidence that web-based PNF for alcohol is effective, there is a need to test its impact on RSB.
Patton R (2015) Alcohol related deaths in the UK,
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.
Deluca P, Coulton S, Perryman K, Bland M, Cassidy P, Crawford M, Gilvarry E, Godfrey C, Heather N, Kaner E, Myles J, Newbury-Birch D, Oyefeso A, Parrott S, Patton R, Phillips T, Shepherd J, Touquet R, Drummond C (2012) INDIVIDUAL AND ORGANIZATIONAL DETERMINANTS OF ALCOHOL SCREENING AND BRIEF INTERVENTION IMPLEMENTATION IN EMERGENCY DEPARTMENTS (SIPS-ED),ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH36pp. 162A-162A
Patton R (2011) SIPS ED Outcomes,
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.
Troup L, Andrzejewski JA, Braunwalder JT, Torrence RD (2016) The relationship between cannabis use and measures of anxiety and depression in a sample of college campus cannabis users and non-users post state legalization in Colorado, PeerJ
As part of an ongoing research program into the relationship between cannabis use and emotion processing, participants were assessed on their level of cannabis exposure using the Recreational Cannabis Use Examination, a measure developed specifically to assess cannabis use in Colorado post state legalization. Three groups were created based on self-reported use: a control group who have never used, a casual user group and a chronic user group. Each participant also completed two measures of mood assessment, the Center for Epidemiologic Studies Depression Scale and the State-Trait Anxiety Inventory. Relationships between cannabis use groups and scores on these measures were then analyzed using both correlations and multivariate analysis of variance. Results indicate a relationship between casual cannabis use and scoring highly for depressive symptomatology on the Center for Epidemiologic Studies Depression Scale. There were no significant relationships between cannabis use and scores on the State-Trait Anxiety Inventory.
Steafel E (2016) New alcohol guidelines: six tips for cutting down on your booze intake, The Telegraph
Men across the country let out a collective groan this morning as their plans to head to the pub straight after work for a guilt-free drink were scuppered by a government announcement that slashed their recommended drinking limit.
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).
Patton R (2015) Alcohol, Adolescents & the Emergency Department,
Patton R, Joubert E (2016) Telling your patients to cut down on alcohol: does it work?, TRENDS IN UROLOGY & MEN?S HEALTH7(2)pp. 18-20 JOHN WILEY & SONS
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.
" 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<0.001) in the proportion of departments routinely asking about alcohol, using a screening questionnaire, offering help / advice for alcohol problems and having access to Alcohol Health Workers or Clinical Nurse Specialists. More than half of all departments indicated that they had an ?alcohol champion?, and this was significantly associated with access to training on both identification and provision of brief advice (p<0.001). Departments that routinely asked questions were the most likely to use a formal screening tool (P<0.05) and the Paddington Alcohol Test was the most frequently used measure (40.5%). " conclusions ? There have been significant improvements in ED alcohol identification and brief advice activity since 2007 in line with the recommendations of the Royal College of Physicians, Department of Health and NICE guidelines. English EDs are beginning to maximise the likelihood of identifying patients who may benefit from further help or advice about their alcohol consumption, and are able to offer access to specialist staff who can provide appropriate interventions
Patton R, Crawford M, Touquet R (2005) Hazardous drinkers in the accident and emergency department--who attends an appointment with the alcohol health worker?, Emerg Med J22(10)pp. 722-723
To identify factors that predict attendance at a brief assessment and referral session among patients identified as hazardous drinkers while being treated in an accident and emergency department.
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.
Patton R (2004) Reduction of alcohol consumption among patients attending an accident & emergency department,
Patton R, Strang J, Birtles C, Crawford M (2005) The more things change the more they stay the same: Assessing the immediate impact of the licensing act (2004) on attendances to accident & emergency departments.,
Patton R (2003) Reducing alcohol misuse among patient attending an accident & emergency department: A randomised Controlled Trial,
Newbury-Birch D, Coulton S, Bland M, Cassidy P, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Kaner E, McGovern R, Myles J, Oyefeso A, Parrott S, Patton R, Perryman K, Phillips T, Shepherd J, Drummond C (2014) Alcohol screening and brief interventions for offenders in the probation setting (SIPS Trial): a pragmatic multicentre cluster randomized controlled trial., Alcohol Alcohol49(5)pp. 540-548
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.
Deluca P, Drummond C, Boniface S, Patton R (2016) Optimal screening tool for under age drinking: Findings from the SIPS Jr Programme,
Patton R (2016) Should alcohol limits for men and women really be the same?, The Conversation
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?
Patton R (2010) Alcohol and the Emergency Department. Screening and
interventions to reduce harm.,
Drummond C, Deluca P, Myles J, Patton Bob, Perryman K, Phillips T, Coulton S, Bland M, Dale V, Godfrey C, Parrott S, Cassidy P, Crawford M, Gilvarry E, McGovern R, Newbury-Birch D, Kaner E, Heather N, Oyefeso A, Shepherd J, Touquet R (2014) The effectiveness of alcohol screening and brief intervention in emergency departments: A multicentre pragmatic cluster randomized controlled trial,PLoS ONE9(6)
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.
Patton R (2012) Alcohol and the Emergency Department: Interventions to reduce harm, Lambert Academic Press
Huntley JS, Patton R, Touquet R (2004) Attitudes towards alcohol of emergency department doctors trained in the detection of alcohol misuse, Annals of the Royal College of Surgeons of England86(5)pp. 329-333
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.
Deluca P, Drummond C, Coulton S, Perryman K, Bland M, Cassidy P, Crawford M, Gilvarry E, Godfrey C, Heather N, Kaner E, Myles J, Newbury-Birch D, Oyefeso A, Parrott S, Patton R, Phillips T, Shepherd J, Touquet R (2010) CHALLENGES AND SOLUTIONS IN IMPLEMENTING SCREENING AND BRIEF INTERVENTIONS FOR HAZARDOUS ALCOHOL USE IN ACCIDENT AND EMERGENCY DEPARTMENTS, ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH34(6)pp. 294A-294A
Patton R, Crawford M, Touquet R (2003) Reducing alcohol misuse in patients attending an accident and emergency department: A randomised controlled trial, Proceedings of the British Psychological Society11(2)pp. 281-281
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
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
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.
Patton R (2004) Referral of alcohol misusing patients attending an accident & emergency department,
Patton R (2007) Alcohol problems in the AED ? researching the interventions,
Cathcart S, Patton R, Hickman M, Hendry C, Ashworth M (2007) Comparing population estimates for drug users, the prevalence of blood-borne viruses and the provision of services in one London borough: Evidence of a gap in provision?, DRUGS-EDUCATION PREVENTION AND POLICY14(3)pp. 205-215
Mohiddin A, Devall A, Hicyilmaz M, McCormick G, Crompton J, Patton R (2012) STI clinic demonstrates potential as a location to provide education to parents., Sex Transm Infect88(1)pp. 69-70
Patton R, Smythe W, Kelsall H, Selemo FB (2007) Substance use among patients attending an accident and emergency department , Emergency Medicine Journal24(2)pp. 146-146
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.
Patton R, Vohra M (2013) Hazardous drinking among patients attending a minor injuries unit: A pilot study, Emergency Medicine Journal30(1)pp. 72-73
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.
Patton R (2014) Alcohol-related presentations to the emergency department among young people: some concerns, EMERGENCY MEDICINE JOURNAL31(3) BMJ PUBLISHING GROUP
Davis P, Patton R, Jackson S (2017) Addiction: Psychology and Treatment, Wiley-Blackwell
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
Patton R, Rose H (2014) Hard Evidence: are drunk young people
driving up A&E visits?, The Conversation
Alcohol and drug consumption can affect judgment and may contribute towards an increased likelihood of engaging in risky sexual behaviour. In this cross sectional survey of clients attending STI services levels of drug and alcohol use were assessed using two standardised drug and alcohol screening instruments (the PAT and the SDS).
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.
Williams S, Brown A, Patton R, Crawford MJ, Touquet R (2005) The half-life of the 'teachable moment' for alcohol misusing patients in the emergency department, DRUG AND ALCOHOL DEPENDENCE77(2)pp. 205-208
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 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.
Coulton S, Dale V, Deluca P, Gilvary E, Godfrey C, Kaner E, McGovern R, Newbury-Birch D, Patton R, Parrot S, Perryman K, Phillips T, Shepherd J, Drummond C (2017) Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches,Alcohol and Alcoholism52(3)pp. 312-317
Oxford University Press
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.
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.
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.
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?
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.
Donoghue K, Rose H, Boniface S, Deluca P, Coulton S, Gilvary E, Kaner E, McGovern R, Newbury-Birch D, Patton R, Phillips T, Maconochie I, Russell I, Strang J, Drummond C (2017) Alcohol consumption, early onset drinking and health-related consequences in adolescents presenting at Emergency Departments in England,Journal of Adolescent Health60(4)pp. 438-446
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.
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.
Deluca P, Coulton S, Boniface S, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McGovern R, Newbury?Birch D, Phillips C, Pockett R, Phillips T, Patton R, Russell I, Strang J, Drummond C (2017) Effectiveness and cost effectiveness of a smartphone based
electronic alcohol intervention for adolescents: findings from the
SIPS jr trials,Addiction Science & Clinical Practice12
Proceedings of the 14th annual conference of INEBRIA
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.
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.
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.
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.
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.
Coulton S, Fasihul Alam M, Boniface S, Deluca P, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton Bob, Phillips C, Phillips T, Rose H, Russell I, Strang J, Drummond C (2018) Opportunistic screening for alcohol use problems in adolescents attending emergency departments: an evaluation of screening tools,Journal of Public Health41(1)fdy049pp. e53-e60
Oxford University Press
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.
Objective: To explore whether nostalgia, a bittersweet emotion characterised by sentimental longing for the past, can improve well-being in older adults and buffer against threats to well-being in this population. Design: A between-subjects experimental design was conducted with random group assignment for participants to recall either a nostalgic memory or an ordinary memory (control group). Ryff & Keyes (1995) Psychological Well-being factors and Life Satisfaction were measured post-intervention and potential threats to wellbeing: loneliness, time-limitedness, and activity levels were measured pre-intervention. Participants: 161 older adults (age 65 years and above) completed the questionnaire on paper or via an internet survey and 132 were able to be used in data analysis. They were recruited through opportunity sample from local community groups and residential homes in England with the majority being White British, retired and living independently alone or with a partner.
Results: Method of survey completion (paper vs. online) was found to represent different sub-populations of the sample and to have a significant impact upon findings. Well-being (both life satisfaction and scales of psychological well-being (total, environmental mastery and self-acceptance) was significantly higher for older adults in the nostalgia condition comparative to control (for those who completed the questionnaire online). Nostalgia was found to buffer against loneliness to protect well-being (for those who completed the questionnaire on paper).
Conclusions: This research partly supports the beneficial effects of nostalgia specifically in older adult populations. Future research can build upon the findings of this study, in particular, recruiting older adults experiencing high levels of threats to well-being such as loneliness. Should a body of literature begin to form around the benefits of nostalgia in older adults, this population could be supported to not just be living longer, but also to be living a better quality of life.
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.
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.
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.
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.
The prevalence of hazardous drinking among females ages 18?30 may be significantly higher than current estimates.
Rodda Simone, Lynch Ellen, McGovern Ruth, Elzerbi Catherine, Breckons Matthew, Deluca Paolo, Drummond Colin, Alam Mohammed Fasihul, Boniface Sadie, Coulton Simon, Gilvarry Eilish, McArdle Paul, Patton Robert, Russell Ian, Strang John, Kaner Eileen (2019) Adolescent perspectives about their participation in alcohol intervention research in emergency care: A qualitative exploration using ethical principles as an analytical framework,PLOS ONE14(6)e0217855pp. 1-18
Public Library of Science
To explore adolescents? experiences of consenting to, and participating in, alcohol intervention trials when attending for emergency care.
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.
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.
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.
Objective: Previous work suggests that diabetes stigma may be associated with poorer psychological wellbeing in people with type 2 diabetes. However, no study has determined whether social support might moderate this association. The primary aim of this study was to examine the association between diabetes-related stigma and symptoms of depression and anxiety. The secondary objective was to determine whether different forms of social support (i.e. generic social support or diabetes-specific social support) moderated the relationships between stigma and symptoms of depression and/or anxiety.
Research design and methods: An online survey was distributed through diabetes-related charities, social media and diabetes forums. Participants were 108 adults, aged 18 or older diagnosed with type 2 diabetes who lived in the United Kingdom (mean age 58.4 years old, 63.9% female). The survey asked about diabetes stigma, depressive symptoms, anxiety symptoms, generic social support and diabetes-specific social support. Data was analysed using linear regression; firstly, to determine the direct association between diabetes-stigma with depressive and anxiety symptoms, and then to examine whether generic and diabetes-specific social support moderated those associations.
Results: Type 2 diabetes-related stigma predicted depressive symptoms after adjusting for all covariates (² = 0.284, p Â .05). Type 2 diabetes-related stigma predicted anxiety symptoms when sociodemographics were controlled for (² = 0.249, p Â .05), but this relationship was attenuated by the inclusion of diabetes characteristics (² = 0.188, ns). Neither form of social support functioned as a moderator in these relationships.
Conclusion: This study lends support to previous research which has found an association between type 2 diabetes-related stigma and psychological wellbeing. This indicates the need for interventions to reduce type 2 diabetes-related stigma and to improve psychological wellbeing amongst individuals with the condition.
Introduction: Teachers are often faced with incidences of young people who self-harm but can feel ill-equipped to offer support. The United Kingdom (UK) government state that all staff working in schools should be trained on how to deal with self-harm, yet a large proportion of teachers identify a lack of training as a barrier to supporting students. Barriers to receiving training are a lack of time and resource in schools.
Aim: This study seeks to investigate whether a bespoke eLearning module, designed for UK secondary school teachers, helps to increase knowledge and confidence in supporting young people who self-harm.
Method: Twenty-one schools across the West Midlands and South West of England were contacted via email and invited to complete a 30-minute web-based eLearning module on self-harm in schools. Participants were also invited to complete pre-and post-intervention measures and a follow-up questionnaire. The data was analysed using non-parametric statistics and the free-text comments using Thematic Content Analysis.
Results: 173 teachers completed the eLearning and pre-and post-measures and 16 completed a follow-up questionnaire. The eLearning significantly enhanced participants? perceived knowledge, actual knowledge and confidence in talking to and supporting young people who self-harm. 90.7% of participants felt that eLearning was a good way to receive training. The following themes emerged from the qualitative data: Learning about self-harm is important; eLearning is convenient and accessible; eLearning is less engaging than other modes of training delivery; Training improved my confidence and understanding; The module could be enhanced with further detail and guidance; Wanting ongoing support.
Background: Eating disorders are most commonly diagnosed in adolescence and when left untreated cause serious psychological and physical harms. Early intervention is most effective at reducing negative outcomes, however there are delays to adolescents recognising a problem and seeking help for eating disorders (Beat, 2017).
Aims: The present study aimed to address a gap in the literature by investigating the gender differences in how young adolescents recognise early signs of eating disorders in their peers, and their intentions to seek help for the problem. The study also aimed to investigate whether a brief film intervention that is focused on adolescent males? experiences of body image concerns had a positive impact on problem-recognition and help-seeking intentions.
Methods: Participants (N=194, 12-13 years, 57% female) from two secondary schools in the UK completed online measures of their recognition of a mental health problem and help-seeking intentions at three time points: before and immediately after watching the film intervention, and at one-month follow up.
Results: Females recognised a mental health problem in a vignette at a higher rate compared to males. Recognition of a mental health problem improved for males and females after the film intervention but more so for males. Help-seeking intentions also improved after the film intervention. However, at one-month follow up much of the gains in recognition and help-seeking intentions were lost.
Conclusions: Adolescent males are poorer at recognising and intending to seek help for eating disorders compared to females, but males can catch up with females following a brief film intervention. More investigation is required into whether gender-sensitive interventions can help maximise the effectiveness of interventions particularly toward gender-related mental health inequalities.
Materialism is associated with negative personal outcomes including reduced well-being, increased risk behaviours, lower quality relationships and reduced pro-social behaviours. Self-determination theory has been used to explain these links, suggesting that dissatisfaction with basic psychological needs underpins this relationship. The majority of the research addressing the effects of materialism is based on adult populations. This thesis aimed to determine the impact of materialism on adolescents.. Part one presents an empirical paper that investigated the association between materialism and well-being within an adolescent sample using comprehensive measures of well-being and materialism. The study also looked at whether satisfaction and frustration with basic psychological needs played an explanatory role within this relationship. Materialism within adolescence was found to be associated with reduced life satisfaction and psychological needs satisfaction had an explanatory role in this relationship. Materialism was not universally related to all well-being dimensions measured. Applications of these findings and future research directions are discussed. Part two of this portfolio is a systematic review of the literature on materialism and well-being within adolescent populations. The findings of the review suggested that materialism was associated with increased health risk behaviours and reduced life satisfaction within adolescent populations. However, the review found large variations in the findings with some contradicting evidence. The review identified methodological issues which limited the conclusions drawn
Deluca Paolo, Coulton Simon, Alam Mohammad Fasihul, Boniface Sadie, Donoghue Kim, Gilvarry Eilish, Kaner Eileen, Lynch Ellen, Machonochie Ian, McArdle Paul, McGovern Ruth, Newbury-Birch Dorothy, Patton Bob, Pellatt-Higgins Tracy, Phillips Ceri, Phillips Thomas, Pockett Rhys, Russell Ian T., Strang John, Drummond Colin (2020) Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs,Programme Grants for Applied Research8(2)
NIHR Journals Library
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 e 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 re
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.
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.
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?.
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: 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.
Aims: Using two data-sets, this study aimed to determine the prevalence of alcohol consumption among people with type 2 diabetes mellitus (T2DM) in England and Wales, compared with people without T2DM, and to explore associations between alcohol consumption and both psychological and behavioural outcome measures in people with T2DM.
Methods: Two data-sets were used. 7,848 participants from the Health Survey for England (HSE) 2016 (549 with T2DM) completed the General Health Questionnaire-12 (GHQ-12) and Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and reported average weekly alcohol consumption in units. Sixty-one UK participants with T2DM were recruited through diabetes peer-support websites to complete a survey, comprising the Alcohol Use Disorder Identification Test (AUDIT), WEMWBS, Diabetes Self-Management Questionnaire (DSMQ), and Diabetes Distress Scale (DDS). Spearman?s rank correlations, Chi-squared, Mann-Whitney U, and Kruskal-Wallis tests were used to explore the relationships between alcohol consumption and mental wellbeing (WEMWBS) in both samples, psychological distress (GHQ-12) from the HSE, and diabetes-related distress (DDS) and self-management (DSMQ) from the online survey.
Results: From HSE data, people with T2DM were more likely to be non-drinkers (OR=2.087) and to have poorer mental wellbeing (p<0.0005) and psychological distress (p<0.0005) than people without T2DM. Non-drinkers with T2DM had poorer mental wellbeing (p<0.0005) and psychological distress (p<0.0005) than drinkers. From the online survey, AUDIT score was not associated with general (p=0.323) or diabetes-related distress (p=0.475). A greater AUDIT score was associated with poorer glucose management (p<0.0005) and dietary control (p=0.041), but not with physical activity (p=0.229) or healthcare use (p=0.708).
Conclusions: Alcohol consumption is less prevalent among people with T2DM than the general population but may be associated with difficulties in some aspects of self-management. Drinking is associated with lower psychological distress than non-drinking among people with T2DM. Tentative clinical recommendations are made based on these findings and areas for further research are suggested.
Keywords: type 2 diabetes, alcohol, self-management, distress, wellbeing
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.