Working with Older People with Alcohol Problems: Insight from Specialist Substance Misuse Professionals and their Service Users

Significant numbers of older people worldwide have a drinking level or pattern which places them at risk of harm. In England, older people are more likely to be admitted to hospital for an alcohol-related condition than younger people and levels of alcohol-related harm are increasing fastest in this population. Whilst alcohol problems in older people are highly treatable, they frequently go undetected or ignored. The aim of this study was to develop guidelines for health and social care workers on what intervention strategies are likely to work best with older drinkers. Insight from alcohol practitioners who specialise in working with older people and the perspectives of older people receiving alcohol treatment were gained through focus groups and individual interviews. This paper reports some of the key findings including a perception that health and social care workers often did not intervene when alcohol misuse was suspected because of ageist attitudes and false beliefs about older people's drinking. Participants however acknowledged that social workers faced difficult choices in relation to the ‘right’ of older people with alcohol problems to continue to drink and the ‘risk’ associated with them doing so. The implications for social work education and training are discussed.     

Starting to drink: the experiences of Australian lower secondary students with alcohol

This study describes Australian year eight students' (13-14 years old) experiences with alcohol in terms of communication with parents, initiation into drinking, patterns of consumption, context of use, and harms experienced. The sample comprised 521 year eight students from four state government secondary schools in the state of Victoria. Three of the schools are in Melbourne, the capital of Victoria; the fourth is in a rural center. Female and rural students were more likely to talk to parents about alcohol, but this was not associated with safer drinking. Initiation into drinking was higher among rural students. Rural students also drank more, were more likely to drink without adult supervision, to drink to get drunk, and drink more than planned. Student drinkers experienced just over four alcohol-related harms on average in 12 months, with some indication of greater harm among rural students. Higher levels of drinking by rural students, accompanied by more risky patterns of consumption and the possibility of greater harm, supports prioritizing interventions in rural schools.     

Sex-Related Alcohol Expectancies Among African American Women Attending an Urban STI Clinic

African American women are disproportionately affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs). Alcohol use is a significant risk factor for HIV/STI acquisition. Sex-related alcohol expectancies (SRAEs) may partially account for alcohol-related risky sexual behaviors. Using qualitative interviews we explored the link between alcohol use and risky sex among 20 African American women attending an STI clinic who had consumed four or more alcoholic drinks per drinking day (binge drinking) and/or reported vaginal or anal sex while under the influence of alcohol. Four SRAEs emerged, which we named drink for sexual desire, drink for sexual power, drink for sexual excuse, and drink for anal sex. While the desire SRAE has been documented, this study identified three additional SRAEs not currently assessed by expectancy questionnaires. These SRAEs may contribute to high-risk sex when under the influence of alcohol and suggests the importance of developing integrated alcohol–sexual risk reduction interventions for high-risk women.     

Trends in College Binge Drinking During a Period of Increased Prevention Efforts: Findings from 4 Harvard School of Public Health College Alcohol Study Surveys: 1993–2001

Abstract

The 2001 Harvard School of Public Health College Alcohol Study surveyed students at 119 4-year colleges that participated in the 1993, 1997, and 1999 studies. Responses in the 4 survey years were compared to determine trends in heavy alcohol use, alcohol-related problems, and encounters with college and community prevention efforts. In 2001, approximately 2 in 5 (44.4%) college students reported binge drinking, a rate almost identical to rates in the previous 3 surveys. Very little change in overall binge drinking occurred at the individual college level. The percentages of abstainers and frequent binge drinkers increased, a polarization of drinking behavior first noted in 1997. A sharp rise in frequent binge drinking was noted among students attending all-women's colleges. Other significant changes included increases in immoderate drinking and harm among drinkers. More students lived in substance-free housing and encountered college educational efforts and sanctions resulting from their alcohol use.     

Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001

The 2001 Harvard School of Public Health College Alcohol Study surveyed students at 119 4-year colleges that participated in the 1993, 1997, and 1999 studies. Responses in the 4 survey years were compared to determine trends in heavy alcohol use, alcohol-related problems, and encounters with college and community prevention efforts. In 2001, approximately 2 in 5 (44.4%) college students reported binge drinking, a rate almost identical to rates in the previous 3 surveys. Very little change in overall binge drinking occurred at the individual college level. The percentages of abstainers and frequent binge drinkers increased, a polarization of drinking behavior first noted in 1997. A sharp rise in frequent binge drinking was noted among students attending all-women's colleges. Other significant changes included increases in immoderate drinking and harm among drinkers. More students lived in substance-free housing and encountered college educational efforts and sanctions resulting from their alcohol use.     

The personal protective behaviors of college student drinkers: evidence of indigenous protective norms

Given the prevalence of alcohol consumption and the relative infrequency of harm among college students, the authors sought to determine how most college students protect themselves from alcohol-related harm. An analysis of the aggregate National College Health Assessment data identified a cluster of personal protective behaviors that correlated with reduced risk when drinking. Further analysis revealed that nearly three-quarters of student drinkers regularly employ at least 1 protective behavior, and well over half of the students who use protective behaviors routinely employ 2 or more. In addition, the data reveal that student drinkers employ situational abstinence, with nearly 7 out of 10 students reporting that they sometimes or usually refrain from drinking alcohol when they socialize. The use of these protective behaviors is a strong predictor of safety and harm for college-student drinkers.     

Underage college students' drinking behavior, access to alcohol, and the influence of deterrence policies. Findings from the Harvard School of Public Health College Alcohol Study

Underage drinking is a major problem at American colleges, but little is known about the extent of alcohol use in different student groups, in different colleges, and in states with different control policies. We used data from the 2001 and 3 previous Harvard School of Public Health College Alcohol Studies that compared responses of underage students with those of their 21-23-year-old peers. Underage students drank alcohol less frequently but were more likely to drink to excess when they drank. College educational efforts and deterrent policies were limited in their outreach, and half of underage students obtained alcohol very easily. Underage students in states with extensive laws restricting underage and high-volume drinking were less likely to drink and to binge drink. A majority of underage students supported increasing efforts to control underage drinking. The results suggest that additional policy efforts to control underage drinking may be effective and feasible.     

The road to a world health organization global strategy for reducing the harmful use of alcohol

Harmful alcohol use and the related health effects are a global problem and therefore need to be addressed not only by individual nations but also on an international level. For example, the World Health Organization (WHO) noted that harmful alcohol use is the third leading risk factor for premature deaths and disabilities in the world, accounting for approximately 2.5 million deaths worldwide (corresponding to 3.8 percent of all deaths) in 2004 (WHO 2010). Moreover, harmful alcohol use was considered responsible for 4.5 percent of the global burden of disease as measured in disability-adjusted life-years lost in the same year. Given this scope of the impact, the WHO initiated a series of efforts that culminated in the development of a global strategy for reducing the harmful use of alcohol. This article reviews the alcohol-related activities of the WHO over the years and summarizes the central issues addressed by the global strategy.     

Early onset of drinking as a predictor of alcohol consumption and alcohol-related problems in college

A survey of 4,202 students enrolled in the State University System of Florida from 1986 to 1988 showed that 14 percent started drinking in elementary school, 34 percent started in middle school, 45 percent in high school, and 7 percent in college. A General Linear Models analysis of variance procedure showed that the time of first drink significantly predicted the quantity-frequency of alcohol consumption and the incidence of alcohol-related problems reported by students in college. Students who started to drink while in elementary and middle school reported significantly higher levels of consumption and problems than those who started drinking while in high school or college.     

University students' knowledge of alcoholic drinks and their perception of alcohol-related harm

A total of 371 university students were asked to estimate the amount of alcohol contained in a standard drink and to estimate the number of standard drinks contained in popular alcoholic beverages. In addition, students completed questionnaires assessing their perception of short and long term harm related to the consumption of beer, wine, spirits and pre-mixed alcopops. Results revealed that students were generally inaccurate in their estimate of alcoholic content of beverages, and national guidelines for low risk drinking. Students were also found to hold different perceptions regarding how harmful different alcoholic beverages were. While both male and female students considered spirits to be more harmful than beer, wine and pre-mixed drinks, males also believed beer to be more harmful than wine when considering the short term consequences. The pattern of beliefs reported by this sample suggest a high-risk population who are not aware of the risks they are exposing themselves to through their drinking behavior.     

Self-reported drinking-game participation of incoming college students

Drinking games are associated with excess alcohol use and alcohol-related problems, yet it is unclear whether they are unique to the college environment or whether students come to college familiar with such games. The authors queried 1,252 students attending voluntary summer orientation programs about their experiences with drinking games. A majority (63%) indicated they had played drinking games and viewed them as a means to get drunk quickly and to socialize, control others, or get someone else drunk. Logistic regression analyses revealed that familiarity with drinking situations was associated with a greater likelihood of playing drinking games. Students who reported drinking more frequently and consuming greater quantities of alcohol than others, having lifetime marijuana use, and initiating alcohol consumption between the ages of 14 and 16 years were significantly more likely to have participated in drinking games. These findings demonstrate the importance of considering students' participation in drinking games when campus officials address alcohol use.     

Do lesbians overestimate alcohol use norms? Exploring the potential utility of personalized normative feedback interventions to reduce high-risk drinking in Southern California lesbian communities

This study examines the potential utility of social norms-based approaches to reduce heavy alcohol use in lesbian community settings. In a sample of 278 Southern Californian lesbians recruited from social media networks to complete an online survey, the majority of participants overestimated the quantity of alcohol consumed by their lesbian peers and more frequent lesbian bar attendance was associated with elevated perceptions of how much other lesbians drink. Greater than 90% of participants expressed interest in receiving personalized normative feedback, suggesting that culturally tailored personalized normative feedback interventions focused on correcting perceptions of heavy drinking may be successful in mitigating the alcohol-related risks of lesbians in Southern California, and potentially beyond.     

Drinking Game Participation Among Undergraduate Students Attending National Alcohol Screening Day

Abstract

Objectives, Participants, Methods: Drinking game participation has increased in popularity among college students and is associated with increased alcohol consumption and alcohol-related problems. The current study investigated drinking game participation among 133 undergraduates attending National Alcohol Screening Day (NASD) in April of 2007. Results: A large percentage of the sample reported lifetime (77%) and recent (52%) drinking game participation. Males were more likely to report recent participation and reported higher levels of consumption while playing drinking games. Drinking game participants were more likely to experience a range of alcohol-related problems, and the relationship between drinking game participation and alcohol-related problems was mediated by weekly alcohol consumption. Conclusions: These results suggest that drinking game participation is a risk factor for elevated levels of alcohol consumption and alcohol-related problems. Programs should be developed to educate students about the risks of drinking game participation, and prevention programs like NASD should address drinking games.     

Educating women about the hidden dangers of alcohol

1. There is mounting research evidence that alcohol use and abuse affects women much differently than men. 2. Research indicates that women absorb and metabolize alcohol differently than men, partly due to body composition differences and the production of less gastric alcohol dehydrogenase by women. 3. Women of child-bearing age who engage in binge drinking are at increased risk of bearing children with fetal alcohol syndrome or alcohol-related neurological deficits. 4. Psychiatric nurses are often in the position to provide education and counseling to women regarding the hidden dangers of alcohol use and abuse.     

Sleep Quality and Alcohol Risk in College Students: Examining the Moderating Effects of Drinking Motives

Abstract

Objective: Sleep problems and alcohol misuse are common issues experienced by college students that can have detrimental effects on overall health. Previous work indicates a strong relationship between poor sleep quality and alcohol risk in this population. This study explored the moderating effect of drinking motives in the relationship between global sleep quality and experience of alcohol-related negative consequences. Participants: College students (N = 1,878) who reported past-month drinking. Methods: Participants completed online surveys assessing sleep and alcohol-related behaviors. Results: Poorer sleep quality and higher drinking motives (coping, conformity, and enhancement) predicted greater alcohol-related consequences, controlling for drinking. Further, coping motives moderated the relationship between sleep quality and consequences such that participants reporting poor sleep and high coping motives experienced heightened levels of consequences. Conclusions: These findings advance the understanding of the relationship between sleep problems and alcohol-related risk and provide implications for targeted campus-based health promotion interventions.     

Efficacy of a Web-Based,Tailored, Alcohol Prevention/Intervention Program for College Students: Initial Findings

Abstract

Objective: Reduce college student at-risk drinking (ARD) using a Web-based brief motivational alcohol prevention/intervention called Michigan Prevention and Alcohol Safety for Students (M-PASS). Participants: Participants included 1,137 randomly sampled first-year college students, including 59% female, 80% white, and averaged age 18.1 years. Methods: Intervention group participants (n = 616) attended 4 online M-PASS sessions, receiving feedback tailored to individual drinking patterns and concepts from 4 behavior change theories. Control group participants (n = 521) completed a mid-phase survey, and both groups were surveyed at baseline and posttest. Results: Evidence of M-PASS's efficacy was found. The intervention was associated with advanced stage of change, lower tolerance of drinking and drink/driving, fewer reasons to drink, and use of more strategies to avoid ARD. Preliminary evidence of behavioral change was also found. Efficacy was greater for women than men. Conclusions: Web-based programs may be useful in reducing alcohol-related risk among college students. Further evaluation is needed.     

College alcohol use: a full or empty glass?

Data from the Harvard School of Public Health College Alcohol Study (1993) were used to describe weekly alcohol consumption and its associated problems among a representative national sample of college students. The median number of drinks consumed/week by all students, regardless of drinking status, was 1.5. When students were divided by drinking pattern, the median number of drinks/week was 0.7 for those who did not binge drink and 3.7 for those who did so infrequently. For frequent binge drinkers, the median was considerably higher: 14.5 drinks/week. Nationally, 1 in 5 five college students is a frequent binge drinker. Binge drinkers consumed 68% of all the alcohol that students reported drinking, and they accounted for the majority of alcohol-related problems. The data indicate that behavioral norms for alcohol consumption vary widely among students and across colleges. Therefore, it may not be possible to design an effective "one size fits all" approach to address college alcohol use.     

Calorie Restriction on Drinking Days: An Examination of Drinking Consequences Among College Students

Objective: This study examined the association between restricting calories on intended drinking days and drunkenness frequency and alcohol-related consequences among college students.

Participants: Participants included a random sample of 4,271 undergraduate college students from 10 universities.

Methods: Students completed a Web-based survey regarding their high-risk drinking behaviors and calorie restriction on intended drinking days.

Results: Thirty-nine percent of past 30-day drinkers reported restricting calories on days they planned to drink alcohol, of which 67% restricted because of weight concerns. Restricting calories on drinking days was associated with greater odds of getting drunk in a typical week. Women who restricted were more likely to report memory loss, being injured, being taken advantage of sexually, and having unprotected sex while drinking. Men were more likely to get into a physical fight.

Conclusions: These results highlight the importance of considering weight control behaviors in the examination of high-risk college drinking.     

Alcohol abuse as a rite of passage: the effect of beliefs about alcohol and the college experience on undergraduates' drinking behaviors

Qualitative studies of alcohol's ritual influences indicate that college undergraduates who drink heavily tend to view alcohol use as integral to the student role and feel entitled to drink irresponsibly. Our analyses, based on a standardized measure of these beliefs administered to approximately 300 students, confirmed these findings. Among our sample, beliefs about alcohol and the college experience had an effect on levels of alcohol consumption similar in magnitude to that of other variables commonly associated with a risk for heavy drinking. Moreover, the alcohol beliefs index moderated the effects of three risk factors--gender, high school drinking, and friends' use of alcohol--on respondents' drinking behaviors. These findings are discussed within the context of the anthropological literature on liminality and rites of passage and with regard to strategies for intervention that address the structural roots of the widespread abuse of alcohol on college campuses.