Is there anything he could organize in a brewery? Comments on Minimum Unit Pricing

This post was written by Natasha Clarke, an MSc student at the University of Liverpool.

I recently attended the first annual Alcohol Research UK conference in London and wanted to focus this post on the fascinating day of talks that I was honoured to get the chance to listen to. I found the day engaging, all the talks were brilliant and inspiring and I just wanted to touch on an important issue that stuck with me on my journey home.

The most interesting for me related to MUP, Minimum Unit Pricing. Cheap alcohol is said to be a major reason for heavy drinking and talks of plans to increase the MUP to 40p or 45p have been long discussed. Its first mention of the day was by Professor Jonathan Chick and Dr Jan Gill in regards to Scotland. There it has been legislated but not yet implemented, despite the predictions of a 7.2% decrease in consumption and a reduction in hospital admissions. It was then discussed by Professor Keith Humphreys. He mentioned some facts about MUP that I must admit I wasn’t quite aware of. I know it’s a good idea but I’m never particularly good at defending its corner when my friends complain about more expensive drinks. I now have more evidence to throw back at them. It is not a taxation (it’s an increase in what the merchant charges on some beverages), and it’s not moderate drinkers who will be affected, it is heavy drinkers, because they generally buy cheaper drinks and therefore spend less per unit of alcohol. Furthermore, most beverages would not actually be affected by the change in price. Professor Humphreys interestingly mentioned that the cost to moderate drinkers would be greater with a lower MUP, due to NHS costs associated with heavy drinkers.

Evidence supporting its implementation from modelling data shows that the benefits of MUP are greater at 45p than 40p in terms of reducing consumption and health care costs in all population subgroups. Direct evidence from Canada shows that a 10% increase in average minimum price resulted in a 32% reduction in wholly alcohol attributable deaths between 2002 and 2009. This suggests the potential for great benefits, and shows promise for the future. So I go home, enlightened, and fall asleep dreaming of an improved world with a higher MUP, wake up and see an article on the BBC News discussing the uncertainty of whether Cameron will introduce the 45p per unit policy. He has now failed to commit on the pricing change, so it seems the plans may have been dropped…

Who knows what the future will hold: the evidence suggests MUP will be effective yet the government are having second thoughts. Moderate drinkers will hardly be affected, and nobody is trying to get all of us who do like a drink now and then to abstain completely. We enjoy ourselves and that’s what life is about. But the key word is moderation. Even if we don’t want to stop drinking ourselves, we should support any policy changes that might help heavier drinkers get back their enjoyment from life by cutting down on their alcohol.

The day ended with Professor the Baroness Finlay of Llandaff, who emphasised that even if public opinion is that alcoholics have made a choice and are therefore unwilling to take the steps to give them help, nobody can deny the secondary benefits that will come with reducing heavy drinking in the wider population. Maybe we can prevent innocent bystanders from being the victims of alcohol-related crimes, or free up NHS time from treating drunken injuries so they can focus on other illnesses and ailments. People think a rising MUP will punish the average drinker, but this is not the case. If we want to push change then public opinion needs to change. This can only happen when the public are informed properly about the benefits and understand the evidence. At the end of the day that is why research is conducted, to get the scientific evidence out to the public and ensure it has impact and promotes change.

See below some interesting posts from Keith Humphreys, one discussing MUP, the other on 24/7 sobriety for crime control.

http://www.samefacts.com/2010/09/crime-control/british-drug-and-alcohol-policy-iii-what-is-minimum-pricing-of-alcohol-and-will-it-reduce-problem-drinking/

http://www.samefacts.com/2012/11/crime-control/update-on-247-sobriety-in-south-dakota/

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A fine VINTAGE? The benefits and consequences of alcohol consumption in older adults

This article was written for the Mental Elf website by Matt Field, you can find the original post here.

We know a lot about the health consequences of drinking too much alcohol, but most of this research comes from studies of adults in their twenties, thirties and forties. But what about older adults? The European project VINTAGE reviewed and synthesised the available evidence relating to alcohol consumption in older people across many European countries. This project has now been published in two papers, one describing the methodology in detail, and the other summarizing the findings.

You might ask why we should be particularly concerned about alcohol consumption in older people. There are several reasons. Firstly, we know that when older people drink alcohol, their blood alcohol content rises more quickly and peaks at a higher rate, compared to younger people. The elderly may also show reduced tolerance to the effects of alcohol. Secondly, the authors make the point that the current generation of ‘baby boomers’ (those born in the years after the end of the Second World War) have more favourable attitudes to drinking, and more disposable income, than previous generations.  Both of these things are likely to be linked to increased consumption of alcohol. More generally, as life expectancy continues to increase and the proportion of elderly people making up the population of the European Union continues to rise, it is very important that we understand the influence of alcohol consumption on the health of older people.

Methods

This team of researchers from a number of European countries searched the research literature for articles that examined alcohol consumption in older adults, and assessed the consequences of drinking for health and well-being. The focus was on alcohol consumption in the general population, it is not a review of medical complications arising from alcohol dependence in older people. They only included systematic reviews or original research papers that had not been included in a previous systematic review, so this paper was a review of reviews. They then completed a narrative review, with some meta-analyses, based on a total of 78 papers.

Results

This is what they found:

Older people with low to moderate alcohol consumption have improved general health, well-being and cognitive function, relative to those who drink heavily, or abstainers

• Compared to younger adults, adults in the 50-65 age bracket do not drink significantly less, or drink less frequently, than younger adults
• However in people aged 75 or above, fewer people ever drink alcohol, and rates of heavy drinking are very low
• Older people with low to moderate alcohol consumption have improved general health, well-being and cognitive function, relative to those who drink heavily, or abstainers
• The relationships between alcohol intake and incidence of dementia, Alzheimer’s disease, cardiovascular disease and some types of stroke were best described by U-shaped or J-shaped curves, meaning that low to moderate alcohol consumption was associated with reduced incidence, but heavy drinking was associated with increased incidence of these diseases.
• The relationship between alcohol use and injuries, all cause mortality and some other health problems was a little unclear (meta-analyses would have been very useful here)

Conclusions

• Overall, we see that older adults (those aged 75 or above) drink less often and drink lower amounts of alcohol compared to younger adults. Their rates of alcohol-related harm are correspondingly low.
• Consumption of low to moderate amounts of alcohol in older age is associated with improved health. We don’t know the optimum amount of alcohol that people should drink, but we have to be very careful before recommending that older people should drink more, because:

for those who do drink, there is certainly no evidence that those who consume 20g alcohol per day are any worse or any better off than those who drink less. Of course, this may just mean that those who are healthier, wealthier and better socially adjusted are more likely to be light drinkers than abstainers or heavy drinkers

It is important to note that the authors reported a mix of meta-analyses and narrative reviews of the literature. For example, when discussing the link between alcohol use and some types of injuries, they reported that five of the available studies found a statistically significant association whereas the remaining five studies did not. If a meta-analysis had been conducted, this would have revealed the ‘bigger picture’ (for example, it might show a small but robust association between alcohol use and injuries).

The authors conclude by acknowledging that cumulative alcohol exposure over the lifetime is likely to be strongly associated with poor health, particularly as people get older. So even if somebody doesn’t drink very much at the moment, if they were a heavy drinker for most of their life then problems may be brewing.

Links

Galluzzo L, Scafato S, Martire S, Anderson P, Colom J, Segura L et al for the VINTAGE project working group. Alcohol and older people. The European project VINTAGE: good Health Into Older Age. Design, methods and major results. Ann. Ist. Super. Sanità 2012  Jan: 48(3): 221-231. DOI: 10.4415/ANN_12_03_03

Anderson P, Scafato E, Galluzzo L for the VINTAGE project working group. Alcohol and older people from a public health perspective. Ann. Ist. Super. Sanità. 2012  Jan: 48(3): 232-247. DOI: 10.4415/ANN_12_03_04

Matt Field

mfield@liv.ac.uk

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Sippin’ on Gin and Juice! The effect of music on alcohol consumption

This post was written by Lisa Di Lemma and Andy Jones, who are researchers at the University of Liverpool.

In the previous fortnight we have both been to music gigs and this got us thinking about the effects of music on behaviour, particularly alcohol use. Music and drinking alcohol seem to go hand-in-hand, for example songs about drinking or the culture of gigs and music festivals (until fairly recently, Leeds and Reading music festivals were sponsored by Carling, and called the Carling Weekender). Our discussion coincided with the publication of an interesting piece of research examining how different music genres can directly influence  alcohol consumption, and we discuss this paper here.

We often listen to music to alter our mood states or to stimulate behaviours. For example, how many times have we reached for a certain CD when we feel bad? Or created a playlist of high intensity tracks for our gym session in order to push ourselves that little bit further? These anecdotes are backed up by scientific research showing that certain characteristics of music can influence mood and exercise performance.

Because of the large and varied effects that music can have on individuals, our exposure to music is now becoming more and more ubiquitous in commercial environments, and this is no coincidence. Research has shown that Classical music can increase spending in restaurants, and songs referring to alcohol in the lyrics can increase spending on alcohol in bars. Importantly, the effects of music on our purchasing behaviour may occur outside our awareness. A simple, but interesting, correspondence published in Nature demonstrated that playing French Music increased purchases of French wine, whilst playing German Music increased purchases of German Wine. When asked about the reasons for their purchase only 6 of 44 shoppers alluded to music influencing their choice. It is important to note however, that larger scale studies have failed to replicate these effects!

Specific genres of music are also more likely to be associated with the use of different substances, for example illegal drugs versus alcohol. Dance music and raves are associated with the use of stimulants and hallucinogens, which are taken to amplify sensory experiences and increase energy. Rap and Rock music lyrics often glorify drug and alcohol use, and videos for these songs are often party themed. Finally, artists often associate themselves with drug and alcohol use, which is very ‘rock n’ roll’.

However, these studies do not identify causality. Do particular types of music actually influence our consumption of alcohol, or of particular alcoholic drinks? A recent Dutch study looked at this issue. They recruited 249 young adults, who were tested in groups of their peers. A total of 32 groups of friends visited the ‘bar lab’ (a laboratory which is decorated to look like a bar) to take part in the study. On the day they visited, participants were asked to complete some questionnaires and, after a 50-minute break, to perform some group tasks. The purpose of the questionnaires and group tasks was to disguise the true aims of the study from the participants.

Critically, during the break participants were exposed to one of four different types of music: Pop, Hard Rock, Rap or Classical. While the music was played they were allowed to order alcoholic and non-alcoholic drinks (which they didn’t have to pay for and weren’t forced to order). The researchers predicted that individuals who were exposed to Rap and Hard Rock would order the most alcoholic drinks, those exposed to classical music would order fewer alcoholic drinks, with those exposed to Pop music somewhere in the middle. However, this is what they found:

• Participants who listened to Classical music ordered and consumed significantly more alcohol than those who heard Hard Rock or Rap, with an almost significant difference with Pop music (p = .07).
• Looking at individual drinks, participants who listened to Pop and Classical Music drank more beer than those exposed to Hard Rock, whereas those who listened to Classical music drank significantly more wine compared to those who heard Pop or Hard Rock. Finally, Hard Rock music led to increased consumption of mixed drinks (e.g. rum and coke) compared to Pop and Classical music.
• Importantly, individual music preferences, importance of music to the individual and susceptibility for exposure to specific genres did not influence these results, which suggests relatively uncomplicated effects of music on consumption of different types of drinks.  

Now, we don’t think that students associate Classical music with wild parties and binge drinking, so this result was a surprise to us. The authors also acknowledge this and suggest that the increased alcohol consumption may be due to a ‘prediction error’ mechanism. It is probably fair to say that Classical music is not the music of choice in bars that students frequent. Therefore, they suggest that ‘people might deviate more from what their habitual drinking is in a bar when they are exposed to atypical music for that context’.

There are some other caveats to this research that should be taken into account before people throw out their symphony and concerto CDs. Firstly, the musical preference ratings given by participants may have been influenced by recent exposure to that music. Secondly, the authors did not control for the lyrical content of their music, and as we have discussed this has been shown to influence alcohol consumption. We suggest that future research should also attempt to examine not only consumption of alcohol but also purchases of alcohol after exposure to different types of music. Would people still drink more alcohol after hearing Classical music, if they have to pay for their own drinks?

These findings suggest that music can have a subtle influence on our alcohol consumption. A recent, well-publicised study shows that that the shape of glasses can influence the rate at which beer is consumed.  Although background music and glass shape are very different issues, if we take these findings together they show that subtle cues in our drinking environments may drive us to drink, and we might not be aware that our behaviour is being ‘nudged’ in this way!

Target paper:

Engels, R.C., Poelen, E.A., Spijkerman, R., Ter Bogt, T. (2012). The effects of music genre on young people's alcohol consumption: an experimental observational study. Substance Use and Misuse 47, 180-188.

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Using a Chinese herbal medicine to reduce excessive drinking

This post was written by Natasha Clarke, an MSc student at the University of Liverpool.

Many current drinkers report drinking to excess, therefore it is important to identify treatments which can reduce these drinking levels, even if the reductions are modest. Medicines derived from natural products that have few side effects and low toxicity are desirable. Kudzu extract, a Chinese herbal medicine, has long been used to treat alcoholism and reduce hangover symptoms in Asian cultures. A previous study reported that treatment with kudzu extract led to significant reductions in alcohol consumption in heavy drinkers over the course of a week (Lukas et al, 2005).

This randomised, double-blind, placebo controlled study was designed to see if treatment with kudzu extract (NPI-031) over a longer period of 4 weeks would reduce alcohol consumption. It was conducted in Boston and published in Psychopharmacology. Authors found a modest reduction in alcohol consumption, and the kudzu extract was well-tolerated with minimal side effects.

Methods

The study recruited 21 male heavy drinkers aged 21-33 years, of whom 17 completed the study. Only males could take part because kudzu extract may interfere with oestrogen activity.

The study had a 2-week baseline period, 4 weeks of medication (or placebo) and a 2-week follow up. Participants were assigned to receive either kudzu extract or a placebo, and they attended the laboratory twice per week for the first 6 weeks and once per week in the follow-up fortnight. Alcohol and other drug use were monitored with self-report measures which were validated with breath, urine and blood samples. Safety of the kudzu extract was monitored by assessments of vital signs, daily reports, weekly assessments of adverse events, blood sample testing and an ECG at the end of the study.

Results

•   During the 4 weeks when participants received medication (or placebo), participants who received kudzu extract reported significant reductions in drinking compared to baseline. Participants in the placebo group also reported reductions in drinking compared to baseline, although these reductions were not statistically significant. However, differences between the kudzu extract and placebo groups were only statistically significant during the third week of receiving medication. Overall, the interaction between medication group and study week was statistically significant (p=0.034, ηPartiall²= 0.146), which reflects the reduction in drinking compared to baseline in the kudzu extract group only.  However, it seems that the study was underpowered to detect differences between kudzu extract and placebo.

•   There were also differences between the kudzu-treated and placebo groups in terms of the number of days per week that they drank heavily, as revealed by main effects of time (p<0.005, ηPartiall²= 0.197) and drug (p=0.008, ηPartiall²= 0.386). Relative to baseline, the kudzu group showed a reduction in heavy drinking days on the first, third and fourth treatment weeks (but not the second week). Differences between kudzu and placebo were only statistically significant on week 4, which again seems down to low statistical power.

•   Importantly, these reductions in drinking in the kudzu extract group (compared to baseline) were maintained during the two-week follow-up period, after they had stopped taking the medication.

•   The medication also influenced the number of days that participants remained abstinent from alcohol during the treatment phase. Nine out of 10 participants in the kudzu extract group achieved three or more consecutive days of abstinence, compared to only three out of seven participants in the placebo group. This difference was statistically significant, although we have to again note the small sample size and the fact that 3 of 10 participants originally assigned to the placebo group did not complete the study, as opposed to only one of the 11 participants assigned to the kudzu group.

•   There were no indications that kudzu extract altered desire for alcohol.

•   Medication adherence was excellent.

•   There were no adverse events and changes in vital signs, blood chemistry and renal or liver function.

Conclusions

The researchers stressed that their most important finding was that 4 weeks treatment with the kudzu extract led to a reduction in self-reported alcohol consumption in heavy drinkers who were not seeking treatment. It also increased the number of consecutive days that participants did not drink alcohol.

Overall, it seems that kudzu extract could be a useful add-on to other treatments for problem drinking. However, the sample size in this study was very small and differences between kudzu extract and placebo were not consistent across time, so a much larger randomised controlled trial (RCT) is needed.

 

This study suggests that kudzu extract can result in a desirable reduction in drinking (compared to baseline), with no adverse side effects, and it may be beneficial when combined with a comprehensive treatment program. However, this study only tested this effect in Males, and for safety reasons they could not test the drug in Females. Which is a shame!

Link to paper

Lukas SE, Pentair D, Su Z, Geaghan T, Maywalkt M, Tracy M, Rodolico J, Palmer C, Ma Z, Lee DY-W. A standardized kudzu extract (NPI-031) reduces alcohol consumption in nontreatment-seeking male heavy drinkers. Psychopharmacology 2013, 226: 65-73.

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Cost-effectiveness of internet-based interventions for harmful drinking

This post was written by Andy Jones for the Mental Elf website, you can find the original here.

The World Health Organisation (WHO) considers harmful drinking as the third largest contributor to the Global Burden of Disease, an index of disability, poor health and mortality. The majority of people who suffer from alcohol use disorders do not receive any treatment, due in part to lack of access. One way of increasing the availability of treatment is to administer it via the internet. Overall, internet-based interventions do seem to lead to reductions in harmful drinking.

The authors of the current study, published in the Journal of Medical Internet Research, compared the efficacy and cost effectiveness of two types of internet-based interventions: Internet-based self-help and Internet-based therapy (the Mental Elf previously discussed the efficacy of these interventions here). Both are based on cognitive behaviour therapy and motivational interviewing, but there are a few major differences. Internet-based self-help provides information and introduces heavy drinkers to exercises that help them to resist craving and peer pressure, and deal with drinking ‘lapses’. Whereas internet-based therapy is driven by online chat sessions with a qualified therapist and has specific aims including self-control, goal setting, and relapse prevention. Despite being significantly more costly (€283 compared to €12 for the self-help sessions), the authors discovered that Internet-based therapy may be a more cost effective intervention than Internet-based self-help.

Methods

The research was conducted alongside a randomised controlled trial comparing the two types of interventions and a waiting list control (data from the waiting list control were not analysed, and we assume that ‘waiting’ doesn’t cost anything). Participants were recruited through the website of a substance abuse treatment centre based in the Netherlands and in order to take part they had to be between 18-65 years old, drink alcohol at levels that are harmful to health (indicated by a score of 8 or above on the Alcohol Use Disorders Identification Test) and have internet access (obviously!). Overall, 136 participants were included in the analyses (68 in each treatment condition). Participants were followed up three months after the intervention, and again at six months.

At follow-up, the researchers counted the number of ‘treatment responders’ in each group. A treatment responder was defined as somebody who had reduced their alcohol consumption to ‘safe’ levels (based on recommendations from the British Medication Association: no more than 14 standard units for women, or 21 units for men, per week)), along with no substantial deterioration in scores on the AUDIT, Quality of Life Scale or Brief Symptom Inventory.

The researchers also calculated Quality Adjusted Life Years (QALYs; more information on this measure can be found here), and the Incremental Cost Effectiveness Ratio (ICER; more information here) in order to quantify the cost effectiveness of any additional benefits caused by internet based therapy, when compared to internet based self-help.

Results

This is what they found:

• Internet-based therapy was much more effective at reducing drinking than internet based self-help at 6 month follow-up. In the Internet-based therapy group 36 (53%) participants responded favourably, whereas in the Internet-based self-help group only 20 (36%) participants showed a reduction in their drinking. 
• The Internet-based therapy intervention also led to improved QALYs compared to Internet-based self-help (0.89 vs. 0.78 years). 
• Despite being considerably more expensive than self-help (recall that internet-based therapy cost €283 per session as opposed to €12 per session for internet-based self-help), Internet-based therapy had a 60% likelihood of being a more cost-effective treatment, with an Incremental Cost Effectiveness Ratio of €14,710. 

Conclusions

The paper set out to answer the question of whether the beneficial effects of Internet-based therapy (IT) would outweigh its significantly greater cost compared to the much cheaper (but also effective) internet-based self-help (IS).

The authors concluded that:

‘IT offers outcomes for money equal to or better than those obtained with IS, and might therefore be considered as a possible treatment option’.

The results suggest that an internet intervention comprising interaction with a therapist via online chat was significantly more effective than a self-help internet intervention, and the additional cost of this intervention was money well spent in terms of improvement in Quality Adjusted Life Years (QALYs). However, participants were only followed up for six months, so we need to evaluate the efficacy and cost-effectiveness of this treatment in the long-term. Furthermore, a 60% likelihood of increased cost effectiveness for Internet-based therapy is relatively small. Therefore, because of the larger costs involved in Internet-based therapy (it was over 20 times more expensive than comparable ‘self-help’) the authors suggested a stepped care approach. This would mean referring individuals for internet self-help first, and then moving them on to the more expensive Internet-based therapy if they did not reduce their drinking in response to the self-help.

Links:

Target Paper:

Blankers, M., Nabitz, U., Smit. F., Koeter, M.W.J., Schippers, G.M. (2012). Economic Evaluation of Internet-Based Interventions for Harmful Alcohol Use Alongside a Pragmatic Randomized Controlled Trial. J Med Internet Res, 14, e134 (free PDF).

More information:

Bambha, K., Kim, W.R. (2004). Cost-effectiveness analysis and incremental cost-effectiveness ratios: uses and pitfalls. Eur J Gastroenterol Hepatol, 16(6):519-26.

National Institute for Health and Clinical Excellence. Briefing paper for the Methods Working Party on the Cost Effectiveness Threshold.

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Tailored primary care intervention for heavy drinking may be counterproductive

This post was written by Matt Field for the Mental Elf website, you can find the original here.

Approximately 15% of adults in Europe drink alcohol to excess, at levels that are likely to affect their health. Most of these people are not alcohol dependent and do not require intensive treatment such as detox and aftercare, but many of them would benefit from a ‘nudge’ to reduce their drinking to safer levels.  Screening and Brief Interventions for hazardous drinking are a useful and cost-effective way of doing this. Indeed the Lifestyle Elf has recently written about screening and brief interventions in primary care and for general hospital patients.

This Randomised Controlled Trial, published in the Journal of the American Board of Family Medicine, describes an evaluation of an intervention that was delivered through 70 GP practices in the Netherlands. The headline result is that the group of patients who received the intervention did show a significant reduction in hazardous drinking when assessed at two-year follow-up. However, this was no cause for celebration because a control group of patients also showed a significant reduction in hazardous drinking at follow-up, and to a greater extent than the group that received the intervention! Therefore, it seems that this particular intervention was, unfortunately, counterproductive.

Methods

The research team invited 2758 general practices to participate, of which 82 practices (3%) agreed to take part. Five practices dropped out subsequently, and another seven were eliminated because they did not identify any patients who met the criteria for ‘hazardous drinking’ (defined as a score of 8 or above on the Alcohol Use Disorders Identification Test; AUDIT). The final sample comprised 712 patients, who all scored at least 8 on the AUDIT, recruited from a total of 70 GP practices. Each practice was then randomly assigned to either the intervention group (346 patients from 36 practices), or the control group (366 patients from 34 practices). The GP practices in the intervention group received the following:

·      Professional-directed interventions such as drinking guidelines, reminder cards, and training sessions about hazardous drinking provided to the GPs themselves.

·      Organization-directed interventions including feedback from the researchers about their patients’ drinking characteristics, introductions to local addiction treatment services, and provision of training in the alcohol intervention by a trained facilitator

·      Patient-delivered interventions including a poster in the waiting room, personalised feedback on their alcohol consumption, and leaflets on alcohol consumption and harmful drinking.

The control group were mailed the leaflets about alcohol consumption and harmful drinking (described above), but did not receive any personalised feedback on their drinking or any of the other interventions described above. The primary outcome measure was the proportion of patients in each group who still met the criteria for hazardous drinking, which the researchers obtained by mailing the AUDIT to all of the participants two years after they had originally enrolled in the study.

Results

This is what they found:

·      35.5% of patients from the intervention group had reduced their alcohol consumption to low-risk levels (a score of 7 or below on the AUDIT) after two years.

·      47% of patients from the control group had reduced their alcohol consumption to low-risk levels after two years.

·      This difference between groups was statistically significant (Odds Ratio: 0.62, 95% CI: 0.43-0.90).

·      They also found that, across both groups, females, older participants and non-smokers were more likely to shift to low-risk drinking across the follow-up period. Other variables, including beliefs about the effects of alcohol and intentions to reduce drinking, also predicted outcome. 

Conclusions

The authors concluded that their intervention was counterproductive: although some patients who received the intervention did reduce their drinking to ‘low risk’ levels, the proportion that did so was actually significantly lower than the proportion in the control group, who only received leaflets about alcohol in the post! The research team discussed several possible explanations for their findings. Firstly, the participation rate was low (only 3% of practices that were invited actually took part). Perhaps most importantly, the researchers noted that:

‘our program did not result in improvements in rates of screening and giving of advice’

 In other words, compliance with the intervention among the GPs was low.

Overall, it is not such a mystery that patients in both the control and intervention conditions showed a reduction in hazardous drinking, because factors such as regression to the mean and ‘non-specific effects’ are common with these types of brief interventions, as the Lifestyle Elf discussed in regards to a different study here. But it is unusual to demonstrate that a control condition produces better results than a brief intervention, and the authors were not really able to explain this in their paper. I cannot explain it either.

Link to paper:

Hilbink M, Voerman G, van Beurden I, Penninx B, Laurant M. A randomized controlled trial of a tailored primary care program to reverse excessive alcohol consumption. J Am Board Fam Med. 2012 Sep-Oct;25(5):712-22. doi: 10.3122/jabfm.2012.05.120070.

Matt Field

mfield@liv.ac.uk

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A teetotaller’s view on life as an alcohol researcher

Whenever I go out to a pub or bar and decline a drink, people generally think it’s quite strange. What's more, when we talk about jobs and interests it gets worse. When I tell them I conduct research into alcohol and problem drinking they either think I am joking, begin to shuffle nervously and assume I am silently judging them, or perhaps more surprisingly they become generally interested in what I do and start picking my brain.

When I say I study alcohol, I’m only really at the beginning of my research career (well, I hope I am not near the end of it). I recently finished a PhD in at the University of Liverpool investigating disinhibition and cognitive biases in heavy drinkers (you can read some of my published, peer-reviewed research here, here, here and here. Having finished, I decided that research was the job for me, and signed up to three more years as a post-doc on an MRC-funded project that will examine the issues from my PhD in more detail.  When I tell people I don’t drink they assume that my research interests have contributed to my choice, when in fact this isn’t the case.

I’m still not entirely sure what drives my abstinence. I did the usual heavy drinking in my teens. Heading into the city centre tanked up on cheap vodka and someone else’s ID, I had some of the best times (as far as I can remember!).  At the same time, not all of my experiences with alcohol were positive. When I did drink, it wasn’t in moderation and I do not like vomiting! Drinking to get drunk is a strategy adopted by many young people: they drink huge amounts of alcohol not for the taste, but for the effects. Regardless, I think my experiences fit in with the well-established roles for both positive and negative experiences and expectations as determinants of individual differences in alcohol consumption. The idea that something can be pleasurable but can also have negative consequences, and the ambivalence this causes, is what made me interested in studying addiction in the first place. 

So, how does teetotalism affect me and my work? It has its pros and cons. I have to rely on purely objective accounts of the effects of drug and alcohol use. This is perhaps both good and bad. My discipline (experimental psychology) is defined by its objectivity, and as noted in a previous post here, scientists shouldn’t infer much from their own experiences. Besides, my subjective experiences of the effects of alcohol are now a distant memory. However, maybe to truly understand something you have to experience it (think Freud and cocaine or Hofmann and LSD)?  I can honestly say that sometimes, particularly during the early stages of my PhD, I did not feel as qualified or knowledgeable as my peers who went to the pub regularly. I assumed they held a greater understanding at least partly because of their personal experiences!

Aside from the obvious health related benefits, a major ‘pro’ is that I always have a clear head for work; there are no hangovers for me! I have never experienced a hangover but they sound pretty unpleasant. This means my productivity doesn’t suffer due to hangover. Something that was highlighted by the government recently is the cost to the economy of hangovers whilst at work. Over 200000 people go to work with a hangover every day. However, I’d like to think I am not a robot purely focused on my work and that the most understandable ‘con’ of my total abstinence is that occasionally I think I am missing out on something. Alcohol plays an important role in British culture (including at Universities!):  socialising, celebrations, commiserations and everything in-between.  When I decided I did not want to drink any more, the hardest part in the beginning was the peer-pressure; my friends didn’t understand (some still don’t) why I would choose to do such a foolish thing.  I find that there is no pressure from my friends now. Maybe they have accepted I am a ‘lost cause’, but what I have noticed is that they themselves are starting to reduce their alcohol consumption. I am now in my mid twenties, so my peers and I are at an age now where heavy drinking is not compatible with our responsibilities. Have I produced this healthy change in my friends, or are they ‘maturing out’ of heavy drinking, as the evidence suggests they should?

Anyway, I am not advocating abstinence for all: moderation is a sensible goal for most people, and is likely to lead to fewer suspicious glances when you go to the pub. However, I do think my choices give me a different insight into the topic that I study for my day job, and I wanted to share those with you here. Thanks for reading.

Andy Jones (or: Dr Andrew Jones)

Twitter: @ajj_1988