Summarising the impacts of the Queensland Alcohol-related violence and Night-Time Economy (QUANTEM) project

This closing commentary to the special section presents an overview of the Queensland Alcohol-related violence and Night-Time Economy Monitoring evaluation findings in comparison to those from other jurisdictions where similar interventions have been implemented (such as Sydney and Newcastle), and especially with previous studies that have used similar evaluation methodologies, such as the Dealing with Alcohol and the Night-Time Economy study. Overall, the articles documented promising reductions in alcohol-related harm, building on the existing evidence base for multi-pronged interventions in entertainment districts. Importantly, this is the first comprehensive investigation to also look at impacts on nightlife-related business and findings demonstrated, that there were improvements for many businesses. There are substantial policy implications for Queensland and other jurisdictions (nationally and globally) wanting to reduce late night alcohol-related harm in entertainment districts.     

Science,politics, and the play of chance in recent Australian drinking law changes

Regulating late‐night alcohol sales to prevent violence continues to be hotly debated in Australia. From July this year, Queensland required premises to stop serving alcohol (last drinks) by 3 am in entertainment precincts and by 2 am in the rest of the state. The Government made legislative provision for 1 am lockouts in entertainment precincts but at the time of writing has not committed to introducing them. Lockouts, also known as one‐way‐doors, permit patrons to remain drinking in premises until last drinks but deny entry to new patrons. In Newcastle, New South Wales, lockouts and earlier closing of licensed premises were introduced in 2008. Evidence that these produced large reductions in assault informed the 2014 Sydney restrictions that are currently under review. The global research evidence for last drinks regulations is compelling: trading extensions of as little as one h increase harm, and similarly modest restrictions reduce harm. In contrast, the effectiveness of lockouts, a phenomenon unique to Australasia, is uncertain. The Newcastle, Sydney and Queensland reforms are a stepwise progression in alcohol harm countermeasures, a welcome example of evidence‐based public policy. However, the aetiologies of these policy changes were complex. I present accounts of each and offer commentary on the interplay between scientific evidence, public health advocacy, politics, and chance occurrences that preceded these significant changes.     

Drinking, personality, and bar environmental characteristics as predictors of involvement in barroom aggression

Theoretical approaches to alcohol and violence have emphasized three interrelated domains of influence: the situational context, aggression-facilitating characteristics of individuals, and the impact of alcohol consumption. We examined these three domains as predictors of experiencing violence in the barroom setting. Participants were recruited through one of two phone surveys or through newspaper advertisements and classified into one of three groups: Experienced Bar Violence (EBV), Observed Bar Violence (OBV), and No Bar Violence (NBV). They completed questionnaires assessing individual difference and alcohol use variables, and an interview that assessed characteristics of their usual bar. The results suggested that individual difference and alcohol variables distinguished men in the EBV group from men in the OBV and NBV groups. However, women in the EBV group were distinguished from women in the NBV group by the characteristics of their usual bar and by the alcohol variables, but were distinguished from the OBV group only in terms of individual difference variables. The implications of these findings with respect to the influence of alcohol on barroom violence are discussed.     

Déjà vu? Opportunities and obstacles in developing alcohol policy in English prisons

Under the new Alcohol Harm Reduction Strategy for England published by the Prime Minister's Strategy Unit in 2004, there has been an increasing focus on crime and public order issues and alcohol-related harm experienced by 'vulnerable' or 'at risk' groups. Prisoners have been identified as a vulnerable group who have high rates of dependence on alcohol and problems with alcohol-related offending. In late 2004, the Prison Service launched its first alcohol strategy. Based on an analysis of key policy documents, official enquiries and research, this paper explores how the 'problem' of alcohol can be defined within the prison setting and the issues it raises for both the individual prisoner and the institution. It examines the lack of policy and strategic direction prior to the publication of the new prison alcohol strategy and the possible reasons for the complacency around alcohol in prisons in contrast to illicit drugs. The paper critically assesses the new strategy in relation to the testing and treatment initiatives proposed and the lack of research and resources underpinning them. There is a real risk that the strategy will fail unless adequate resources are forthcoming to expand treatment provision. Given the neglect and complacency around alcohol, policy champions or policy entrepreneurs are needed to lobby for funding and keep the prison alcohol issue on the policy agenda.     

Modification of a traditional motivational interviewing-based brief intervention training for hospital staff: The approach and refer method

Under the new Alcohol Harm Reduction Strategy for England published by the Prime Minister's Strategy Unit in , there has been an increasing focus on crime and public order issues and alcohol-related harm experienced by ‘vulnerable’ or ‘at risk’ groups. Prisoners have been identified as a vulnerable group who have high rates of dependence on alcohol and problems with alcohol-related offending. In late 2004, the Prison Service launched its first alcohol strategy. Based on an analysis of key policy documents, official enquiries and research, this paper explores how the ‘problem’ of alcohol can be defined within the prison setting and the issues it raises for both the individual prisoner and the institution. It examines the lack of policy and strategic direction prior to the publication of the new prison alcohol strategy and the possible reasons for the complacency around alcohol in prisons in contrast to illicit drugs. The paper critically assesses the new strategy in relation to the testing and treatment initiatives proposed and the lack of research and resources underpinning them. There is a real risk that the strategy will fail unless adequate resources are forthcoming to expand treatment provision. Given the neglect and complacency around alcohol, policy champions or policy entrepreneurs are needed to lobby for funding and keep the prison alcohol issue on the policy agenda.     

The Relationship Between Adolescent Alcohol Use and Delinquent and Violent Behaviors

ABSTRACT

Longitudinal and cross-sectional relationships between alcohol use, psychological risk (as measured by four MMPI-A scales), and delinquent and violent behaviors were analyzed using self-reported data from eighth and ninth grade students from a rural and small town population. Alcohol use and acknowledgement of alcohol and drug-related problems were statistically associated with delinquent and violent behaviors, even after adjusting for personality and behavioral risk. These results suggest that alcohol use is an independent risk factor for delinquent and violent behaviors among young people. Violence prevention efforts among adolescents, therefore, should recognize and address alcohol use. Alcohol use prevention efforts among adolescents should evaluate the effects of reducing alcohol use on subsequent violent behaviors.     

Sexual assault perpetrators' alcohol and drug use: the likelihood of concurrent violence and post-sexual assault outcomes for women victims

Addressing sexual assault requires policy and practice responses that are well-informed and empirically-grounded. This study examines the impact of perpetrators' drug and alcohol use during and after sexual assault. A representative sample of women, who responded to a random digit dialing survey, and reported that they were sexually assaulted at some time in their lives were utilized. The survey questions were drawn largely from The National Violence Against Women (NVAW) Survey (Tjaden 1996), and a series of binary logistic regressions was conducted to determine the impact of perpetrators' alcohol and drug use on violence before and after the assault. Findings indicate that perpetrators' alcohol or other drug use at the time of the assault resulted in a greater likelihood of concurrent violence, including hitting, slapping, kicking, use of a weapon, threats to harm or kill, and physical injury during the assault, and as a result, assault victims experienced more time lost from work, school, home duties, and recreation. Both these impacts occurred regardless of the relationship of the perpetrator to the victim, location of the sexual assault, or the victim's ethnicity. This information assists advocates and policy makers in prevention efforts where sexual violence is more likely to emerge.     

Strategies used to initiate the first alcohol control law in Thailand: Lessons learned for other low- and middle-income countries

Thailand enacted its first-ever alcohol control law in February of 2008. The process, from its inception to enactment, took a total of two years and eight months. Using an historical analysis approach, the authors describe the policy advocates’ activities aimed at gaining acceptance for the alcohol control policy, and provide advice for policy advocates attempting to pass similar laws in other countries.The advocacy process went through three distinct stages: an agenda-setting stage, followed by a policy-formulation stage and a legitimization stage. The agenda-setting stage involved educating the public about the harmful use of alcohol and its effect on society; during the second stage, an appropriate policy response was drafted and, lastly, during the legitimization phase, policy advocates navigated the political landscape in order to win final approval for the proposed policy.A tri-party coalition strategy (known as the ‘triangle that moves the mountain’ strategy) was employed which synchronized the work of three forces, each representing one of the three points of a triangle—of policy, knowledge, and civic expertise—coupled with media advocacy activities in order to increase the public and government acceptance of the proposed law. The public's view of the proposed law was critical to influence politicians to favour its adoption. While the knowledge and civic forces play a larger role during the agenda-setting and policy-formulation stages, the policy force was more active during the legitimization stage. Lastly, having a funding agency in place, such as Thai Health in this example, to provide a sustained source of funds for health promotion initiatives was critically important for policy advocates. Economic growth is an important determinant of increased consumption of alcohol per capita, and Thailand's experience of passing its first alcohol control law may serve as a useful guide for other low- or middle-income countries wishing to put a national alcohol control law in place.     

Risk-based licensing of alcohol venues and emergency department injury presentations in two Australian states

BackgroundRisk-based licensing (RBL) is among the more recent policy interventions to reduce alcohol-related harm in and around licensed venues. RBL sets licence fees to reflect the venue’s propensity to cause harm as a means of encouraging operators to improve their practices. We assessed whether the introduction of RBL in the Australian states of Queensland and Victoria was associated with a reduction in the incidence of emergency department (ED) injury presentations.MethodsWe employed an interrupted time series design using Prais-Winsten and Cochrane-Orcutt regression modelling to estimate step and slope parameters in injury incidence rates in each state. We defined the population as residents of the state, aged 15–54 years, the age group we considered most likely to be exposed to the night-time economy. To reduce noise, we confined cases to presentations during times previously identified as correlated with a high probability of alcohol involvement, namely ‘high alcohol hours’ (HAH). We adjusted our models for the alcopops tax, implemented shortly before RBL, and for assaults during low alcohol hours (LAH) as a proxy for other risk factors for assault.ResultsRBL was not associated with an overall reduction in the incidence of ED injury presentations during HAH in Queensland (β = 0.003; 95% CI: −0.010, 0.003, p = 0.318) or Victoria (β=−0.010; 95% CI: -0.021, 0.001, p = 0.087). Post-hoc subgroup analyses showed a reduction in ED injury presentations among men aged 20–39 years in Victoria (β=−0.026; 95% CI:-0.012, −0.040, p-0.0003) but this was not replicated in Queensland.ConclusionThere was little evidence that RBL affected the incidence of ED presentations for injury. This may be due to weak financial penalties being applied to venues assessed as high-risk.     

Overview of harm reduction treatments for alcohol problems

As evidenced by the tremendous range of scholarly articles included in this special issue, it is readily apparent that harm reduction is more than a theory, treatment approach, or policy. Rather, harm reduction is an orientation and belief system that has widespread empirical support as a means to improve the lives and functioning of individuals who use and abuse alcohol. In this article, we review recent empirical articles and scholarly reviews of harm reduction treatments for alcohol abuse and dependence. We focus this review on peer-reviewed articles published in the last 3 years, with a particular emphasis on interventions designed to reduce alcohol-related harm, including overall levels of consumption and alcohol-related problems. We conclude with a section on books, Web sites, and training and treatment centres devoted to harm reduction psychotherapy.     

Drug education and prevention: Has progress been made?

Ten years after publication of the UK Government's strategy for drug misuse in 1995, Tackling Drugs Together, the impact of drug education and prevention programmes remains less than desired. The 1995 strategy envisaged a new emphasis on education and prevention and there have been developments since then in drug education, especially with universal programmes delivered in schools. This paper considers the extent to which progress has been made in drug education and prevention since the 1995 strategic focus on young people and prevention of drug misuse was set out by government.     

The development of alcohol policy in contemporary China

Over recent years, an increase in alcohol-related problems has been noted in China. Taking effective measures against the problem requires clear reviewing and understanding of the evolution of the Chinese alcohol policy. This study is aimed to evaluate the alcohol policy with special focus on reviewing the alcohol production and consumption situation in China and assessing the changes in Chinese alcohol policy along with other related fields. This article finishes with a set of recommended policy changes that could help solve the recent alcohol-related problems and analyze the major impediments.     

Unintended impacts of alcohol restrictions on alcohol and other drug use in Indigenous communities in Queensland (Australia)

Background‘Alcohol Management Plans’ (AMPs) with a focus on alcohol restrictions were implemented in 19 discrete Indigenous communities, in 15 Local Government Areas, by the Queensland Government from 2002. Community residents’ perceptions and experiences of the impacts of AMPs on local alcohol and drug use are documented.MethodsA cross-sectional study used quantitative and qualitative survey data collected during 2014–2015 in 10 affected communities. Five had some alcohol available. Five had total prohibition. Participant responses were assessed and compared by prohibition status.ResultsOverall, less than 50% of 1098 participants agreed that: i) the restrictions had reduced alcohol availability in their community and ii) that people were drinking less. Nearly three quarters agreed that binge-drinking had increased, attributed to increased availability of illicit alcohol. There were no statistically significant differences between communities with prohibition and those with some access to alcohol. Participants agreed overall that cannabis use had increased but were more equivocal that new drugs were being used. These views were less frequently reported in prohibition communities.ConclusionsContrary to what was intended, Queensland’s alcohol restrictions in Indigenous communities were viewed by community residents as not significantly reducing the availability and use of alcohol. Furthermore, this was compounded by perceived increases in binge drinking and cannabis use; also unintended. There is a need to strengthen resolve at all levels to reduce the supply of illicit alcohol in restricted areas.     

Alcohol treatment systems in Muslim majority countries: Case study of alcohol treatment policy in Iran

BackgroundAlcohol is a leading risk factor for death and disability globally. Due to the Islamic prohibition of alcohol consumption, alcohol policy is an under-studied and sensitive topic in Muslim majority countries (MMCs). In addition, drinkers in these countries may face barriers to treatment access due to stigma or the legal status of alcohol. Using Iran as a case study this paper explores how alcohol treatment is planned and delivered in the complex environment of an MMC.MethodWe searched academic and grey literature, clinical manuals, guidelines and policy documents for information on the development and implementation of alcohol treatment policy in Iran. The search was conducted in English, Persian and Arabic. We conducted 6 consultations to verify information obtained. We analysed information based on the Walt & Gilson health policy analysis triangle, which identifies context, process, actors and content as key factors for understanding policy.ResultsIran initiated an alcohol-specific national strategy in 2011–2012 that aims to prevent, reduce and treat alcohol use disorders. This strategy has been designed to be implemented on a multi-sectoral level. Screening and prevention are mainly initiated in primary health care and cases are referred accordingly. Alcohol treatment is provided in specialised outpatient and inpatient settings. Due to contextual factors such as stigma, feasibility and affordability, alcohol outpatient units are planned to be integrated into existing public/ private drug addiction treatment facilities. However, the Ministry of Health has faced many challenges in implementing this pilot project. To date only small numbers of outpatient and inpatient units have formally commenced offering alcohol treatment.ConclusionImplementing alcohol treatment has been challenging for Iran. Approval of new treatment programs may not be seen as a priority because of the low prevalence of alcohol use disorders in the country. Also, policy makers are implementing treatment services with caution due to the existing alcohol prohibition for the country's Muslim majority population. Barriers to treatment seeking need to be addressed at the micro and macro levels. Support from international agencies such as the WHO could assist MMCs to develop appropriate services that are feasible for their unique alcohol policy environment.     

Tipping the balance? An Irish perspective on Anderson and Baumberg

This brief comment on Anderson and Baumberg's (2006) review of alcohol in Europe looks at this report from an Irish perspective, with a view to assessing its impact on the alcohol policy debate which has been a feature of Irish society over the past decade. It is argued that the review's empirical data and their accompanying policy recommendations are already broadly familiar to Irish stakeholders in the alcohol policy process, but that the provenance of this report---which has been prepared for the European Commission—creates further potential to tip the balance of Irish alcohol policy in the public health direction espoused by its authors.     

The Consultancy Liaison Addiction Service - the first 5 years of an integrated,primary care-based community drug and alcohol team

Government policy, running through the 10-Year Drug Strategy, Tackling Drugs to Build a Better Britain (The Stationery Office, 1998) and the New Drug Misuse Clinical Guidelines (Department of Health, The Scottish Office, 1999) highlights the need for health authorities and now PCGs to invest in shared care mechanisms to support primary care in its task of caring for drug misusers. Primary Care Trusts, as freestanding NHS organizations, will in time be able to commission, purchase and provide these services themselves, using primary care expertise alongside specialists. This paper describes a model of primary care-based shared care service, the Consultancy Liaison Addiction Service, that has been in operation for 5 years in South London, that predates these changes in the NHS yet could be considered by PCGs or PCTs when planning services for drug misusers. The service comprises a team of drug and alcohol community psychiatric nurses, supported and managed by a principal in general practice. Together they have worked with 72 neighbouring general practices, supporting the treatment of alcohol-misusing and drug-misusing patients. The team has a separate identity from, but is closely integrated into the secondary specialist addiction service producing effective continuum of care.     

‘Tackling Drugs Together’ and the establishment of the principle that ‘treatment works’

This article considers the fears and tensions surrounding debate on treatment issues in the 1990s and the contribution of Tackling Drugs Together and the related Effectiveness Review to establishing the principle that ‘treatment works’ and the role of scientific evidence in the policy process.     

Alcohol policy in Iran: Policy content analysis

BackgroundMuslim majority countries (MMCs) typically have limited alcohol policy development due to Islamic prohibition of alcohol consumption. In response to recent increases in alcohol consumption and related harms, MMCs have introduced civil alcohol policies, ranging from total prohibition to European-style regulations. Using Iran as a case study, we describe how alcohol prohibition is translated into policy in the face of influences from globalisation.MethodsWe collected information from publicly available literature and policy documents, because of the sensitivity of the topic of alcohol in Iran. The search was conducted in English and Persian. We verified information through consultations with policy actors. We also reviewed newspapers over periods just before the 1979 Islamic revolution, and before and after the 2011 alcohol policy (2008–2010; 2014–2016) was introduced. We analysed policy content based on WHO policy recommendations and used the Walt & Gilson health framework to identify policy content, context, actors and process.ResultsDespite its broad approach of civil prohibition with concessions for the non-Muslim population, Iran has developed approaches to reduce the harmful impacts of alcohol and adopted nine of ten policy interventions recommended by WHO. Pricing policy was the only intervention not used. We identified contextual challenges, such as resources, stigma and cultural offence that influence policy development.ConclusionMMCs face challenges in creating civil alcohol policies. Iran has taken steps, including a national alcohol strategy, to reduce alcohol-related harms. The socio-cultural, governance and historical context have shaped Iran’s adaptation of policy interventions recommended by WHO.     

The Consultancy Liaison Addiction Service - the first 5 years of an integrated, primary care-based community drug and alcohol team

Government policy, running through the 10-Year Drug Strategy, Tackling Drugs to Build a Better Britain (The Stationery Office, 1998) and the New Drug Misuse Clinical Guidelines (Department of Health, The Scottish Office, 1999) highlights the need for health authorities and now PCGs to invest in shared care mechanisms to support primary care in its task of caring for drug misusers. Primary Care Trusts, as freestanding NHS organizations, will in time be able to commission, purchase and provide these services themselves, using primary care expertise alongside specialists. This paper describes a model of primary care-based shared care service, the Consultancy Liaison Addiction Service, that has been in operation for 5 years in South London, that predates these changes in the NHS yet could be considered by PCGs or PCTs when planning services for drug misusers. The service comprises a team of drug and alcohol community psychiatric nurses, supported and managed by a principal in general practice. Together they have worked with 72 neighbouring general practices, supporting the treatment of alcohol-misusing and drug-misusing patients. The team has a separate identity from, but is closely integrated into the secondary specialist addiction service producing effective continuum of care.     

General Practitioners' views of home detoxification

There is a growing movement towards community-based health care for the treatment and management of alcohol and drug problems across Australia. In spite of substantial evidence to support the clinical efficacy, cost-effectiveness, and the utility of home detoxification, it is not an activity that has been readily embraced by Australian General Practitioners (GPs). Thus, GPs' views on this issue are vital if there is to be any form of viable home detoxification programme for alcohol and/or other drugs. A qualitative study was undertaken to determine General Practitioners' views in regard to alcohol and drug home detoxification. A qualitative data collection method, focus groups, was used. Focus group participants were obtained from a maximum variation sampling technique. Twelve focus groups were conducted in rural and metropolitan Queensland Australia, over a fourmonth period. Fifty-two participants (43 general practitioners and 9 other health professionals, 20 females and 32 males). Mean age was 40.5 years (age range 19-70). Views about home detoxification were dependent on level of experience with substance abuse treatment. Overwhelmingly, GPs argued that for home detoxification to become viable, there would need to be a more responsive infrastructure, clear policy guidelines, training and more reasonable remuneration than currently exists. GPs require improved training in addiction and drug and alcohol problems. Revised remuneration schemes will facilitate better GP management of complex chronic problems such as addiction. Even though GPs' held quite negative views about alcohol and drug dependent patients there was a high level of willingness to become involved in their treatment and support. Although the clinical efficacy of home detox has been demonstrated GPs have understandably mixed views about their potential involvement. Improved training, support and resourcing is needed to substantially facilitate the expansion of GPs' role into this growing area of care.