Five typologies of alcohol and drug prevention programmes. A qualitative review of the content of alcohol and drug prevention programmes targeting adolescents

Adolescents exhibit a high rate of use of alcohol and illicit drugs. Effect studies rarely describe the actual content of the interventions in detail. Less is known about what was actually done in the prevention than about their effects.

Aim: This study is a review study grouping the qualitatively different content components of the various approaches into five categories. Methods: A systematic literature review from Western countries on the topic of school-based interventions and prevention initiatives targeting young people aged 12–20. A modified version of the narrative synthesis approach is used for analysis. The sample consisted of 33 peer-reviewed articles published between January 2010 and December 2014. Findings: Five categories of intervention and prevention programmes were identified: ‘Information-based or testing-based primary prevention approaches’, ‘Primary prevention approaches incorporating skill-training components’, ‘Universal or primary prevention approaches that include family components’, ‘Targeted approaches incorporating skill-training components’, and ‘Approaches incorporating digital features’. Conclusion: Only four studies that employed any form of targeting or profiling of the subjects prior to the delivery of the prevention intervention or initiative were identified. The skewness towards primary prevention skill-training approaches should be addressed, given the diverse consumption patterns among adolescents.     

Drinking restraint, alcohol consumption and alcohol dependence among children of alcoholics

OBJECTIVE: Previous research has found drinking restraint to be a risk factor for alcohol use and alcohol-related problems in normative populations, but has not tested these relations in high-risk populations. The current study tested whether drinking restraint predicted alcohol-related outcomes in the same way for high-risk and low-risk individuals and tested whether there was a quadratic effect of drinking restraint on alcohol-related outcomes. METHOD: Data from an ongoing longitudinal study of children of alcoholics (COAs; n = 189) and controls (n = 192) were collected at two time points 5 years apart. RESULTS: The prospective findings extended previous cross-sectional literature by replicating the main effects of drinking restraint as a risk factor for subsequent drinking for controls. For COAs, however, higher levels of drinking restraint were associated with lower levels of later drinking. There was also a quadratic effect of drinking restraint in the prediction of alcohol dependence diagnoses, suggesting that those at the extreme levels of drinking restraint were least likely to develop alcohol dependence. CONCLUSIONS: The relation of drinking restraint to alcohol-related outcomes may be more complex than previously hypothesized because it may work in different directions for high- and low-risk individuals and may have a nonlinear relationship to diagnostic outcomes.     

Drinking patterns,gender and health I: Attitudes and health practices

Background: Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking. We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status.

Methods: A stratified random sample of adult health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). Using multivariate analyses of covariance and adjusting for health-related attitudes, values, and practices, we examined gender differences in relationships between alcohol consumption and health.

Results: More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers.

Conclusions: Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts.     

Drinking practices and alcohol-related problems among Nigerian students

Abstract

Background: Alcohol-related problems are increasing among Nigerian University students. However, very few studies have explored the ways in which hazardous drinking practices facilitate these problems in Nigerian University students, aside from quantitative studies focussing on students in South-Western Nigeria.

Methods: Drawing on qualitative semi-structured interviews involving students from a South-Eastern Nigerian University, this study begins to address these gaps. The participants were recruited through convenience and snowballing sampling techniques, and the data were analysed thematically.

Results: The findings show that 24 out of 31 participants engaged in heavy drinking by consuming between 3 and 9 bottles of beer/stout or flavoured spirits regularly. These heavy drinkers had suffered financial, academic, and health problems. Some lost valuable personal items such as mobile phones, wallets, and money as a result of drinking, while others missed examinations because drinking had rendered them either too ill or had caused them to oversleep and missed the examination. Almost all participants had suffered multiple health-related problems such as hangovers, accidents and injuries, liver enlargement, stomach ache, attempted suicide (under the influence of alcohol), and sex with strangers.

Conclusion: Evidence-based public health interventions to address easy alcohol availability and heavy drinking should be implemented in Nigerian Universities.     

The relationship between alcohol problems, perceived risks and attitudes toward alcohol policy in Canada

Introduction and Aims. Approval of alcohol policies by the public in democratic countries is critical for instituting social change. With respect to alcohol policies, mounting research indicates that a higher price per unit of ethanol is an effective approach for reducing alcohol‐related problems, yet surveys have found this approach is usually unpopular. The purpose of this paper is to assess the relationship between amount of drinking and support for various alcohol policies. Design and Methods. A secondary analysis was conducted on the Canadian Addictions Survey, a randomised telephone survey of over 10 000 Canadians. The relationship between the amounts of drinking reported by the respondents was examined in relation to the perceived seriousness of alcohol problems in their communities and the endorsement of several alcohol policies. Results. Increased amount of drinking was significantly related to lower perceptions of drinking‐related risks. Furthermore, heavier consumers had less favourable attitudes than lighter drinkers and abstainers toward alcohol policies, such as increased taxation. Aggregated data across the 10 Canadian provinces showed a strong effect size (r = ?0.515, P = 0.128) between endorsement of alcohol taxation and rates of hospital separations for alcohol. Discussion and Conclusions. Results from this study show that the more that people drink, the more they oppose taxation. The implications of these findings are that as alcohol problems in communities become worse, the population may become more resistant to effective alcohol policies. Strategies are suggested for implementing effective policies.[Macdonald S, Stockwell T, Luo J. The relationship between alcohol problems, perceived risks and attitudes toward alcohol policy in Canada. Drug Alcohol Rev 2010;30:652–658]     

Drinking settings,alcohol consumption,and sexual risk behavior among gay men

We sought to 1) describe the settings or groups of settings where men who have sex with men (MSM) consume alcohol in 16 U.S. metropolitan statistical areas (MSA); and 2) investigate whether certain drinking settings or groups of settings are associated with higher levels of alcohol consumption, problem drinking, and sexual risk behavior. Latent class analysis was used to develop our measure of drinking settings. The final latent class model consisted of four distinct classes which captured the typical settings where MSM consumed alcohol: “home” “social,” “bar/social,” and “general” drinkers (i.e., drinks in all settings). Regression models showed that “general” drinkers were more likely than “social” drinkers to engage in frequent heavy drinking. Compared to ‘social’ drinkers, general drinkers were also more likely to engage in unprotected anal intercourse (UAIMP) and UAIMP with men met in bars and other venues (e.g., private parties, bath houses) while intoxicated. Assessment of drinking settings may be a means of identifying MSM who are at greater risk for frequent, heavy drinking and related sexual risk behavior.     

Strategic developments in drug and alcohol policy

This review of recent developments in drug and alcohol policy investigates the reasons behind those developments and questions some of the directions in which this policy is taking the services. There is a possibility that services may become superficial and it appears that there are clients who are effectively denied public health services.     

Traditional practices, traditional spirituality, and alcohol cessation among American Indians

OBJECTIVE: The detrimental effects of alcohol misuse and dependence are well documented as an important public-health issue among American Indian adults. This preponderance of problem-centered research, however, has eclipsed some important resilience factors associated with life course patterns of American Indian alcohol use. In this study, we investigate the influence of enculturation, and each of the three component dimensions (traditional practices, traditional spirituality, and cultural identity) to provide a stringent evaluation of the specific mechanisms through which traditional culture affects alcohol cessation among American Indians. METHOD: These data were collected as part of a 3-year lagged sequential study currently underway on four American Indian reservations in the upper Midwest and five Canadian First Nation reserves. The sample consisted of 980 Native American adults, with 71% women and 29% men who are parents or guardians of youth ages 10-12 years old. Logistic regression was used to assess the unique contribution of the indicators of alcohol cessation. Excluding adults who had no lifetime alcohol use, the total sample size for present analysis is 732 adult respondents. RESULTS: The findings show that older adults, women, and married adults were more likely to have quit using alcohol. When we examined the individual components of enculturation, two of the three components (participation in traditional activities and traditional spirituality) had significantly positive effects on alcohol cessation. CONCLUSIONS: Although our findings provide empirical evidence that traditional practices and traditional spirituality play an important role in alcohol cessation, the data are cross-sectional and therefore do not indicate direction of effects. Longitudinal studies are warranted, in light of the work that concludes that cultural/spiritual issues may be more important in maintaining sobriety once it is established rather than initiating it.     

Political science, public policy, and drug use prevention

Increasingly, drug use prevention programs and research are being considered in the environmental contexts in which they occur. One context that is rarely considered is the political context. This article examines the reciprocal effects of policy and prevention programs from four perspectives representing different contexts, beginning with political science, and followed by social work and public health administration, psychology, and education. Four specific issues are considered. First is how current national policies on drug use shape our nation's prevention efforts, from a political science perspective. Second is how effective prevention programs can affect and shape policy change. This issue is considered from a social and public health administration perspective. Third is how policy change can act as an intervention to prevent drug use, from the perspective of psychology. The fourth issue is how dissemination of prevention programs and policies can impact drug use prevention. This question considers an educational perspective. The perspectives are integrated into a general conceptual model to improve our understanding of how drug use prevention occurs in a national political context. Finally, examples are given of how this model might inform the other perspectives represented in this special issue on transdisciplinary drug abuse prevention research.     

Drinking context and problematic alcohol consumption in young Swedish women

Previous research has indicated that a variety of contextual factors are involved in the development of drinking behavior. An integrated perspective can extend our understanding of the context and circumstances in which individuals drink. In this study, a person-oriented approach, cluster analysis, was used to identify drinking context clusters in a population of 20- and 25-year-old Swedish women. A further aim was to analyze how these clusters were associated with problematic alcohol consumption (high episodic drinking (HED) and alcohol use disorder (AUD)). A total of 760 respondents were interviewed, some in 1996 and some in 2001. Self-reported effects of drinking and situational factors associated with drinking alcohol were used in the cluster analysis procedure. Logistic regression models were used to analyze the associations with problematic alcohol consumption. The results revealed four distinct clusters of drinking patterns: coping drinkers, social drinkers, controlled drinkers, and moderate drinkers. Differences between clusters concerning problematic alcohol consumption were found. HED was significantly more common among the social drinkers and alcohol use disorder was more prevalent among the coping drinkers. Age differences and to a lesser extent secular trends in drinking pattern could be observed. The findings suggest that information on drinking context can help to explain differences in patterns of risky drinking and AUD. This highlights the importance of identifying groups of individuals with potentially harmful drinking patterns, which could be the target of specific preventive actions.     

Barriers and facilitators for the implementation of the integrated public policy for alcohol,drug, tobacco,and gambling prevention: a qualitative study

Abstract

In the field of alcohol, drug, tobacco, and gambling studies, empirical research on the barriers and facilitators for public prevention policies has been scarce. Public policy studies show that the implementers of different organizational positions impact on policy implementation. In this paper, the barriers and facilitators for the implementation of an integrated national policy for addiction prevention, as seen from the positions of managers, prevention specialists, and frontline workers, are analyzed on the basis of qualitative interview data. The results indicate that the managers were structurally oriented in their thinking and emphasized local structures as facilitators. All the groups saw prevention as underfunded and undervalued. The specialists were most focused on the official structures and regarded the functioning of the structures as a key facilitator. The frontline workers underlined that their position was a facilitator in itself, offering a unique viewpoint to the localities and to the lives of their clients. A key finding is also the normalcy of gambling that both the specialist and frontline workers regarded as a major barrier. The results show that studying the policy implementation context is important: it makes it possible to understand social and cultural factors that can function as barriers or facilitators.     

Randomized controlled trial in alcohol relapse prevention: Role of atenolol,alcohol craving,and treatment adherence

Previous studies suggest that beta-adrenergic blockers reduce craving levels during acute alcohol withdrawal. We conducted a new study to assess whether the daily use of atenolol by the abstinent alcoholic could maintain a blunted craving for alcohol and result in a decreased rate of relapse for alcohol abuse. The study was designed as a randomized, controlled, double-blind clinical trial. Among all 100 patients (50 atenolol, 50 placebo), only 15 stayed in the trial and remained fully abstinent for 1 year (7 atenolol, 8 placebo). Of the remaining 85 patients, 30 withdrew early while still abstinent (17 atenolol, 13 placebo). In the 57 high-risk patients who reported craving for alcohol at baseline, the treatment failure rates were 90% for patients receiving placebo, and was reduced to 65% in those who received atenolol (risk reduction = 28%, 95% confidence interval, -3% to 49%). The data from this trial also support the observation that poorer levels of treatment adherence are strongly associated with adverse outcomes for alcoholics during follow-up. This relationship was present both for patients who received atenolol and for those who received placebo.     

Drinking in alcoholics following an alcohol challenge research protocol

OBJECTIVE: The present study examined the impact of participating in an alcohol administration study on the subsequent drinking behavior of 25 non-treatment-seeking alcoholics. METHOD: Subjects attended two assessment sessions, followed by a week-long regimen on one of three pharmacological agents (naltrexone, nalmefene, or placebo), a day-long laboratory assessment including a standardized alcohol administration procedure, and a debriefing session consisting of individualized feedback and alcohol counseling. Follow-up consisted of a telephone interview 6 weeks after the alcohol challenge session. RESULTS: At the follow-up interview, subjects reported significant reductions in drinking quantity and frequency from the prestudy period, and no subjects reported increased drinking following study participation. CONCLUSIONS: These findings suggest that alcohol administration research procedures may not be detrimental to the poststudy drinking behavior of alcoholics. The use of such procedures could be cautiously expanded to improve the generalizability of findings for alcoholic populations of interest.     

Drinking motives and PTSD-related alcohol expectancies among combat veterans

IntroductionCombat veterans are at increased risk for PTSD and alcohol misuse, and expectancies and motives for drinking may help explain the link between these comorbid issues. This investigation explored the relationships between PTSD symptoms, PTSD-related alcohol expectancies, motives for drinking, and alcohol consumption/misuse.Method67 veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) participated in this project. We examined correlations between PTSD severity, alcohol misuse, drinking motives, PTSD alcohol expectancies, and tested models of mediation and moderation.ResultsCoping-anxiety drinking motives and positive PTSD-related alcohol expectancies were associated with alcohol misuse and alcohol-related consequences, but not with consumption. Each PTSD symptom cluster was associated with positive and negative PTSD alcohol expectancies, and coping-anxiety was specifically related to reexperiencing and avoidance. Drinking to cope mediated the relationship between PTSD symptoms and hazardous drinking. Moderation analyses showed that a positive relationship between PTSD severity and hazardous drinking existed among those with moderate and higher levels of positive PTSD-alcohol expectancies.DiscussionOur findings point to surprising, and in some cases complex, relationships between PTSD and alcohol use. Although related, PTSD alcohol expectancies and drinking motives seem to function differently in the relationship between PTSD and alcohol misuse.