How the alcohol industry relies on harmful use of alcohol and works to protect its profits

The alcohol industry have attempted to position themselves as collaborators in alcohol policy making as a way of influencing policies away from a focus on the drivers of the harmful use of alcohol (marketing, over availability and affordability). Their framings of alcohol consumption and harms allow them to argue for ineffective measures, largely targeting heavier consumers, and against population wide measures as the latter will affect moderate drinkers. The goal of their public relations organisations is to ‘promote responsible drinking’. However, analysis of data collected in the International Alcohol Control study and used to estimate how much heavier drinking occasions contribute to the alcohol market in five different countries shows the alcohol industry's reliance on the harmful use of alcohol. In higher income countries heavier drinking occasions make up approximately 50% of sales and in middle income countries it is closer to two‐thirds. It is this reliance on the harmful use of alcohol which underpins the conflicting interests between the transnational alcohol corporations and public health and which militates against their involvement in the alcohol policy arena. [Caswell S, Callinan S, Chaiyasong S, Cuong PV, Kazantseva E, Bayandorj T, Huckle T, Parker K, Railton R, Wall M. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev 2016;35:661–664]     

Identifying viable theoretical frameworks with essential parameters for real-time and real world alcohol craving research: a systematic review of craving models

Background: Substance use is known to be episodic, dynamic, complex, and highly influenced by the environment, therefore a situational and momentary focus to alcohol craving research is appropriate. Current advances in mobile and wearable technology provide novel opportunities for craving research. However, the lack of consensus within craving theory impedes the identification and prioritization of parameters to be monitored. The aim of this study is to critically review current craving models in order to determine viable theoretical frameworks of alcohol craving and its essential parameters.

Methods: Eighteen models of craving were reviewed by applying a literature search with a five-step strategy that accounted for the momentary nature of craving and included a snowballing search and a key term extraction algorithm. Based on this review, multiple decision criteria were defined upon which to evaluate the models.

Results: Six models for alcohol craving were supported by sufficient empirical research to be eligible. The inferences drawn on these six models resulted in three decision criteria: the model should (1) incorporate negative affect as a predictor of relapse; (2) explain that dependent drinkers have a higher attentional bias towards alcohol cues than nondependent drinkers; (3) incorporate increased risk of relapse with heightened stress levels.

Conclusions: The affective processing model of negative reinforcement, the cognitive processing model, the incentive sensitization theory of addiction and the theory of neural opponent motivation are classified as viable theoretical frameworks, resulting in negative affect and stress as relevant parameters to include in real-time craving monitoring research.     

Psychological interventions with families of alcohol misusers: A systematic review

Aims: To review the literature on psychological interventions for families affected by alcohol misuse, with a focus on outcomes for family members.

Methods: A comprehensive and systematic literature review. A detailed search strategy was developed and implemented with no date, language or time restrictions. Two reviewers screened all identified titles and abstracts, and then independently assessed the eligibility and quality of all potential studies. The studies were analysed according to whether or not the alcohol misuser was involved in the primary intervention under investigation and analysed thematically.

Results: Forty-three publications (34 studies) were included in the review. All were in English, covered the period 1979–2009, were mainly published articles in peer review journals and included 2500–3000 family members. Research with female family members (particularly spouses or partners), and ‘white’ family members dominated. The included studies show how the field has moved from primarily focussing on how family members can engage and support the user through treatment to adopting a wider holistic focus which considers the needs of family members in their own right. Studies in both categories demonstrated positive outcomes for family members across a range of domains.

Conclusions: Adopting a broader review methodology has brought a fuller understanding of a field where few such reviews have been conducted, and offers direction for future research. Further work is needed in terms of broadening the reach of such interventions and embedding them more firmly into routine therapeutic practice.     

The effectiveness of brief alcohol interventions in primary care settings: A systematic review

Issues. Numerous studies have reported that brief interventions delivered in primary care are effective in reducing excessive drinking. However, much of this work has been criticised for being clinically unrepresentative. This review aimed to assess the effectiveness of brief interventions in primary care and determine if outcomes differ between efficacy and effectiveness trials. Approach. A pre‐specified search strategy was used to search all relevant electronic databases up to 2006. We also hand‐searched the reference lists of key articles and reviews. We included randomised controlled trials (RCT) involving patients in primary care who were not seeking alcohol treatment and who received brief intervention. Two authors independently abstracted data and assessed trial quality. Random effects meta‐analyses, subgroup and sensitivity analyses and meta‐regression were conducted. Key Findings. The primary meta‐analysis included 22 RCT and evaluated outcomes in over 5800 patients. At 1 year follow up, patients receiving brief intervention had a significant reduction in alcohol consumption compared with controls [mean difference: ?38 g week^?1, 95%CI (confidence interval): ?54 to ?23], although there was substantial heterogeneity between trials (I² = 57%). Subgroup analysis confirmed the benefit of brief intervention in men but not in women. Extended intervention was associated with a non‐significantly increased reduction in alcohol consumption compared with brief intervention. There was no significant difference in effect sizes for efficacy and effectiveness trials. Conclusions. Brief interventions can reduce alcohol consumption in men, with benefit at a year after intervention, but they are unproven in women for whom there is insufficient research data. Longer counselling has little additional effect over brief intervention. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care. [Kaner EFS, Dickinson HO, Beyer F, Pienaar E, Schlesinger C, Campbell F, Saunders JB, Burnand B, Heather N. The effectiveness of brief alcohol interventions in primary care settings: A systematic review. Drug Alcohol Rev 2009;28:301–323]     

Harm reduction in gambling: a systematic review of industry strategies

Abstract

Background: Gambling venues and industry regulators utilise a variety of strategies to reduce potential consumer harm from gambling. These strategies originate at the level of governmental and industry policy, and are distinct from responsible gambling behavioural strategies that individual gamblers may choose to implement.

Method: This systematic review examined industry-implemented or environmental-level strategies aimed at reducing consumer harm from gambling. Twenty-seven studies that met inclusion criteria were summarised based on the type of strategy examined. Due to variability in study designs, strategies examined, and outcome measures employed, meta-analyses could not be completed.

Results: Strategies that were most effective in reducing gambling time or expenditure included: self-appraisal pop-up messages, $1 maximum bets, removal of large note acceptors and ATMs, reduced operating hours, and smoking bans. These findings were limited by the quality of studies available, however. Many studies did not include pre- and post-measurement or control groups, and most relied on retrospective self-report.

Conclusions: These results provide insight into strategies that demonstrate preliminary effectiveness in reducing both the amount of time spent gambling and the amount of money gamblers spend. Further research that employs rigorous prospective experimental designs, appropriate control conditions, and both pre and post-intervention measures is required before firm conclusions can be drawn. However, there is sufficient evidence to support the continued use and further development of such industry-implemented strategies aimed at reducing gambling-related harm.     

Australian school-based prevention programs for alcohol and other drugs: A systematic review

Issues. To reduce the occurrence and costs related to substance use and associated harms it is important to intervene early. Although a number of international school-based prevention programs exist, the majority show minimal effects in reducing drug use and related harms. Given the emphasis on early intervention and prevention in Australia, it is timely to review the programs currently trialled in Australian schools. This paper reports the type and efficacy of Australian school-based prevention programs for alcohol and other drugs. Approach. Cochrane, PsychInfo and PubMed databases were searched. Additional materials were obtained from authors, websites and reference lists. Studies were selected if they described programs developed and trialled in Australia that address prevention of alcohol and other drug use in schools. Key Findings. Eight trials of seven intervention programs were identified. The programs targeted alcohol, cannabis and tobacco and most were based on social learning principles. All were universal. Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use at follow up. Conclusion. Existing school-based prevention programs have shown to be efficacious in the Australian context. However, there are only a few programs available, and these require further evaluative research. This is critical, given that substance use is such a significant public health problem. The findings challenge the commonly held view that school-based prevention programs are not effective.[Teesson M, Newton NC, Barrett EL. Australian school-based prevention programs for alcohol and other drugs: A systematic review. Drug Alcohol Rev 2012;31:731-736].     

Australian Aborigines and alcohol: A review

Following a summary of the relevant historical and legislative background, this article reviews the literature on: (i) rates of alcohol usage and problem drinking in Aboriginal populations; (ii) adverse effects of drinking; (iii) suggested causes of problem drinking among Aborigines; and (iv) treatment and preventive initiatives. The need to examine Aboriginal alcohol use in the wider context of socio-economic deprivation and rapid social change is emphasized. Key issues warranting further research attention are identified and, while recognizing the difficulties inherent in doing so, suggestions are made as to how the quality of research in the area might be raised. It is concluded that, without long-term planning and commitment of the necessary resources by government, little progress will be made in reducing the problems associated with Aboriginal use of alcohol.     

Mixing alcohol with energy drink (AMED) and total alcohol consumption: a systematic review and meta‐analysis

It has been suggested that consuming alcohol mixed with energy drink (AMED) may increase total alcohol consumption. Aims of this systematic review and meta‐analysis were (i) to compare alcohol consumption of AMED consumers with alcohol only (AO) consumers (between‐group comparisons), and (ii) to examine if alcohol consumption of AMED consumers differs on AMED and AO occasions (within‐subject comparisons). A literature search identified fourteen studies. Meta‐analyses of between‐group comparisons of N = 5212 AMED consumers and N = 12 568 AO consumers revealed that on a typical single drinking episode AMED consumers drink significantly more alcohol than AO consumers (p = 0.0001, ES = 0.536, 95%CI: 0.349 to 0.724). Meta‐analyses of within‐subject comparisons among N = 2871 AMED consumers revealed no significant difference in overall alcohol consumption on a typical drinking episode between AMED and AO occasions (p = 0.465, ES = ?0.052, 95%CI: ?0.192 to 0.088). In conclusion, between‐group comparisons suggest that heavy alcohol consumption is one of the several phenotypical differences between AMED and AO consumers. Within‐subject comparisons revealed, however, that AMED consumption does not increase the total amount of alcohol consumed on a single drinking episode. © 2016 The Authors. Human Psychopharmacology: Clinical and Experimental Published by John Wiley & Sons Ltd     

Alcohol industry arguments for putting profit before health in the midst of a pandemic: The Western Australian experience

In an effort to limit the impact of alcohol on the Western Australian (WA) health system during the coronavirus disease (COVID-19) pandemic, the WA Government introduced temporary restrictions on takeaway alcohol purchases for several weeks in March and April 2020. In response, alcohol industry representatives encouraged the WA Government to remove the restrictions and replace them with a voluntary alcohol industry initiative. We looked at alcohol industry representatives' comments in media and online publications during this period. We found that the industry framed alcohol as an essential product, focused on the impact of the restrictions on WA businesses and framed the restrictions as complex and ineffective. The themes and arguments we identified are commonly used by the alcohol industry and are not unique to the pandemic. The alcohol industry's response to the COVID-19 restrictions in Australia provides a unique case study of how the alcohol industry attempts to interfere in public health policy.