Police knowledge and attitudes regarding crime, the responsible service of alcohol and a proactive alcohol policing strategy

The purpose of this study was to investigate the pattern and predictors of police knowledge and attitudes regarding alcohol and crime, the responsible service of alcohol by licensees and proactive alcohol policing strategies. Operational police in the Hunter region of NSW, Australia who attended for duty on a selected weekday were invited to complete a questionnaire during their shift. Two hundred and ninety-eight police participated (77%). Police estimated that 60% of the incidents that they attend are related to the consumption of alcohol, with 44% of such incidents relating to alcohol consumed on licensed premises. Three-quarters of police were able to identify correctly responsible service components of the Liquor Act. A large proportion of police (93%) considered that alcohol servers are responsible for preventing intoxication and that trying to improve licensee serving practices is not a waste of police time (89%). Considerable support (67%) was shown for police using education rather than enforcement as a method for improving licensee responsible service practices. Strong support (92%) was shown for providing information to licensees about alcohol-related incidents associated with their premises. Only 55% of police reported having sufficient skills and 17% reported that sufficient police resources were used to enhance licensee alcohol service practices. The introduction of liquor legislation, with an explicit "responsible service of alcohol" emphasis, provides police with considerable opportunity to improve the serving practices of licensed premises and to reduce alcohol-related harm. The perception by police of a lack of skill, a low prioritization for alcohol policing, limited time availability and inadequate penalties may prevent the realization of these benefits. Enhanced police training and the development of alternative responsible service of alcohol policing strategies are needed if these benefits are to be achieved.     

The feasibility and acceptability of introducing brief intervention for alcohol misuse in an urban aboriginal medical service

We report on the feasibility and perceived acceptability of brief motivational interviewing for hazardous alcohol use in an urban Aboriginal health service. General practitioners (GPs) were trained in brief motivational interviewing, and health workers in other aspects of the intervention. Screening was initially carried out using the AUDIT, but subsequently reduced to two simple questions. Information was obtained through a combination of participant observation by the study team, ongoing ad hoc review and feedback from staff, periodic group meetings, and one-on-one interviews with health workers and GPs. The AUDIT was felt to be intrusive and some questions were poorly understood. Brief intervention seemed to be culturally appropriate, but barriers to wider administration included lack of time and the complexity of patients' presenting health problems. As a result of the research there was an increase in general awareness and acceptability of addressing alcohol issues at the health service. This study raises a number of issues that both support and threaten the wide implementation of brief intervention in urban Aboriginal primary care settings.     

Environmental contexts of combined alcohol and energy drink use: Associations with intoxication in licensed venues

BackgroundEnvironmental factors inside licensed venues have been found to influence the intoxication levels and consumption practices of patrons. The consumption of alcohol mixed with energy drinks (AmED) occurs primarily at or prior to attending licensed venues, however there is a lack of in situ research investigating AmED use in these contexts. Given that AmED use has been linked with increased alcohol consumption, intoxication, illicit substance use, and risk taking behaviours, this paper explores the environmental correlates and levels of intoxication associated with AmED use in licensed venues.MethodsStructured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4–5 h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels.Results898 hourly observations were recorded across 68 venues. All but one venue served energy drinks, and patron AmED use was observed during 34.9% of hourly records. AmED use was more prevalent after 12am and in nightclub venues compared to bars and pubs, and was positively associated with high intoxication levels, illicit drug use, and younger crowds. After controlling for environmental factors (i.e. venue crowding, service practices, venue characteristics, patron demographics and behaviour) AmED use did not predict high intoxication at a venue level in multivariable models.ConclusionAmED consumption is ubiquitous in the licensed venues of Australian night-time entertainment districts, particularly busy nightclub venues where intoxication and risky consumption are heightened. However, AmED use was not associated with high patron intoxication when environmental factors were considered.     

Management of alcohol intoxication and aggressive behaviour: a tale of two cities

ABSTRACT

Background: Violence and aggressive behaviour are a growing problem in emergency departments on both sides of the Atlantic, and alcohol intoxication is often involved. A wide range of management options is available, and policies vary considerably.

Methods: We compared the management of alcohol intoxication and aggressive behaviour in four New York and four London emergency departments, using a semi-structured interview which covered 15 issues.

Results: Differences were apparent between New York and London emergency departments in the method used for diagnosis of alcohol intoxication, the investigations carried out and discharge criteria. Chemical and physical restraints were readily and frequently used in New York in order to prevent intoxicated patients leaving the department, while in London disruptive patients tended to be ejected.

Conclusions: The marked transatlantic differences, while partly due to cultural and historic reasons, are largely due to the pressures to limit the risk of litigation in the United States and the constraints of a cost-limited health service in Britain. The management of violent and intoxicated patients deserves further refinement.     

Combined effects of alcohol and hepatitis C: A secondary analysis of alcohol use biomarkers and high-risk behaviors from two medication trials for alcohol dependence

Objectives

The goal of this secondary analysis was to examine the combined effects of HCV infection and recent alcohol use on baseline biologic markers of alcohol consumption in two outpatient medication trials for alcohol dependence. In addition, the relationship between Hepatitis C virus (HCV) infection and behavioral risk factors for HCV infection in these clinical populations were examined.

Methods

Data (n = 345) from two randomized, placebo-controlled trials of naltrexone and psychosocial treatment for alcohol dependence (Study I, n = 212) and comorbid alcohol and cocaine dependence (Study II, n = 133) were used to examine baseline measures of HCV risk behaviors (injection drug use, needle sharing), and biomarkers of alcohol use (AST, ALT, GGT and CDT) were compared by HCV serostatus first within each study and then across studies.

Results

Although groups had differing sociodemographic profiles (as indicated by race, marital status, level of education) subjects in Study I exhibited no statistically significant differences from the Study II cohort in HCV prevalence (12.7 vs. 20.0%, p = 0.07), lifetime history of injection drug use (13.8 vs. 22.0%, p = 0.74), lifetime history of needle sharing (9.1 vs. 18.0%, p = 0.62). As such, the data from both studies were analyzed together. Regardless of drinking status, HCV infection was significantly associated with an upward shift in the baseline level of ALT, AST, and GGT (p < 0.006 for all measures) and a downward shift in baseline CDT (p = 0.002). When using standard laboratory cutoff values to determine clinically significant elevations, HCV seropositivity was significantly associated with elevations in ALT, AST, GGT (p < 0.001), and with decreases in CDT (p = .002).

Conclusions

These data emphasize the importance of evaluating HCV infection and HCV risk behaviors at intake in medication trials for alcohol dependence and also raise questions regarding the use of cutoff scores for ALT, AST, GGT and CDT levels as biologic markers of alcohol use in subjects when HCV status is unknown.     

The onset and progression of alcohol use disorders: A qualitative study from Goa,India

Quantitative evidence about the burden of alcohol use disorders (AUDs) needs to be complemented with a nuanced qualitative understanding of explanatory models to help supplement public health strategies that are too often steeped uncritically in biomedical models. The aim of this study was to identify the role of various factors in the onset and persistence of AUD and recovery from AUD. This was a qualitative study nested in a population cohort from Goa, India. In-depth interviews of men with incident, recovered, and persistent AUD covered topics such as changes in drinking habits over time, perceptions and experiences about starting/stopping drinking, and so on. Data were analyzed using thematic analysis. Reasons to begin drinking included social drinking, functional use of alcohol, stress, and boredom. Progression to problematic drinking patterns was characterized by drinking alone, alternating between abstinent and heavy drinking periods, and drinking based on the availability of finances. Some enablers to reduce/stop drinking included consequences of drinking lifestyle and personal resolve; some barriers included availability of alcohol at social events and stress. Some reasons for persisting heavy use of alcohol included lack of family support, physical withdrawal symptoms, peer pressure, stress, and easy availability. This article offers a strong conceptualization and nuanced understanding of AUD across a spectrum of developmental courses. This adds to the limited literature on explanatory models of AUD in India and identifies potential targets for prevention and treatment strategies for AUD in low- and middle-income country settings.     

Long-term behavior in treated alcoholism: Evidence for beneficial carry-over effects of abstinence from smoking on alcohol use and vice versa

Co-dependence of alcohol and nicotine is quite frequent. Research results on the mutual influence one drug has on the other - i.e., on the further course of the dependence - has been inconclusive. Our primary aim is to investigate the natural course of smoking behavior in a long term follow-up study with alcohol-dependent patients who completed an inpatient treatment program. A sample of 139 out of originally 190 patients was successfully followed up 7 years after index alcohol treatment. After 7 years, 56% of patients (total surviving sample: 46%, 21 [11.1%] patients deceased during the follow-up time interval) were abstinent. Our results show that being a non-smoker at treatment entry is a predictor for alcohol abstinence 7 years later. The rate of non-smokers among the abstinent patients increased by 32%. Potential explanations for our findings lie in carry-over effects. Skills and insights gained in treatment of alcohol dependence could be instrumental in coping with smoking behavior as well. Non-smokers may have more functional coping abilities from the beginning. We conclude that it is warranted and recommendable to explore the willingness of alcohol-dependent patients to quit smoking and to offer them treatment options addressing this point.     

Association of functional DBH genetic variants with alcohol dependence risk and related depression and suicide attempt phenotypes: Results from a large multicenter association study

Objective

Dopamine-beta-hydroxylase (DBH) metabolizes the conversion of dopamine to noradrenaline. DBH, located on chromosome 9q34.2 has variants with potential functional consequences which may be related to alterations of neurotransmitter function and several psychiatric phenotypes, including alcohol dependence (AD), depression (MD) and suicidal behavior (SA). The aim of this association study in a large multicenter sample of alcohol-dependent individuals and controls is to investigate the role of DBH SNPs and haplotypes in AD risk and associated phenotypes (AD with MD or SA).

Method

1606 inpatient subjects with DSM-IV AD from four addiction treatment centers and 1866 control subjects were included. Characteristics of AD, MD and SA were obtained using standardized structured interviews. After subjects were genotyped for 4 DBH polymorphisms, single SNP case–control and haplotype analyses were conducted.

Results

rs1611115 (near 5′) C-allele and related haplotypes were significantly associated with alcohol dependence in females. This association with female alcohol dependence also accounts for the significant relationship between this variant and comorbid conditions and traits.

Conclusions

This study presents evidence for a potentially functional DBH variant influencing the risk for alcohol dependence while other comorbid conditions are not independently influenced by this SNP. However, the study also supports the possible role of the dopamine system in the etiology of female alcohol dependence.     

Experience of harm from others’ drinking and support for stricter alcohol policies: Analysis of the Australian National Drug Strategy Household Survey

BackgroundPrevious research indicates that those who have experienced alcohol-related harm from others are more likely to support stricter alcohol control policies. This study investigates the association between types of harm experienced because of others’ drinking and support for stricter alcohol control policies.MethodsData from 20,570 Australians aged 18 and over who completed the 2013 National Drug Strategy Household Survey was used. Questions about experience of alcohol-related harm from others – being put in fear and abuse (verbal or physical) – were asked. Support for stricter alcohol control policies was quantified by a mean policy support score across 18 alcohol policy questions.ResultsTwenty seven percent of respondents reported harm from someone’s drinking. Respondents who were put in fear had a higher level of support for stricter alcohol control policies than respondents who were not harmed (p < 0.001), regardless of whether they were abused or not. Conversely, respondents who experienced abuse but were not put in fear did not significantly differ in their support for stricter policies from those who experienced no harm.ConclusionIt is the apprehension of harm (i.e. having been put in fear), and not the experience of harm itself (i.e. abuse), which is related to people’s support for stricter alcohol policies. These findings suggest that perceiving others’ intoxication as dangerous to oneself may motivate support for stricter alcohol policies.     

The health and well-being of Indigenous drug and alcohol workers: Results from a national Australian survey

The increasing demand for alcohol and other drug (AOD) treatment services among the Australian Indigenous population, complex organisational challenges and limitations, and high unemployment rates are likely to negatively impact Indigenous AOD workers' health and well-being. Building the capacity of Indigenous AOD workers is vital, as they play a crucial role in the delivery of treatment services and offer essential support to their communities. A national online survey was conducted to examine organisational, workplace and individual factors that might contribute to levels of stress and well-being among workers who provide services to Indigenous clients. A total of 294 eligible surveys were completed; 184 (63%) from Indigenous and 108 (37%) from non-Indigenous AOD workers. Multiple regression models were conducted to assess the significant predictors of mental health and well-being, job satisfaction, emotional exhaustion, and turnover intention. Indigenous AOD workers typically experienced above average levels of job satisfaction and relatively low levels of emotional exhaustion. However, 1 in 10 reported high levels of emotional exhaustion, a key predictor of turnover intention. Indigenous workers also experienced significantly lower levels of mental health and well-being and greater work/family imbalance, which was a significant contributor to emotional exhaustion. The findings highlight the importance of implementing workforce development strategies that focus on achieving culturally appropriate, equitable and supportive organisational conditions for Indigenous AOD workers. Preventing or managing levels of stress, ensuring adequate and equitable salaries and benefits, and providing more opportunities for career and personal growth may increase job satisfaction and reduce turnover intention among Indigenous workers in the drug and alcohol field.     

High prevalence rates of tobacco, alcohol and drug use in adolescents and young adults in France: results from the GAZEL Youth study

BACKGROUND: Rates of substance use among adolescents have increased in the 1990s, however little is known about current patterns of substance use among youths entering adulthood. METHODS: We studied sex and age-specific rates of substance use (tobacco, alcohol, cannabis, other illicit drugs, inhalants and psychotropic medications) in a large sample of French youths aged 12-26 years (the GAZEL Youth study, n=1333). RESULTS: Prevalence rates of substance use were high and varied with age and sex. Tobacco, cannabis and polysubstance use were most frequent among 19-21 year-olds (regular tobacco use: 41.5% in males, 39.9% in females; regular cannabis use: respectively 23.9% and 10.9%; tobacco+alcohol+cannabis: respectively 9.9% and 4.6%). Regular alcohol use was most frequent among 22-26 year-olds (29.8% in males, 15.6% in females). Across successive birth cohorts, the age of initiation of tobacco and cannabis use decreased. Males were consistently more likely to use psychoactive substances than females (except for tobacco and psychotropic medications). CONCLUSIONS: Rates of substance abuse peak in late adolescence but remain high among a subgroup of young adults. Moreover, substance use initiation appears to be occurring at increasingly younger ages.     

Risks of major depressive disorder and anxiety disorders among Thais with alcohol use disorders and illicit drug use: Findings from the 2008 Thai National Mental Health survey

Little is known about the risks of mood and anxiety disorders among Asians with alcohol use disorders and the effect of illicit drug use in this population. All participants from the 2008 Thai National Mental Health survey (N=17,140) were assessed for current major depressive disorder, anxiety disorders, and alcohol use disorders by using the Mini International Neuropsychiatric Interview (MINI) and were interviewed for illicit drug use within one year prior to their assessment. Logistic regression modeling was used to determine (a) whether alcohol use disorders were associated with major depressive disorder and anxiety disorders and (b) whether the use of illicit drugs increased these associations. Sex, age, marital status, region, and educational level were found to be significantly associated with major depressive disorder and anxiety disorders and were taken into account in the regression analysis. Compared with the general population, individuals with alcohol use disorders alone had significantly increased risks of major depressive disorder (OR 2.49, 95%CI 1.76-3.53 in men and OR 4.09, 95%CI 2.31-7.26 in women) and anxiety disorders (OR 2.21, 95%CI 1.46-3.36 in men and OR 4.34, 95%CI 2.35-8.03 in women). The risks became higher among individuals with both alcohol use disorders and illicit drug use (OR 3.62, 95% CI 1.64-8.01 in men and OR 11.53, 95%CI 1.32-100.65 in women for major depressive disorder, and OR 3.20, 95%CI 1.36-7.51 in men and OR 13.10, 95%CI 1.48-115.60 in women for anxiety disorders). In conclusion, alcohol use disorders were significantly associated with major depressive disorder and anxiety disorders. Illicit drug use was an important factor in increasing these associations, especially in women. Screening for depression, anxiety, and illicit drug use should be done in individuals with alcohol use disorders.     

Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: Results from National Epidemiological Survey on Alcohol and Related Conditions

Background

Despite the high rates of comorbidity of post-traumatic stress disorder (PTSD) and alcohol dependence (AD) in clinical and epidemiological samples, little is known about the prevalence, clinical presentation, course, risk factors and patterns of treatment-seeking of co-occurring PTSD-AD among the general population.

Methods

The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Weighted means, frequencies and odds ratios (ORs) of sociodemographic correlates, prevalence of psychiatric disorders and rates of treatment-seeking were computed.

Results

In the general population, the lifetime prevalence of PTSD only, AD only and PTSD-AD was 4.83%, 13.66% and 1.59%, respectively. Individuals with comorbid PTSD-AD were more likely than those with PTSD or AD only to have suffered childhood adversities and had higher rates of Axis I and II disorders and suicide attempts. They also met more PTSD diagnostic criteria, had earlier onset of PTSD and were more likely to use drugs and alcohol to relieve their PTSD symptoms than those with PTSD only; they also met more AD diagnostic criteria than those with AD only and had greater disability. Individuals with PTSD-AD had higher rates of treatment seeking for AD than those with AD only, but similar rates than those with PTSD only.

Conclusion

PTSD-AD is associated with high levels of severity across a broad range of domains even compared with individuals with PTSD or AD only, yet treatment-seeking rates are very low. There is a need to improve treatment access and outcomes for individuals with PTSD-AD.     

“I like to be different from how I normally am”: Heavy alcohol consumption among female Spanish adolescents and the unsettling of traditional gender norms

Public debate on the consumption of alcohol by adolescents has grown over recent years. It has intensified in Spain after epidemiological reports of a significant increase in alcohol consumption among adolescent girls. We designed this study to gain insights into this new trend from a gender perspective. The objective was to understand the meanings and motivations attributed to alcohol consumption by female adolescents. A qualitative study was undertaken with 96 female and male adolescents aged between 14 and 17 years, using focus groups and in-depth individual interviews. The analysis presented in this paper is based largely on the female sample. We subjected their narratives to summative content analysis. The results show how the attributed meanings of disinhibition and having a good time may be contributing to the generation of new expectations and demands in relation to codes of femininity and breaks with the gender system. We discuss the results in terms of the implications for preventive interventions with a gender perspective.