Study protocol for a randomised controlled trial of Allen Carr's Easyway programme versus Lambeth and Southwark NHS for smoking cessation.

INTRODUCTION: Smoking is a major cause of ill health and is associated with several diseases including cancer, coronary heart disease and stroke. Many psychological and pharmacological smoking cessation treatments are available and although they are undoubtedly the most cost-effective health interventions available, many people still fail to maintain cessation in the longer term. Recently, National Institute for Health and Care Excellence called for comparative studies to determine the short-term and long-term effectiveness of Allen Carr's Easyway (ACE) method of stopping smoking. This study will compare the efficacy of the ACE programme and a 1-1 counselling service available via the National Health Service. METHODS AND ANALYSIS: A two-arm, parallel-group, blinded, randomised controlled trial will be conducted with people who smoke tobacco cigarettes, are aged ≥18 years and are motivated to quit. Exclusion criteria comprise self-reported mental health condition, pregnancy or respiratory disease such as chronic obstructive pulmonary disease or emphysema. The primary treatment outcome is smoking cessation 26 weeks after treatment. Participants will be analysed on an intention to treat basis at the point of randomisation. Before being randomised, the research team will not inform participants which two treatments are being compared. Once randomised researchers will be blinded to participant condition, and participants will be blinded to the condition they are not assigned to. Logistic regression will be used to estimate the effectiveness of the treatment condition on smoking cessation at 26 weeks. The following covariates will be included: baseline quit efficacy (at inclusion), age (at inclusion), gender and baseline nicotine dependency. ETHICS AND DISSEMINATION: Approval was granted by London-Fulham Research Ethics Committee (ref: 16/LO/1657). The study's findings will be published in peer-reviewed journals and disseminated at national and international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier number: NCT02855255. ISRCTN registration number: ISRCTN23584477; Pre-results

Effect of health messages on alcohol attitudes and intentions in a sample of 16- & 17-year-old underage drinkers

Background. Responsible drinking messages (RDMs) are a key component of many education-based interventions for reducing alcohol harms. The evidence base for the effectiveness of RDMs is extremely limited, with some recent research suggesting iatrogenic effects of such messages. Objective. To examine the effects of exposure to health messages on attitudes towards drinking and drunkenness, and intentions to drink and get drunk, amongst underage drinkers. Methods. Ninety-four underage drinkers were recruited from colleges in the UK. Participants were either actively or passively exposed to one of two health messages (RDM or general wellbeing). Measures of attitudes and intentions towards drinking and drunkenness were obtained one week before and immediately after participation in the study. A unit estimation task was also included. Results. Active exposure to RDMs led to more positive attitude towards drunkenness, while passive exposure led to more negative attitudes. Passive RDM exposure led to increased intentions to get drunk in future. Wellbeing posters produced the opposite effect in some but not all of these measures. Conclusions. Exposure to RDMs may have some beneficial effects in terms of creating more negative attitudes towards alcohol consumption, but we also identified potential iatrogenic effects regarding attitudes and intentions towards drunkenness amongst an underage sample of drinkers. Further research is required to better understand optimal ways of framing RDMs to produce positive changes in attitudes, intentions and prospective drinking behaviour

Exploring the Alcohol-Behaviour Link: Myopic self-enhancement in the absence of alcohol consumption as a function of past alcohol use

Dual process accounts of the alcohol-behaviour link hypothesise that differences in drinking patterns will moderate the effects of exposure to alcohol-related cues on behaviour, such as when a placebo is administered. We test this hypothesis by adapting a paradigm used in alcohol myopia research to examine the effects of alcohol-related priming on self-enhancement behaviour among social drinkers. Participants were asked to engage in a computerised self rating task prior to being exposed to alcohol related and/or motivational primes. A staged computer error then occurred, and participants were then asked to complete their self ratings again – this method allowed for an immediate assessment of the impact of alcohol and motivational primes on self enhancement. As predicted by alcohol myopia theory, the overall effect of priming with alcohol-related cues was not significant irrespective of response-conflict manipulations. However, drinker type moderated this effect such that heavier drinkers self-enhanced more after exposure to alcohol-related cues, but only in high-conflict conditions. This suggests that the efficacy of a placebo may be significantly moderated by individual differences in reactions to alcohol-related stimuli, and that dual process accounts of the effects of alcohol on behaviour better explains this variation than alcohol myopia theory

Implicit and explicit drinker identities interactively predict in-the-moment alcohol placebo consumption

© 2016 The Authors.Introduction: Having an identity as a 'drinker' has been linked to increased alcohol-related harm, self-reported consumption and self-reported intention to engage in risky drinking behavior. These effects have been observed when identities have been measured using explicit measures (e.g. via questionnaires) and implicitly (e.g. using Implicit Association Tests [IATs] adapted to measure identity). Little research has used actual behavioral measures to measure alcohol consumption in-the-moment, nor compared the effects of implicit and explicit identities directly. Methods: Participants' (n = 40) implicit and explicit identities associated with being a drinker were measured. Attitudes towards one's own drinking were measured explicitly. Participants completed a Pouring Taste Preference Task [PTPT] involving the consumption and rating of non-alcoholic wine. This provided a behavioral measure of intention (pouring), a behavioral measure of consumption and a measure of the implementation of intention into behavior. Results: Results showed an interactive effect of implicit and explicit identities on attitudes and behavior. Explicit identities predicted attitudes towards drinking, but not behavior. Neither identity predicted the amount poured. Implicit identities predicted the amount consumed. A greater proportion of wine poured was predicted by higher implicit identities when explicit identities were absent. Conclusion: These results suggest that explicit identities may be associated more with those beliefs about drinking that one is aware of than behavioral intention. In addition, explicit identities may not predict behavioral enactment well. Implicit identity shows effects on actual behavior and not behavioral intention. Together this highlights the differential influence of reflective (explicit) and impulsive (implicit) identity in-the-moment behavior

Impact of alcohol promoting and alcohol warning advertisements on alcohol consumption, affect, and implicit cognition in heavy drinking young adults: a laboratory-based randomized controlled trial

Objectives: There is sparse evidence regarding the effect of alcohol advertising exposure on alcohol consumption among heavy drinkers. This study aimed to assess the immediate effects of alcohol promoting and alcohol warning video advertising on objective alcohol consumption in heavy drinking young adults, and to examine underlying processes. Design: Between-participants randomized controlled trial with three conditions. Methods: Two hundred and four young adults (aged 18-25) who self-reported as heavy drinkers were randomized to view one of three sets of 10 video advertisements that included either: (i) alcohol promoting, (ii) alcohol warning, or (iii) non-alcohol advertisements. The primary outcome was the proportion of alcoholic beverages consumed in a sham taste test. Affective responses to advertisements, implicit alcohol approach bias, and alcohol attentional bias were assessed as secondary outcomes and possible mediators. Typical alcohol consumption, internet use, and television use were measured as covariates. Results: There was no main effect of condition on alcohol consumption. Participants exposed to alcohol promoting advertisements showed increased positive affect and an increased approach/reduced avoidance bias towards alcohol relative to those exposed to non-alcohol advertisements. There was an indirect effect of exposure to alcohol warning advertisements on reduced alcohol consumption via negative affect experienced in response to these advertisements. Conclusions: Restricting alcohol promoting advertising could remove a potential influence on positive alcohol-related emotions and cognitions among heavy drinking young adults. Producing alcohol warning advertising that generates negative emotion may be an effective strategy to reduce alcohol consumption

Impact of lower strength alcohol labelling on consumption: A randomised controlled trial

Objective: Labels indicating low/light versions of tobacco and foods are perceived as less harmful which may encourage people to consume more. There is an absence of evidence concerning the impact on consumption of labelling alcohol products as lower in strength. The current study tests the hypothesis that labelling wine and beer as lower in alcohol increases their consumption. Methods: Weekly wine and beer drinkers (n=264) sampled from a representative panel of the general population of England were randomised to one of three groups to taste test drinks in a bar-laboratory varying only in the label displayed; Group 1: verbal descriptor Super Low combined with 4%ABV for wine/1%ABV for beer; Group 2: verbal descriptor Low combined with 8%ABV for wine/3%ABV for beer; Group 3: No verbal descriptors of strength (Regular). Primary outcome was total volume (ml) of drink consumed. Results: The results supported the study hypothesis: the total amount of drink consumed increased as the label on the drink denoted successively lower alcohol strength, BLin=.71, p=.015, [95%CI=0.13/1.30]. Group contrasts showed significant differences between those offered drinks labelled as Super Low (M=213.77) compared to Regular (M=176.85), B=1.43, p=.019, [95%CI=0.24/2.61]. There was no significant difference in amount consumed between those offered drinks labelled as Low compared to Regular. Conclusions: These results suggest that labelling drinks as lower in strength increases the amount consumed. Further studies are warranted to test for replication in non-laboratory settings and to estimate whether any effects are at a level with the potential to harm health. Trial registration: ISRCTN1553080

Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study

© 2019 Elsevier Ltd Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk

Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment

<p>Abstract</p> <p>Background</p> <p>In opioid maintenance treatment (OMT) there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1) assess if there were differences in staff attitudes within a national OMT programme, and 2) investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes.</p> <p>Methods</p> <p>This study was a cross-sectional multicentre study. Norwegian OMT staff (<it>n </it>= 140) were invited to participate in this study in 2007 using an instrument measuring attitudes towards OMT. The OMT programme comprised 14 regional centres. Data describing treatment organisation, clinical practices and patient outcomes in these centres were extracted from the annual OMT programme assessment 2007. Centres were divided into three groups based upon mean attitudinal scores and labelled; "rehabilitation-oriented", "harm reduction-oriented" and "intermediate" centres.</p> <p>Results</p> <p>All invited staff (<it>n </it>= 140) participated. Staff attitudes differed between the centres. "Rehabilitation-oriented" centres had smaller caseloads, more frequent urine drug screening and increased case management (interdisciplinary meetings). In addition these centres had less drug use and more social rehabilitation among their patients in terms of long-term living arrangements, unemployment, and social security benefits as main income. "Intermediate" centres had the lowest treatment termination rate.</p> <p>Conclusions</p> <p>This study identified marked variations in staff attitudes between the regional centres within a national OMT programme. These variations were associated with measurable differences in caseload, intensity of case management and patient outcomes.</p

Experience of road and other trauma by the opiate dependent patient: a survey report

Background: Trauma plays an important role in the experience of many patients with substance use disorder, but is relatively under-studied particularly in Australia. The present survey examined the lifetime prevalence of various forms of trauma including driving careers in the context of relevant medical conditions. Methods: A survey was undertaken in a family medicine practice with a special interest in addiction medicine in Brisbane, Australia. Results: Of 350 patients surveyed, 220 were substance dependent, and 130 were general medical patients. Addicted patients were younger (mean ± S.D. 33.72 ± 8.14 vs. 44.24 ± 16.91 years, P < 0.0001) and had shorter driving histories (15.96 ± 8.50 vs. 25.54 ± 15.03 years, P < 0.0001). They had less driving related medical problems (vision, spectacle use, diabetes) but more fractures, surgical operations, dental trauma and assaults. Addicted patients also had significantly worse driving histories on most parameters measured including percent with driving suspensions (O.R. = 7.70, C.I. 4.38-13.63), duration of suspensions (1.71 ± 3.60 vs. 0.11 ± 0.31 years, P < 0.0001), number of motor vehicle collisions (2.00 ± 3.30 vs. 1.10 ± 1.32, P = 0.01), numbers of cars repaired (1.73 ± 3.59 vs. 1.08 ± 1.60, P = 0.042), rear end collisions (O.R. = 1.90, CI 1.13-3.25), running away after car crashes (O.R. = 26.37, CI 4.31-1077.48), other people hospitalized (O.R. = 2.00, C.I. 0.93-4.37, P = 0.037) and people killed (17 vs. 0 P = 0.0005). Upon multivariate analysis group membership was shown to be a significant determinant of both cars repaired and cars hit when controlled for length of driving history. Hence use of all types of drugs (O.R. = 10.07, C.I. 8.80-14.72) was more common in addicted patients as were general (O.R. = 3.64, C.I. 2.99-4.80) and road (O.R.= 2.73, C.I. 2.36-3.15) trauma. Conclusion: This study shows that despite shorter driving histories, addicted patients have worse driving careers and general trauma experience than the comparison group which is not explained by associated medical conditions. Trauma is relevant to addiction management at both the patient and policy levels. Substance dependence policies which focus largely on prevention of virus transmission likely have too narrow a public health focus, and tend to engender an unrealistically simplistic and trivialized view of the addiction syndrome. Reduction of drug driving and drug related trauma likely require policies which reduce drug use per se, and are not limited to harm reduction measures alone