Magazines as contradictory spaces for alcohol messaging: a mixed method content and thematic analysis of UK women’s magazine representations of alcohol and its consumption

BACKGROUND Women’s magazines provide a space in which gendered norms around alcohol-related practice are (re)-produced. They act as important points of reference for women to draw upon in their own understandings of alcohol use within their identity making. Studying the alcohol-related messages women’s magazines disseminate is therefore an important line of inquiry. METHODS An analysis of textual and visual alcohol depictions, including alcohol advertising, in 70 editions of 20 printed magazines targeted at and read by women, published between August 2020 and January 2021, was conducted using quantitative content and qualitative thematic analysis. RESULTS Women’s magazines have the potential to disseminate public health messages about the physical and mental health impacts of alcohol use, alcohol’s role in gender inequalities and the risk of harm from alcohol use by men. However, they do so in ways that reproduce harmful gender norms and expectations, and overlook the structural causes of alcohol-related harms. Associations between alcohol use and violence against women were simplified, in ways that ignored the root causes, produced victim-blaming narratives and deflected responsibility from the perpetrator to the effects of alcohol. Narratives around drinking and sobriety were underpinned by concerns over appearance, which reinforced social expectations of the ideal feminine body. Health narratives were in conflict with the presence of pro-alcohol messages such as consumption suggestions and alcohol advertising, which promoted alcohol use as a normalised aspect of women’s day to day lives. CONCLUSIONS Women receive a number of mixed and contradictory messages on alcohol use through their magazine readership, which places limits on magazines as educational sources of public health messaging

Effects of media representations of drug related deaths on public stigma and support for harm reduction

Background Drug related deaths (DRD) are at historically high levels in the United Kingdom (UK), but some approaches that have the potential to reduce risk of mortality remain controversial. Public support makes an important contribution to drug policy development but there are high levels of public stigma towards people who use drugs (PWUD), and this is partly shaped by media representations. We investigated whether depiction of the characteristics of decedents represented in news articles about DRD was associated with differences in stigmatising attitudes and support for harm reduction policy. Methods We undertook a cross-sectional online study with a randomised design, conducted with a nationally representative sample (UK). Participants (N = 1280) were randomly presented with one of eight simulated news stories that reported on a DRD that differed with respect to drug (ecstasy or heroin), and the gender (male or female) and age (younger or older) of the decedent. Data were analysed using MANOVA. Results Data were obtained for 1248 participants (51.0% female; mean age 45.7±15.4). Stigma was higher towards depictions of male, older, and heroin deaths (all p < .001). Harm reduction support was higher in those participants seeing older compared to younger subjects (p = .035), and the older ecstasy decedent compared to younger decedent (p = .029). Conclusion Presentation of some types of DRD are associated with higher public stigma towards the decedent than others. Those groups developing agenda-setting activities designed to reduce stigma or foster public support for harm reduction policies should consider the different ways in which audiences may respond to the depiction and framing of DRD in news media

Evidence Review Of Drug Treatment Services For People Who Are Homeless And Use Drugs

First paragraph: People who are homeless have complex and challenging lives. They tend to have worse physical and mental health, and are more likely to report problem substance use, than the general population. Substance use is more prevalent among people who are homeless than in the general population, and providing support services and drug treatment in a holistic way for this population should be a priority (St Mungo’s, 2020). Increasing the provision of evidence-based support may lead to improvements in health, well-being, and quality of life (QoL), and to a reduction in costs to healthcare and wider public services. The Irish National Drugs Strategy aims to improve access to treatment services for people who are homeless who use drugs and have complex needs

What treatment and services are effective for people who are homeless and use drugs? A systematic ‘review of reviews’

BackgroundPeople who experience homelessness and those vulnerably housed experience disproportionately high rates of drug use and associated harms, yet barriers to services and support are common. We undertook a systematic ‘review of reviews’ to investigate the effects of interventions for this population on substance use, housing, and related outcomes, as well as on treatment engagement, retention and successful completion.Methods and findingsWe searched ten electronic databases from inception to October 2020 for reviews and syntheses, conducted a grey literature search, and hand searched reference lists of included studies. We selected reviews that synthesised evidence on any type of treatment or intervention that reported substance use outcomes for people who reported being homeless. We appraised the quality of included reviews using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and the Scale for the Assessment of Narrative Review Articles. Our search identified 843 citations, and 25 reviews met the inclusion criteria. Regarding substance use outcomes, there was evidence that harm reduction approaches lead to decreases in drug-related risk behaviour and fatal overdoses, and reduce mortality, morbidity, and substance use. Case management interventions were significantly better than treatment as usual in reducing substance use among people who are homeless. The evidence indicates that Housing First does not lead to significant changes in substance use. Evidence regarding housing and other outcomes is mixed.ConclusionsPeople who are homeless and use drugs experience many barriers to accessing healthcare and treatment. Evidence regarding interventions designed specifically for this population is limited, but harm reduction and case management approaches can lead to improvements in substance use outcomes, whilst some housing interventions improve housing outcomes and may provide more stability. More research is needed regarding optimal treatment length as well as qualitative insights from people experiencing or at risk of homelessness

Europe needs a central, transparent, and evidence-based approval process for behavioural prevention interventions.

Fabrizio Faggiano and colleagues discuss how a central, transparent, and evidence-based approval process is needed for behavioral prevention interventions in Europe and propose a way forward. Please see later in the article for the Editors' Summary.The research leading to these findings has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013), under Grant Agreement n. 266813-Addictions and Lifestyle in Contemporary Europe-Reframing Addictions Project (ALICE RAP). Participant organizations in ALICE RAP can be seen at http://www.alicerap.eu/about-alice-rap/partners.html. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Challenges for drug checking services in a Scottish context: a qualitative exploration of police perceptions

BackgroundThe impact of policing practices on the engagement of people who use drugs (PWUD) with harm reduction services is well evidenced. Although the police have traditionally taken an enforcement role in responding to drug use, it is increasingly clear that they can play an important part in multiagency delivery of harm reduction interventions. Despite this, there have been no studies exploring police officer perceptions of drug checking services (DCS), which provide analytical testing of client drug samples alongside harm reduction support and advice.MethodsSemi-structured interviews were conducted with 10 police officers to explore the policing and legal challenges which could be encountered in the delivery of DCS in Scotland.ResultsParticipants expressed general support for DCS and described this support as part of a wider organisational shift towards public health-oriented policing. Participants also discussed different potential approaches to the policing of areas surrounding DCS including: formal limits on police presence around the service and/or stop and search powers in relation to personal possession; the effective decriminalisation of personal possession within a specified boundary around the service; and informal agreements between local divisions and DCS outlining expected policing practices. Any formal limitation on the capacity of police officers to respond to community concerns was viewed as problematic and as having the potential to erode public confidence in policing. Participants also highlighted the potential for frontline officers to utilise discretion in ways which could undermine public health goals. Legislative change, or national strategic guidance from relevant stakeholders, was seen as a means of providing ‘cover’, enabling local divisions to support the operation of drug checking.ConclusionsDespite a small sample of participants, this study summarises key challenges to be addressed in the implementation and operation of DCS in Scotland, and more widely. The paper concludes with suggested opportunities to develop approaches to policing that can facilitate rather than impede implementation and operation of these services

Achieving integrated treatment: a realist synthesis of service models and systems for co-existing serious mental health and substance use conditions.

Approximately 30-50% of people with serious mental illness have co-existing drug or alcohol problems (COSMHAD), associated with adverse health and social care outcomes. UK guidelines advocate both co-occurring needs being met within mental health services, but uncertainty remains about how to operationalise this to improve outcomes. Various unevaluated service configurations exist in the UK. A realist synthesis was done to identify, test, and refine programme theories of how context shapes the mechanisms through which UK service models for COSMHAD work, for whom, and in what circumstances. Structured and iterative realist searches of seven databases identified 5099 records. A two-stage screening process identified 132 papers. Three broad contextual factors shaped COSMHAD services across 11 programme theories: committed leadership, clear expectations regarding COSMHAD from mental health and substance use workforces, and clear care-coordination processes. These contextual factors led to increased staff empathy, confidence, legitimisation, and multidisciplinary ethos, which improved care coordination and increased the motivation of people with COSMHAD to work towards their goals. Our synthesis highlights that integrating COSMHAD care is complex, and both individual and cultural behavioural shifts in leadership, workforce, and service delivery are essential to ensure people with COSMHAD receive compassionate, trauma-informed care that meets their needs