Mind-mapping: a tool for eliciting and representing knowledge held by diverse informants

Practical investigation of the use of mind-mapping at different stages of the research process: eliciting, representing and integrating knowledge. EPSRC-funded MAGNET project (developing theoretical models of gun crime to inform stakeholder decision-making about interventions). Mind-maps were particularly useful for communication within our transdisciplinary team and brainstorming, interviews and focus groups with a diverse range of stakeholders

Treatment approaches for dual diagnosis clients in England

Introduction - Dual diagnosis (DD, co-occurrence of substance use and mental health problems) prevalence data in England are limited to specific regions and reported rates vary widely. Reliable information on actual service provision for dual diagnosis clients has not been collated. Thus a national survey was carried out to estimate dual diagnosis prevalence in treatment populations and describe the service provision available for this client population in drug/alcohol (DAS) and mental health services (MHS). Design - A questionnaire was sent to managers of 706 DAS and 2374 MHS. Overall, 249 (39%) DAS and 493 (23%) MHS participated in the survey. Results - In both DAS and MHS, around 32% of clients were estimated to have dual diagnosis problems. However, fewer than 50% of services reported assessing clients for both problem areas. Regarding specific treatment approaches, most services (DAS: 88%, MHS: 87%) indicated working jointly with other agencies. Significantly fewer services used joint protocols (DAS: 55%, MHS: 48%) or shared care arrangements, including access to external drug/alcohol or mental health teams (DAS: 47%, MHS: 54%). Only 25% of DAS and 17% of MHS employed dual diagnosis specialists. Conclusions - Dual diagnosis clients constitute a substantial proportion of clients in both DAS and MHS in England. Despite recent policy initiatives, joint working approaches tend to remain unstructured

The collectivity of British alcohol consumption trends across different temporal processes : a quantile age‐period‐cohort analysis

Background and aims UK alcohol consumption per capita has fallen by 18% since 2004 while the alcohol‐specific death rate has risen by 6%. Inconsistent consumption trends across the population may explain this. Drawing on the theory of the collectivity of drinking cultures and age‐period‐cohort analyses, we tested whether consumption trends are consistent across lighter and heavier drinkers for three temporal processes: (i) the life course, (ii) calendar time, (iii) successive birth cohorts. Design Sex‐specific quantile age‐period‐cohort regressions using repeat cross‐sectional survey data. Setting Great Britain, 1984‐2011. Participants Adult (18+) drinkers responding to 17 waves of the General Lifestyle Survey (total N=175,986). Measurements Dependent variable: The 10th, 25th, 50th, 75th, 90th, 95th and 99th quantiles of the logged weekly alcohol consumption distribution (excluding abstainers). Independent variables: seven age groups (18‐24, 25‐34 … 65‐74, 75+), five time periods (1984‐1988 … 2002‐2006, 2008‐2011) and 16 five‐year birth cohorts (1915‐1919 … 1990‐1994). Additional control variables: ethnicity and UK country. Findings Within age, period and cohort trends, changes in consumption were not consistently in the same direction at different quantiles of the consumption distribution. When they were, the scale of change sometimes differed between quantiles. For example, consumption among women decreased by 18% (CI95: ‐32% ‐ ‐2%) but increased by 11% (CI95: 2% ‐ 21%) at the median and by 28% (CI95: 19%‐38%) at the 99th quantile, implying consumption fell among lighter drinkers and rose among heavier drinkers. This type of polarised trend also occurred between 1984‐1988 and 1996‐2000 for men and women. Age trends showed collectivity but cohort trends showed a mixture of collectivity and polarisation. Conclusions Countervailing alcohol consumption and alcohol‐related harm trends in the UK may be explained by lighter and heavier drinkers having different period and cohort trends as well as by the presence of cohort trends that mean consumption may rise in some age groups while falling in others

Developing a social practice-based typology of British drinking culture in 2009-2011: Implications for alcohol policy analysis

Background and aims: The concept of national drinking culture is well-established in research and policy debate but rarely features in contemporary alcohol policy analysis. We aim to apply the alternative concept of social practices to quantitatively operationalise drinking culture. We discuss how a practice perspective addresses limitations in existing analytical approaches to health-related behaviour before demonstrating its empirical application by constructing a statistical typology of British drinking practices and examining sociodemographic variation in practice. Design: Cross-sectional latent class analysis of drinking occasions derived from one-week drinking diaries collected for market research. Occasions are periods of drinking with no more than two hours between drinks. Setting: Great Britain, 2009-2011. Cases: 187,878 occasions nested within 60,215 nationally-representative adults (18+). Measurements: Beverage type and quantity per occasion. Location, company and gender composition of company. Motivation and reason for occasion. Day, start-time and duration of occasion. Age, sex and social grade. Findings: Eight drinking practices are derived. Three of the four most common practices are low risk, brief, relaxed, home-drinking (46.0% of occasions). The most high risk practices had diverse characteristics and were observed across all sociodemographic groups. Two often-high risk practices identified are rarely acknowledged in policy debate: lengthy weekend domestic gatherings of friends and/or family (14.4% of occasions) and lengthy, typically weekend occasions encompassing both on-trade and off-trade locations (10.4% of occasions). Conclusions: A practice-based perspective offers potential for a step-change in alcohol policy analysis by enabling evaluation of how much and why drinking cultures change in response to public health interventions

Alcohol consumption among the over 50s: international comparisons.

Research exploring alcohol consumption patterns and behaviour change among older adults is relatively scarce, often necessitating reliance on international evidence. To understand the degree to which findings may be generalizable across countries, this review compares recent epidemiological evidence from developed countries on the prevalence of abstention and potentially problematic alcohol consumption in older adults

Alcohol policy and gender : a modelling study estimating gender‐specific effects of alcohol pricing policies

Aims To describe gender differences in alcohol consumption, purchasing preferences and alcohol‐attributable harm. To model the effects of alcohol pricing policies on male and female consumption and hospitalizations. Design Epidemiological simulation using the Sheffield Alcohol Policy Model version 4. Setting and Participants Adults aged 18+ years, England. Interventions Three alcohol pricing policies: 10% duty increase and minimum unit prices (MUP) of £0.50 and £0.70 per UK unit. Measures Gender‐specific baseline and key outcomes data: annual beverage‐specific units of alcohol consumed and beverage‐specific alcohol expenditure (household surveys). Alcohol‐attributable hospital admissions (administrative data). Key model parameters: literature‐based own‐ and cross‐price elasticities for 10 beverage‐by‐location categories (e.g. off‐trade beer). Sensitivity analysis with new gender‐specific elasticities. Literature‐based risk functions linking consumption and harm, gender‐disaggregated where evidence was available. Population subgroups: 120 subgroups defined by gender (primary focus), age, deprivation quintile and baseline weekly consumption. Findings Women consumed 59.7% of their alcohol as off‐trade wine while men consumed 49.7% as beer. Women drinkers consumed fewer units annually than men (494 versus 895) and a smaller proportion of women were high‐risk drinkers (4.8 versus 7.2%). Moderate drinking women had lower hospital admission rates than men (44 versus 547 per 100 000), but rates were similar for high‐risk drinking women and men (14 294 versus 13 167 per 100 000). All three policies led to larger estimated reductions in consumption and admission rates among men than women. For example, a £0.50 MUP led to a 5.3% reduction in consumption and a 4.1% reduction in admissions for men but a 0.7% reduction in consumption and a 1.6% reduction in hospitalizations for women. Conclusion Alcohol consumption, purchasing preferences and harm show strong gender patterns among adult drinkers in England. Alcohol pricing policies are estimated to be more effective at reducing consumption and harm for men than women

The role of personality functioning in drug misuse treatment engagement

Background and aim Personality functioning is predictive of drug misuse and relapse, yet little is known about the role of personality in engagement with the treatment process. This study aimed to estimate the extent to which broad‐ and facet‐level characteristic adaptations contribute to or hinder treatment engagement, while controlling for psychosocial indicators. Design Multi‐site cross‐sectional survey. Setting In‐patient treatment units covering 80% of residential treatment entries in Greece. Participants A total of 338 service users, 287 (84.9%) male, 51 (15.1%) female, average age 33.4 years. Measurements Expressions of personality functioning (characteristic adaptations) were assessed using the Severity Indices of Personality Problems (SIPP‐118). Treatment engagement was measured using the Client Evaluation of Self and Treatment, in‐patient version (CEST). Findings Dysfunctional levels of relational capacities predicted counselling rapport [β = 1.50, 95% confidence interval (CI) = 0.326–2.69, P = 0.013], treatment participation (β = 2.09, 95% CI = 1.15–3.11, P < 0.001) and treatment satisfaction (β = 1.65, 95% CI = 0.735–2.57, P < 0.001). Counselling rapport was also predicted by dysfunctional levels in self‐control (β = 1.78, 95% CI = 0.899–2.67, P < 0.001), self‐reflective functioning at the facet‐level (β = 2.24, 95% CI = 1.01–3.46, P < 0.001) and aggression regulation (β = 1.43, 95% CI = 0.438–2.42, P = 0.005). Dysfunctional levels on social concordance (β = −1.90, 95% CI = −2.87 to –0.941, P = 0.001), emotional regulation (β = 1.90, 95% CI = 0.87–2.92, P < 0.001) and intimacy (β = 2.04, 95% CI = 1.31–3.05, P < 0.001) were significant predictors of treatment participation. Treatment readiness and desire for help predicted treatment engagement. Conclusions In people attending substance use treatment services, maladaptive interpersonal patterns and relational intimacy, emotional dysregulation and impulse control may be associated with low levels of counselling rapport and treatment participation. Low frustration tolerance and aggressive impulses also appeared to predict low participation

Reporting the characteristics of the policy context for population-level alcohol interventions: A proposed 'Transparent Reporting of Alcohol Intervention ContExts' (TRAICE) checklist

Issues Effectiveness of alcohol policy interventions varies across times and places. The circumstances under which effective polices can be successfully transferred between contexts are typically unexplored with little attention given to developing reporting requirements that would facilitate systematic investigation. Approach Using purposive sampling and expert elicitation methods, we identified context-related factors impacting on the effectiveness of population-level alcohol policies. We then drew on previous characterisations of alcohol policy contexts and methodological-reporting checklists to design a new checklist for reporting contextual information in evaluation studies. Key Findings Six context factor domains were identified: (i) baseline alcohol consumption, norms and harm rates; (ii) baseline affordability and availability; (iii) social, microeconomic and demographic contexts; (iv) macroeconomic context; (v) market context; and (vi) wider policy, political and media context. The checklist specifies information, typically available in national or international reports, to be reported in each domain. Implications The checklist can facilitate evidence synthesis by providing: (i) a mechanism for systematic and more consistent reporting of contextual data for meta-regression and realist evaluations; (ii) information for policy-makers on differences between their context and contexts of evaluations; and (iii) an evidence base for adjusting prospective policy simulation models to account for policy context. Conclusions Our proposed checklist provides a tool for gaining better understanding of the influence of policy context on intervention effectiveness. Further work is required to rationalise and aggregate checklists across interventions types to make such checklists practical for use by journals and to improve reporting of important qualitative contextual data

The impact of promoting revised UK low-risk drinking guidelines on alcohol consumption: interrupted time series analysis

Background The UK’s Chief Medical Officers revised the UK alcohol drinking guidelines in 2016 to ≤ 14 units per week (1 unit = 10 ml/8 g ethanol) for men and women. Previously, the guideline stated that men should not regularly consume more than 3–4 units per day and women should not regularly consume more than 2–3 units per day. Objective To evaluate the impact of promoting revised UK drinking guidelines on alcohol consumption. Design Interrupted time series analysis of observational data. Setting England, March 2014 to October 2017. Participants A total of 74,388 adults aged ≥ 16 years living in private households in England. Interventions Promotion of revised UK low-risk drinking guidelines. Main outcome measures Primary outcome – alcohol consumption measured by the Alcohol Use Disorders Identification Test – Consumption score. Secondary outcomes – average weekly consumption measured using graduated frequency, monthly alcohol consumption per capita adult (aged ≥ 16 years) derived from taxation data, monthly number of hospitalisations for alcohol poisoning (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: T51.0, T51.1 and T51.9) and assault (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: X85–Y09), and further measures of influences on behaviour change. Data sources The Alcohol Toolkit Study, a monthly cross-sectional survey and NHS Digital’s Hospital Episode Statistics. Results The revised drinking guidelines were not subject to large-scale promotion after the initial January 2016 announcement. An analysis of news reports found that mentions of the guidelines were mostly factual, and spiked during January 2016. In December 2015, the modelled average Alcohol Use Disorders Identification Test – Consumption score was 2.719 out of 12.000 and was decreasing by 0.003 each month. After the January 2016 announcement, Alcohol Use Disorders Identification Test – Consumption scores did not decrease significantly (β = 0.001, 95% confidence interval –0.079 to 0.099). However, the trend did change significantly such that scores subsequently increased by 0.005 each month (β = 0.008, 95% confidence interval 0.001 to 0.015). This change is equivalent to 0.5% of the population moving each month from drinking two or three times per week to drinking four or more times per week. Secondary analyses indicated that the change in trend began 6 months before the guideline announcement. The secondary outcome measures showed conflicting results, with no significant changes in consumption measures and no substantial changes in influences on behaviour change, but immediate reductions in hospitalisations of 7.3% for assaults and 15.4% for alcohol poisonings. Limitations The pre-intervention data collection period was only 2 months for influences on behaviour change and the graduated frequency measure. Our conclusions may be generalisable only to scenarios in which guidelines are announced but not promoted. Conclusions The announcement of revised UK low-risk drinking guidelines was not associated with clearly detectable changes in drinking behaviour. Observed reductions in alcohol-related hospitalisations are unlikely to be attributable to the revised guidelines. Promotion of the guidelines may have been prevented by opposition to the revised guidelines from the government's alcohol industry partners or because reduction in alcohol consumption was not a government priority or because practical obstacles prevented independent public health organisations from promoting the guidelines. Additional barriers to the effectiveness of guidelines may include low public understanding and a need for guidelines to engage more with how drinkers respond to and use them in practice. Trial registration Current Controlled Trials ISRCTN15189062. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information

Effects on alcohol consumption of announcing and implementing revised UK low-risk drinking guidelines : findings from an interrupted time series analysis

Background: In January 2016, the UK announced and began implementing revised guidelines for low-risk drinking of 14 units (112 g) per week for men and women. This was a reduction from the previous guidelines for men of 3–4 units (24–32 g) per day. There was no large-scale promotion of the revised guidelines beyond the initial media announcement. This paper evaluates the effect of announcing the revised guidelines on alcohol consumption among adults in England. Methods: Data come from a monthly repeat cross-sectional survey of approximately 1700 adults living in private households in England collected between March 2014 and October 2017. The primary outcomes are change in level and time trend of participants’ Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) scores. Results: In December 2015, the modelled average AUDIT-C score was 2.719 out of 12 and was decreasing by 0.003 each month. After January 2016, AUDIT-C scores increased immediately but non-significantly to 2.720 (β=0.001, CI −0.079 to 0.099) and the trend changed significantly such that scores subsequently increased by 0.005 each month (β=0.008, CI 0.001 to 0.015), equivalent to 0.5% of the population increasing their AUDIT-C score by 1 point each month. Secondary analyses indicated the change in trend began 7 months before the guideline announcement and that AUDIT-C scores reduced significantly but temporarily for 4 months after the announcement (β=−0.087, CI −0.167 to 0.007). Conclusions: Announcing new UK drinking guidelines did not lead to a substantial or sustained reduction in drinking or a downturn in the long-term trend in alcohol consumption, but there was evidence of a temporary reduction in consumption