Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

Aims To test two central assumptions of the Transtheoretical Model (TTM) regarding recovery from alcohol problems: (i) individuals making a forward transition from pre-action to action stages will show greater drinking improvements than those remaining in pre-action stages; and (ii) individuals remaining in pre-action stages will not demonstrate improvements in drinking outcomes. Design and setting Large, multi-centre, randomized controlled trial of treatment for alcohol problems [United Kingdom Alcohol Treatment Trial (UKATT)]. Measurements Stage of change, drinks per drinking day and percentage days abstinent at baseline, 3- and 12-month follow-ups. Findings In support of TTM assumption 1, improvements in drinking outcomes were consistently greater among clients who showed a forward stage transition (Cohen's d = 0.68) than among those who did not (d = 0.10). Two tests of assumption 2 showed a significant improvement in drinking outcomes in non-transition groups, inconsistent with the TTM; one test showed a significant deterioration and the other showed equivalent drinking outcomes across time. An explanation is offered as to why, under the relevant assumption of the TTM, clients in non-transition groups showed small changes in drinking outcomes. Conclusions In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change

Delivering alcohol IBA: broadening the base from health to non-health contexts: review of the literature and scoping

A review of the literature and scoping on alcohol brief interventions. The review considers the evidence base on the delivery of identification and brief advice in a wide range of settings. It concludes that broader delivery of IBA is feasible, but requires strong organisational support, effective training and financial investment

When two worlds collide: Critical reflection on co-production

Purpose: This paper reports the findings from reflexive data collection on the evolving co-production research relationship between the two ‘worlds’ of community and academia: people with lived experience and community their intermediaries and academic researchers. It reports analysis of reflections on experience as the different partners explore and evaluate their own experiences of co-productive research within the context of substance use recovery co-production research. Design/methodology/approach: The research uses reflexive data from perspectives of an intermediary community partner, academic partners, and community researchers on experiences of a series of co-productive research projects. The aim is to identify thematic features of the co-productive experiences from different positions and through the process of adaptation to a co-productive relationship. Findings: This paper outlines what has been learnt from the experience of co-production and what has ‘worked’ for community and academic partners; around the nature of co-production, barriers to performance, and its value to participants and the wider recovery research agenda. Originality/value: This paper reports a unique perspective on a developing methodology in health and social care, contributing to a growing body of knowledge pertaining to experiences of co-production research. Co-production, recovery, substance use, reflection, research

Public awareness and healthcare professional advice for obesity as a risk factor for cancer in the UK:a cross-sectional survey

BACKGROUND: Overweight and obesity is the second biggest preventable cause of cancer after smoking, causing ~3.4 million deaths worldwide. This study provides current UK data on awareness of the link between obesity and cancer by socio-demographic factors, including BMI, and explores to what degree healthcare professionals provide weight management advice to patients. METHODS: Cross-sectional survey of 3293 adults completed an online survey in February/March 2016, weighted to be representative of the UK population aged 18+. RESULTS: Public awareness of the link between obesity and cancer is low (25.4% unprompted and 57.5% prompted). Higher levels of awareness existed for least deprived groups (P < 0.001), compared to more deprived groups. Most respondents had seen a healthcare practitioner in the past 12 months (91.6%) and 17.4% had received advice about their weight, although 48.4% of the sample were overweight/obese. CONCLUSION: Cancer is not at the forefront of people’s minds when considering health conditions associated with overweight or obesity. Socio-economic disparities exist in health knowledge across the UK population, with adults from more affluent groups being most aware. Healthcare professionals are uniquely positioned to provide advice about weight, but opportunities for intervention are currently under-utilized in healthcare settings

Devising and communicating public health alcohol guidance for expectant and new mothers: a scoping report

The aim of this research was to understand the experiences and perceptions of key stakeholders in response to revisions to the CMO guidance. This report identifies areas for further consideration in communication of public health messages on alcohol consumption in pregnancy. The report begins with an overview of the guidance and evidence context for drinking during pregnancy, including known levels of consumption and harm. Findings from focus groups with policy makers, health service practitioners, antenatal educators and parents, convened to discuss understanding and application of current guidance, are then presented. The report concludes with recommendations for improving communication of evidence on alcohol use in pregnancy

Roles of Alcohol in Intimate Partner Abuse

There is little available evidence relating to the measurement of alcohol use in IPV relationships (McMurran & Gilchrist, 2008). This mixed-method, multi-phase project aimed to unpick some of the complicated roles that alcohol appears to have in intimate partner abuse. The study did not set out to focus on male to female abuse but the data available resulted in this being the focus.The mixed-method design comprised three phases:Phase 1 involved secondary data, incorporating statistical analysis of cases from Strathclyde Police’s databases which provided details of almost a quarter of amillion police call-outs to domestic incidents.Phase 2 involved 80 quantitative interviews with three groups who were termed as follows; the ‘convicted’ (male prisoners - including both those convicted ofdomestic offence and general offenders’), the ‘conflicted’ (mainly female clientsof agencies dealing with domestic issues – comprising those who might beconsidered as ‘victims’/survivors of domestic problems), and the ‘contented’ (male community football players – envisaged to be experiencing general population levels of relationship conflict). All three groups received the same questionnaire pack which included three validated screening tools that assess alcohol and/or violence risk, specificallyThe Alcohol Use Disorders Identification Test (AUDIT),The Alcohol Related Aggression Questionnaire (ARAQ)The revised Conflict Tactics Inventory (CTS2) (Phase2); (Phase3).Phase 3 involved semi-structured one-to-one digitally recorded qualitativeinterviews with a subset of the prisoner group who had completed thequestionnaire pack from Phase2.The police records phase indicated that most domestic call-outs involved alcoholuse in some way (usually with the accused being recorded as ‘under theinfluence’), with alcohol often being noted at more serious cases (those resulting in a crime being recorded, or physical violence).In the questionnaire phase, screening tool scores indicated high levels of riskyalcohol use, alcohol-related aggression, and partner conflict among prisoners.Partner conflict, but not alcohol use, was also high amongst the agency clients.The qualitative interview phase indicated a high rate of problematic alcohol use in prisoners’ family backgrounds, and conscious awareness of the effects of alcohol use in enabling violent behaviour and criminality. Also that participants considered alcohol to have a direct effect on their behaviour and did present alcohol as an exculpatory factor, sometimes. However multiple roles by which alcohol use may influence partner conflict were reported (not just intoxicated violence) including male entitlement to drink and alcohol spend harming limited family budgets.There were clear indications that cultural, sub-cultural, familial and contextualinfluences on gender and alcohol use were intertwined, for example that whenwomen were drinking they were held more accountable for any relationshipconflict (victim blaming), whilst if men were drinking they were held to be lessaccountable (accused excusing).We conclude that alcohol is a correlate of domestic abuse and thus does need tobe addressed. The high levels of alcohol consumption in our convicted sample, and relationship conflict in our conflicted and convicted samples suggests that joint intervention might be appropriate for those experiencing relationship conflicts. However the strong beliefs in a direct causal effect of alcohol, and strong culturally shaped and gendered beliefs about men and women’s drinking also demands that alcohol is addressed not as an individual risk factor but in terms of alcohol expectancies, related beliefs and as a gendered issue