The Effectiveness of Brief Interventions in Reducing Binge

Authors Avatar

CHAPTER ONE: INTRODUCTION

The Effectiveness of Brief Interventions in Reducing Binge Drinking: Perceptions of Voluntary Sector Practitioners

A Case Study of Phoenix Futures

1.1 Background to Binge Drinking

Alcohol use has been a widely practiced tradition among nations around the world for the last centuries. Alcohol was consumed in large amounts regardless of its implication on health because the populace considered it a form of socialisation. For generations, it had been largely perceived as an integral part of British culture to get drunk (Alcohol Concern, 2003), as well as an accepted form of exchange at every level of interaction in society, especially in the western world (Dean, 1990). Consumption is often associated with a number of factors, which include: hygiene, diet, medicinal requirements, religion and recreation. In most countries over the world, one of the prime reasons for consuming alcoholic beverages is socialisation or recreation, although it may also be precipitated by stressful events.

Alcohol consumption has emerged as one of the most contentious practices around the world; where drinking was previously a common tradition, it is now faced with stiff health concern. To some scholars, moderate consumption of alcohol is safe. Other researchers have stated that alcohol limits are unclear in that many (young) people do not identify themselves as binge drinkers because, despite exceeding the number of drinks officially used to define bingeing (eight or more units of alcohol per day for men, and six or more for women) they drink at a slow enough pace to avoid getting seriously drunk. Determining the point to which alcohol consumption can be deemed excessive has proved a challenge. Safe levels of alcohol consumption during pregnancy for instance are not known, therefore, pregnant women are advised to abstain from drinking alcohol. Due to such challenges, several scholars have attempted to define the term ‘binge drinking’ in different ways.

Initially, the term `binge’ was used in its clinical sense to imply a periodic bout of continual drinking, perhaps over a period of days, by someone who was alcohol dependent, and ending only when the drinker was unable to continue. In recent years, however, the term has been altered to include a high intake of alcohol in a single drinking occasion (Institute of Alcohol Studies (IAS), 2005). There are disagreements regarding the completeness of these definitions and other scholars assume a more appreciative definition can include quantification in the concept. They define binge drinking as the number of units of alcohol consumed, specifically eight or more units of alcohol per day for men, and six or more for women (Alcohol Concern 2003). This definition has been embraced by many experts and institutions that now use this quantification as a rule-of-thumb definition of binge drinking. This is also the definition employed for the current study.

Inappropriate alcohol use is a persistent public health concern to different countries as excess intake directly affects the growth and development of the human resource and the general wellbeing of the individual. Although alcohol consumption does not contribute to any large proportion of the total production losses from work absenteeism, it is well established that alcohol dependent people and heavy drinkers have more sick-leave days than other employees have and thus cost their employers considerable amounts. In Britain, for instance, alcohol-related losses have been estimated at £779 million per year (Klingemann, 2001).

In terms of wellbeing, alcohol misuse in the form of binge drinking has become a prevailing problem internationally, especially among young people; there is sufficient evidence indicating that it is a significant threat to health such causing Liver dysfunction, short term memory lose etc.(WHO, 2001). Over the past 20 years, adverse consequences resulting from high levels of alcohol consumption have been documented by several dependable reports. These indicate that almost two million people, more than 6 percent of whom are men and 2 percent women, consume more than what is regarded as a safe level of alcohol. The consumption levels vary from 50 units of alcohol a week in the case of men and 35 units for women (a unit being approximately equivalent to half a pint of beer or larger or a 152ml glass of wine). Based on the high consumption, alcohol is linked to more than 1.8 million deaths per annum the world over with most of the burden in the developed countries like the US and Britain (WHO, 2008). The burden of ill health due to alcohol is disproportionally shouldered by young men in Europe, 13,000 of who die from an alcohol-related condition in the EU each year.

Management of the consumption of large doses of alcohol in any country is a crucial aspect of public health because of problems arising from binge drinking. In recent years, dramatic changes in several countries have been taken, dawning upon them a need to censure excessive drinking. According to the International Centre for Alcohol Policies (ICAP), over 100 countries now have laws that regulate their production, sale, and consumption. Several interventions like personality-targeted interventions, community based interventions, the social norms marketing technique and brief interventions have been put in place targeting the family, schools, workplace, and community.

When reviewing and designing ways to address “binge drinking,” however, more attention has been focused on spree drinking among young people in whom it is most prevalent due to factors such as curiosity and experimentation.  Alcohol can also become a way of socialising, and feeling more confidence and enjoyment in social and sexual situations (Institute of Alcohol Studies (IAS), 2005). While binge drinking involves a period of unrestrained, immoderate self-indulgence, spree involves a brief indulgence on impulse or a brief period of extravagant drinking. Therefore major mitigation strategies focus on them yet this practice is however not restricted to the only the young, but continues on a diminishing scale through adult life. It is important to appreciate the fact that binge drinking cuts across all age groups but may probably be influenced by a range of environmental and interpersonal factors that could differ according to age group.

Given the different factors that lead people to binge drink, this study was specifically interested in the voluntary sector practitioners’ views of the effectiveness of brief interventions in relation to binge drinking. Such interventions are highly recommended by Cordoba et al. (1998) for situations where people do not have a serious drinking problem yet infrequently drink alcohol at hazardous or offensive levels. Brief interventions can be an effective way of helping people to moderate their alcohol consumption and stop harmful drinking patterns. In the current research, the puzzle was whether this intervention indeed has the capacity to reduce binge drinking as it is presented and what the practitioners thought about it. Unlike the conventional alcoholism treatment, which can take weeks and even months and is aimed at promoting total abstinence in those who have become alcohol dependent, brief interventions are typically one to four short sessions to help the person reduce their level of drinking or change their harmful pattern of drinking (Alcohol Concern 2003). In order to determine how effective this mode of intervention is, one organisation that provides these services and a non- profit making organisation is targeted. This is Phoenix Futures, an organisation that brings positive change in the lives of individuals, families and communities affected by subsistence misuse. Therefore, this project seeks to examine the effectiveness of brief intervention in curbing binge drinking among different age groups through exploring the Perception of Voluntary Sector Practitioners with a focus on Phoenix Futures as a case study.

1.2 Rationale for the Study

The UK has an interesting heterogeneous palette of people and cultures, which also implies large differences in ways of life. It also implies varying levels of alcohol consumption based on social class status, physical availability and affordability, interpersonal or genetic predisposition. However, awareness in the growth of alcohol misuse, known as binge drinking, and its associated problems has become a prevailing problem in present society. There are issues that have not been explored concerning people’s knowledge of binge drinking and, most especially, the practitioner’s perception of the most effective way of reducing binge drinking.

The WHO Collaborative Project on Identification and Treatment of Persons with Harmful Alcohol Consumption was initiated in 1982 to develop a scientific basis for screening and brief interventions in primary care settings (Saunders et. al., 1993). Very few people understand the concept, let alone if it has the capacity to help practitioners deal with alcohol abuse. It is important to identify the reasons for drinking among people, the most efficient methods of identifying persons practicing harmful and hazardous alcohol consumption and subsequently ways to address the problem before health and social consequences become pronounced. The brief intervention has so far been initiated because there was an urgent call for the development of strategies that could be applied in primary health care settings within a minimum time frame and resources. The brief intervention is presided by the efforts from those in the alcohol field that recognise that problems associated with drinking begin at alcohol consumption levels (Prime Minister Strategy (PMSU), 2004). This project therefore set out to assess the perception of voluntary sector practitioners towards the effectiveness of the brief intervention in reducing alcohol consumption in England, using Phoenix Futures as a case study.

1.3 Objectives of the Study

  1. To undertake a critical review of knowledge and understanding of the phenomenon of binge drinking
  2. To analyse and understand the practice of brief intervention in Public Health, with the effort to combat binge drinking.
  3. To explore with a number of voluntary sector practitioners their perceptions on binge drinking and in particular the use of brief interventions to support changes in alcohol- related behaviour, with a focus on binge drinking.

CHAPTER TWO: LITERATURE REVIEW

2.1 Methodology for Literature Search/Review

An extensive electronic literature search was performed through searching the electronic databases that include the Cochrane Library, Medline, CINAHL, PsychInfo, and British Nursing Journal.  The search was conducted using all combinations of search terms: alcohol, binge drinking, and perception of brief intervention.

Another search was carried out using the search engine Google Scholar with the same search keywords. Many of the studies found from this search were excluded, with the exception of a few that did include sufficient information on the topic. The various articles reviewed combined a mixture of both qualitative and quantitative studies that provide deliberations on Voluntary Sector Practitioners providing support for alcohol abuse. It also included information for the brief intervention on drinking in UK and its effectiveness.

The exclusion and inclusion criteria for the articles reviewed were that articles must be published in English language, be published in peer-reviewed journals, and obtained with the search terms mentioned above.

2.2        Introduction to the Review

This chapter is sub-divided into four sections. The first section examines the nature of the problem; the second section highlights the impact of binge drinking on individuals and society; the third section tackles Public Health responses to the problem of binge drinking; and the fourth and final section reviews information on the perceptions of Voluntary Practitioners on brief interventions. These areas were reviewed so as to bring out the background to the critical issues under investigation.  Information was handled thematically according to the objectives of the study.

2.3        The Nature of the Problem of Binge Drinking

The nature of binge drinking, particularly in the UK, is a broad issue covering attitudes of people towards binge drinking especially among the younger ages that is reflected in the amount, duration and frequency at which individuals are consuming alcohol in a day (Klingemann, 2001). At the same time, much anxiety has also been expressed about alcohol consumption among children and young people (Joseph Rowntree Foundation (JRF), 2009). Although there is no clear evidence to suggest that more children are drinking alcohol, surveys  frequently find that the majority of those aged 16 have tried alcoholic drinks, with an increase in the percentage of 11-16 year olds reporting that they consume alcohol on a weekly basis (Department of Health (DoH), 2007). Binge drinking manifests itself in several ways, ranging from individual, gender, environmental, culture and age.

One school of thought suggests that binge drinking has a direct connection with social class status. The Prime Minister‘s Strategy Unit (2004) asserts that there is an existence of different patterns of binge drinking between men and women according to their class. The less educated men and those in unskilled manual occupations are substantially (up to 3 times) more likely than those with higher qualifications to binge drink up to early middle age. In contrast, women with higher educational qualifications are more likely to binge drink in their early twenties, but during their thirties the pattern reverses and it was the less educated and those in unskilled manual occupations who most likely engage in excessive drinking. Moore et al. (1994) also confirmed that binge drinking was most prevalent among young adults, males, the manual social group, those who did not undertake any further education after secondary school, those who are single, divorced or separated, beer drinkers and those who concentrate most of their drinking at weekends.

Another school of thought attributes binge drinking to gender. These assert that, in addition to social status, alcohol consumption has a connection with gender, which explains the differences in consumption in both the developed and other less developed countries. Frances et al., (1995), in their study on young adults in university, confirmed the gender theory. They indicated that gender differences in the quantity of alcohol consumed indicated that males tended to drink more than females. A further presentation by Webb et al., (1996) also showed gender differences among university students; 61 percent of men compared to 48 percent of women exceeded the recommended drinking level of 1-14units per week for women and 1-21 units per week for men.

In Britain however, the JRF (2009) revealed that the consumption among women was increasing at alarming rates. They reported that the proportion of women who binge-drink almost doubled between 1998 and 2006 and is now at 15%; men who binge-drink increased by 1% to 23%. Yet among the 16- to 24-year-old men, binge-drinking decreased by 9% since 2000. This means that women binge drink more than before and are catching up with men since at least 22% of women in England are binge drinking higher than other European countries except Ireland (IAS, 2005). A similar household survey in the UK carried out in 1998, for the first time investigated daily alcohol consumption (Bridgwood et al, 2000). Within the 16–24-year age group, 37% of men reported drinking the equivalent, or more, of 8 units on 1 day in the last week. For women, the corresponding value for drinking the equivalent or more than 6 units of alcohol was 23%. While the values reported by the student research are clearly variable (particularly for female students), three groups of authors, Norman et al. (1998), Pickard et al. (2000) and Underwood and Fox (2000), reported values for both genders in excess of those in the general household survey which used less demanding criteria to define binge drinking. Similarly, the study carried out by Alcohol Concern (2003) reflected binge drinking among students as almost two in five male students reported drinking less than 10 units of alcohol within two and half hours and one in ten males had done so more than ten times in the previous year. For females, very similar figures were recorded for the consumption of six units within 4 hours. In addition, Delk and Meilman (1996) show in their study carried out among students that 62.6% of students had binged in the last two weeks (11% more than five times).

In addition to social status and gender issues, physical availability and affordability also contribute to the level of alcohol consumption among people in the community.  In the UK, a popular conception is that binge drinking is fuelled, if not largely caused, by heavy discounting. Promotions and special offers are responsible for unhealthy patterns of alcohol consumption (British Medical Association, 2009). Yet other scholars do not agree that the over abundance of access to alcohol are reason enough for increase in alcohol consumption since it is not the case in all countries, especially in Mediterranean countries as it rather appears that the prevailing culture is more predominant (Parliament Office of Science and Technology, 2005). This, therefore, leaves the line of thought that argues that environmental and interpersonal factors are important aspects for binge drinking.

There is yet another group of researchers who believe that a genetic predisposition could also underlie binge drinking, particularly in the more severe forms of the disease. Here, heritability of alcoholism (the genetic component of inter-individual variation in vulnerability) is 40 to 60 percent (Enoch and Goldman, 1999). The major genes that have so far been identified are protective against alcoholism; approximately one half of all Southeast Asians have genetic variants of alcohol metabolising enzymes such that, after drinking only small amounts of alcohol, they experience an unpleasant facial flushing reaction with tachycardia, nausea, and headaches as a result of the accumulation of the toxic metabolite acet aldehyde (IAS, 2001). Similarly, the clinical and epidemiological studies have reported a relationship between binge drinking and certain clinical presentations such as injuries, physical and psychiatric illnesses, frequent sickness, absence from employment and social problems (Dobson, 2003). In the UK for instance, between the years 2005 and 2006, the number of alcohol attributable admissions was, 909 per 100, 000 men and 510.4 per 100, 000 women (NICE, 2008).

Conclusively, the above scholars have stated the settings in which binge drinking thrives. They clearly cite several scenarios ranging from the individual, gender, environmental, culture, genetic predispositions, and age to clinical presentations. It seems to indicate that multiple approaches should be employed to address each. How the brief intervention applies to these is a critical area of concern for this study.

2.4        Impact of Binge Drinking on Individuals and Society

Based on the nature of binge drinking, it is evident that alcohol is being consumed in exceeding amounts above the suggested eight or more units of alcohol per day for men, and six or more for women.  This can potentially lead to alcohol dependence and a wide-range of long-term health problems. Binge drinking encompasses: alcohol misuse that involves a person consuming high levels of alcohol that can cause them physical, psychological and social problems - both in the short term and the long term; alcohol abuse, a pattern of drinking that consequently impairs an individual's health, interpersonal relationships, or ability to work; and alcohol dependence, a chronic and potentially fatal disease in which a person is addicted to alcohol. Several investigations have considered the impact of binge drinking on health, which has been mostly classified into social and medical impact in much of the literature reviewed.

 Social Impact of Binge Drinking

In the social arena, most of the literature reviewed revealed that alcohol misuse was closely linked to anti-social, aggressive and violent behaviour (JRF, 2009). It is explained that the social consequences of alcohol based on changes subjectively or objectively attributable to alcohol, occurring in individual social behavior affects social interaction or the social environment. Thus, society is placed at greater risk of undesirable behavior from people consuming alcohol in excessive amounts. For example, in an analysis of data drawn from 41 probation areas between 1 April 2004 and 31 March 2005, the Offender Assessment System Data Evaluation and Analysis Team found the following: 37% of offenders had a current problem with alcohol use; a similar proportion  of 37% had a problem with binge drinking; 47% had misused alcohol in the past; 32% had violent behaviour related to their alcohol use; 38% were found to have a criminogenic need relating to alcohol misuse, potentially linked to their risk of reconviction (IAS, 2005). Binge drinking, therefore, contributes to a variety of severe social problem, including homelessness, murder, suicide, injury, and violent crime.

In a review by Orford et al. (1974), alcohol misuse is reported among young adults. They present that 8.3% of males and 4.3% of females had at one time been involved in an accident in which someone was hurt while another 30.3% of males and 13.8% of females had broken the law with no police involvement. This is a clear indication of how alcohol causes accidents and accidental injury in the home, on the roads, in workplaces and during leisure-time activities. Alcohol is an intoxicant affecting a wide range of structures and processes in the central nervous system, which, interacting with personality characteristics, associated behaviour and socio-cultural expectations, are causal factors for intentional and unintentional injuries and harm to people other than the drinker (Rehm et al, 2004). It has been responsible for falls, collisions, fires and drowning. The presence of alcohol in the body has also been shown to increase the severity of injuries from accidents (Fuller, 1995).

Another social area where alcohol misuse is prevalent is within the family. It raises domestic violence linked to vulnerability of spouse or partner outbursts. The effect of alcohol on an individual has a direct implication on the surrounding people, who are victims. These include children living with parental alcohol misuse and adult victims of violence who are also at increased risk of problem drinking as a possible means of coping with the violence. Legal and cultural limits bar access to the private or domestic sphere, even if the physical and psychological wellbeing of women is at stake, and victims are reluctant to report this covert violence. In the UK, research has found that alcohol had been consumed prior to the offence in nearly three-quarters (73%) of domestic violence cases and was a ‘feature’ in almost two-thirds (62%). Furthermore, almost half (48%) of these convicted domestic violence offenders were alcohol dependent (IAS, 2005).

Alcohol plays a major role in domestic violence as the partners of alcohol abusers pay a heavy price. The negative effects of excessive drinking on non-drinking family members, and particularly on children, remain a cause of concern and have to be considered a pertinent public health issue (Klingemann, 2001).

Furthermore, scholars argue that alcohol abuse extends to the community as it often triggers highly visible disruptive behaviour such as impaired driving reflected in hospital casualty statistics, hooliganism and racial violence. The prevalence of offending is substantially higher among binge drinkers than among non-binge drinkers. Alcohol consumption, and especially abusive consumption, can entail important costs to society.

Alcohol related crime and disorder is also considerable among young people, with the only comparison to adults suggesting that alcohol plays a greater part in assaults committed by juveniles than adults (Hibell et al. 2004). The study carried out by Delk and Meilman (1996) reported that, under the influence of alcohol, participants (young people) had taken part in acts of violence, had been hurt or injured and had been in arguments or fights. Similarly, West et al. (1990) found that 20% of male and 6% of female students had caused damage to property when drunk. The costs involved for repairs in most cases are enormous.

Join now!

Researchers argue that most times compared with tobacco or illicit drugs, alcohol is clearly more “expensive” in terms of the resources expended in dealing with the adverse consequences of abusive drinking. The costs of alcohol consumption may be broadly categorised as follows:  direct costs like health, judicial and social welfare systems, material damage and indirect costs like premature death, excess morbidity and unemployment (Klingemann, 2001). For instance, alcohol is considered a factor for about 30% of sexual offences, 33% of burglaries and 50% of street crimes, with such incidences imposing significant costs on society via intervention from the National Health ...

This is a preview of the whole essay