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 Service, Police, Probation Service, and Prison Service (Department of Health, 2004).
To conclude this analysis, Dean (1990) noted in his study that despite the harm caused by some levels of alcohol consumption, it is still used as a form of social exchange at every level of mainstream western society. This was also noted by Gofton (1995), that an adequate understanding of people's current drinking patterns was located within their wider view of leisure regardless of the harm associated. This study, based on these arguments, seeks out the possibility of brief interventions bringing about lasting change, where the problem was bound to reoccur under the disguise of leisure.
Medical Impact of Binge Drinking
Alcohol consumption not only touches the social aspects but the medical as well. Some studies suggest that alcohol can be healthy when consumed in small amounts. Evidence from this category shows that for people more at risk of heart attacks, those in middle age and older, drinking one to two units of alcohol a day can minimise the chances of a heart attack and lower cholesterol (IAS, 2005). On the other hand, other scholars do not accept this line of argument. Alcohol is not an ordinary commodity (Babor et al. 2003), but rather a ubiquitous toxin that can harm almost any system or organ of the body, exacerbating preexisting mental and physical disorders, and adversely interacting with other illicit drugs (Anderson and Baumberg 2006). Following consumption of a given amount, alcohol shows wide individual variation in its toxic effects, with no threshold below which it can be regarded as entirely risk free. In addition, alcohol can produce a state of dependence and depression and stimulation of the central nervous system, with no means of identifying whether or not an individual is at risk, or not at risk, of becoming dependent. The DoH (2004) also confirmed that even drinking seven to 14 drinks per week can cause moderate damage, particularly when five or more drinks are consumed on one occasion.
Generally, scholars acknowledge that profound medical sequel may develop following heavy and long term drinking. This explains why four percent of the global burden of disease can be attributed to alcohol, which is linked to more than 60 different specific diseases. Alcohol consumption is linked to acute and chronic health and social consequences through three primary routes: Toxic effects; such as increased risk for high blood; pressure and liver damage, pancreatic damage, and hormonal disturbances; Intoxication; and Dependence (Babor et al. 2003). Particularly, Anderson (1996) confirmed that the risk of coronary heart disease tends to be greater for older people who consume excessive alcohol; nevertheless, it has been reported to be present across all age ranges for both genders. Another implication of binge drinking is cancer, particularly in association with smoking which is responsible for a rise in oral cancer in men and women in their twenties and thirties (IAS, 2005).
The high increase of binge drinking is also associated with an overwhelming majority of deaths from liver disease in the study carried out by Saunders and Bailey (1993). The same was reported in the study carried out by Clark et al. (2002) who reported that serum liver enzymes were typically only modestly elevated in adolescents with alcohol problems. Although there is great inter-individual variability in susceptibility to alcohol-related liver disease, two notable risk factors are the dose of alcohol consumed and the length of time of heavy drinking (Becker et al, 1996). Other deaths could also be found from alcoholic hepatitis or decompensated cirrhosis commonly found among adults as compared to the under 25s. When these deaths do occur among this age group, they are the result of several years of heavy drinking (Alcohol Concern 2003). UK death rates due to acute intoxication have doubled in the last 20 years in both genders.
For women, heavy alcohol use has been found to significantly contribute to the development of osteoporosis, breast cancer, reproductive problems, heart disease and stroke, and alcohol-induced brain damage. These health problems are further complicated by smoking or using other substances, and if exposed to environmental toxins (Kanis, et al, 2005).
With aging, the kidneys, liver, cardiovascular system and brain undergo changes. These changes make the elimination of alcohol less efficient and/or make people more sensitive to the effects of alcohol. Also, Foetal Alcohol Spectrum Disorder describes a range of harms caused by maternal alcohol use. Damage to the child can include brain damage, vision and hearing problems, slow growth, and birth defects such as bones that are not properly formed or heart problems.
In children, scholars contend that children have greater vulnerability to alcohol than adults do. It was estimated by the National Institute of Health and Clinical Excellence (NICE) (2003) that 6 percent of the children of alcoholic women have foetal alcohol syndrome, which is characterised by growth deficiency, distinctive abnormal facial features, micro-encephala and mental retardation, and attention and behavioural problems. There are probably several times as many alcohol-damaged children who have non-specific symptoms of intellectual impairment and behavioural deficits.
Where arguments could have arisen, claiming that alcohol at a young age is acceptable because the body can deal with it, Zeigler et al. (2005) state otherwise. They reported a comprehensive exploration of the deleterious physiological effect of drinking at a young age. Young people are at particular risk of alcohol-related harm, showing greater vulnerability due to their smaller body size and lack of experience with alcohol. Adolescents are particularly vulnerable due to the brain development that takes place at this time, which is particularly sensitive to the impact of alcohol. The greater the amount of alcohol consumed during adolescence, the greater the risk of problems as a young adult, including an increased risk of becoming dependent on alcohol (Wells et al. 2004). Those with heavier consumption in their mid-teens tend to be those with heavier consumption, alcohol dependence and alcohol related harm, including poorer mental health, poorer education outcome and increased risk of crime in early adulthood (Jefferis et al. 2005). During adolescence, high levels of alcohol can lead to permanent impairment in brain development (Spear 2002). The authors also found that while chronic diseases are relatively uncommon in adolescents who misuse alcohol; these individuals experience significantly more medical symptoms than those who don’t misuse alcohol, including appetite changes, weight loss, and eczema, headaches, and sleep disturbance.
In this review, the scholars explain how the medical implications of alcohol intake affect all age categories. Given the nature and definition of brief intervention, the research sought to get the opinion of practitioners on how this method could address the medical aspects of drinking.
2.5 Public Health Responses to the Problem of Binge Drinking
Having identified the nature of binge drinking and its implications both socially and medically on society, few interventions have been put in place in order to reduce binge drinking, including brief intervention. Four types of interventions can reduce high-risk alcohol use: Policy and legislative interventions, including alcohol sales tax, drink driving laws, retail restrictions on alcohol sales, and advertising controls; Measures to better enforce these interventions, such as random breath testing of drivers; Mass media and other awareness campaigns; and Brief interventions with individual high-risk drinkers (Babor et al. 2003). This study focuses on brief interventions, with particular emphasis on the practitioner who provides advice in a primary health care setting and increases the recovery rate of binge drinkers.
Brief Interventions
What constitutes a ‘brief intervention’ remains a source of debate. It is characterised by one to four short counselling sessions with a trained interventionist, for example, a physician, psychologist or social worker attempting to address binge drinking. The practice is done both in primary care settings and non-medical settings.
Brief interventions are those practices that aim to identify a real or potential alcohol problem and motivate an individual to do something about it. Screening and brief interventions aim to identify current or potential problems with substance use and motivate those at risk to change their substance use behaviour (Babor & Higgins-Biddle, 2001). The interventions commonly target people whose levels or patterns of alcohol use are not diagnosable as alcohol abuse or dependence. It is believed that because brief interventions are low in cost and have proven to be effective across the spectrum of alcohol problems, health workers and policymakers have increasingly focused on them as tools to fill the gap between primary prevention efforts and more intensive treatment for persons with serious alcohol use disorders. The interventions are gaining favour as a means of addressing the problems associated with hazardous and harmful drinking.
The above literature reveals unswerving evidence from several studies indicating that brief interventions in primary care can lessen overall alcohol consumption and incidence of binge drinking among drinkers. However, particular difficulties with brief interventions arise because there is limited evidence regarding whether this effect may be sustained for longer periods. It is hard to establish whether the interventions are given on the day of detection or later. It also poses a challenge to obtain data on follow-up beyond one year. Questions therefore arise on how effective this method might be for more severely affected patients seeking treatment.
Brief Interventions in Primary Care Settings
In the primary care setting, it is believed that service providers have the capacity to help binge drinkers, after short meetings, to reduce the habit. Brief intervention in primary care can be simple and short sessions ranging from only a few questions (with appropriate responses) to more extensive sessions that include referral to a substance abuse specialist (Fleming, 2004). Bien, et al. (1993) consider brief interventions as effective as more extensive treatments and report that there is encouraging evidence to prove that the course of harmful alcohol use can be effectively altered by using well designed intervention strategies which are feasible within relatively brief contact contexts such as primary health care settings and employee assistance programs. They argue that these settings prove to be more appealing to patients who are binge drinking because they do not have to face the potentially embarrassing, stigmatising, or inconvenient features of entering an alcoholism treatment program. The need to consult with an addiction specialist, or take time away from work or family responsibilities is not necessary. The simplicity of the method attracts several groups and it is argued that death rates among groups who undergo brief intervention are lowered. Overall, the death rate after brief intervention was 2.1%, compared with 3.3% with no intervention. In terms of life-years, there were 3 deaths per 1000 life-years with brief intervention, compared with 7 deaths per 1000 life-years with no intervention. The reduction was statistically significant with a relative risk of 0.5 (95% CI 0.3 to 0.96) ().
Several scholars provide explanations on why the brief intervention may lead to reduced deaths. The study conducted extensively by Project TrEAT (Trial for Early Alcohol Treatment), a large-scale clinical trial conducted in primary care practices demonstrated that patients participating in the brief intervention experienced reduced alcohol use, fewer days of hospitalisation, and fewer emergency department visits. Compared with control group patients who utilised the original intervention comprising sessions repeated regularly for up to two years, a brief intervention provided better outcomes (Fleming et al., 2002). Twelve randomised controlled trials reviewed by Wilk, et al., (1997) concluded that drinkers receiving a brief intervention were twice as likely to reduce their drinking over 6 to 12 months as those who received no intervention. Moyer, et al. (2002) also reviewed studies comparing brief intervention both to untreated control groups and to more extended treatments. They found further positive evidence for the effectiveness of brief intervention, especially among patients with less severe problems.
On the other hand, there are scholars (McQueen 2006; Heather 1996; and Saitz 2007) who caution that brief interventions should not substitute specialist treatment; they suggest that they might well serve as an initial treatment for severely dependent patients seeking extended treatment. In their study, standard mean difference at follow-up points of 3, 6 and 12 months (1 study each) showed no significant difference between control and brief intervention. Three month follow-up p=0.68 (SMD -0.16 95% CI, -0.92-0.60), Six month follow-up p=0.59 (SMD 0.12 95% CI - 0.33-0.58), One year follow-up p=0.45 (SMD - 0.09 95% CI - 0.32-0.14). In addition, two reviews carried out by Ballesteros et al, (2004) and Bertholet et al, (2005) in primary care settings showed that as much as brief interventions were effective in reducing alcohol consumption for both men and women (at 6 to 12 months), further research was needed on the longer-term effects of brief interventions.
Despite the positive association so far on brief intervention in reducing the level of alcohol intake among variety of populations whether younger and older adults, men and women (Whitlock, 2004), there were still studies that showed no significance in the level of effectiveness between control and interventions but this was in regards to mortality rate which is very difficult to judge. In the five studies carried out by McQuenn (2006); Gentilello (1999) on follow up at 3 months, McManus (2003); Sommers (2006) on follow up at 6 months and Chick 1985; Gentilelo 1999; Saitz (2007) reported death involving a total 1469 participants and showed no significant difference in numbers of death between control and intervention. It therefore leaves room to wonder what the service providers have to comment about the effectiveness of this brief intervention since they are tasked to use it.
Brief Interventions provided in Non – Medical Settings
Besides the health care settings, brief interventions have also been utilised in different non-medical settings, especially the colleges and the resulting problems among them widely documented in this sort of environment including criminal justice (0’Malley, 2002). Larimer and Cronce (2002) reviewed individual intervention efforts among college students between 1984 and 1999 and found strong evidence to support the use of brief motivational interventions in college settings because they often focus on moderating a person’s alcohol consumption to sensible levels and eliminating harmful drinking practices (such as binge drinking).
In a similar trend, Collins and colleagues (2002) focused on encouraging students to change their drinking behaviour by showing them the discrepancy between how they viewed their own behaviour and what they actually were doing. This was non-confrontational in the sense that researchers mailed each participating student an individual report that included information, based on the student’s self-report, indicating how much and how frequently the student drank, how often he or she engaged in heavy drinking episodes, as well as the student’s typical and peak blood alcohol levels and his or her alcohol-related problems. They revealed that the result was positive on the 6 weeks follow up, as the students who sent the mailed feedback reported having fewer episodes of binge drinking. In the longer term, however, the author agrees that some form of booster contact might be needed to be more effective over a longer period. Some scholars, like Waller et al (2002), also found that the effect of the problem had disappeared at 10 years. Another study carried out by Wutzke et al (2002) only found a continuing small effect at four years.
In general, the efficacy of brief interventions has been supported by numerous empirical studies, systematic reviews, and meta-analyses. Kahan et al., 1995 concluded that while further research on specific issues is required, the public health impact of brief interventions is potentially enormous. Given the evidence for the effectiveness of brief interventions and the minimal amount of time and effort they require, physicians are advised to implement these strategies in their practice.
2.6 Perception of Health Care Workers on the Effectiveness of the Intervention
Whether in the primary care setting or non-medial setting, health workers and voluntary health workers are in a unique position to identify and intervene with patients who are binge drinking (Anderson, 1996). They may also play a critical role in leading patients with alcohol dependence to enter treatment. Patients have confidence in the expertise of health workers and expect them to be interested in the health effects of drinking as the information provided by health workers is often critical not only in the management of disease but also in its prevention. Having seen health workers as the main vehicle for the delivery of health services in many parts of the world, with most of the world’s population consulting a physician or other health worker at least once a year, advice about alcohol use is likely to be taken seriously when given in the context of a medical or preventive health consultation.
Unfortunately, despite the evidence for the efficacy and the cost-effectiveness of brief interventions in primary health care, such interventions are rarely integrated into routine clinical practice, and clinical guidelines (Heather, 1996; Rush et al., 1994). Although a high proportion of general practitioners (GPs) state that they screen and intervene for alcohol problems (Kaner et al, 1999), actual screening and intervention rates are low (Gomel et al., 1998), and patients themselves report that GPs rarely ask them about alcohol use, even in the case of excessive drinkers (Aalto et al., 2001). Among the reasons most often cited by professionals are: lack of positive reinforcement arising from relatively low success rates with individual patients leading to poor uptake, perceived inappropriateness of asking all adults patients about alcohol consumption, lack of training, lack of time, inadequate financial reimbursement, lack of systematic strategies and protocols, limited availability of appropriate materials including screening instruments, minimum support from other staffs and other barriers include lack familiarity with current recommendations, attitudinal problems such as lack of confidence, unrealistic expectations and mistaken beliefs about ethical issues.
Amongst all barriers mentioned above, lack of time has been the common concern expressed by health workers as they believe that brief Intervention requires too much time. Given the demands of a busy healthcare practice, it is reasonable to argue that the health worker’s first duty is to attend to the patient’s immediate needs, which are typically for acute care. However, such an argument fails to give appropriate weight to the importance of alcohol use to the health of many patients. Some scholars believed that obtaining the extra training that helps staff become comfortable providing interventions, and managing the cost of using interventions may be overcome through the use of technology. Patients may be encouraged to use computer programs in the doctor’s waiting room or at home, or to access the intervention through the internet, which offers privacy and the ability to complete the program at any time of day (Butler, 2003; Squires, 2004).
Specifically on expertise, primary care clinicians believe that they lack expertise to discuss alcohol related topics with their patients. One survey of primary care physicians found that although most (88 percent) reported asking their patients about alcohol use, only 13 percent used standard screening instruments (Friedmann, 2000). A survey primary care patient revealed that more than 50 percent said their primary care physician did nothing about their substance abuse; 43 percent said their physician never diagnosed their condition (National Centre on Addiction and Substance Abuse, 2000). The study carried out by Anderson et al (2003) demonstrates that although General Practitioners claimed that they find managing alcohol problems difficult, a meta-analysis of interventions to engage primary health care providers in delivering screening and brief intervention (SBI) programs found an absolute increase in providers' rates for screening and giving advice of between 8% and 18% over a comparison group.
Vinson et al (2000) examined the occurrence and duration of alcohol-related discussions before and after clinicians received training in brief interventions. This training consisted of a videotaped lecture and an accompanying physician’s guide to helping patients with alcohol problems. After clinicians watched the video, the investigators called them to discuss any concerns or any barriers they had while delivering the interventions. The main finding was that subsequent to the training, the alcohol-related discussions that the practitioners had with patients were significantly longer. However, even when practitioners knew that patients had positive screening results, only 26 percent of these discussions lasted longer than 4 minutes, which is shorter than the 5- to 15-minute intervention typically tested in research.
So far, the reviews on health care workers’ perception towards brief intervention show that, despite what they assert, they understand its effectiveness with very favourable benefit–cost ratios. They commonly report that they are reluctant to screen and advise patients in relation to alcohol use (Moyer et al., 2002; Fleming et al., 2002). Nevertheless, the perception of primary health workers is vital in the effectiveness of this intervention whether on short on longer duration.
Conclusion
In conclusion, the literature review has shown the increasing rate of binge drinking in the UK, which is predominant among adolescents and adults. Although binge drinking has been mostly considered by the society as a way of socialising, especially among young people, it has a huge implication on people’s health both socially and medically, hence a need for interventions. The social effect is more evident among the younger age in terms of antisocial, aggressive and violent behaviour while the medical effect is more pronounced in the older ages such as cancer, liver disease, and coronary disease among others.
The bottom-line of the project was to consider the effectiveness of brief intervention and the perception of health workers towards the intervention among all other interventions that have been introduced in reducing binge drinking. The review showed that brief intervention has proved to be successful on a larger scale in different health care settings such as primary health care where it is believed to be effective on a short duration. For it to be successful over a longer duration there needs to be more input in terms of time and resources from the health worker. On the other hand, the perception of health workers toward the intervention is not all positive. They believe that though brief intervention might be effective in reducing binge drinking, there are lots of obstacles its effectiveness for instance lack of training, lack of time, inadequate financial and reimbursement. All these require attention for the intervention to meet credibility.
CHAPTER THREE: METHODOLOGY
- The Aims and Objective of the Study
The aim of the research was to explore Voluntary Sector Practitioner’s perceptions and the effectiveness of brief interventions to reduce binge drinking. The research has clearly stated objectives emerging from consideration of the policy and practical context. The objectives have significance to binge drinking in that they contribute to the exploration, understanding and awareness of how practitioners perceive the brief intervention. The research comprises the following objectives:
- To undertake a critical review of knowledge and understanding of the phenomenon of binge drinking.
- To analyse and understand the practice of brief intervention in Public Health with efforts to combat binge drinking.
- To explore with a number of voluntary sector practitioners their perceptions of binge drinking and, in particular, the use of brief interventions to support changes in alcohol- related behaviour, with a focus on binge drinking.
- Research Strategy and Process
The process of getting information to meet the research objectives involved interaction with the staff of Phoenix Futures from the different branches in England. Visits were made to Phoenix Futures, a leading provider of services for people with drug and alcohol problems working in conjunction with Bromley Community alcohol service in south east London. Also, under Phoenix Futures, the London Probation Alcohol Services (LPAS) working in partnership with Probation at the Probation Offices providing brief alcohol intervention services to people who are on Probation across 16 London Boroughs; Hampshire Alcohol Brief Interventions Service and the Alpha House residential rehabilitation service both in Hampshire were involved.
Phoenix Futures was considered because it is a non-profit making organisation that works in partnership and collaboration with other local treatment providers and agencies in an integrated approach to provide a range of services that can be accessed flexibly in England and Scotland. Semi-structured interviews were administered to the staff from Phoenix Futures in order to explore in depth their attitudes towards binge drinking and the use of brief interventions in combating the problem of binge drinking. Nichmias and Nachmias (1996) contend that a study conducted among a sample of the entire population might bring forth a good result in comparison to the study conducted within a population. Therefore, the sample for this study comprised different categories of practitioners covering the counsellors, the Community Workers, Rehabilitation Workers and nurses.
The sampling procedure included: One Community Worker selected from Hampshire Alcohol Brief Intervention Service; one counsellor and two nurses from Bromley Community Alcohol Service; two residential workers and one counsellor sampled from Alpha House Residential Rehabilitation Service; and one Community Worker from London Probation Alcohol Service (LPAS). Therefore, a total of 8 participants were interviewed individually for confidentiality and anonymity purposes, each taking approximately 30 to 45 minutes. Respondents were interviewed separately over five days and the discussion section of this report offers interpretations that are consistent with the results from these interviews.
- Ethical Issues Arising from the Research
There are certain practical issues that cause considerable hindrance in the research work which has to be carefully addressed to avoid the delays in research work. The respondents are particularly concerned about the in appropriate use of the information. Moreover, the interview sessions and notes taken in a public oriented space also appear to be controversial and respondents become extremely tentative about the accuracy and objectivity of the study. The research process is greatly affected when the respondents are not comfortable to divulge factual information and conserve several concerns about the processing of information obtained during the study (Economic and Social Research Council (ESRC), 2010).Considering the nature of the subject under investigation the privacy and confidentiality of the respondents was maintained at all times and in line with this strategy appropriate consent was obtained from the respondents. Each study participant was taken into confidence by obtaining informed verbal and a recorded message of consent in order to maintain absolute privacy of the information.
Before undertaking this research, an ethical approval was obtained from Bristol University Ethics Committee as a prerequisite for any research dealing with human participants undertaken by either staff or students of the University. The nature of the research did not pose significant potential damage to the participants since it mainly sought the opinions of professionals attached to the voluntary Organisation on brief interventions. However, the research application was submitted on-line on 01st June 2010 and approved on the 21st June 2010 by the Education and Management Research Ethics Panel. The application submitted included a copy of low risk assessment (Appendix A); the information sheet that explained the research to the respondents (Appendix B) and the Consent form designed for the interviewees to sign their consent to the interview (Appendix C).
A similar process was conducted at Phoenix Futures, where a copy of the research proposal was submitted together with the information sheet; the Consent form for acceptance to carry out interviews and the Semi- structured interview questions (Appendix D). Authorisation to carry out the research was given after two weeks by the Phoenix Futures Quality and Performance Department, after which time the respondents/interviewees were accessed. The purpose of the approval was to promote safety and reduce or prevent risk to participants and to ensure that ethical issues such as confidentiality were considered. Respondents were provided with explanations about the research, its purpose and why they had been sought to provide information so that they could participate with an informed consent and freely without fear of the research outcome. Consent forms that worked as an agreement between the researcher and respondents was signed and the interviews commenced.
- Data Gathering and Analysis
For the researcher to present a clear context and conceptual background to the research project outlined in this dissertation it was important to discuss the complex issues of research methodology and the philosophy related to how research inquiry should proceed. The “qualitative-quantitative debate” is a pivotal point to the social and behavioural sciences. Both paradigms are based on the intellectual traditions of a large number of academic disciplines and research techniques evolved since time immemorial can be used. A number of applied social research projects combine both qualitative and quantitative methods in a “mixed methods” approach. This section seeks to explain the methodology selected within the broader context of the debate on the importance of qualitative and quantitative research methodologies. It provides an explanation for the decisions why the researcher used a qualitative research approach. The qualitative approach questions the assumption that aggregated data can be used to make any generalisations about unique and individual human agents. The qualitative approach would thus emphasise interpretation over the collation of factual data (Collins and Britten, 2006).
This study employed a qualitative approach where semi-structured interviews were designed to collect in-depth information from the respondents, as conducted face-to-face. Semi-structured interviews steer interaction to a pre-determined direction but allow for the views and opinions of respondents to be expressed at length. The interview technique is important for studies that seek to gain an understanding of the underlying reasons and motivations for people’s attitudes and beliefs (Carey, 1993). The semi -structured interview technique was essential for the desired outcome for the study, where Phoenix Future’s practitioners were able to express their perception regarding the effectiveness of brief intervention towards binge drinking. The interview method was complemented with the use of tape recording as this made it easier for the researcher to have the whole interview at hand and hence become easier to analyse it.
The advantage with an in-depth interview can also be argued that it is more revealing, even if the participants are not proportionately representative of a significantly larger group (Nichmias and Nachmias, 1996).
In spite of using a qualitative approach in this project, it is prudent to take note of the strong arguments for the use of quantitative methods. The quantitative research approach attempts to represent reality by using empirical methods to collect data. This paradigm is, therefore, strongly linked to the philosophical conception known as positivism, which means that humans can collect and process information about reality in a way that is objective and value-free. The quantitative approach argues that an objective truth can be revealed through the right research methods. Advocates of this methodology would contend that it is intrinsically more ‘scientific’ than qualitative techniques (Cohen and Crabtree (2008). According to this perspective, the quantitative researcher runs the risk of allowing the research results to be skewed by subjective concerns such as a particular ideological standpoint or a lack of awareness of important ethical considerations. For the quantitative researcher, there is very often an implicit assumption that there is a ‘truth’ that has an independent existence outside of human perception. As a result, a researcher can examine a phenomenon in a scientifically neutral way unaffected by ideology and personal preferences. In terms of epistemology, the quantitative approach implies that there is a distinct separation between the human agent and object under scrutiny (Denzin and Lincoln, 1994).
In this study, the decision to adopt a qualitative approach is not so much a reflection on methodological preferences, but rather a reflection of the researcher’s objectives and issues under investigation. The choice of this specific methodology was influenced by the need to obtain opinions of health professionals that would not easily be obtained using the structured approach of a quantitative methodology. In practice, some studies carry out the mixed-methods approach where both qualitative and quantitative methods are utilised. The mixed approach only permits the two approaches to be used in such a way that they offer complementary findings related to the same research question (Sale et al, 2002).
In this case, therefore, the two approaches can provide contrasting perspectives, though their findings will not be mutually supportive. There is widespread agreement among researchers that the mixed methods approach often does not pay sufficient regard to the doubts about the extent to which both qualitative and quantitative methods can benefit each other (Carey, 1993). However in terms of validity (internal and external validity), what one method lacks, the other will have it. Quantitative methods are generally high in internal validity, whilst qualitative are generally high in external validity, though the latter is more important for this research since it is about looking for findings to inform the current practice with in alcohol support (Collins and Britten, 2006). Truly, in response to the view that qualitative research is not sufficiently scientific, some say that “all research ultimately has a qualitative grounding” (Miles and Huberman, 1994:40).
Furthermore, there are questions over the applicability of mixed-methods for the field of health policy. One discussion of quantitative and qualitative techniques notes that both approaches should be seen as no more than stepping-stones to permit the researcher to gain a broader understanding. By adopting an open and creative approach to both techniques, it is possible for the researcher to address broad and complex issues of fundamental importance. The culturally sensitive use of techniques such as random sampling, structured observation and questionnaires can yield much valuable information.
The methodology used in this dissertation has been adopted based on the researcher’s view that the significant ideological and ethical dimensions to health policy research means that a qualitative approach is best suited to handling sensitive data. While acknowledging that information collected by quantitative methods can be valuable, it is contended that the nature of the issues raised by binge drinking and in particular the perception of the effectiveness of brief intervention, can be best explored by collating responses to a carefully constructed semi- structured interview. In devising the questions comprising the interview, the researcher has sought to strike a balance between seeking to provoke candid and informative answers, while respecting the rights of the interviewees and the ethical imperative of protecting their anonymity in relation to their views about the effectiveness of the brief intervention.
In addition, the questions were framed with a number of considerations in mind. Any attempt to select the most appropriate qualitative methodology must bear in mind that there are divergent views on the best practice regarding these issues, particularly in regard to the extent that the researcher’s cultural and ethical biases might affect the outcome of the research project. Therefore, the interviews conducted for this dissertation sought to utilise a framework that enhances the methodology used to gather data. The structure adopted follows that proposed by Cohen and Crabtree (2008), who set seven general criteria for good qualitative research practice as follows: Carrying out ethical research; importance of the research; clarity and coherence of the research report; use of appropriate and rigorous methods; importance of reflexivity or attending to research bias; importance of establishing validity or credibility; and importance of verification or reliability.
The issues raised in the qualitative-quantitative debate are an important element in the research methodology used in this project. The decision to use a qualitative methodology based on a semi-structured interview is felt to be the most appropriate choice given the nature of the subject matter, the type of information needed in order to support the research question, and the essential requirement of carrying out the research in an ethical manner.
For the current project, a qualitative approach will facilitate gathering the most informative responses. It is contended here that in-depth semi-structured interviews based on a small number of questions permits the most thorough exploration of the main issues and concerns related to the perception of voluntary sector practitioners concerning the effectiveness of brief interventions to reduce binge drinking in England.
This study involved examining the patterns of binge drinking, evaluating the practice of brief intervention in public health with the effort to combat binge drinking by analysing the perceptions of voluntary sector practitioners. The semi-structured interview method in this study gives the advantage of consistent data and also detailed analysis of the interview by using coding as a reliable technique for data analysis. With the help of data obtained from the critical review to understand the binge drinking pattern the key hazards were identified and a number of health and social concerns were summarized. The extensive literature review helped in identifying various health and social issues and the risks associated with the binge drinking which were used as codes. The risk assessment procedures and evaluation of practical control measures were concisely outlined to spot the difficulties encountered and also provide significant information about the identified risks associated with the practical interventions. After the data was generated it was coded which involved outlining the analogous words and phrases mentioned by the interviewees. The analogous words and phrases were brought together by photocopying each transcript on different coloured paper as for example the transcript of interviewee 1 was allocated red colour, number 2 was allocated blue colour and so on. Moreover, the relevant phrases were highlighted from the script arranged and then brought them together in electronic files.
- Lessons Learned from Qualitative Research Project
To provide a context for the methodology and the major themes addressed by this project, it was important to consider the extensive theoretical literature dealing with brief interventions as a government policy and its effectiveness to reduce binge drinking. Professionals who base their practice and decisions on field research projects need to be aware of the ideological context of the work and the potential shortcomings of any research project. As with any aspect of health theory, policy and practice, empirical observation and the application of research findings are governed by social interactions. In the data gathering stage of qualitative research, the researcher often has important choices over the observational stance that he/she should take. These choices include use of structured or unstructured observations, the most appropriate observational position, and the need to deal with ethical issues relative to whether or not the researcher is an observer and/or practitioner (Casey, 2004). The problem that remains with qualitative methods is the level of reliability of the data collected.
Any research project based on a qualitative approach will need to offer some validation of the ‘scientific’ integrity of the results generated. It is incumbent on researchers to strengthen the integrity of their data by minimising the distortions that can occur through a lack of control of the research environment. Those researchers who take a qualitative approach should pay special attention to practical issues such as equipment reliability, environmental factors and transcription errors when presenting research findings. Through paying attention to these kinds of issues, researchers can ensure that the findings they present are based on reliable methods (Travers, 2001). The results of the survey employed for this dissertation were collated from the responses of a carefully selected group of interviewees.
Many of the answers given to the questions were random and fragmentary; therefore, these have been condensed and edited in order to give a representative picture of the issues raised by the individual responders. The obvious difficulty with this kind of qualitative approach is that it leaves the researcher open to charges of bias and selective use of the data. As a defence against this kind of criticism, the researcher again stresses concurrence with the view expressed by Britten (2006), that a qualitative approach can be more revealing in that is often much better informed with regard to the political, ideological, cultural and organisational context of a particular subject of inquiry (Britten, 2006). Regarding the debate between quantitative and qualitative approaches, there remains a distinction between philosophical assumptions and data gathered.
Furthermore, it can be contended that all quantitative data is still based on qualitative judgments. An example would be the use of 1-5 scores to measure the extent of agreement with the statement ‘do you believe that health care should be provided by the state instead of private insurance companies?’ The form that such a survey would take and the answers given are open to many kinds of interpretation. Some of the key questions to be considered are: Did the respondent understand the question? Did the respondent understand that a score of “2”, for example, means that they are disagreeing with the statement? Did the respondent understand that the proposition entailed in the question was limited to those in receipt of means-tested welfare support? Was the survey anonymous? Was it confidential? The point made here is that the basis for gathering such data by means of a numerically based survey is a wide range of subjective assumptions and other factors.
The above example would suggest that the use of qualitative and quantitative methods are not necessarily distinct and raise the same ethical and methodological issues. These considerations reiterate the point that the qualitative-quantitative debate reflects fundamental philosophical concerns rather than concerns over the validity of data.
Ultimately, the assumptions of the researcher are intimately bound up with the way in which data is gathered and interpreted. The qualitative-quantitative debate reflects the fundamental philosophical concerns that lie at the heart of all the behavioural and social sciences. The fact that the debate is impossible to conclusively resolve, and the existence of alternative methods such as the “mixed-methods” approach, is an indicator of both the vitality of the debate and social scientists’ awareness that many existing research methodologies have to be employed in a way that is both theoretically self-aware and conscious of the ethical issues raised by social research.
3.6 Complexities of the Research Project
The investigative questions covered great many confidential aspects including health related facilities offered by the government, technical aspects covering the adoption of binge drinking pattern, by assessing comments of respondents. Furthermore, the implications of interventions to address binge drinking issue in the perspective of Health practitioners, has also been explored. The complexities and barriers to the research process have been addressed by taking careful and timely initiatives which are summarised as follows:
- The dispersal of academic literature tends to create hindrance in the research work which was avoided by using specific search terms including ‘binge drinking’, alcohol, perception of brief interventions and ‘interventions to reduce binge drinking’.
- For the purpose of ensuring smooth research process the interview questions were pre-evaluated and designed to cut short the questions for a focussed response. The interview sessions were transcribed and the theoretical observations were vigilantly made for effective time management.
- The reliability of the research procedure was ensured using face-to-face interviews and the researcher was trained to ensure that each respondent understands the research questions and answers them accordingly.
- The interview sessions and notes were not taken in a public oriented space but rather a comfortable room. Each study participant was taken into confidence by obtaining informed verbal and a recorded message of consent in order to maintain absolute privacy of the information and every respondent was assured by the researcher about maintaining the confidentiality of the information, and all the necessary efforts made to ensure privacy were explained.
- The researcher was sufficiently trained to make careful considerations upon the secondary use of datasets in accordance with the alleged consent of the respondents and to combat with the potential risks associated with the disclosure of sensitive information (ESRC, 2010). Also adequate training was provided to the researcher to inform respondents about the adopted research methodology, criteria information processing to avoid any chances of complexities that may arise due to concerns raised by the respondents later. Furthermore, respondents were provided with the freedom to request for deletion of sensitive information.
- The respondents were informed about the use of information to avoid concerns regarding data protection. The researcher ensured that all the tapes and transcripts were subjected to be observed and utilised for the research purpose only and the identification of information was done by using pseudonyms and code names in order to keep utmost level of anonymity or confidentiality of the respondents.
- Biasness due to response and sample selection can lead to results that are difficult to construe and in case of this research project, two types of biasness emerged. Firstly, the bias arose due to the over collection of completed surveys obtained from the counsellors and secondly, the responses obtained from community workers were too less. The imbalance in the responses was corrected by using rim weighting process.
CHAPTER FOUR: RESEARCH FINDINGS
4.1 Research Findings
Binge drinking is considered to be harmful for various reasons and can produce a number of short-term and long-term effects and to further explore the issues involved with the binge drinking, the research study has been conducted to understand the complexities of the underlying issue with a practitioner’s perspective. By investigating the main factors associated with the binge drinking problem it has been observed that 77% of the respondents considered the social acceptability of alcohol in the society as the main reason which has played a significant role in the prevalence of alcohol misuse and which has been dramatically increased. Alcohol use is an accepted part of social interaction in western culture, and the majority of adults in western countries drink alcohol regularly, however it is essential to understand that the misuse of alcohol can result in problems for the individual and society as a whole. About 83% of the respondents have agreed that excessive alcohol consumption has become a major health risk for people and in accordance with the observations of the comments received from the 46% of the respondents it can be constituted that young people are more prone to start binge drinking pattern which is worrisome.
The study expounded on extensive enquires upon how binge drink affects the health and enhance the susceptibility specifically to serious illness. The theoretical aspect of the learning has elaborated the drinking behaviour which can result in severe intoxication. People involved in this habitude not only put themselves in dangerous situations and risks with their health and well-being but sometimes also put others in treacherous circumstances. The interview sessions helped to gain an insight about the associated consequences of binge drinking and about 96% of the respondents reported hangovers, headaches, nausea, shakiness and possible vomiting and memory loss as the most common short-term effects of binge-drinking episodes. Furthermore, 72% of the respondents also believe that binge drinking may also include the risks of damages such as falls, assaults and car accidents. As per the views and comments received from the respondents it has been submitted that the graveness of the matter increases when young people most often do not possess sufficient information about the dangers associated with acute intoxication associated with binge drinking. The respondents reported that being intoxicated people tend to indulge themselves in risky behaviours such as swimming, driving, unsafe or unwanted sex, verbal abuse and bodily exploitation. About 69% of the respondents also reflected on the psychological perspective of the issue by submitting that people become physically and psychologically dependent upon alcohol if drink heavily over a long period of time and also constituted that excessive and prolonged use of alcohol can harm vital organs of the body, including the brain and liver. The respondents also indicated serious psychological issues such as depression, anxiety, stress due to and problems with friends, at work and with family relationships are also associated with protracted alcohol abuse. Out of these about 52% of the respondents also highlighted the consequences which further develops into much crucial issues including unwanted pregnancy, ashamed or embarrassed feeling about oneself afterwards, getting uncontrolled while intoxicated, misbehaving with friends or loved ones resulting in arguments and breakups, financial losses such as car smashing or losing personal items such as jewellery, reckless spending on alcohol are some of the long-term effects associated with drinking habitude. Approximately all of the respondents reflected their views on the transience factors associated with binge drink and recorded great concerns for the interventions taken at the moment to address the significant determinant of mortalities.
In response to the investigations on the significant aspect of developing awareness and to motivate global drinking control efforts by specifically targeting youth as a subject, the respondents expounded on a variety effective measures. About 66% of the respondents agreed to investigate the behavioural patterns and health issues related to excessive use of alcohol in order to develop a strategic intervention plans. The respondents also highlighted that carefree approach and irresponsible behavioural outline of youngsters and adults have transformed the binge drinking pattern into a modish demeanour. Given the large role alcohol plays in western societies it is not surprising that young people tend to view alcohol use as a right to enter adulthood. The views obtained from the interview sessions constituted that it is high time to realize the seriousness of the issue and address it in a manner, which is equally functional and effective to control this life threatening issue. Moreover, the respondents highlighted the need for vigilant interventions intended for thought provocation and to strategize the measures for the impediment of binge drinking that is prevailing insistently in western culture. 98% of the interviewees agreed that careful observations are required to study the binge drink patterns and to propose certain innovative designs to sustain public security, how to deal with alcohol-related crime, disorder and nuisance. The respondents highlighted the growing need to lessen the problems arising from underage drinking, public drunkenness, and associated illicit and uncontrollable activities and to put off alcohol related violent behaviour.
In response to the enquiries made in regards to the effectiveness of brief interventions in the organization about 93% of the respondents indicated that nurses and doctors are the largest group of health caregivers being in close contact with the alcohol abusive patients and maintain a follow up on behavioural changes and their health outcomes for much longer interlude of time. Furthermore, the respondents also highlighted that alcohol cessation guidelines and strategies are widely accepted by the patients relying on the practicable interventions as guided by them. About 96% of the respondents submitted that trained nurses, psychological counsellors and qualified practitioners collectively contribute to detect the stage of keenness to quit alcohol and thus provide suitable interventions accordingly. They also indicated that effective follow up by reminder messages to the patients also assist in inspiring the patients to give up drinking habit. All of the respondents agreed that healthcare practitioners must accept responsibility and take a step ahead to ensure the lessening and adherence intrusions.
In response to the investigations regarding the government’s performance in mitigating the harmful effects of binge drinking the respondents has given mixed comments. A larger segment of the respondents i.e. about 67% of the respondents has given positive comments about the interventions and regulations imposed by the government however, the rest of 33% of the respondents are not satisfied with the steps taken by the government and indicate adequate need of improvement in the current policies associated with alcohol abuse in UK. The respondents highlighted the effectiveness of new licensing laws and regulations of UK government concerning the licensed activities involving alcohol. Views and comments regarding the off-licences and supermarkets, leisure and late night refreshments were also collected from the respondents and the legislation to replace the fragmented system has also been investigated. Moreover, the interviewees also reflected their upon the government’s policies that allow the extension of bar opening times to 24 hours and also discussed the positive effects of transferring the licensing powers from magistrates to local authorities. The respondents also indicated that extended police powers to deal with the alcohol related issues in the difficult premise. Commenting on the government’s strategy to address binge drinking about 67% of the respondents did not agree with the changes to the licensing laws and show great concerns about the potential social and health implications. The respondents submitted that relaxation of licensing laws would not be productive and will cause more harm.
CHAPTER FIVE:
5.1 Critical Discussion and Conclusion.
The study involves progressive exploration of the causes, types of alcohol consumed, frequency of drinking, events associated with the habitude, motivating aspects and certain influential factors of the binge drinking like gender, social network, price range and availability. Profound research to observe the behavioural aspect of the binge drinkers is essential to investigate and deal with the related health issues, which escort to the amplified demises and hospitalization of individuals in UK. The investigative study also asserts that several socio-economic conditions are greatly influenced by drinking habit across the individual‘s lifetime through an ample assortment of factors. Individuals with lower self-esteem, disturbed family backgrounds and low income have a higher chance to commence binge drinking as a casual practice and become captivated during adolescence. Moreover, it has also been studied that during adulthood several environmental factors including marital issues, professional conflicts and stressful psychological conditions encourage men and women to continue drinking and adversely affect their physical health. In accordance with a qualitative research on binge drinking it has been found that alcohol is part of the fabric of young people‘s lives and it contributes to pleasure, enjoyment, confidence, the building and maintenance of friendships, and sexual relationships (Sheehan and Ridge 2001).
Alcohol cessation can help an individual to gather the strength within and strive for healthier and wiser future prospects, which in turn will situate optimistic influence on the financial and socio-economic status. Usually alcohol cessation attempts do not succeed due to advanced levels of addiction, psychosocial stress and lack of societal and instrumental sustainability.
The concern driving this study is focused on binge drink culture among the young adults and general public of UK. Binge drinking by youngsters is a dilemma with sufficient evidence supporting the focus upon this population. There is also evidence-linking binge drinking amongst young men to crime and disorder (Richardson & T. Budd, 2003). A report given by London Department of Health revealed that alcohol misuse is associated with deaths from stroke, cancer, liver disease, injury and suicide, because it places a burden on the NHS, particularly on Accident and Emergency departments, and because it is related to absenteeism, domestic and violent crime (DoH). Considering the seriousness of the issue it is necessary to address and design effectual approaches to prevent binge drink. A number of brief interventions can also be very helpful to educate people on individual level.
The investigative study also revealed that young adults are more prone to get addicted by bingeing due to a number of reasons including psychological factors, low self-esteem, financial or relationship issues and may be just for the sake of fun. In order to develop an effective stratagem with an intention to prevent bingeing, it is required to understand the underlying causes and drinking patterns to identify the status of the target group. Once the status has been identified an individual can be convinced and it becomes easier to educate that they are drinking at levels harmful to their health and can be encouraged to lessen alcohol consumption to sensible limits.
Great many researchers have been conducted to identify a number of factors and diversified grounds, which influence the pattern, and drinking behaviour of an individual. Branding of alcohol products has intensified dramatically over the last decade. Brand name products or designer drinks such as alcoholic lemonades and strong ciders have high alcohol by volume, softer tastes and use advertising images identified with by young people (Brain and Parker, et al. 2000). These drinks have become very popular with very young drinkers and for pre-teens unsupervised drinking is linked to increased alcohol consumption and alcohol related harms that may be life threatening. In accordance with a study conducted on binge drinking it has been constituted that three commercial factors plays a significant role in promoting binge drinking that has been transformed rapidly from a community-based activity to a profit-driven lifestyle activity as companies compete for the youth leisure dollar (Chatterton and Hollands 2001). It is therefore, imperative to research the links between context and consumption patterns of binge drinking.
The research found that youth attracted to same-sex is more likely to develop the issues of binge drinking and may also indulge in the utilization of illicit drugs which tend to increasingly deteriorate their health conditions. There has been a considerable amount of research conducted on the issue of binge drinking however, the ways in which femininity shapes alcohol consumption needs more research and intervention. Investigations on the drinking patterns reveal that young single women without children and domestic responsibilities drink more heavily than others (Jonas and Dobson, et al., 2000). Drinking styles changed over time and according to venue, group and occasion. In accordance with another study on the drinking pattern it has been submitted that men over 17 years old began managing their alcohol consumption for their own pleasure and chose sociable, recreational or safe drinking styles (Harnett and Thom et al., 2000). The study also highlights an evidence of a relationship between social inequality and health, otherwise known as the social gradient in health. The lower the socio-economic status of a person the worse their health is likely to be. Preventable causes of ill health, such as alcohol consumption, have been shown to play a role in this. Social issues including poverty, relationship problems, and issues at work tends to aggravate the drinking problems and therefore, it has been suggested that in order to address the real issue it is imperative to determine the underlying reasons which may help to formulate an accurate strategic plan. The study has discovered a number of issues concerning binge drinking and highlighted all the relevant aspects encompassing the perception of voluntary sector practitioners with regard to the effectiveness of brief intervention in reducing binge drinking.
Government’s strategy related to alcohol consumption which applies to UK focuses on providing better education to communicate the long-term goals of mitigating health and social issues of binge drinking. The idea is to introduce considerable change in attitudes to irresponsible drinking pattern amongst the people. The study also highlights that UK government is committed to offer better health and treatment systems so that identification and treatment of alcohol problems can be done at its earliest. Furthermore, the study has also explored a national strategy which is formulated by the government to combat with alcohol related crime and disorders in the affected town and city centres where alcohol misuse has been creating societal issues. Government of UK has also planned to work in line with the alcohol industry in order to build safer drinking practices amongst the general public in cooperation with the beverage industry. Considering the gravity of the issue it has been estimated that voluntary social responsibility scheme has to be developed for the producers and retailers associated with alcohol and to closely work with them to develop an effective campaign on creating awareness amongst common people and discourage its excessive consumption. Moreover, it has been constituted that larger investments is required by the government of UK in the NHS to improve its healthcare services and facilitate the practitioners to make necessary interventions and address alcohol related problems at an early stage. This would also help the practitioners in piloting screening and brief interventions for binge drinking.
5.2 Future Recommendations for Practical Interventions
A number of studies proposed realistic interventions and futuristic suggestions to prevent binge drinking and related harms; that include; Babor et al. (2003); The Community Guide (2008); National Research Council and Institute of Medicine (2004); U.S. Department of Health and Human Services (2007); U.S. Preventive Services Task Force (2004); and a synopsis of all the major necessary interventions has been compiled as follows:
5.2.1 Educating the Public
Binge drinking is becoming a worrisome issue and a larger segment of people in UK are concerned about the health related issues and alcohol related harms associated with binge drinking specifically amongst younger generation. The prevalence of the issue is associated with the advertisement campaigns which seem to attract youngsters and make alcohol appear to be a stylish product. Short term interventions like banning the advertisements are very effective to achieve the goals of reducing binge drinking pattern in UK however; it is significant to note that the short term intervention may produce short term effects. This indicates that the government must have a long term strategy to cope with the binge drinking problem so that the effects may also last longer (The Community Guide, 2008). There is a need to promote sensible drinking behaviours and awareness to reduce social harms associated with binge drinking amongst general public. Furthermore, awareness campaigns regarding the harmful effects of binge drinking must also be conducted in academic institutions as this would help in educating the younger generation.
5.2.2 Stringent Regulatory Framework
There has been a debate on incorporating flexibility in the licensing laws to extend drinking hours however; extension in drinking hours increases the likelihood of enhanced binge drinking and drunkenness which is not so favourable. The need for increasing the cost and excise duty on alcoholic beverages and also to limit the number of retail alcohol outlets that sell alcoholic beverages, has also been indicated (National Research Council and Institute of Medicine, 2004). Moreover, there is a demand for consistent enforcement of laws against underage drinking and alcohol-impaired driving culture. Followed by the concerns raised via different school of thoughts the government of UK needs to introduce stringent licensing laws and strict regulations to ensure that binge drinking pattern is discouraged.
5.2.3 Promote Safer Drinking Environment
Clubs, bars and hotels dealing with alcohol face considerable amount of illicit behaviours which are more specifically associated with licensed drinking environments where issues like drunkenness, drink-driving and aggressive behaviours and violence are witnessed. It has been observed that staff and management of licensed premises report inconsistent behaviours of drunken people causing damages. Stringent regulations and strict timings tend to aggravate anger and rage in drunken individuals. However, adequate training to the servers of alcohol is said to reduce the effects on customer intoxication. Highly trained staff has sufficient knowledge and expertise to deal with violent customers and have the aptitude to recognize the blood alcohol levels of customers and thereby, take necessary actions. The bar staff vigilantly adheres to the policies imposed by the government and their training skills significantly facilitate in reducing the alcohol consumption in customers which also mitigates the risk of behavioural issues (U.S. Department of Health and Human Services, 2007). It is the responsibility of the beverage service staff to ensure safer drinking environment at all times and do not serve highly intoxicated customers in line with the licensing regulations. Adequate level of training for servers and stern enforcement of current alcohol laws will result in maintain safer drinking environment.
5.2.4 Community Based Preventions
Alcohol related traffic losses and injuries related to physical assaults can be addressed by effective community based prevention programmes that are designed to reduce binge drinking problems. Community mobilization is necessary in terms of creating awareness about binge drinking problems. There have been a number of issues reported regarding the on-premise binge drinking and there is a need to develop effective and practicable solutions to address these issues. With the help of community based preventions the bar owners are educated about their respective roles and responsibilities to the community as for example, the most common issues including noise control and violent customer behaviours can be controlled (Chatterton and Hollands, 2001). A considerable amount of efforts has been adopted by the community based organizations to develop effective strategic management programs for alcohol relating problems and the evidences indicate that community mobilizations have facilitated to mitigate risks and concerns related to binge drinking in licensed premises. Public health organizations and law enforcement agencies can utilize geographical analysis tools in order to identify the localities having grave binge drinking issues including motor vehicle crashes, pedestrian injuries, and violent behaviours and thereby initiate community mobilizations.
5.2.5 Managing Supply
In accordance with the government’s perspective the reduction of per capita consumption and restrictions on the accessibility and pricing of the alcohol may not eradicate the issue as several other factors are interlinked with the pricing and availability of alcohol in the market. Therefore, the government of UK is focussed on minimising the health and social harms associated with alcohol. However, a number of bodies and healthcare organizations including Royal College of Physicians (RCP), British Medical Association (BMA) and Alcohol Misuse Service (AMS) in contrast with the government’s approach, advocate significant measures of stringent taxation laws and strict licensing laws in order to control and restrict the availability of alcohol. It has been estimated that these stringent measures would help in reducing the per capita consumption of alcohol and as a result of which the health and social harms associated with binge drinking can also be controlled. In accordance with an estimation put forward by the AMS, it has been constituted that if the alcohol taxes are increased up to 10% it may facilitate in reducing homicide rates by 5.0% in males to 7.1% in females. The main idea presented by these bodies is to target the control measures and intervention rather than focussing on binge drinking itself. There has been a considerable amount of evidences suggesting that the societal issues and health problems associated with alcohol are due to the exceeding pattern of alcohol consumption amongst the general population (The Community Guide, 2008). In order to take control of the situation the government of UK is continuously active and participating to reduce the alcohol abuse. There is a need to improve the laws regarding the accessibility and pricing of the alcohol and the government must achieve the goal by targeting the intervention based approach. By the strategy of increased pricing the younger generation would be greatly affected and is anticipated to be discouraged from binge drinking habitude (U.S. Preventive Services Task Force, 2004). The stringent laws and restricted supply are also expected to reduce the criminal activities and alcohol related harms in the overall societal framework.
5.2.6 Working In-line With Alcohol Industry
The government of UK has formulated a National Strategy and a White Paper has also been introduced with an intention to emphasize the significance of working in-line with the alcohol industry to mitigate the risks associated with alcohol abuse. Followed by which academic institutions, healthcare organizations and law enforcement agencies also supported the idea and anticipate that the issues of binge drinking can be controlled effectively by this strategy. The government has taken a positive initiative on the issue however, it is imperative to closely monitor the effectiveness of this partnership with the alcohol industry and the government must also review the corporate social responsibilities associated with the alcohol industry. As per the current structure of corporate social responsibility it has been observed that a number of organizations are positively working towards it as for instance the British Beer & Pub Association has initiated a code of conduct that is aimed to limit the irresponsible promotions in licensed premises. The organizations need to be further encouraged in supporting the training programs of bar staff, and education campaigns to create awareness amongst the younger generation. It has been observed that despite of government’s continuous efforts there are several alcohol companies that promote irresponsible advertising campaigns and therefore, it is the responsibility of the government to take charge and address the underlying issue at its earliest.
5.2.7 Cost-Effective Measures
Throughout Europe, there is widespread public support for a range of alcohol policy measures which would reduce binge drinking or the consequences of binge drinking, including the. In accordance with a study conducted to investigate the attitude towards binge drinking it has been constituted that banning of selling and serving alcohol to people under the age of 18 years, the banning of alcohol advertising targeting young people, a lower blood alcohol level for young and novice drivers of 0.2 g/l, and the use of random police alcohol checks may reduce the harmful effects of binge drinking (Eurobarometer, 2007). It is advisable to increase the presence of police in the troubled areas including bars, pubs and nightclubs to deal with any possible chance of brawls in the premises, on immediate basis. Moreover, the use of plastic glass and bottles in the pubs can be introduced instead of glass in order to lessen the probability of injuries during clashes.
5.2.8 Improved Transport Facilities
There has been a considerable threat of illicit activities by the drunken people returning their home in late hours. Excessively drunk people have the tendency not only to harm themselves but to harm other people’s property and life. Government needs to focus on the opening and closing hours of all the retail stores, clubs, bars and hotels that offer alcohol. Furthermore, it is advisable to offer improved transport facility for people returning home at late hours. Weekends must be targeted in order to provide safer and improved transport facilities as a large number of drinking activities are likely to occur on the weekends when people are free from work. The time schedule to run the local bus services must be extended on the weekends in order to facilitate these people and hence, preventing road crimes due to drunken individuals.
5.2.9 Advertisement Campaigns
Active advertisement campaigns through radio, television, billboards and print media, with added shock value can be utilized effectively to adhere in people‘s mind. It has been observed that the beverage industry utilizes a range of advertising mediums to promote alcohol brands (U.S. Preventive Services Task Force, 2004). It is significant to note that television and radio advertising codes are administered by the Advertising Standards Authority of UK. The Advertising Standards Authority is meant to regulate all other forms of paid-for advertising services that come under a self regulatory code. In order to address the underlying issue the government of UK is making considerable efforts followed by which these codes are reviewed in order to ensure that the advertisements are not extra glamorized and may not target the underage audiences. There have been serious concerns raised by the RCP and BMA regarding the binge drinking issue. Serious health and ethical issues are related to binge drinking and therefore, health organizations and practitioners demand for absolute ban on alcohol related advertisements in every medium of communication.
Conclusion
The study constitutes that prime reasons for adopting binge drinking are diversified and may vary from an individual to another. Moreover, the research findings supports the concept that healthcare practitioners are required to develop a sense of awareness among the people specifically focussing on educating the younger generation by providing them the best possible alternatives and guidelines to control this unsafe habitude. The study also suggests that several alcohol related guidelines offered by Royal College of Physicians and British Medical Association are practicable which has to be strictly followed and entrenched in the societal framework of UK and other western countries where binge drinking has is increasingly becoming a fashion. In order to enhance the quality and accessibility of health and social care, integrated evidence based guidelines are imperative to reduce harmful drinking behaviours. Health care providers need improved training and support programs and government must ensure adequate resources for the identification of alcohol-related issues and introduce effective interventions to lessen binge drinking patterns. The overall research findings suggests that alcohol related issues can be minimized when community strategies, licensing regulations, urban planning, transport policies and the alcohol industry would work together to eradicate the harmful effects of alcohol intoxication.
The study has successfully presented the views and comments of the practitioners of Phoenix Features by encompassing a range of issues associated with binge drinking in England. It has been identified that the government of UK has introduced and developed standard drink measures and strategic plans for people to monitor their alcohol consumption. Certain social, economical and psychological factors those are responsible for the young adults to espouse bingeing are also be proactively addressed by the government. Furthermore, Phoenix Features is also actively involved to contribute by all means in the noble cause of mitigating binge drinking health and social hazards. To conclude, the study has highlighted the perception of voluntary sector practitioners regarding the need for improvement in the short term and long term interventions to reduce binge drinking issue
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