THE DRINKING DRIVER, A guide to the five part series ONE FOR THE ROAD

THE DRINKING DRIVER is a guide for listeners to the Adult Education radio series ONE FOR THE ROAD, a five-part series on drink-driving and Australia’s road toll. ONE FOR THE ROAD was produced by Lee Parker and Julie Levi, with assistance from the Federal Office of Road Safety in Canberra. The five programs, presented by Lee Parker were first broadcast on ABC Radio National in January 1989, and repeated on Radio National and Regional Stations across Australia in April/May 1989. THE DRINKING DRIVER was written by Mark King, Senior Project Officer with the Road Safety Division of the South Australian Department of Transport.

Development and preliminary validation of the Drinking Expectancy Sexual Vulnerabilities Questionnaire (DESV-Q): A purpose-specific instrument for rape-perception research

Background Alcohol expectancies likely play a role in people’s perceptions of alcohol-involved sexual violence. However, no appropriate measure exists to examine this link comprehensively. Objective The aim of this research was to develop an alcohol expectancy measure which captures young adults’ beliefs about alcohol’s role in sexual aggression and victimization. Method Two cross-sectional samples of young Australian adults (18–25 years) were recruited for scale development (Phase 1) and scale validation (Phase 2). In Phase 1, participants (N = 201; 38.3% males) completed an online survey with an initial pool of alcohol expectancy items stated in terms of three targets (self, men, women) to identify the scale’s factor structure and most effective items. A revised alcohol expectancy scale was then administered online to 322 young adults (39.6% males) in Phase 2. To assess the predictive, convergent, and discriminant validity of the scale, participants also completed established measures of personality, social desirability, alcohol use, general and context-specific alcohol expectancies, and impulsiveness. Results Principal axis factoring (Phase 1) and confirmatory factor analysis (Phase 2) resulted in a target-equivalent five-factor structure for the final 66-item Drinking Expectancy Sexual Vulnerabilities Questionnaire (DESV-Q). The factors were labeled: - (1) Sexual Coercion - (2) Sexual Vulnerability - (3) Confidence - (4) Self-Centeredness - (5) Negative Cognitive and Behavioral Changes The measure demonstrated effective items, high internal consistency, and satisfactory predictive, convergent, and discriminant validity. Conclusions The DESV-Q is a purpose-specific instrument that could be used in future research to elucidate people’s attributions for alcohol-involved sexual aggression and victimization.

The role of moral disengagement in underage drinking and heavy episodic drinking

Objectives The current study had two aims. First, to develop a moral disengagement scale contextualized to underage drinking. Second, to investigate Bandura’s (1986) self-regulatory model within the context of underage drinking. Method Two different samples of students participated in the study. The first sample included 619 (362 females) adolescents (Mage = 15.3 years, SD = 1.09 years) and the second sample 636 (386 females) adolescents (Mage = 15.3 years, SD = 1.03 years). Students in the first sample completed the Underage Drinking Disengagement Scale (UDDS), and measures of engagement in underage drinking and heavy episodic drinking. Students in the second sample completed these measures as well as scales of general moral disengagement, personal standards and anticipatory guilt associated with underage drinking. Results For the UDDS, exploratory and confirmatory factor analyses verified a single factor structure. The UDDS was more strongly associated with engagement in underage drinking and heavy episodic drinking than a general measure of moral disengagement. A moderated mediation analysis revealed that adolescents who negatively evaluated underage drinking reported more anticipatory guilt, and more anticipatory guilt was associated with less engagement in underage drinking and less heavy episodic drinking. This relationship was weaker at high compared to low levels of underage drinking disengagement. Conclusions/Importance Understanding how adolescents self-regulate their drinking, and ways that such self-regulation may be deactivated or disengaged, may help identify those adolescents at increased risk of drinking underage and of engaging in heavy episodic drinking.

Non-alcoholic fatty liver disease : can ultrasound assist in early diagnosis of prediabetes and delay progression to type2 diabetes mellitus

Non Alcoholic Fatty Liver Disease (NAFLD) is a condition that is frequently seen but seldom investigated. Until recently, NAFLD was considered benign, self-limiting and unworthy of further investigation. This opinion is based on retrospective studies with relatively small numbers and scant follow-up of histology data. (1) The prevalence for adults, in the USA is, 30%, and NAFLD is recognized as a common and increasing form of liver disease in the paediatric population (1). Australian data, from New South Wales, suggests the prevalence of NAFLD in “healthy” 15 year olds as being 10%.(2) Non-alcoholic fatty liver disease is a condition where fat progressively invades the liver parenchyma. The degree of infiltration ranges from simple steatosis (fat only) to steatohepatitis (fat and inflammation) steatohepatitis plus fibrosis (fat, inflammation and fibrosis) to cirrhosis (replacement of liver texture by scarred, fibrotic and non functioning tissue).Non-alcoholic fatty liver is diagnosed by exclusion rather than inclusion. None of the currently available diagnostic techniques -liver biopsy, liver function tests (LFT) or Imaging; ultrasound, Computerised tomography (CT) or Magnetic Resonance Imaging (MRI) are specific for non-alcoholic fatty liver. An association exists between NAFLD, Non Alcoholic Steatosis Hepatitis (NASH) and irreversible liver damage, cirrhosis and hepatoma. However, a more pervasive aspect of NAFLD is the association with Metabolic Syndrome. This Syndrome is categorised by increased insulin resistance (IR) and NAFLD is thought to be the hepatic representation. Those with NAFLD have an increased risk of death (3) and it is an independent predictor of atherosclerosis and cardiovascular disease (1). Liver biopsy is considered the gold standard for diagnosis, (4), and grading and staging, of non-alcoholic fatty liver disease. Fatty-liver is diagnosed when there is macrovesicular steatosis with displacement of the nucleus to the edge of the cell and at least 5% of the hepatocytes are seen to contain fat (4).Steatosis represents fat accumulation in liver tissue without inflammation. However, it is only called non-alcoholic fatty liver disease when alcohol - >20gms-30gms per day (5), has been excluded from the diet. Both non-alcoholic and alcoholic fatty liver are identical on histology. (4).LFT’s are indicative, not diagnostic. They indicate that a condition may be present but they are unable to diagnosis what the condition is. When a patient presents with raised fasting blood glucose, low HDL (high density lipoprotein), and elevated fasting triacylglycerols they are likely to have NAFLD. (6) Of the imaging techniques MRI is the least variable and the most reproducible. With CT scanning liver fat content can be semi quantitatively estimated. With increasing hepatic steatosis, liver attenuation values decrease by 1.6 Hounsfield units for every milligram of triglyceride deposited per gram of liver tissue (7). Ultrasound permits early detection of fatty liver, often in the preclinical stages before symptoms are present and serum alterations occur. Earlier, accurate reporting of this condition will allow appropriate intervention resulting in better patient health outcomes. References 1. Chalasami N. Does fat alone cause significant liver disease: It remains unclear whether simple steatosis is truly benign. American Gastroenterological Association Perspectives, February/March 2008 www.gastro.org/wmspage.cfm?parm1=5097 Viewed 20th October, 2008 2. Booth, M. George, J.Denney-Wilson, E: The population prevalence of adverse concentrations with adiposity of liver tests among Australian adolescents. Journal of Paediatrics and Child Health.2008 November 3. Catalano, D, Trovato, GM, Martines, GF, Randazzo, M, Tonzuso, A. Bright liver, body composition and insulin resistance changes with nutritional intervention: a follow-up study .Liver Int.2008; February 1280-9 4. Choudhury, J, Sanysl, A. Clinical aspects of Fatty Liver Disease. Semin in Liver Dis. 2004:24 (4):349-62 5. Dionysus Study Group. Drinking factors as cofactors of risk for alcohol induced liver change. Gut. 1997; 41 845-50 6. Preiss, D, Sattar, N. Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci.2008; 115 141-50 7. American Gastroenterological Association. Technical review on nonalcoholic fatty liver disease. Gastroenterology.2002; 123: 1705-25

Physical aspects

As teachers, we must know about the physical developmental processes our students are experiencing. These are reflected in behaviour, emotions and relationships. And for adolescents, who are trying hard to figure out how the world operates, the physical changes they experience have a potent impact on their world view. While the sequencing of much of our physical development is pretty well according to a grand template and rolls out in much the same way from one person to the next, not everything occurs in a set way (Richter, 2006). Some aspects of our physical development cause other things to occur and are tied together. For example, hormonal changes during puberty are tied to the development of secondary sexual characteristics. However, there is individual variation at multiple levels, and we will discuss these. To complicate things, adolescents’ feelings and ideas about themselves and the ways in which they interact with the world as they grow and change are coloured by our societies’ multifaceted sets of ideals, standards and expectations for physical development. Many other things also impact on our conceptions of self and these will be discussed when we turn our attention to the development of identity through adolescence. In this chapter we will present some basic information about the types of physical changes to expect during adolescence, and consider some challenges that confront adolescents during this time of development.

The effectiveness of designated driver programs

Designated driver programs aim to reduce alcohol related crashes by encouraging and facilitating a safe means of transport for those who have been drinking and by influencing attitudes and knowledge. This review discusses the use and effectiveness of designated driver programs in preventing drink driving and ultimately reducing alcohol related road trauma. The limitations of studies examining designated driver programs and recommendations for further research are also discussed. The available evidence suggests that while designated driver campaigns can successfully increase the awareness and use of designated drivers, it is less clear whether these programs lead to a reduction in drink driving and/or alcohol related crashes. Differences in the way that designated driver programs have historically been implemented may account for the inconsistent evidence for their effectiveness in reducing drink driving. There are also a variety of methodological problems relating to the evaluation of designated driver programs which need to be addressed by future research.

Prags Boulevard in Copenhagen : from run-down strip to boulevard

Prags Boulevard will form a 2km long pedestrian spine running east-west between the historic cities of Copenhagen and Amager. It is located on a some-what run down site, which accommodated illicit functions such as casual drug use and drinking, as well as sheds for squatters. The renovation of this site by the city of Copenhagen forms part of the Holmbladsgade renovation project, and a two-phase competition was held in 2001 to develop a green area and meeting place, transforming it into a place that residents would want to visit rather than avoid. The designer, local landscape architect Kristine Jensens recognises that though the site is linear it ‘has no traffic importance’, though as she notes ‘we like the project because it runs straight east west from the city pulse to the water of Oresund’. In developing the project, she has attempted to allow it to ‘run parallel’ to its existing illicit uses, using a ‘light touch’ of insertions. While it would be hard to describe the project as truly light in its touch (graphically, it is a very bold scheme), there is no doubt that it is parallel: in terms of use it runs alongside rather than against existing uses; in terms of its type it’s all about length, like a boulevard, although it clearly differs from a boulevard in other respects.

Neurocognitive profiles of people with comorbid depression and alcohol use : implications for psychological interventions

Depression and alcohol use disorders frequently co-occur and are highly prevalent. Both conditions are known to impair cognitive functioning, yet research into the role of these impairments in response to Cognitive Behaviour Therapy (CBT) is limited. The purpose of the present study was to examine the relationship between baseline neuropsychological performance, severity of depressive symptoms and alcohol use disorders. Participants with current depression and hazardous alcohol use were functioning in the average range on all neuropsychological measures prior to treatment entry. Baseline measures of drinking severity and a range of cognitive functions were inversely correlated. After controlling for other baseline variables, superior baseline cognitive functioning predicted greater reductions in depression severity after 17 weeks. These predictive effects occurred across both brief and extended interventions. Findings suggest that improvement in depression following psychological treatment is enhanced by greater fluid reasoning ability and is predicted by executive functioning, regardless of the treatment length or problem focus.

Mailed treatment to augment primary care for alcohol disorders : a randomised controlled trial

Introduction and Aims: Remote delivery of interventions is needed to address large numbers of people with alcohol use disorders who are spread over large areas. Previous correspondence trials typically examined its effects as stand-alone treatment. This study aimed to test whether adding postal treatment to general practitioner (GP) support would lower alcohol use more than GP intervention alone. Design and Methods: A single-blind, randomised controlled trial with a crossover design was conducted over 12 months on 204 people with alcohol use disorders. Participants in an immediate correspondence condition received treatment over the first 3 months; those receiving delayed treatment received it in months 3–6. Results: Few participants were referred from GPs, and little intervention was offered by them. At 3 months, 78% of participants remained in the study. Those in immediate treatment showed greater reductions in alcohol per week, drinking days, anxiety, depression and distress than those in the delayed condition. However, post-treatment and follow-up outcomes still showed elevated alcohol use, depression, anxiety and distress. Greater baseline anxiety predicted better alcohol outcomes, although more mental distress at baseline predicted dropout. Discussion and Conclusions: The study gave consistent results with those from previous research on correspondence treatments, and showed that high levels of participant engagement over 3 months can be obtained. Substantial reductions in alcohol use are seen, with indications that they are well maintained. However, many participants continue to show high-risk alcohol use and psychological distress.

Friends looking out for friends as an intervention strategy for young adults' risky driving

Young adults are at the greatest risk of experiences road trauma disproportionately to those in other age groups. While the influence of peers is commonly associated with motor vehicle crashes and injury few studies examine whether their influence can be positive. In particular friends may be able to actively intervene to reduce the likelihood of risky driving (e.g. speeding, drink driving or drug driving) and alcohol use. The aim of this paper is to conduct a systematic review on intervening in risky driving behaviour including the situations in which it is likely or unlikely to occur, factors associated with individuals who might or report having intervened and any evaluated programs that make use of such strategies. In addition a study was conducted with 247 first year university students (32% males) to examine whether young adults report engaging in protective behaviour with their peers in South-east Queensland. In particular, if they intervene if their friends are about to drive after drinking, drive after taking illicit drugs or when speeding. It examines any differences in reported likelihood of discouraging such illegal and dangerous behaviour (in the past 12 months prior to the survey). Findings showed that young adults (17-25 years) did indeed report protective behaviour in relation to friends’ drink driving, drug driving, speeding and binge drinking. Conclusions will be drawn regarding important considerations in developing positive strategies and advertising campaigns that encourage positive behaviours (e.g. ‘don’t let mates drink and drive’).

Start Over and Survive : A Brief Intervention For Substance Abuse in Early Psychosis

Over the last decade, brief intervention for alcohol problems has become a well-validated and accepted treatment, with bried interventions frequently showing equivalence in terms of outcome to more extended treatments (Bien et al, 1993). A recent review of this studies found that heavy drinkers who received interventions of less than 1 h were almost twice as likely to moderate their drinking over the following 6-12 months as did those not receiving intervention (Wilk etal, 1997).Some studies have used motivational interviewing (MI) strategies (Monti et al, 1999); others have simply given information ajnd advice to reduce drinking (Fleming et al, 1997). Leaflets or information on strategies to assist in the attempt or follow-up sessions are sometimes provided (Fleming et al, 1997). In general practice research, provision of one or more follow-up sessions increases the reliability of intake reductions across studies (Poikolainen, 1999).

Barriers and facilitators of a designated driver program

The general aim of designated driver programs is to reduce the level of drink driving by encouraging potential drivers to travel with a driver who has abstained from (or at least limited) consuming alcohol. Designated driver programs are quite widespread around the world, however a limited number have been rigorously evaluated. This paper reports the qualitative results from an evaluation of a designated driver program known as ‘Skipper’, in a provincial city in Queensland. Focus groups were conducted with 108 individuals from the intervention area. These focus groups aimed to assess the barriers and facilitators to the programs’ effectiveness by obtaining information about the patrons’ views on various aspects of the program, as well as designated driver and travelling after drinking more generally. A brief questionnaire was also given to participants in order to present responses in terms of the participants’ characteristics. Results suggest general support for the designated driver concept and the ‘Skipper’ program specifically. Facilitating factors reported by participants included the media coverage highlighting the risks associated with drink driving and the social acceptability of choosing not to drink. However, there was also some suggestion that the impact of the program was mainly to encourage those who already engage in designated driver behaviour to continue doing so, rather than encouraging the uptake of the behaviour among potential new users. Some of the suggested barriers to this kind of behaviour change include: social pressure to drink; alcohol dependency; and a failure to plan ahead.

The Alcohol Helplessness Scale and its prediction of depression among problem drinkers

Event-specific scales commonly have greater power than generalized scales in prediction of specific disorders and in testing mediator models for predicting such disorders. Therefore, in a preliminary study, a 6-item Alcohol Helplessness Scale was constructed and found to be reliable for a sample of 98 problem drinkers. Hierarchical multiple regression and its derivative path analysis were used to test whether helplessness and self-efficacy moderate or mediate the link between alcohol dependence and depression, A test of a moderation model was not supported, whereas a test of a mediation model was supported. Helplessness and self-efficacy both significantly and independently mediated between alcohol dependence and depression. Nevertheless, a significant direct effect of alcohol dependence on depression also remained.

Brief opportunistic intervention : the role of psychologists in initiating self-change amongst problem drinkers

Excessive consumption of alcohol is a serious public health problem. While intensive treatments are suitable for those who are physically dependent on alcohol, they are not cost-effective options for the vast majority of problem drinkers who are not dependent. There is good evidence that brief interventions are effective in reducing overall alcohol consumption, alcohol-related problems, and health-care utilisation among nondependent problem drinkers. Psychologists are in an ideal position to opportunistically detect people who drink excessively and to offer them brief advice to reduce their drinking. In this paper we outline the process involved in providing brief opportunistic screening and intervention for problem drinkers. We also discuss methods that psychologists can employ if a client is not ready to reduce drinking, or is ambivalent about change. Depending on the client's level of motivation to change, psychologists can engage in either an education-clarification approach, a commitment-enhancement approach, or a skills-training approach. Routine engagement in opportunistic intervention is an important public-health approach to reducing alcohol-related harm in the community.

Alcohol consumption by undergraduate students

Assessed correlates of alcohol consumption (AC) in 212 undergraduates (81 "college" and 131 "noncollege" residents [COLRs and NCOLRs], mean ages 18.9 and 18.6 yrs, respectively) and studied the proportion who were drinking at potentially harmful levels (HLs). This study also examined changes in AC during the course of the 1st semester and predicted drinking levels in the 2nd semester from demographics, drug use, social variables and self-efficacy data. Data were collected using self-administered questionnaires. During both semesters, the COLRs reported drinking significantly more alcohol than NCOLRs, but during vacation the intake of the 2 groups was almost equal. Higher AC in the 2nd semester was best predicted by higher AC during the 1st semester, followed by more AC by friends and higher parental occupation status. Female COLRs were those most likely to be drinking at HLs. Results also showed that a significant proportion of COLRs were drinking at HLs.