Helping someone with problem drinking: Mental health first aid guidelines - a Delphi expert consensus study

Background Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence). Methods A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines. Results The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by ≥80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency. Conclusion The guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

Media as creative industries : conglomeration and globalization as accumulation strategies in an age of digital media

This chapter will begin by considering some of the distinctive features of media as creative industries, including their assessment of risk and return on investment, team-based production, the management of creativity, the value chain of production, distribution and circulation, and the significance of intellectual property in their revenue strategies. It will then critically appraise three strategies to capture new markets and revenue streams in the context of the rise of the Internet, digital media and globally networked distribution. The three strategies to be considered are conglomeration, networking and globalization, and the focus will be on the media giants such as News Corporation, Disney and Time-Warner. It will be argued that all three present considerable challenges in their application, and digital media technologies are weakening rather than strengthening their capacity to control the global media environment. The chapter will conclude with consideration of some implications of this analysis for questions of media power.

The Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ-MSM): A measure of substance-related beliefs

Introduction and Aims. Alcohol expectancies are associated with drinking behaviour and post-drinking use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub-cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance use. This study describes the specific development of a measure of such beliefs for alcohol, the Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ-MSM). Design and Methods. Items selected through a focus group and interviews were piloted on 220 self-identified gay or other MSM via an online questionnaire. Results. Factor analysis revealed three distinct substance reinforcement domains ('Cognitive impairment', 'Sexual activity' and 'Social and emotional facilitation'). These factors were associated with consumption patterns of alcohol, and in a crucial test of discriminant validity were not associated with the consumption of cannabis or stimulants. Similarities and differences with existing measures will also be discussed. Discussion and Conclusions. The DEQ-MSM represents a reliable and valid measure of outcome expectancies, related to alcohol use among MSM, and represents an important advance as no known existing alcohol expectancy measure, to date, has been developed and/or normed for use among this group. Future applications of the DEQ-MSM in health promotion, clinical settings and research may contribute to reducing harm associated with alcohol use among MSM, including the development of alcohol use among young gay men.

Women, drinking and aggression on a night out: Do girls just wanna have fun?

Alcohol misuse and violence is a major public safety concern. Although the extent and nature of alcohol-related violence has been examined there is a paucity of research surrounding the ongoing construction and re-construction of gender identity and its relationship to aggression and alcohol consumption. A social constructionist perspective was used to explore women’s perceptions and experiences of drinking alcohol and incidents of public violence and aggression. Two methods were used. Firstly, an exploratory study consisting of three in-depth interviews and three focus groups to examine the ideas women constructed in relation to their experiences; and further, an online survey to explore self-reported drinking patterns among men and women. The main themes emerging from the qualitative material were ‘planned drinking to excess’ (incorporating the rituals of a ‘pre-drink’ routine), and perceptions of appropriate feminine behaviour (particularly in relation to excessive drinking and alcohol related aggression in and around licensed venues). The survey data indicated that men continue to consume more alcohol and at higher levels than women, while women’s involvement in aggressive incidents on a night out being similar to that of men. Both genders considered that women’s involvement in aggressive incidents in and around licensed venues as ‘unfeminine’. Understanding drinking as a socially constructed activity adds to our understanding of the meaning of drinking for women, and in particular, young women. This perspective may allow more focussed initiatives to address the social and health related harms associated with drinking in and around licensed venues.

The impact of completing a drink driving rehabilitation program on future drinking : the clients’ perspective

The paper explores the role and focus of drink driving rehabilitation programs. It is particularly concerned with whether programs that specifically focus on reducing driving after drinking also have a positive effect on clients’ levels of drinking. A sample of volunteering clients was recruited while they were participating in the Australian “Under the Limit” program and they were followed up at least three months post completion. Response rates were very low and the sample is assumed to reflect the views and outcomes of persons who felt positive about the program. Clients reported large and meaningful reductions in their drinking and in their drink driving. They also reported important moves towards action and change in their drinking habits. The findings deserve to be followed up given the fact that drink driving programs are generally of much shorter duration than alcohol focussed interventions. There is a need for further research in this area and for developing more effective recruitment strategies.

Chronological age and age-related cognitive deficits are associated with an increase in multiple types of driving errors in late life

Objective: Older driver research has mostly focused on identifying that small proportion of older drivers who are unsafe. Little is known about how normal cognitive changes in aging affect driving in the wider population of adults who drive regularly. We evaluated the association of cognitive function and age, with driving errors. Method: A sample of 266 drivers aged 70 to 88 years were assessed on abilities that decline in normal aging (visual attention, processing speed, inhibition, reaction time, task switching) and the UFOV® which is a validated screening instrument for older drivers. Participants completed an on-road driving test. Generalized linear models were used to estimate the associations of cognitive factor with specific driving errors and number of errors in self-directed and instructor navigated conditions. Results: All errors types increased with chronological age. Reaction time was not associated with driving errors in multivariate analyses. A cognitive factor measuring Speeded Selective Attention and Switching was uniquely associated with the most errors types. The UFOV predicted blindspot errors and errors on dual carriageways. After adjusting for age, education and gender the cognitive factors explained 7% of variance in the total number of errors in the instructor navigated condition and 4% of variance in the self-navigated condition. Conclusion: We conclude that among older drivers errors increase with age and are associated with speeded selective attention particularly when that requires attending to the stimuli in the periphery of the visual field, task switching, errors inhibiting responses and visual discrimination. These abilities should be the target of cognitive training.

Negotiation 2.0 in the twitter age : using Web 2.0 applications to facilitate successful negotiation outcomes

The high-pressure, cross-cultural, cross-factional and frequently cross-national nature of contemporary negotiation means that there are a number of clements potentially hampering efforts to achieve successful negotiation outcomes from face-to-face interactions. These hindrances include: resource scarcity (for example, finances, technology and facilities), time scarcity, geographical separation, lack of a COnl1110n language and an inability to Inaintain a consistent ongoing dialogue.

Cabergoline Decreases Alcohol Drinking and Seeking Behaviors Via Glial Cell Line-Derived Neurotrophic Factor

Background: Cabergoline is an ergotamine derivative that increases the expression of glial cell line-derived neurotrophic factor (GDNF) in vitro. We recently showed that GDNF in the ventral tegmental area (VTA) reduces the motivation to consume alcohol. We therefore set out to determine whether cabergoline administration decreases alcohol-drinking and -seeking behaviors via GDNF. Methods: Reverse transcription polymerase chain reaction (RT-PCR) and Enzyme-Linked ImmunoSorbent Assay (ELISA) were used to measure GDNF levels. Western blot analysis was used for phosphorylation experiments. Operant self-administration in rats and a two-bottle choice procedure in mice were used to assess alcohol-drinking behaviors. Instrumental performance tested during extinction was used to measure alcohol-seeking behavior. The [35S]GTPγS binding assay was used to assess the expression and function of the dopamine D2 receptor (D2R). Results: We found that treatment of the dopaminergic-like cell line SH-SY5Y with cabergoline and systemic administration of cabergoline in rats resulted in an increase in GDNF level and in the activation of the GDNF pathway. Cabergoline treatment decreased alcohol-drinking and -seeking behaviors including relapse, and its action to reduce alcohol consumption was localized to the VTA. Finally, the increase in GDNF expression and the decrease in alcohol consumption by cabergoline were abolished in GDNF heterozygous knockout mice. Conclusions: Together, these findings suggest that cabergoline-mediated upregulation of the GDNF pathway attenuates alcohol-drinking behaviors and relapse. Alcohol abuse and addiction are devastating and costly problems worldwide. This study puts forward the possibility that cabergoline might be an effective treatment for these disorders. © 2009 Society of Biological Psychiatry.

Attachment Security and Alexithymia in a Heavy Drinking Population

Attachment difficulties have been proposed as a key risk factor for the development of alexithymia, a multifaceted personality trait characterised by difficulties identifying and describing feelings, a lack of imagination and an externally oriented thinking style. The present study investigated the relationship between attachment and alexithymia in an alcohol dependent population. Participants were 210 outpatients in a Cognitive Behavioural Treatment Program assessed on the Toronto Alexithymia Scale (TAS-20) and the Revised Adult Attachment Scale (RAAS). Significant relationships between anxious attachment and alexithymia factors were confirmed. Furthermore, alexithymic alcoholics reported significantly higher levels of anxious attachment and significantly lower levels of closeness (secure attachment) compared to non-alexithymic alcoholics. These findings highlight the importance of assessing and targeting anxious attachment among alexithymic alcoholics in order to improve alcohol treatment outcomes. Keywords: Attachment, alexithymia, alcohol dependence.