1195 ssm 1: dr j o’neill - healthy inclusion · 2011-02-11 · 1195 ‐ ssm 1: dr j o’neill ......

John Paul McLindon 200665371 SSM 1: Addiction Medicine: Alcohol Word Count: 2,828

1195‐ SSM 1: Dr J O’Neill

What are the attitudes & behaviours of the

young population regarding alcohol addiction?

Figure: 1 1

“Responsible Drinking? Now that's an Oxymoron”2

John Paul McLindon

Candidate Number: 1195

1st Year Medical Student University of Liverpool

Word Count: 2,828

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Contents

Abstract Page 3

Learning Objectives & Core Learning Activities Page 4

Acknowledgements Page 4

Introduction Pages 5‐6

Definitions Pages 6‐8

Global/National/Local Perspectives of Alcohol Pages 8‐9

Key Statistics of Alcohol in Liverpool Pages 9‐10

Media Portrayal of Alcohol Page 11

Key Health Problems of Alcohol Page 11

Screening Page 12

Treatment Options Page 12

Literature Review

Method Pages 12‐13

Search Results Pages 13‐14

Critical Appraisal Skills Programme Page 14

Chosen Articles Page 15

Strengths & Weaknesses Pages 15‐16

Discussion Pages 16‐18

Conclusion & Recommendations Pages 18‐19

References Pages 20‐22

Reflection 3

Appendix Pages 23‐34

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Abstract

Figure: 2

Background

Alcohol and its acceptance in society vary from country to country. In the UK alcohol is

widely accepted as a vital ingredient to many social events. Most people drink responsibly

not putting themselves or others at risk, however excessive alcohol consumption can be

harmful. Drinking has a minimum legal limit of eighteen years of age, but in reality the

majority of the population of the UK are introduced to alcohol earlier than this. Young

adults often indulge in binge drinking (BD) a pattern of alcohol consumption seen in many

N. European countries with recent studies suggesting that the UK has the 2nd highest rate

in Europe.5

Aim

The aim is to apply search methods to find articles relevant to the subject matter and

analyse them accordingly.

Method

Using a variety of search tools like Science Direct, NHS Athens and PubMed, a wide

collection of articles were found around alcohol, addiction and the youth. After applying

filters and criteria like year of publication, the number of accepted articles for use was

narrowed.

Results

The results of the Science Direct search produced four usable articles. An article from a

previous health promotion presentation was also used. After applying criteria like a CASP

table three articles were discarded leaving one paper from the Science Direct database

search and the previously owned article.

Conclusion

The Government needs to invest in effective Public Health strategies for harm reduction,

engaging with health providers, service users, voluntary agencies, the legal profession, the

drinks industry and the judicial system to promote safe drinking through a range of

positive actions. Screening tools need to be employed to identify problems at an early

stage and to target specific interventions to those at risk of progressing to harmful

drinking patterns. A cohesive approach between all of these interested parties should

facilitate change and improvement for a more positive approach to drinking in society

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Learning Objectives & Core Learning Activities.

Figure: 3

Learning objectives:

1. To understand the attitudes and behaviours of young adults which lead to patterns of

excessive drinking and alcohol dependence, including psychological, social and physical

aspects.

2. Evaluate the clinical and aftercare treatments available for an individual addicted to alcohol

including medication to aid detoxification and strategies to help support mental and

physical dependency on alcohol.

3. To understand the strategies, legal, clinical and social employed to support individuals

addicted to alcohol.

Core Learning Activities:

1. Hospital Placements at Aintree Hospital

2. Case histories from inpatients

3. Journal Club Presentation

Acknowledgements and Thanks.

Figure: 4

I would like to begin by thanking my convenor Dr O’Neil and his administrator Siobhan for

their support. Also I must express my gratitude to Sarah Haywood for all the help and

teaching given to myself and my fellow student Jill Richardson on our placement at Aintree

Hospital. Sarah gave considerable time from her busy working day to allow Jill and myself to

shadow her in her role as the Alcohol Specialist Nurse. In this role Sarah’s aim is to educate,

treat and support those patients in the area who are either addicted to alcohol or binge

drink on a regular basis. It was a great learning curve for me to see the variety of health

problems caused by continuous excessive consumption of alcohol but also to understand

the problems in life that people face which might steer them towards a life dependant upon

alcohol. My final thanks are to those patients who allowed Jill and I to explore their history

related to alcohol. This insight broadened my understanding of their personal experiences.

Examples of these case histories are included in the Appendix 8 & 9.

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Introduction

General Medical Council’s (GMC); Duties of a Doctor

Patients must be able to trust doctors with their lives and health. To justify that trust you

must show respect for human life.3 The GMC has published guidelines for doctors to ensure

that they provide the highest standard of healthcare to all service users. These guidelines

cover many areas ranging from clinical skills, knowledge and professionalism to

understanding how to treat patients as individuals. The guidelines are summarised in

appendix 1.

Beauchamp & Childress: four principles of medical ethics.

The “four principles plus scope” approach to ethics developed by Beauchamp and Childress

was reviewed by Gillon in 1994.4 It provides a relatively simple unbiased framework for

ethical issues in clinical practice based on four prima facie moral commitments respect for

autonomy, beneficence, non‐maleficence, and justice with consideration for the scope of

how they are applied. The moral framework couched in basic moral language aids carers to

make decisions in clinical practice.

Figure 5

Respect for Autonomy

Autonomy or “self rule” means to make one’s own decisions following deliberation.

Respect for autonomy is a moral obligation to appreciate autonomy in others. In the

context of health care this includes respect for an individual’s decision following

consultation, full informed consent and with confidentiality.4 Respect for patients'

autonomy requires the carer, not to deceive patients, for example, about their

diagnosed illness unless they clearly wish to be deceived. Respect for autonomy even

requires us to be on time for appointments as an agreed appointment is a kind of

mutual promise and if we do not keep an appointment we break the promise. 4 To

exercise respect for autonomy health care workers must be able to communicate well

with their patients and clients. Effective communication requires, most importantly,

active listening (and not just with the ears) as well as telling (and not just with the lips

or a word processor) and is usually necessary for giving patients adequate information

about any proposed intervention and for finding out whether patients want that

intervention. 4 It is also essential to appreciate when patients do not want to receive

information and to respect their wishes in this context

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Definitions

General Phrases Figure: 6

Definition

World Health

Organisation (WHO)

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence‐based policy options, providing technical support to countries and monitoring and assessing health trends. 5

Human Rights Anyone who is in the UK for any reason has fundamental human rights

which government and public authorities are legally obliged to respect.

Beneficence & Non‐maleficence.

Health care workers committed to helping others inevitably risk harming them. In this

context they must consider the principles of beneficence and non‐maleficence.4 in

essence we aim to offer net benefit over harm. Where we can offer no benefit we must

certainly cause no to harm them). i.e. the principles may be considered together but are

in fact separate.

To apply these principles the professional must fully understand the risks and benefits

of a procedure/treatment including proven scientific evidence about the proposed

intervention. Then follows the process of gaining informed consent before applying the

moral and ethical principles of beneficence and non‐maleficence.

Another obligation overlaps with the ethical principal of autonomy as we may not insist

upon treating an individual, even though it may benefit them if their wish is to refuse a

certain treatment/procedure.

Justice.

Justice is often regarded as being synonymous with fairness and can be summarised as

the moral obligation to act on the basis of fair adjudication between competing claims.4

In medical ethics the duties of justice can be subdivided into three categories: fair

distribution of scarce resources (distributive justice), respect for people's rights (rights

based justice) and respect for morally acceptable laws (legal justice).4 In health care the

ethical principle of justice ties closely with the obligation of treating patients equally but

with appropriate adjustment to the individuals needs where applicable.

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These became law as part of the Human Rights Act 1998.6 The list of

these Human Rights can be found in Appendix 2.

Inverse Care Law The inverse care law was first described by Julian Tudor Hart in 1971. It

states that "the availability of good medical care tends to vary inversely

with the need for it in the population served." 7

Health Inequalities Health inequality refers to all those barriers in an individual’s life that mean he/she will not receive an equal level of healthcare to another. Some of these inequalities the NHS try to rule out as best as possible but some inequalities they can’t deal with. Health inequalities can be found in many aspects of health; for example, poor people not only live less long than rich, but also have more years of poor health. Access to health is also uneven. The old and disabled receive worse treatment than the young and able bodied. 8

Poverty There is no one true definition for poverty. After researching from

various sources the most widely defined definition is an individual living

on less than 60% of the median income of the population however other

sources have segregated poverty into three areas; social exclusion,

relative poverty and absolute poverty. These are defined further in

Appendix 3.

Vulnerable Groups This has a wide definition that varies from country to country. The key

characteristics of a vulnerable group are age, location, ethnicity and sex

as well as disabilities both physical and mental.

Harm Reduction Harm reduction (or harm minimisation) refers to a range of public health

policies designed to reduce the harmful consequences associated with

recreational drug use and other high risk activities. Harm reduction is

put forward as a useful perspective alongside the more conventional

approaches of demand and supply reduction. 9

Prohibition Prohibition is a method of inhibiting something in law or religion, for

example the advertisement of smoking on the television or alcohol

before a certain time is prohibited.

Polydrug Use Polydrug use refers to the use of two or more psychoactive drugs in combination to achieve a particular effect. In many cases one drug is used as a base‐primary ‐ or preferred drug, with additional drugs to leaven or compensate for the side effects of the primary drug and make the experience more enjoyable with drug synergy effects, or to supplement for primary drug when supply is low. 10

Alcohol Specific

Unit The strength of an alcoholic drink is determined by the percentage of alcohol by volume (ABV). A unit corresponds to approximately 8g (or 10ml) of pure alcohol, regardless of the amount of liquid in which it is diluted. For instance, half a pint of beer has an ABV of 3.5% or a small

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http://encyclopedia.thefreedictionary.com/Public+health

http://encyclopedia.thefreedictionary.com/Recreational+drug+use

http://encyclopedia.thefreedictionary.com/Demand+reduction

http://encyclopedia.thefreedictionary.com/Psychoactive+drug

http://encyclopedia.thefreedictionary.com/Synergy


glass of wine has an ABV of 12‐14% and is therefore the equivalent to one unit. Guidelines issued by the Department of Health in 1995 recommends a maximum daily alcohol intake of 3‐4 units for men and 2‐3 units for women. This is the equivalent of 2 pints of normal strength (4%) beer for a man or 3 standard 175 ml glasses of wine for a woman.11

Harmful/Hazardous

intake

Hazardous drinking is considered to be drinking between 15 and 35 units a week for women and between 22 and 50 units a week for men. Harmful drinking levels are considered to be drinking more than 35 units a week for women and more than 50 units a week for men. 12

Binge Drinking Binge drinking is the consumption of excessive amounts of alcohol in a limited time period. Although opinions on what constitutes binge drinking vary, the accepted definition is the consumption of twice (or more) maximum daily recommended alcohol intake in the Governments guidelines (3‐4 units for men and 2‐3 units for women). This means that binge drinking is defined as 8 units for men or 6 units for women in either a drinking session or 24 hour period.11

Detoxification Detoxification (detox for short) is the physiological or medicinal removal of toxic substances from a living organism, including, but not limited to, the human body and additionally can refer to the period of withdrawal during which an organism returns to homeostasis after long‐term use of an addictive substance. 13

Abstinence Abstinence is a voluntary restraint from indulging in bodily activities that are widely experienced as giving pleasure. Most frequently, the term refers to Sexual abstinence, or abstention from alcohol or food. The practice can arise from religious prohibitions or practical considerations. 14

Rehabilitation Drug rehabilitation (often drug rehab or just rehab) is a term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so‐called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse. 15

Global/National & Local Perspectives of Alcohol.

Alcohol and its acceptance in society vary from country to country. In the UK alcohol is widely accepted as a vital ingredient to many social events. Most people drink responsibly not putting themselves or others at risk, however excessive alcohol consumption can be harmful. It may cause accidents and injuries, serious and even fatal illnesses. Drinking too

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http://encyclopedia.thefreedictionary.com/Physiology

http://encyclopedia.thefreedictionary.com/Organism

http://encyclopedia.thefreedictionary.com/Withdrawal

http://encyclopedia.thefreedictionary.com/Homeostasis

http://encyclopedia.thefreedictionary.com/Pleasure

http://encyclopedia.thefreedictionary.com/Sexual+abstinence

http://encyclopedia.thefreedictionary.com/Alcohol

http://encyclopedia.thefreedictionary.com/Food

http://encyclopedia.thefreedictionary.com/Psychoactive+drug

http://encyclopedia.thefreedictionary.com/Alcoholic+beverage

http://encyclopedia.thefreedictionary.com/Medical+prescription

http://encyclopedia.thefreedictionary.com/Medical+prescription

http://encyclopedia.thefreedictionary.com/Heroin


much may also lead to anti‐social behaviour, alcohol related violence and drink driving all of which have an impact on wider society. Statistics provided by the Home Office for 2008 indicate 9031 deaths directly attributed by alcohol but more than 40,000 alcohol related deaths. There has been a threefold increase in liver cirrhosis deaths between 1970 and 1998 and when broken down into age young groups this reflects an eightfold increase for men and a sevenfold increase for women ages 34 to 44. Of even greater concern is a fourfold increase in cirrhosis deaths in 25 to 34 year olds indicating that drinking is starting at a very young age.16 Drinking has a minimum legal limit of eighteen years of age, but in reality the majority of the population of the UK are introduced to alcohol earlier than this. Young adults often indulge in binge drinking (BD) a pattern of alcohol consumption seen in many N. European countries with recent studies suggesting that the UK has the 2nd highest rate in Europe.11 The peak prevalence of BD is the age group of 16‐24 year olds. The majority of BD problems are visible in urban areas at weekends. Studies on teenage binge drinking conducted by the Academy of Medical Sciences and the Health Development Agency have demonstrated the scale of the problem in the UK.

23% of adult males and 9% of adult females engage in binge drinking, a total of

almost 6 million people in the UK.

Within the last ten years binge drinking in young British women has risen more than

in any other EU country.

Death rates from acute intoxication due to binge drinking have doubled over the

past 20 years in both sexes.

29% of alcohol related deaths are due to the injuries sustained whilst intoxicated and

are more common among 16‐34 year olds. 11

Key Statistics of Alcohol in Liverpool

The Centre for Public Health at Liverpool John Moores University regularly compiles data

related to patterns of alcohol consumption in Merseyside. The following charts detail some

of their findings.12 The chart on alcohol consumption patterns demonstrates that Liverpool

has figures exceeding the N. West and England as a whole for the three main patterns of

excess drinking behaviour. A similar pattern is followed for alcohol specific hospital

admissions where Liverpool again significantly exceeds the figures for the N. West and the

rest of England for both males and females, though in general terms men are admitted

twice as often as women.

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27

23

8

23 22

6

1820

5

0

5

10

15

20

25

30

Binge Hazardous Harmful

percentage of population(synthetic estimate)

Alcohol Consumption Patterns

Liverpool

N.West

England

Figure: 7

915

536

340422

270164

0

100

200

300

400

500

600

700

800

900

1000

Liverpool N.West

rate per 100,000

pop

Alcohol specific hospital admissions for Liverpool 2005/06

England

Males

Females

Figure: 8

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Media Portrayal of Alcoholics

There would appear to be a great conflict in the portrayal of alcohol and alcoholics in a

variety of media settings. Newspapers in particular will often highlight the negative impact

of alcohol often related to criminal activities and anti‐social behaviours such as drink driving.

In T.V and film alcoholism is often portrayed, particularly amongst older individuals as

secretive and likely to cause problems in relationships, at work and also with health.

Contrast this with the generally more positive attributes of alcohol promoted to the younger

generation through celebrity magazines and in music videos. This is particularly relevant

over recent years for younger females influenced by the “ladette” culture of celebrities and

radio DJ’s. Alcohol is often promoted for its effects in increasing confidence in social settings

and sexual success. Media coverage typically focuses on the effects of alcoholism rather

than the root causes. The potential effect of this is to stigmatise and stereotype the alcohol

making it increasingly difficult for the individual to obtain help and support.

Key Health Problems Associated with Alcohol

Physical effects of alcohol on our bodies are largely dose‐dependent. This means that the

more we drink the more pronounced the effects will be. The effects of alcohol intoxication

are also related to the time scale in which alcohol is consumed. Drinking alcohol quickly

leads to a rapid increase in the blood alcohol concentration (BAC) and this is a characteristic

of binge drinking. A rapid increase in BAC leads to intoxication and impaired neurological

functions. Further physical risks include hypothermia, hypoglycaemia (extremely low blood

sugar levels), coma, heart irregularities and strokes. Vomiting is a common effect of

intoxication and if the conscious level is impaired then there is an increased risk of

aspiration of vomit into the lungs leading to pneumonia and even death due to airway

obstruction. 11

Binge drinking is closely related to mental health problems. In up to 25% of suicides and

65% of suicide attempts binge drinking has been a contributing factor. The figure is up to

75% of other cases of deliberate self harm. The number of teenagers being admitted to

hospital for psychiatric problems attributed to the effects of binge drinking has increased in

the last 10 years. Alcohol has direct effects upon the brain affecting mood, motivation,

memory, attention span and lowering overall performance at school. 11

Alcohol consumption and in particular binge drinking affects not only physical and mental

health but also social health. Binge drinking promotes violent and aggressive behaviour

particularly in men. In women binge drinking increases their risk of being a victim of assault

and in particular serious sexual assaults. It also increases the chance of having unsafe and

unprotected intercourse with resultant effects being sexually transmitted infections and

unplanned pregnancies. Antisocial behaviour and criminal offences linked to binge drinking

contribute to a considerable burden for the countries healthcare systems, police, courts and

prisons. 11

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Screening

Screening tools can be used to determine if a patient has alcohol dependency problems and

may also help guide management and treatment. Various screening tests are available, they

all should be easy to administer, consistent to interpret and relevant in a clinical setting.

Examples including; Alcohol Use Disorders Identification Test (AUDIT), Alcohol Assessment

Tool (AED) and Severity of Alcohol Dependence Questionnaire (SADQ‐C) are shown in

Appendix 4, 5 & 6.

Treatment Options

Treatment options for alcohol dependency are limited both in terms of range and success.

Where screening tools identify problem drinking structured brief interventions may help

reduce drinking back to normal levels. Patients admitted to hospital with acute

detoxification may benefit from sedative treatments such as chlordiazepoxide or lorazepam,

together with vitamin supplements such as pabrinex or thiamine for nutritional support. For

longer term management of alcohol dependency various drugs such as disulfiram,

acamprosate and naltrexone have been used. From my discussions with Sarah Haywood it

would appear that few of these treatment options offer significant long term benefit.

Literature Review

Method

3. Attitudes & Behaviour

Hits: 193,735

2. Addiction

Hits: 72,455

1. Alcohol

Hits: 675,212

Read books and websites related to the subject matter to gain a greater understanding of the topic.

Research using the internet, journals and library materials for relevant documentation.

Use website search engine Science Direct to scan for approved documentation for literature review.

Using key words individually then combined along with other criteria to narrow down literature

search to specific documents to then put into a CASP table to determine whether they can be used

or not for critical analysis.

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9. Criteria same as 8, but years 2009‐2011

Hits: 215

Chosen Papers (4 from website search, 1 from previous research)

Of the 215 results those related to drugs were excluded. I then reviewed the abstracts of the remaining

documents and identified four that appeared suitable for my literature appraisal. From my foundation

course health promotion presentation I already had the article by Lightowlers C et al. Database articles

found were;

1. Cranford J A, Zucker R A, Jester J M, Puttler L I, Fitzgerald H E. Parental alcohol involvement &

adolescent alcohol expectancies predict alcohol in male adolescents. Psychology of Addictive

Behaviours. 21/09/2009. Volume 24. Issue 3. Pages 386‐396. 06/02/2011 17

2. Chartier K G, Hesselbrock M N, Hesselbrock V M. Alcohol problems in young adults transitioning from

adolescence to adulthood: The association with race & gender. Addictive Behaviours. March 2011.

Volume 36. Issue 3. Pages 167‐174. 06/02/2011 18

3. Corbin W R, Iwamoto D K, Fromme K. Broad social motives, alcohol use, and related problems:

mechanisms of risk from high school through college. Addictive Behaviours. March 2011. Volume 36.

Issue 3. Pages 222‐230. 06/02/2011 19

Figure: 9

8. Clicked; addictive behaviour, drug & alcohol

dependence & psychology of addictive behaviours

Hits : 288

7. Clicked Years 2008‐2011

Hits: 1,264

6. Clicked Journals Only

Hits: 4,309

5. Combine 1,2,3 & 4

Hits: 4,666

4. Adolescents

Hits: 227,883

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4. Clark H K, Ringwalt C L, Shamblen S R. Predicting adolescent substance use: The effects

of depressed mood and positive expectancies. Addictive Behaviours. Available on

database from 11/01/2011. 06/02/2011 20

Previously owned article was;

5. Lightowlers C, Morleo M, Harkins C. Understanding young people’s alcohol‐related

social norms in Sefton‐Interim Report. Centre for Public Health. April 2099. Accessed

December 2009. 21

Critical Appraisal Skills Programme

To help me determine whether the chosen articles are suffice to use in my literature review

I created a small CASP table to compare and review the contents of each article.

Article/Journal Number CASP Question

1 2 3 4 5

Are the aims of the research clearly stated? Yes Yes Yes Yes Yes

Is the qualitative method appropriate for design?

Yes

Yes Yes Yes Yes

Have ethical issues been considered? Yes No Yes Yes Yes

Is there a clear statement of the findings? Yes No Yes Yes Yes

Were the results processed appropriately? Yes No Yes Yes Yes

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There are 4 criteria an article must match for it to be suitable;

1. Is it Relevant?

2. Is it Readable?

3. Is it Reliable?

4. Is It Recent?

Article 1; this was a well structured article with relevant subject material and also recent, however

only male participants were used and therefore the young population isn’t portrayed accurately.

This article is discarded.

Article 2; this article was recent and quite relevant, however it focussed on two variables; race

and gender and how these affected alcohol behaviours. As many other variables were excluded I

have discarded this article.

Figure: 10


Article 4; this document focused only on depression as a factor contributing to drinking. In

addition I struggled to find a published date for this article therefore discarded

This left me with both article 3 & 5 left as possibilities to analyse.

Article 3; this is a current article assessing relevant criteria across a broad range of factors

and multiple behavioural aspects contributing to excessive drinking in individuals over a

period of time. As the study is performed in a population based in the U.S it will allow a

comparison with the experience of alcohol and youth in the U.K.

Article 5; article 5 is dated 2009, not as recent as the other three articles, it is focussed on

the attitudes and behaviours towards alcohol of young people in a borough of Merseyside. I

therefore feel its findings are relevant as it evaluates the local population near the Primary

Care Trust in which I had my SSM placement.

I also searched the NHS Athens database but found no additional relevant material which would

have broadened my understanding of alcohol problems in youth.

Strengths & Weaknesses

Article 3

Strengths;

Published in a renowned American journal

Looks professional

Copyrighted

Clear outline in the introduction as to why the research is required

Participant number high (2245)

Initial survey reported, follow up awaited

Females well represented

Wide range of race/ethnic groups surveyed

Survey measures frequency and quantity of alcohol use

Use of standardised survey tool (Rutgers Alcohol Problem Index‐ Appendix 7)

Broad social motives researched addressing why an individual feels the need to drink

e.g. drinking to feel popular.

Personal drinking values assessed e.g. “it’s okay if I get drunk frequently if that is

what I want to do” 17

Investigated participants perception of “normal” drinking patterns for their peers

Investigated participant’s expectations of alcohol consumption, e.g. will it heighten

their sexual experiences?

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Relevant age range (17‐19)

Results analysed by recognised statistical means and tabulated for data comparison.

In depth discussion drawing appropriate conclusions.

Numerous references.

weaknesses;

Non‐random selection for participation.

Voluntary participation may have biased against those with alcohol dependency or

those not willing to admit to drink problems

Tables and results sections difficult to interpret

Conclusions difficult to interpret due to use of jargon

Article 5

Strengths;

Published by a known agency of local PCT

Local population studied

Clear introduction explaining reasons for research

Clear and understandable methodology

Ethically approved

Participants chose at random

Relevant age range (15‐16)

Looks professional

Broad range of social factors investigated

Personal drinking values assessed

Investigated participants perception of “normal” drinking patterns for their peers

Easy to read results from the study in graphs, most of which include the questions

asked

Explanation of statistics displayed in the graphs

Recommendations page is helpful with understanding what can be done to help as a

conclusion

Numerous references

Weaknesses;

Participant number low (149)

Only 2 of 6 schools participated, may generate bias in results

Discussion

Both articles identify that the factors underlying problem drinking in young adults in both

the U.K and the U.S are multifactorial. As both studies were conducted across a diverse

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range of students and found that the results were largely consistent across the group it is

reasonable to suppose that the findings will translate to the young population as a whole.

The broad analysis of social norms and mediators which might trigger alcohol consumption

and problem drinking might be useful in planning strategies for prevention and support.

Both articles explore the theme of perceived normal drinking patterns in youth together

with an evaluation of potentially harmful drinking patterns. Furthermore both articles also

explore the reasons why the participants feel they have to drink. In both studies

participation was voluntary, though whether this is possible to achieve given that they were

administered within places of education, is difficult to assess. The age range in both studies

is similar though it is not possible to determine whether cultural and contextual differences

between the two countries will have an impact upon behaviours, even in the same age

groups, therefore skewing the results and making comparisons difficult. The U.S article

(article 3) has larger participant number which should in theory make the results more

reliable and representative than in the smaller cohort UK study. In addition, the US study

utilises a validated and standardised tool for their questionnaire. This should make data

comparison between other studies using the same tool easier. Statistical analysis of the

results in the US study also uses validated tools which again would facilitate comparison

with subsequent data collection or with other studies using the same tools. However, I

found navigation and interpretation in the results section to be difficult. The UK paper uses

a researcher designed online questionnaire which might well be fit for purpose in this study

but would make comparison with other studies more difficult. The results are presented as a

series of percentage bar histograms without further evaluation. However, they are very easy

to interpret and understand, clearly conveying the answers to each question.

Both articles cover a range of psychological and motivational factors which contribute to

drinking. They raise the importance of drinking to be liked, to fit in, engage socially with

friends and to be sociable. Peer pressure is acknowledged in both papers as an important

factor leading to drinking. Both papers also comment on the role of drinking in obtaining a

high, getting a buzz or to enhance confidence in social settings. Perhaps of greater concern

is the role of alcohol to help forget, cheer people up from depression or to help the drinker

from feeling left out. These might be considered the mindsets most likely to favour problem

drinking.

The UK paper offers worrying findings about complicity of adults with adolescent drinking.

Whilst it might be acceptable to drink safely at home with parents a significant number

reported that adults outside shops purchases alcohol for them. Considering that many then

consume the alcohol on the streets, in friends houses or other sites where there may be no

responsible adults this increases their risk from drinking. Other safety measures such as

whether the participant is accompanied and if they have other security measures like a

mobile telephone present whilst drinking are evaluated in the UK paper but are not covered

by Corbin R et al.

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One area that is questioned in article 5 that isn’t explored in article 3 is the influence of the

media and celebrities on the alcohol consumption of the young population. The participants

might see alcohol promoted in advertisements or as content in films and videos. When

asked whether they feel the media and celebrities portrayal of alcohol influences their own

consumption the majority responded that they “neither agreed nor disagreed”19 with the

comment. However a greater number of respondents felt that media and celebrities

influence increased their consumption than those who stated it had no effect on their

consumption.

The layout and language used in article 3 appears more academic than article 5. This is

consistent with the complicated way the results have been comprised into formatted tables

and analysed as mentioned above. Although the tables are comprehensive they aren’t easy

to interpret as the numbers in the table aren’t explained easily making it hard to draw a

conclusion. Also the explanation of the results contains considerable jargon and multiple

layers of statistical analysis make it difficult to understand. On the other the language

utilised in article 5 is typically simple, jargon free and therefore easy to understand.

Additionally, the results are laid out in a simple, consistent manner, well formatted and

straightforward to interpret.

Conclusion & Recommendations

Both articles have contributed to furthering my understanding of alcohol problems in a

youthful population. They both identify and I agree that further research needs to be

completed on the drinking behaviours and attitudes of the youth within the UK and the US.

This research might help to identify strategies for reducing levels of harmful drinking. Public

education programmes need to be considered that not only educate the youths themselves

but also those providing alcohol for the youths, parents, unknown adults and shop keepers.

Legislation may be of benefit, minimum pricing strategies and reduced drinking sales hours

or availability may help to reduce drinking patterns. Understanding the pressures that

motivate youths to drink might provide them with alternate strategies to employ in order to

avoid those pressures and situations which lead them to drinking. The positive effects of

such programmes will not only be upon health but many other social and criminal type

behaviours. This will have a net effect in cost saving for the country as a whole.

Whilst not an integral part of this systematic review, through my reading it is also clear to

me how limited the strategies are for interventions once harmful drinking patterns are

established. Prevention is clearly better than cure but for established drinkers we need a

greater range of more effective interventions and treatments to allow self determination of

normal drinking patterns or abstinence.

The Government needs to invest in effective Public Health strategies for harm reduction,

engaging with health providers, service users, voluntary agencies, the legal profession, the

drinks industry and the judicial system to promote safe drinking through a range of positive

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actions. Screening tools need to be employed to identify problems at an early stage and to

target specific interventions to those at risk of progressing to harmful drinking patterns. A

cohesive approach between all of these interested parties should facilitate change and

improvement for a more positive approach to drinking in society.

The three main conclusions are;

1. The need for more UK based research into the attitudes and behaviours of the young

population in regards to alcohol consumption

2. The need to explore in detail what influences the consumption of alcohol youth

3. To provide greater education to society about alcohol & it’s effects

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References.

1. http://www.google.co.uk/imgres?imgurl=http://assets.nydailynews.com/img/2009/0

7/12/alg_teen_alcohol.jpg&imgrefurl=http://www.nydailynews.com/lifestyle/health/

2009/07/11/2009‐07‐

11_teen_drinking_linked_to_depression_anxiety_particularly_among_girls_study.htm

l&usg=__aQLcBgr60SVhTDhwuEt_D98LV‐

M=&h=291&w=450&sz=78&hl=en&start=0&zoom=1&tbnid=8BzA0FNaxyilvM:&tbnh=1

28&tbnw=186&ei=Z51GTcPpEYuYhQeUssSxAQ&prev=/images%3Fq%3Dteenage%2Ba

ddiction%2Bto%2Balcohol%26hl%3Den%26biw%3D1362%26bih%3D553%26gbv%3D2

%26tbs%3Disch:1&itbs=1&iact=hc&vpx=891&vpy=79&dur=140&hovh=180&hovw=279

&tx=166&ty=80&oei=Z51GTcPpEYuYhQeUssSxAQ&esq=1&page=1&ndsp=23&ved=1t:4

29,r:5,s:0 , date accessed [31/01/2011]

2. Howard. A. http://www.finestquotes.com/select_quote‐category‐Drinking‐page‐

0.htm. Accessed [31/01/2011]

3. General Medical Council: Duties of a Doctor. http://www.gmc‐

uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp. Accessed

[31/01/2011]

4. Gillon R. Medical Ethics: four principles plus attention to scope. British Medical Journal.

16th July 1994; 309 : 184. Available from

http://www.bmj.com/content/309/6948/184.full?ijkey=a3ed9f8cb3df8f310bec00940e1

d889524f6ba98&keytype2=tf_ipsecsha. Accessed 01/02/2011

5. World Health Organisation website. http://www.who.int/about/en/. Accessed

30/02/2011

6. Direct Government Website. Human Rights. Human Rights Act 1998. Available from

http://www.direct.gov.uk/en/Governmentcitizensandrights/Yourrightsandresponsibilitie

s/DG_4002951. date accessed 08/02/2011

7. Patient UK website. Document ID: 2339. Document Version: 21. Document Reference:

bgp2412. Last Updated: 16 Jun 2009. Planned Review: 16 Jun 2011.

http://www.patient.co.uk/doctor/Inverse‐Care‐Law‐and‐Distributive‐Justice.htm.

Accessed 03/02/2011

8. House of Commons Health Committee. Health Inequalities, Third Report of Session

2008‐09. Volume 1. Printed 26th February 2009. Published 15th March 2009. Page 11.

Accessed 03/02/2011. Available from

http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf

9. The Free Online Dictionary; definition of harm reduction. Accessed 06/02/2011.

Available http://encyclopedia.thefreedictionary.com/Harm+Reduction

10. The Free Online Dictionary; definition of poly drug use. Accessed 06/02/2011. Available

http://encyclopedia.thefreedictionary.com/polydrug+use

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http://www.google.co.uk/imgres?imgurl=http://assets.nydailynews.com/img/2009/07/12/alg_teen_alcohol.jpg&imgrefurl=http://www.nydailynews.com/lifestyle/health/2009/07/11/2009-07-11_teen_drinking_linked_to_depression_anxiety_particularly_among_girls_study.html&usg=__aQLcBgr60SVhTDhwuEt_D98LV-M=&h=291&w=450&sz=78&hl=en&start=0&zoom=1&tbnid=8BzA0FNaxyilvM:&tbnh=128&tbnw=186&ei=Z51GTcPpEYuYhQeUssSxAQ&prev=/images%3Fq%3Dteenage%2Baddiction%2Bto%2Balcohol%26hl%3Den%26biw%3D1362%26bih%3D553%26gbv%3D2%26tbs%3Disch:1&i











http://www.finestquotes.com/select_quote-category-Drinking-page-0.htm

http://www.finestquotes.com/select_quote-category-Drinking-page-0.htm

http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp

http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp

http://www.bmj.com/content/309/6948/184.full?ijkey=a3ed9f8cb3df8f310bec00940e1d889524f6ba98&keytype2=tf_ipsecsha

http://www.bmj.com/content/309/6948/184.full?ijkey=a3ed9f8cb3df8f310bec00940e1d889524f6ba98&keytype2=tf_ipsecsha

http://www.who.int/about/en/

http://www.direct.gov.uk/en/Governmentcitizensandrights/Yourrightsandresponsibilities/DG_4002951.%20date%20accessed%2008/02/2011

http://www.direct.gov.uk/en/Governmentcitizensandrights/Yourrightsandresponsibilities/DG_4002951.%20date%20accessed%2008/02/2011

http://www.patient.co.uk/doctor/Inverse-Care-Law-and-Distributive-Justice.htm

http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/286.pdf

http://encyclopedia.thefreedictionary.com/Harm+Reduction

http://encyclopedia.thefreedictionary.com/polydrug+use


11. Parliamentary office of science and technology. Binge Drinking and Public Health.

Published July 2005. Number 244.

http://www.parliament.uk/documents/post/postpn244.pdf

12. Lightowlers C, Morleo M, Cook P A. The impact of alcohol quarterly report. Centre for

Public Health: Liverpool John Moore University. February 2008. Pages 4‐9. Available

from http://www.cph.org.uk/showPublication.aspx?pubid=362. Accessed 30/02/2011

13. The Free Online Dictionary; definition of detoxification. Accessed 06/02/2011. Available

http://encyclopedia.thefreedictionary.com/detoxification

14. The Free Online Dictionary; definition of abstinence. Accessed 06/02/2011. Available

http://encyclopedia.thefreedictionary.com/abstinence

15. The Free Online Dictionary; definition of rehabilitation. Accessed 06/02/2011. Available

http://encyclopedia.thefreedictionary.com/Drug+rehabilitation

16. Moriarty K J, Cassidy P, Dalton D, Farrell M, Owens L, Gilmore I, et al. Meeting the

challenge of improved quality care and better use of resources. British Society of

Gastroenterology. Accessed 04/02/2011

17. Cranford J A, Zucker R A, Jester J M, Puttler L I, Fitzgerald H E. Parental alcohol

involvement & adolescent alcohol expectancies predict alcohol in male adolescents.

Psychology of Addictive Behaviours. 21/09/2009. Volume 24. Issue 3. Pages 386‐396.

06/02/2011

18. Chartier K G, Hesselbrock M N, Hesselbrock V M. Alcohol problems in young adults

transitioning from adolescence to adulthood: The association with race & gender.

Addictive Behaviours. March 2011. Volume 36. Issue 3. Pages 167‐174. 06/02/2011

19. Corbin W R, Iwamoto D K, Fromme K. Broad social motives, alcohol use, and related

problems: mechanisms of risk from high school through college. Addictive Behaviours.

March 2011. Volume 36. Issue 3. Pages 222‐230. 06/02/2011

20. Clark H K, Ringwalt C L, Shamblen S R. Predicting adolescent substance use: The effects

of depressed mood and positive expectancies. Addictive Behaviours. 11/01/2011.

06/02/2011

21. Lightowlers C, Morleo M, Harkins C. Understanding young people’s alcohol‐related social

norms in Sefton‐Interim Report. Centre for Public Health. April 2099. Accessed

December 2009.

22. Department for Children, Schools & Families, The Home Office, The Department of

Health. Youth Alcohol Action Plan. June 2008. Accessed December 2009.

Best References

The three best/most useful references were;

1. The Free Online Dictionary. http://encyclopedia.thefreedictionary.com. This was

useful as it described all my definitions in detail allowing me to fully understand them

and it was also very easy to use.

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http://www.parliament.uk/documents/post/postpn244.pdf

http://www.cph.org.uk/showPublication.aspx?pubid=362

http://encyclopedia.thefreedictionary.com/detoxification

http://encyclopedia.thefreedictionary.com/abstinence

http://encyclopedia.thefreedictionary.com/Drug+rehabilitation

http://encyclopedia.thefreedictionary.com/


2. Lightowlers C, Morleo M, Harkins C. Understanding young people’s alcohol‐related

social norms in Sefton‐Interim Report. Centre for Public Health. April 2099.

06/02/2011. This was very useful reference as it was one of the articles I used to

analyse

3. Corbin W R, Iwamoto D K, Fromme K. Broad social motives, alcohol use, and related

problems: mechanisms of risk from high school through college. Addictive

Behaviours. March 2011. Volume 36. Issue 3. Pages 222‐230. 06/02/2011. This was

the other paper used and therefore also extremely helpful.

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Reflection

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The past three weeks whilst being on SSM timetabled period has been a great learning curve for

me. I have learnt how to search for scientific research that will explain and display statistics on a

subject area of interest. In addition to this I learnt how to critically appraise the materials that I

found to decide whether or not they were reliable enough to use and how to extract the key pieces

of information.

The research also gave me a great insight into the scale of the alcohol problem not just within the

UK but globally too. These was extremely interesting to me as I am only twenty years old and

therefore have just left the age bracket at which the documentation I researched was aimed at.

This allowed me to relate too many of the psychological stresses that have forced the participants

to drink alcohol, not only in such a high frequency and quantity but also at such a delicate age. The

mean age of one of the articles for the first ever drinking experience was 11.68 years old a whole

six years below the legal drinking limit which was staggering.

Even more shocking to me was the fact the participants parents not only knew they were drinking

under age but were also supplying them with alcohol. This would of never happened in my past

and so it was interesting to discover how the upbringings of different children vary with what is

acceptable and not.

The most exciting experience I gained during this three week period was the opportunity to have

clinical placement for a week at Aintree Hospital with the Alcohol Specialist Nurse; Sarah Haywood.

Sarah was a very well informed, exemplary health care professional that was thought of highly by

all her colleagues and patients alike. She treated her patients with a great deal of respect and

displayed no prejudice opinions towards her patients, which was reflected well in her patient’s

recovery process. Sarah spent the bulk of her time teaching me and my fellow student Jill

Richardson. She informed us not only about her role in the health care system but also about all

the science and psychosocial information about alcohol and the people who suffer from alcohol

addiction.

She arranged many things for us to see while we were on placement ranging from sitting in on her

alcohol detoxification clinic in which patients who are suffering with addiction to alcohol attend as

an outpatient to gain help and advice into how to break the habits which are causing adverse

health problems to them, to watching nurse practitioners perform a colonoscopy scope lists. I also

witnessed a consultant urologist perform a cystectomy. We also visited patients that had been

admitted onto a gastroenterology ward where I had the opportunity to talk to and take histories

from several patients. This experience was further in the A&E department and Medical Assessment

Unit where the more acute cases of alcohol had been admitted.

All these opportunities have emphasised to me the work and care that consummate health care

professionals provide on a daily basis and I would like to take this opportunity to display my sincere

gratitude to all of those who made my placement not only educational but enjoyable too.


Appendix

1.

Appendix 1

3

Make the care of your patient your first concern

Protect and promote the health of patients and the public

Provide a good standard of practice and care

o Keep your professional knowledge and skills up to date

o Recognise and work within the limits of your competence

o Work with colleagues in the ways that best serve patients'

interests

Treat patients as individuals and respect their dignity

o Treat patients politely and considerately

o Respect patients' right to confidentiality

Work in partnership with patients

o Listen to patients and respond to their concerns and preferences

o Give patients the information they want or need in a way they

can understand

o Respect patients' right to reach decisions with you about their

treatment and care

o Support patients in caring for themselves to improve and

maintain their health

Be honest and open and act with integrity

o Act without delay if you have good reason to believe that you or

a colleague may be putting patients at risk

o Never discriminate unfairly against patients or colleagues

o Never abuse your patients' trust in you or the public's trust in

the profession.

You are personally accountable for your professional practice and must always

be prepared to justify your decisions and actions.

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2. Human Rights Act 1998 found on the Direct Government website,

http://www.direct.gov.uk/en/Governmentcitizensandrights/Yourrightsandresponsibi

lities/DG_4002951 , date accessed; 03/02/2011;

a. the right to life

b. freedom from torture and degrading treatment

c. freedom from slavery and forced labour

d. the right to liberty

e. the right to a fair trial

f. the right not to be punished for something that wasn't a crime when you did it

g. the right to respect for private and family life

h. freedom of thought, conscience and religion, and freedom to express your beliefs

i. freedom of expression

j. freedom of assembly and association

k. the right to marry and to start a family

l. the right not to be discriminated against in respect of these rights and freedoms

m. the right to peaceful enjoyment of your property

n. the right to an education

o. the right to participate in free elections

p. the right not to be subjected to the death penalty

3. The Poverty Site, http://www.poverty.org.uk/summary/social%20exclusion.shtml,

date accessed 03/02/2011

Absolute poverty refers to a set standard which is the same in all countries and which does not change over time. An income‐related example would be living on less than $X per day.

Relative poverty refers to a standard which is defined in terms of the society in which an individual lives and which therefore differs between countries and over time. An income‐related example would be living on less than X% of average UK income.

Absolute poverty and relative poverty are both valid concepts. The concept of absolute poverty is that there are minimum standards below which no one anywhere in the world should ever fall. The concept of relative poverty is that, in a rich country such as the UK, there are higher minimum standards below which no one should fall, and that these standards should rise if and as the country becomes richer.

One of the advantages of the term 'social exclusion' is that it is reasonably self‐explanatory, clearly relating to the alienation or disenfranchisement of certain people within society

25 | P a g e

http://www.direct.gov.uk/en/Governmentcitizensandrights/Yourrightsandresponsibilities/DG_4002951

http://www.direct.gov.uk/en/Governmentcitizensandrights/Yourrightsandresponsibilities/DG_4002951

http://www.poverty.org.uk/summary/social%20exclusion.shtml


4.

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5.

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6.

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7. RUTGERS ALCOHOL PROBLEM INDEX

RAPI (23‐item version) Different things happen to people while they are drinking ALCOHOL or because of their ALCOHOL drinking. Several of these things are listed below. Indicate how many times each of these things happened to you WITHIN THE LAST YEAR. Use the following code: 0 = None 1 = 1‐2 times 2 = 3‐5 times 3 = More than 5 times HOW MANY TIMES HAS THIS HAPPENED TO YOU WHILE YOU WERE DRINKING OR BECAUSE OF YOUR DRINKING DURING THE LAST YEAR?

0 1 2 3

Not able to do your homework or study for a test

Got into fights with other people (friends, relatives, strangers)

Missed out on other things because you spent too much money on alcohol

Went to work or school high or drunk

Caused shame or embarrassment to someone

Neglected your responsibilities

Relatives avoided you

Felt that you needed more alcohol than you used to in order to get the same effect

Tried to control your drinking (tried to drink only at certain times of the day or in certain places, that is, tried to change your pattern of drinking)

Had withdrawal symptoms, that is, felt sick because you stopped or cut down on drinking

Noticed a change in your personality

Felt that you had a problem with alcohol

Missed a day (or part of a day) of school or work

Wanted to stop drinking but couldn't

Suddenly found yourself in a place that you could not remember getting to

Passed out or fainted suddenly

Had a fight, argument or bad feeling with a friend

Had a fight, argument or bad feeling with a family member

Kept drinking when you promised yourself not to

Felt you were going crazy

Had a bad time

Felt physically or psychologically dependent on alcohol

Was told by a friend, neighbour or relative to stop or cut down drinking

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8.

Case Histories

Patient A (25/01/2011);

Patient A was an inpatient on the gastroenterology ward at Aintree Hospital. He was towards the end

of his inpatient detoxification plan and soon to be discharged with a scheduled outpatient

appointment to follow in a few days time. On general inspection Patient A was slightly jaundice, had

black dried blood covering his lips and he was slightly confused and a little dazed.

The reason Patient A was admitted to hospital was for his persistent vomiting of black blood for

roughly four days but more importantly whilst out shopping he was found collapsed in the street by

police officers. The reason for his persistent haematemisis could be to do with the fact he drank 2 litres

of vodka everyday and has done for approximately ten years. However he stated that since is previous

admission he had cut is intake down to 1 litre of vodka a day.

He has been in and out of hospital and other rehab clinics on numerous occasions including visits to

the Windsor Clinic. On one of the previous admissions, four years ago, he was diagnosed with Diabetes

after losing 4stone of weight. He says he is normally fit and healthy and swims on a regular basis

however has a poor appetite; however had an MRI scan back in November 2010.

From the tests done on his current and previous admissions Patient A had been diagnosed with a

cirrhotic liver which was a main concern for him.

Patient B (25/01/2011);

Sarah Haywood was asked to visit a gentleman that was in the A&E department at Aintree Hospital. He

had been brought in by ambulance at roughly 9 o’clock that morning. The emergency services were

called when Patient B, a polish man in his late twenties, had collapsed at work and began to seize. It

was apparent that Patient B couldn’t remember any of the accident happening. In addition to this the

case history taken from Patient B was a great challenge as he didn’t speak any English; however his

brother who was with him spoke a little.

Asking Patient B to tell us some of his medical and social history it was discovered that his last drink

was on the 24/01/2011 on which he had drunk a bottle of red wine and a 2 litre bottle of vodka. He

said this was a change from normal as his preferred drinks are beer and vodka. He is a long term

diabetic and takes insulin regularly. He also didn’t appear jaundice or confused, other than not

remembering the accident, but he had quite a severe tremor. Patient B has previously had an

operation on his stomach although what type and the reasons for this operation weren’t discovered.

He used to be a heavy smoker but has never taken recreational drugs.

Sarah Haywood advised Patient B to carry on his drinking decreasing the intake amount as a sudden

stop in alcohol intake can cause seizures which could be fatal. Sarah designed a drinking table for

Patient B where his intake decreased everyday over two weeks until inside recommended limits.

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Contact List

1. Sarah Haywood, Alcohol Specialist Nurse, Aintree Hospital

2. Addaction Croxteth Project, 83‐93 Stonebridge Lane, Croxteth, Liverpool, L11 4SJ, 0151 5461411

3. Addaction (Central Office), 67‐69 Cowcross Street, London, EC1M 6PU, Tel. 020 7251 5860, Fax. 020 7251 5890, Email: [email protected]

4. Kieran Lamb, Librarian, Fade Library, Regatta Place, Summers Road, Brunswick

Business Park, Liverpool, L3 4BL, 0151 2854493

5. Alcoholics Anonymous, PO Box 1, 10 Toft Green, York YO1 7ND, Tel. 01904 644026, [email protected]

6. SMASH Team (North Sefton), Southport Community Drugs Team, 8 Church Street, Southport, PR9 0QT, 01704 534759

7. SMASH Team (South Sefton), Sefton Careers Centre 2nd Floor, 27‐37 South Road, Waterloo, L22 5RF, 0151 949 4470

8. Windsor Clinic, 0151 473 0303 ‐ for all general inquiries (Switchboard including Trust Offices and Ashworth Hospital), 0151 250 3000 ‐ Rathbone Hospital Switchboard (including Mossley Hill Hospital and Liverpool Services), 01704 383600 ‐ Hesketh Centre, Southport (including North Sefton Services)

9. British Liver Trust, 0800 6527330, www.britishlivertruts.org.uk 10. Alcoholics Anonymous, www.al‐anonuk.org.uk

Timetable

Monday Tuesday Wednesday Thursday Friday

Week 1 Placement Placement Placement Placement Research

Week 2 Research Placement Research SSM Journal Club

Week 3 SSM SSM SSM SSM

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mailto:[email protected]

javascript:location.href='mailto:'+String.fromCharCode(103,115,111,64,97,108,99,111,104,111,108,105,99,115,45,97,110,111,110,121,109,111,117,115,46,111,114,103,46,117,107)+'?'

http://www.britishlivertruts.org.uk/

http://www.al-anonuk.org.uk/


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Background

• 90% of 15yr olds admit they drink!

• UK has 2nd highest BD rate in Europe.

• ¼ of men & 10% of women BD regularly.

• BD in young women doubled in last 10yrs.

• Death from intoxication doubled in 20yrs.

• >¼ of all alcohol related deaths occur when

intoxicated.

• Peak prevalence of BD is in 16‐24 yr olds.

Understanding young people’salcohol‐related social norms in

Sefton – Interim Report

Lightowlers C, Morleo M, Harkins C; Centre for Public Health. April 2009

John Paul McLindon

1stYear Medical Student at the University of Liverpool

30/20/2011

Why This Article?

• Explores the statistics of alcohol binge drinking in local area

• It focus’ on reasons as to why teenagers drink and who with not just what/how much they drink

• Study looks at; drink behaviour, sources of alcohol, safety precautions, drinking motives, frequency & consequences

Discussion

• Most drinking was done in places surrounded by peers/family

• Majority of alcohol was given/bought by

adults for teenagers, mainly by family

• Main reasons for drinking are to celebrate at parties

• Low % of pupils results show parents drinking daily, high % showed mates drinking weekly

Criticisms

• Sample size is only 149 participants

• Only initial set of results, follow up results are to be published at a later date so no comparison of intervention

• Answers on questionnaires aren’t greatly specific so specificity of results decreases

Take Home Messages

• Mean age of first alcohol consumption was 11.68 years

• Peer pressure not main reason for drinking, but pleasure and to make an event more enjoyable, 1/3 drank to forget worries

• Alcohol availability made easy by family & strangers buying for the underage teenagers

THE END

Journal Club Presentation

1195 ssm 1: dr j o’neill - healthy inclusion · 2011-02-11 · 1195 ‐ ssm 1: dr j o’neill ......

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