The Psychology of Lifestyle (III)
“92 per cent of men and 86 per cent of women in Britain drink alcohol (DoH 2002a).”
I sort of liked the chapter about alcohol more than I did at first after I’d yesterday read some stuff in Boccia et al. dealing with the same topic (their coverage is much poorer in regards to some key issues). When thinking about how to blog this chapter I was considering including a table from the book, table 5,1, in full, even if it’s rather large, but I decided against it as I might as well report what it’s talking about myself here. The observation that addiction and physical dependence should be treated as separate entities is not included in the coverage, although Clark & Treisman considered this to be a very important point to keep in mind (see also this post: “It is very important to realize that addiction and physical dependence are different phenomena with different underlying brain substrates”), but the coverage is still much more detailed than the public health review text alluded to above. It should be noted that some of the shortcomings of the chapter is presumably due to the intended scope of the coverage which makes the omission of some of the important distinctions seem understandable, sort of; the authors note early on that they mostly focus on volitional rather than dependent drinking, because the book deals with lifestyle behaviours over which individuals have some level of control (but if you’re covering smoking and illegal substance abuse in your book, why not cover dependent drinking as well? I still find their coverage of some of these issues sort of puzzling…). Anyway, table 5,1 includes the ICD-10 diagnostic criteria for alcohol dependence, and these criteria include (my bold):
Evidence of tolerance (need more alcohol to get the same effect); physiological withdrawal when alcohol use is reduced or ceased (or use of a closely related substance with the intention of relieving or avoiding withdrawal symptoms); persisting with alcohol use despite clear evidence of harmful consequences; preoccupation with alcohol use (important other pleasures/interests given up or reduced because of alcohol, much time spent on activities such as procuring alcohol, consuming it, or recovering from its effects); difficulty controlling drinking behaviour in terms of onset-, termination or level of use – evidenced by alcohol being consumed in larger amounts or over a longer period than intended, or by any unsuccessful effort or persistent desire to cut down; and lastly a strong desire or compulsion to use alcohol.
“The majority of people who drink alcohol have not been diagnosed as dependent drinkers. Orton (2001) reported that 7.5 per cent of men and 2.1 per cent of women in Britain in the 1990s could be classified as dependent on alcohol. […] Nonresponse bias is a particular problem in drinking surveys. […] Issues of response bias are a common concern and one that afflicts many of the lifestyle surveys reported throughout this text. […] An important issue for measurement of drinking is the validity and reliability of the instrument in question and unfortunately many widely used measures of alcohol consumption have not been tested for such psychometric properties. […] Probably the most convincing evidence that self-report measures of drinking in any one study do, at the very least, place people in an appropriate place on the drinking continuum compared to their peers is the relationship between self-reported drinking and proven increased risk for a number of alcohol related conditions (Room et al. 2005).”
“Men drink more alcohol than women and they are more likely to exceed their daily and/or weekly guidelines, even though those guidelines are higher than those recommended for women […]. This gender difference in alcohol consumption is consistently reported in the national surveys and elsewhere […] and furthermore is similar to the gendered drinking patterns of previous decades […] There are few clear socio-economic trends in alcohol consumption evident from the National Surveys”
“People under the influence of alcohol are more likely to behave aggressively and this can lead to physical violence that can harm themselves and others […]. Offenders are believed to be under the influence of alcohol in 46 per cent of incidents of domestic violence and 44 per cent of acquaintance violence. […] 15 per cent of rape victims recorded by the 2001 British Crime Survey were raped when they were under the influence of alcohol [I was actually really surprised the number was that low…] […] People under the influence of alcohol are also more likely to have accidents. […] The World Health Organisation (2002) estimates that 20 per cent of motor vehicle accidents worldwide are alcohol related.”
“Alcohol has been implicated in more than 60 medical conditions, predominantly with negative, but occasionally with positive, consequences […] the relationship between alcohol consumption and health is not always linear. […] Episodic heavy drinking, even when the overall volume of alcohol intake is low, has been found to increase the risk for a number of cardiovascular conditions. […] This association is physiologically consistent with the increased clotting, lower threshold for ventricular fibrillation and elevation of low density lipoproteins that occur after heavy drinking (Room et al. 2005). […] Breast cancer risk increases linearly with increased alcohol consumption: 10 grams of alcohol a day (an average UK unit) increases the relative risk of breast cancer by 9 per cent. A daily consumption of between 30 and 60 grams a day increases the relative risk by 41 per cent […] In England and Wales alcohol-related injury or illness accounts for 180,000 hospital admissions a year (HM Government 2007).”
“Alcohol serves an important social function. It enhances social integration and facilitates the development of relationships (Kuther and Timoshin 2003). It is hardly surprising that people drink most at a period in their lives [teen-age years, early twenties] which is normally associated with the development of stable adult relationships (Paglia and Room 1999). Increased levels of drinking in newly divorced people may be in part due to the breakdown of stable relationships and the desire to establish new relationships (HM Government 2007). Social isolation is a key factor in poor health outcomes […] so the positive social function of alcohol in enabling people to develop social relationships should not be overlooked.”
“In contrast to other lifestyle behaviours where social norms have been argued to play little or no part in the explanation for variations in behaviour, social norms are consistently reported to be useful in explaining variations in drinking behaviour”
“it is well established that the earlier a person starts to drink, smoke or use illegal drugs the higher the risk of later abuse […] There is evidence that people drink less if the price of alcohol increases […] and that those of particular concern, heavy drinkers and young people, both respond to price increases by drinking less […] Many interventions to encourage sensible drinking are aimed at adolescents and young people with the goal of preventing the establishment of unhealthy drinking habits. The rationale for a predominance of interventions for this age group includes the indisputable fact that young people are the heaviest drinkers in society […] Many early drinking interventions are educational in nature. In essence these are risk communication messages and the evidence from psychological research is that improving risk perceptions will have little impact on levels of drinking. Unsurprisingly then, there is little evidence that alcohol education and health promotion have any positive effect on drinking habits in Britain […] These campaigns are heard and understood because knowledge increases in targeted populations […] so it is not that the message is failing to reach the designated audience, rather the message has no impact on behaviour. […] Foxcroft et al. (2003) reviewed the effectiveness of programmes designed to prevent excessive drinking in young people. Worryingly, [they] found very little evidence that any of these programmes were effective. Among the studies with medium-term followup that met the methodological guidelines the majority, 19 studies, found no evidence of intervention effectiveness. Several of these studies had previously reported short-term effectiveness which demonstrates the importance of longer term follow-up. […] There are two concerns from these studies on early drinking interventions. First, there are a wealth of studies that report no reduction in any measure of drinking. Second, research has failed to consistently test and tease out what is effective.”
“There is considerable variation in the prevalence of smoking worldwide. In sub-Saharan Africa less than 10 per cent of the population smoke, whereas in Japan this figure rises to above 50 per cent, and in Indonesia 69 per cent, with almost three-quarters of the Vietnamese population smoking (Edwards 2004).” [I had no idea the numbers were that high anywhere… (and I’m perhaps slightly skeptical, in particular about the Japanese estimate; a 50+% smoking prevalence seems to not fit very well with the very high Japanese life expectancy)]
“Despite the health effects of smoking being known since the 1960s, and the health impact being publicised, some 12 million individuals still smoke in the UK: 25 per cent of men and 23 per cent of women (ONS 2007). These figures have shown a substantial decrease since the early 1970s: for example in the 1970s the comparable figures were 51 per cent of men and 41 per cent of women smoking.” [If you’re curious about Danish figures, I blogged some Danish alcohol and smoking stats some years back here (the post is in Danish)] […] smoking is the highest in the 20–24 year age group (about 36 per cent) and the lowest in the over 65 years (about 15 per cent). This reflects both the fact that many former smokers will have quit and also that about a quarter of smokers die before reaching retirement age (ONS 2007). […] in the UK it is suggested that annually some 120,000 people die as a result of their smoking habit (440,000 in the United States). Every year, tobacco smoking kills 5 million people worldwide (Perkins et al. 2008) […] Deaths caused by tobacco smoking in the UK are higher than the number of deaths caused by road traffic accidents (3,500), other accidents (8,500), poisoning and overdose (900), alcoholic liver disease (5,000), suicide (4,000) and HIV infection (250). Almost a half of all regular smokers will be killed by their habit. A man who smokes cuts short his life by 13.2 years and female smokers lose 14.5 years (ASH 2008).”
“It is usually teenagers who experiment with smoking, with very few smokers starting after the age of 25 years […]. There are a number of reasons why people start smoking, but these are mainly related to psychosocial motives […] One of the major reasons for experimenting with cigarettes is social pressure from peers or older siblings […] adolescents are more likely to smoke cigarettes if their parents smoke […] Research has also indicated that teenagers underestimate the health risk of smoking […] and they also believe that they will quit before they do themselves serious damage […]. Hence, they smoke in spite of knowing the health damage effects of smoking: they know of them, they just don’t think it will impact upon them. […] of all the lifestyle behaviours discussed in this book smoking has the simplest relationship with social class and is the only behaviour to demonstrate a totally linear relationship with class.”
“One of the major attempts to reduce smoking has been the introduction of graphic warning labels on cigarette packets or on posters and billboards. […] there is very little evidence of the success of this form of approach. When politicians are asked for the evidence of such approaches there is much filibustering and some reference to dated research which does not stand up to scrutiny (Ruiter and Kok 2005). […] the evidence can be described as, at best, insubstantial. […] there are a large number of studies that highlight that some type of in-person or telephone behavioural support with NRT [nicotine replacement therapy] increases quit rates, especially those using nicotine gum […]. This support works by increasing motivation for quitting and remaining tobacco-free. However, most quitters attempt to stop smoking by use of NRTs alone and overlook the behavioural and psychological support required to enhance and maintain the necessary motivation”
The stuff below is from the smoking chapter, but might easily have been found in a very different chapter (or even in a different book?):
“Motivational interviewing can be defined as ‘a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence’ (Miller and Rollnick 2002). Motivational interviewing has as its goal the simple expectation that increasing an individual’s motivation to consider change rather than showing them how to change should be the key step. If a person is not motivated to change then it is irrelevant if they know how to do it or not. […] Motivational interviewing (MI) is a technique based on cognitive-behavioural therapy which aims to enhance an individual’s motivation to change health behaviour. The whole process aims to help the patient understand their thought processes and to identify how their thought processes help produce the inappropriate behaviour and how their thought processes can be changed to develop alternative, health-promoting behaviours. Motivational strategies include eight components that are designed to increase the level of motivation the person has towards changing a specific behaviour. […] The eight components are: *giving advice (about specific behaviours to be changed) *removing barriers (often about access to particular help) *providing choice (making it clear that if they choose not to change that is their right and it is their choice […] *decreasing desirability (of the ambivalence towards change or the status quo) *practising empathy *providing feedback […] *clarifying goals (feedback should be compared with a standard (an ideal) *active helping”.
“The definition of ‘lapse’ and ‘relapse’ has been debated in various forums […] but simply a ‘lapse’ is a slip into smoking behaviour, whereas ‘relapse’ refers to long-term failure. Most smokers who attempt to quit do so through self-quitting […] but the rates of success are very low with reports suggesting that only about 3–5 per cent of those self-quitting attain long-term abstinence at 6–12 months (Hughes et al. 2004). More recently, self-quitters have been aided by being able to purchase over the counter NRT and although this can double the rate of success this is still a paltry 6–10 per cent success rate. […] Although the majority of smokers want to stop smoking and predict that they will have stopped in twelve months, only 2–3 per cent actually stops permanently a year (Taylor et al. 2006).”
“In London, the area with the highest prevalence of HIV in the UK, 30 per cent of people did not know HIV could be transmitted through unprotected sex (National AIDS Trust 2006; UNAIDS 2006). [first thought: Some of these have got to be joke responses] […] [in the UK] the number of women diagnosed with HIV has increased in recent years and in 2007 it was some 40 per cent of the total (compared to 10 per cent of all diagnoses in 1990). […] 95 per cent of 16–24 year olds who use a condom do so in order to prevent pregnancy whereas only 71 per cent report using a condom in order to prevent infection. Furthermore, less than half (48 per cent) of men and only 37 per cent of women report using a condom ‘always’. […] At least 50 per cent of sexually active men and women acquire genital HPV infection at some point in their lives […] Regarding HIV it is estimated that one-quarter of people living with the disease do not know that they have it and are therefore at risk of transmitting the virus to others (CDC 2006e).”
“The pharmacological effects of alcohol and various other non-prescription substances tend to have the effect of reducing inhibitions, boosting confidence, intensifying emotions and increasing the importance of immediate cues such as sexual desire, at the expense of more future-oriented considerations such as STIs. As a result, users have been shown to engage in more risky sexual behaviours [related link (well, sort of related – if you skip the first paragraph and see link i. and ii…)] […] Alcohol use and sexual activity often co-occur and more than one-quarter of sexually active teens used alcohol or drugs during their last sexual experience […] However, not only does the condom have to be used, but also it has to be used effectively (i.e. properly). Hatherall et al. (2007) report that a sizeable minority (between 12 and 40 per cent) applied a condom imperfectly. […] it is well documented that the earlier first sex occurs the less likely it is that contraception will be used […] Reviews have shown that school-based sex education leads to improved awareness of risk and knowledge of protection strategies, and increases intention to adopt safer sex behaviours. It has also been found to delay sexual debut (Kirby et al. 2006).”
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