Change in vaping, smoking and dual-use identities predicts quit success and cigarette usage: A prospective study of people quitting smoking with electronic cigarette support.

OBJECTIVE: Electronic cigarettes (ECs) are an efficacious support for some but not all people wishing to stop using tobacco. While advice and practical support have been identified as increasing quit success, little research has explored the role of changes in smoking and EC-related social identities. METHODS: A prospective study following 573 people attempting to quit smoking with EC support. Self-report measures of identification with being a smoker, non-smoker, vaper and dual user (people using ECs and tobacco products) were taken prior to the quit attempt and at a 12-week follow-up. RESULTS: Baseline identifications with being a smoker, non-smoker or dual user were not associated with smoking outcomes. Baseline vaper identity baseline was linked to more frequent tobacco abstinence at follow-up and lower levels of cigarette smoking. Levels of social identification at follow-up were consistently linked with outcomes, with vaper identity and non-smoking identities being protective and dual user identity being related to lower abstinence rates but decreased tobacco usage. Changes in identity over time were the most consistent predictor of outcomes. CONCLUSIONS: Findings have implications for smoking cessation practice, informing how and when identity-based interventions may be effective and our understanding of how identity transitions occur.

Look away now! Defensive processing and unrealistic optimism by level of alcohol consumption.

OBJECTIVE: Health risk information is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or 'defensive processing', may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption. DESIGN: Online participants (n = 597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) and demographics. RESULTS: AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson's correlation r from.16 to .36), threat and susceptibility (r = .16) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for controlling alcohol use (r = -0.48). CONCLUSION: People with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.

The "alcoholic other": Harmful drinkers resist problem recognition to manage identity threat.

OBJECTIVE: Harmful drinkers represent an important Alcohol Use Disorder (AUD) group in public health terms, accounting for significant health and social costs. However, harmful drinkers are characterized by low problem recognition; they tend to construct their drinking identity as positive and problem-free, actively setting themselves apart from the stigmatised 'alcoholic other'. As such, harmful drinkers rarely engage in treatment and represent an important opportunity for lower threshold interventions and self-change. The present study sought to explore AUD problem framing and stigma effects on problem recognition. METHODS: Harmful drinkers without perceived addiction experience recruited online (n = 244, 54% male, 46% female, 96% British) were randomised to one of six conditions comprising beliefs about alcohol problems (control, continuum, binary disease model) and stigma (stigma, non-stigma), and completed measures relating to problem recognition. RESULTS: As predicted, results found that harmful drinkers exposed to binary disease model beliefs and stigmatising language had significantly lower problem recognition than those in other conditions. However, no support was found for the prediction that continuum beliefs would be associated with higher problem recognition. Results suggest that the interaction of binary disease model beliefs and stigma prompted alcoholic label avoidance. CONCLUSION: These findings suggest that problem framing has important consequences for harmful drinkers. Implications for behaviour change amongst harmful drinkers through mechanisms of problem framing and identity are discussed.

Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience.

Low problem recognition may be an important barrier to opportunities for self-change or help-seeking in harmful drinkers. Little is known about how the beliefs harmful drinkers hold about the nature and causes of alcohol problems affect problem recognition and subsequent behaviour change processes. Participants (n = 597) recruited online were randomised to one of two conditions designed to promote beliefs according to (a) a continuum model of alcohol problems or (b) a binary disease model, or (c) a control condition. Participants completed measures of alcohol problem beliefs, problem recognition and other indices including the Alcohol Use Disorder Identification Test (AUDIT), addiction beliefs, addiction experience and demographics. Results showed that harmful drinkers without addiction experience exposed to the continuum condition had significantly higher problem recognition than those in binary disease model or control conditions. Continuum beliefs appear to offer self-evaluative benefits for harmful drinkers with low alcohol problem recognition, thus potentially facilitating help-seeking or self-change regarding alcohol use. Further research to understand the mechanisms by which continuum beliefs may promote more accurate drinking self-evaluation and its potential for behaviour change is warranted. The role of continuum beliefs may have important consequences for alcohol-related messaging and interventions seeking to promote self-change or help-seeking.

Who stays in addiction treatment groups? Anxiety and avoidant attachment styles predict treatment retention and relapse.

Attachment styles have been shown to be an important predictor of relationship quality and well-being. They have also been linked with ability to function well in groups. Insecure attachment styles are thought to be an underlying cause of addiction and represent a target for change in one-to-one therapy. How attachment styles themselves affect group therapy for addiction is understudied. The current study addresses this gap by examining the effects of attachment styles on relapse and treatment retention amongst a population of people attending addiction therapy groups. Fifty-eight individuals in such groups completed measures of attachment anxiety and avoidance. Participants were followed up 4 weeks later, and their continued treatment attendance and relapse status were recorded. In terms of treatment retention, high anxiety/high avoidant participants had the highest retention. In terms of relapse, low anxiety/high avoidant participants had the lowest rates. These results are discussed in terms of the potentially protective effects of avoidant attachment styles during group therapy and the role of anxiety attachment in the continued maintenance of both protective and risky personal relationships.

Attentional bias for alcohol-related stimuli among belief based and non-belief based non-drinkers.

BACKGROUND/AIMS: Research has provided evidence for an association between attentional biases for substance-related stimuli and the development and maintenance of a variety of addictive behaviours. Attempts at reducing attentional bias amongst harmful and dependent drinkers have provided evidence to suggest that reduced attentional bias in heavy drinkers would lead to necessary reductions in alcohol intake. We tested one aspect of this assumption by measuring attentional bias amongst non-drinkers who, if the link between attentional bias and actual drug use is causal, should demonstrate no attentional bias for alcohol-related stimuli. METHODS: An alcohol Stroop task was administered to belief-based abstainers, non-belief based abstainers and light social drinkers to measure attentional biases for alcohol-related words compared to neutral words. RESULTS: Belief-based abstainers demonstrated significant attentional bias for alcohol-related stimuli, whilst non-belief based abstainers and light social drinkers did not. CONCLUSION: Attentional biases towards alcohol-related stimuli are not specific to harmful and problem drinkers, which has implications for interventions based on attentional bias change.

The addiction Stroop task: examining the fast and slow effects of smoking and marijuana-related cues.

Research has shown that attentional bias toward smoking-related stimuli is related to the maintenance of smoking behaviour and the chance of a relapse during a quit attempt. Effects of smoking attentional bias can occur both during smoking stimulus presentation (fast effect) and on stimuli that immediately follow smoking stimuli (slow effect). The current research builds on these findings by closely examining the temporal aspects of these fast and slow effects across groups of different smoking status. In Experiment 1 (n = 64), smokers, smokers attempting to quit (SATQ) and non-smokers completed an addiction Stroop task using smoking related, negative emotion and neutral stimuli. In Experiment 2 (n = 32), marijuana smokers and non-marijuana smokers completed an addiction Stroop task using marijuana and neutral stimuli. Results showed fast effects across all smoking groups (except non-smokers) and slow effects in SATQ and marijuana smokers. Furthermore, marijuana smokers showed slow effects over extended periods of time. Results also show a relationship between anxiety, nicotine dependence and attentional bias in SATQ. The implications of these findings are discussed.

Chemotherapy for advanced breast cancer: what influences oncologists' decision-making?

Chemotherapy is widely used in the management of patients with advanced breast cancer. However, a considerable proportion of patients experience toxic side effects without gaining benefit. This study aimed to elicit oncologists' views of the goals of chemotherapy for patients with advanced breast cancer and to elicit which factors are important in decisions to recommend chemotherapy to such patients. 30 oncologists underwent a semi-structured interview to examine their views of 5 goals of chemotherapy and of various disease, treatment and patient-related factors that might influence decisions to offer treatment. The clinicians also made decisions regarding treatment in relation to a hypothetical patient scenario under varying clinical conditions. Relief of symptoms and improvement of activity were rated as the most valuable and achievable goals of treatment. The patient's performance status, frailty and their wishes regarding treatment were the most important patient-related factors in determining decision-making. The most important disease/treatment-related factors were pace of the disease, previous poor response to chemotherapy, co-existing symptoms and concurrent medical conditions. The hypothetical scenario revealed that co-existing medical conditions, adverse previous response, increased age and depression would decrease the likelihood of recommending chemotherapy, whereas key symptoms (e.g. breathlessness) and the patient's goals would increase the likelihood. The findings suggest that British oncologists primarily aim to improve patients' physical function, although subjective factors, such as a patient's desire for anti-cancer treatment and their future goals, also influence decisions to offer treatment.

Selective attentional bias to alcohol related stimuli in problem drinkers and non-problem drinkers.

AIMS: The issues explored in this study were whether a patient group of problem drinkers selectively attend to alcohol-related stimuli and the time course of any interference from alcohol-related stimuli in comparison with two control groups of non-problem drinkers. DESIGN: A 3 x 2 x 2 x 5 factorial design was used. Drinking group (low, high and problem) and word order (alcohol-neutral, neutral-alcohol) were between-participant factors, and word type (alcohol, neutral) and presentation block (1-5) were within participant factors. PARTICIPANTS: Three groups were used, 20 participants from a local community alcohol Service (CAS) and 40 participants (student volunteers) in two control groups. The two control groups were differentiated as scoring high or low on the Alcohol Use Disorders Identification Test (AUDIT). MEASUREMENTS: A modified computerized Stroop colour naming test was used to measure response latencies. Anxiety was measured using the State-Trait Anxiety Inventory. FINDINGS: The CAS group showed significantly longer reaction times to respond to the colour of alcohol-related words than to neutral category words. Although the interference was smaller for the high AUDIT group it was significant. No significant interference was found in the low AUDIT group. There was no statistical evidence that the interference habituated in the three groups. CONCLUSIONS: The present study showed it is possible to use a modified Stroop task as a measure of implicit processing of alcohol stimuli. Despite the fact that all participants were asked to ignore the words, they were unable to do so. Alcohol-related words produced more interference than neutral category words in a group of problem drinkers and a control group of high alcohol drinkers.

Illicit drugs and driving: prevalence, beliefs and accident involvement among a cohort of current out-of-treatment drug users.

Drug-driving behaviour among out-of-treatment dependent drug users has not been investigated while a theoretical perspective on the propensity of certain drug users to drive while impaired has not been suggested. This paper examines illicit drugs and driving behaviour and accident involvement among out-of-treatment current drug users. Psychological evidence of belief-based mechanisms to account for the decision to drive while impaired by drugs are provided. A total of 210 out-of-treatment current drug users were interviewed in a non-clinical setting by privileged access interviewers. Questionnaire measures were: current illicit drug use, severity of dependence, illicit drugs and driving behaviour, impaired and unimpaired accident involvement and beliefs and perceptions about the impairing effects of a number of illicit drugs. Analyses are restricted to participants who reported driving during the previous 12 months (n = 71). Fifty-eight participants (81.7%) reported driving immediately after consuming illicit drugs, primarily heroin and cannabis. Of these 41.4% (n = 24) had at least one road accident as a driver, 15 of whom (62.4%) reported accident involvement following recent drug consumption. Belief-based results showed that participants who reported never driving after using illicit drugs perceived heroin, methadone and alcohol to be greater significance for accident risk and driving skills impairment than other drugs. Those drivers who reported drugs and driving behaviour believed only alcohol to be significantly more impairing than other drugs. Findings indicated that illicit drugs and driving behaviour is common among out-of-treatment drug users. Accident involvement among this cohort is characterised by the previous consumption of illicit substances. Differential beliefs about the effects of drugs on driving performance and accident risk were shown to be dependent upon frequency of drugs and driving behaviour. Results are discussed in terms of experiential factors and consistency theories of attitude formation and change.

Perceptions of risk in motorcyclists: unrealistic optimism, relative realism and predictions of behaviour.

In the first phase of a prospective investigation, a national sample of motorcyclists completed a postal questionnaire about their perceptions of risk, their behaviour on the roads and their history of accidents and spills. In the second phase a year later, they reported on their accident history and behaviour over the preceding 12 months. A total of 723 respondents completed both questionnaires. Four sets of findings are reported. First, the group as a whole showed unrealistic optimism: on average, respondents believed themselves to be less at risk than other motorcyclists of an accident needing hospital treatment in the next year. Second, optimism was tempered by 'relative realism', in that respondents who were young and inexperienced saw themselves as more at risk than other motorcyclists, as did riders who reported risky behaviours on the road. Third, there was some evidence of debiasing by personal history, in that having a friend or a relative who had been killed or injured on the roads was associated with perceptions of absolute risk of injury or death--though there were no effects on comparative risk and no effects on any of the judgments of a history of accidents of one's own. Finally, there was good evidence that perceptions of risk predicted subsequent behaviour, though generally in the direction not of precaution adoption but of precaution abandonment: the greater the perceived risk at time 1, the more frequent the risky behaviour at time 2. The implications of the findings are discussed, and possible interpretations are suggested.

Training primary health care workers about drugs: a national survey of UK trainers' perceptions towards training.

Reports have consistently shown that non-specialist drug workers (whose working role is not specifically concentrated on dealing with drug-related issues) are reluctant to work with drug users. A number of explanations have been offered to account for this unwillingness including attitudinal factors, occupational constraints and a lack of motivation to learn about drug-related issues. Previously, it has been shown that training affects commitment to working with substance misusers, although failure to attract particular professional groups (e.g. general practitioners) into training courses has also been reported. No previous research has examined the views of trainers about training primary health care and health-related workers. This study of a (non-probability) sample of UK drug trainers (n = 145) assessed training activity for different health care workers, and trainers' differential perceptions of training needs and methods. GPs were the group least likely to become trained about drug issues. Training in attitudes towards drug using individuals was perceived to be more important than either skills or knowledge training for GPs, practice nurses, other nurses and probation officers. Experiential training methods were perceived to be more important than a didactic approach for training all health groups except GPs for whom lecture type instruction was believed to be equally appropriate. Seventy-nine percent of subjects reported providing training across drugs in alcohol or drugs, alcohol and tobacco. Most trainers who stated that certain professions required independent training believed that GPs should be trained separately from other groups.

Drivers' biased perceptions of the adverse consequences of drink-driving.

The decision to drink and drive may involve the subjective process of weighing the perceived risks of adverse consequences of the behaviour against perceived utility components. Deterrence theory proposes that an individual will refrain from drink-driving if the perceived chances of experiencing negative outcomes associated with the behaviour are high. Previous research has demonstrated that there may be a mechanism of judgmental bias which influences individuals' perceived probabilities of rarely occurring events. In general driver age and gender have been shown independently to be both indicative and non-indicative for the operation of the bias in terms of subjective perceptions of driver skill, safety and accident involvement. Little evidence has been presented to describe the nature of the bias in the specific domain of drink-driving. Responses from more than 1000 UK drivers were examined to establish whether a system of bias operated for judgments of the likelihood of experiencing several possible adverse consequences of drink-driving across males/females, age groups and offenders/non-offenders. In general drivers were found to perceive themselves as less likely than the average driver to be accident involved while impaired and non-impaired by alcohol. Drivers reporting previous drink-driving behaviour indicated the greatest bias. The age and gender of the driver, independently and in interaction, were not shown to be important in the operation of these perceptual inconsistencies. Findings are discussed for implications of deterrence based drink-driving counter-measures.

The interactionist nature of drinking and driving: a structural model.

A structural model is described that examines the contributions of personal and situational determinants (interactionist theory) for the elicitation of previous self-reported drink-driving offending. Responses of 1011 UK driver's licence holders to 57 questions concerning demographics, driving experience/exposure, deterrence issues, attitudinal factors and situation specific drink-driving behaviour were subjected to a series of multiple regression analyses. Seven variables (five personal and two situational) accounting for 46% of the sample variance were shown to be significantly predictive of undetected offending behaviour. Of these age and safe driving consumption estimates were found to be best described in terms of their direct effects on offending behaviour. The relationships between general alcohol consumption and exposure to secondary level enforcement (breath test) with drink-driving behaviour have both direct and indirect effects. Two attitudinal factors referring to a belief of deterrence if random breath testing were introduced into the UK, and arranging alternative transport on a drinking occasion, as well as exposure to a drink-driving charge, show approximately proportional direct and spurious links with offending. Findings are discussed i n terms of the utility of an interactionist approach for the study of drink-driving behaviour, previous attempts at modelling drink-driving behaviour, and the implications that such results have for counter-measure development.

Drivers' differential perceptions of legal and safe driving consumption.

UK drink-drive countermeasures have been grounded in deterrence theory and more specifically through per se legislation. Education and information campaigns to stimulate inhibitory behavioural systems have emphasized the legal limit in terms of "driving safeness". This study examined the relationship between subjective perceptions of safe driving and legal driving consumption limits and other factors important in the decision to drive after drinking. Responses from over 900 drivers established that those who perceived safe consumption levels to be greater than that required to break the law indicated reduced moral commitment to present and possible future countermeasures. These drivers also had previous experience of being breath tested (but not charged with a drink-driving offence), reported comparatively lower estimates of their chances of apprehension and accident involvement when over the legal limit, showed higher consumption levels on a driving trip and greater self-reported driving while impaired by alcohol. The implications of the findings for the development and delivery of measures to counter drink-driving are discussed.