Components of identity expression in problem and non-problem gamblers.

Few studies have examined whether specific aspects of group identification predict problematic and non-problematic addictive behaviours and none have focused on gambling. Applying Leach et al.'s (2008) hierarchical model of in-group identification, we tested the associations between components of self-investment (satisfaction, solidarity, and centrality) and components of self-definition (individual self-stereotyping, in-group homogeneity) on distinguishing between problem and non-problem gambling (n = 10,157) and on the severity of problematic gambling behaviour (n = 2,568). Results showed that (i) in-group-based identities are important in predicting problematic vs. non-problematic gambling behaviours; (ii) in-group-based identities are important in predicting the severity of problematic gambling; (iii) how self-invested an individual is with their in-group and aspects associated with self-definition processes are both important predictors; (iv) perceptions related to how chronically salient one's group membership is for the self (centrality) are essential features of the self-investment mechanism; and (v) self-stereotypical beliefs about one's essential similarities to the prototypical gambling group member norm are fundamental for the defining oneself as a gambler.

(Safe) Sex on My Mind: The Effects of a Safe Sex Prime and an Alcohol Prime on Sex-Related Perceptions and Behavior.

OBJECTIVE: Previous research suggests that exposure to alcohol primes (i.e., stimuli associated with alcohol) affects drinkers' perceptions and behaviors. The present study investigated the effects of an environmental alcohol prime (being in a simulated bar setting) and a safe sex message prime (a public health safe sex message) on sexually active alcohol drinkers. METHOD: Participants (n = 80) were assigned to one of four conditions according to priming allocation and engaged in a simulated video chat with a potential partner. They reported their sex-related self-perceptions and perceptions of a potential partner upon procedural completion. RESULTS: The alcohol-related environmental prime led participants to rate their potential partner as being significantly less inhibited and more sexual. The safe sex message significantly reduced reported sex-related self-perceptions and perceptions of their partners' disinhibition. There was a significant effect of primes on participants' perceptions of their partner's friendliness--participants exposed to either or both prime(s) perceived their partner as being friendlier than participants exposed to no prime. CONCLUSIONS: Results suggest that environmental alcohol primes may strengthen sexually active drinkers' perceptions of a potential partner's disinhibition and sexuality even before alcohol consumption begins, and that a safe sex message may moderate these effects. The presence of safe sex messages in alcohol-related environments may positively influence sexual risk decision making among sexually active drinkers.

The Effects of Alcohol Use on Prospective Memory: A Systematic Literature Review.

Objectives: Alcohol use remains a public health concern with accumulating evidence pointing to alcohol-associated prospective memory (PM) deficits. PM is the cognitive ability to remember to perform an intended action at some point in the future. Following PRISMA guidelines, we searched the evidence base to identify and explore the evidence of a relationship between alcohol use and PM. Methods: We conducted a systematic literature search in Medline, Embase, Pubmed, CINAHL, PsycINFO and Web of Science databases. Studies were included if they met the following criteria: English language publication, healthy adult participants (16 years and over), primary data on the effects of alcohol on PM. Results: Eight peer-reviewed studies were eligible for inclusion, of which five were randomized controlled trials examining the acute effects of a mild dose of alcohol and three were cross-sectional studies assessing the long-term effects of different drinking patterns on PM. Four main findings were supported by the literature: (1) compared with placebo, an acute administration of a mild alcohol dose to healthy social drinkers may lead to poorer PM performance, (2) alcohol consumption over the recommended weekly units can be associated with impaired PM function, (3) other cognitive domains can play a contributing role in alcohol-induced PM impairment, and (4) following future event simulation alcohol-induced PM impairment may be improved. Conclusion: Alcohol consumption potentially impairs PM, even at a low modest dose. Considering the small number of studies and their methodological flaws, additional research is needed to decipher the alcohol-PM relationship and provide further supporting evidence.

Peer pressure and alcohol consumption in adults living in the UK: a systematic qualitative review.

BACKGROUND: Peer pressure to drink alcohol may influence excessive alcohol consumption, which can have adverse impacts on health and wellbeing. While peer pressure to drink alcohol is extensively studied among youth, less examination exists among adults. This systematic review examined qualitative research studies which explored the role and concept of peer pressure within the context of alcohol consumption in adults living in the UK. METHODS: Qualitative studies which explored peer pressure within the context of alcohol consumption or alcohol related behaviours and views in adults (age range approximately 18-52 years) living in the UK were included. Systematic searches conducted in Medline, PsycINFO and Web of Science identified 1462 references, of which 13 studies met inclusion criteria. Thematic analysis was conducted. RESULTS: Five overarching themes were identified. Four of these themes directly address aspects of peer pressure, including: experiences of peer pressure; consequences of peer pressure; strategies to deal with peer pressure; and conditions perceived to affect peer pressure. The fifth overarching theme explains the wider social context influencing peer pressure. Pressure to drink alcohol affects individuals across the life span and can be experienced as overt and aggressive, or subtle and friendly. Those consuming little or no alcohol are more likely to feel overt forms of peer pressure. Some developed strategies to cope with pressure from drinkers. Peer pressure can result in feelings of social isolation, or giving in by consuming alcohol against ones wishes. CONCLUSION: Peer pressure to drink alcohol is a complex and multifaceted phenomenon experienced across adulthood requiring better understanding to support initiatives to decrease the impact of pressure-inducing environments and develop strategies to deal with perceived pressure conditions. TRIAL REGISTRATION: The protocol for this review is registered with PROSPERO ( CRD42019122201 ). Registered 11 February 2019.

Measuring the impact of the Capital Card®, a novel form of contingency management, on substance misuse treatment outcomes: A retrospective evaluation.

BACKGROUND: The Capital Card, developed by WDP, is a digital innovation which acts as a form of contingency management, and aims to significantly improve service user outcomes. WDP is a substance misuse treatment provider commissioned by local authorities across the UK to support service users and their families affected by addiction. The Capital Card, much like commercial loyalty cards, uses a simple earn-spend points system which incentivises and rewards service users for engaging with services e.g. by attending key work sessions, Blood Borne Virus appointments or group-work sessions. The Spend activities available to service users are designed to improve overall wellbeing and build social and recovery capital, and include activities such as educational classes, fitness classes, driving lessons, and cinema tickets. METHODS AND FINDINGS: We compared successful completion rates of 1,545 service users accessing one of WDP's London based community services over a two-year period; before and after the Capital Card was introduced. Client demographics (age, sex and primary substance) were controlled for during the analysis. Once client demographics were controlled for, analysis showed that clients with a Capital Card were 1.5 times more likely to successfully complete treatment than those who had not had the Capital Card (OR = 1.507, 95% CI = 1.194 to 1.902). CONCLUSIONS: The results of this initial evaluation are of particular interest to commissioners and policy makers as it indicates that the Capital Card can be used effectively as a form of contingency management to enhance recovery outcomes for service users engaging in community-based substance misuse services.

Comparison of Allen Carr's Easyway programme with a specialist behavioural and pharmacological smoking cessation support service: a randomized controlled trial.

BACKGROUND AND AIMS: A combination of behavioural and pharmacological support is judged to be the optimal approach for assisting smoking cessation. Allen Carr's Easyway (ACE) is a single-session pharmacotherapy-free programme that has been in operation internationally for 38 years. We compared the effectiveness of ACE with specialist behavioural and pharmacological support delivered to the national standard in England. DESIGN: A two-arm, parallel-group, single-blind, randomized controlled trial. SETTING: London, UK, between February 2017 and May 2018. PARTICIPANTS: A total of 620 participants (310 in ACE and 310 in the combined behavioural and pharmacological support condition) were included in the analysis. Adult (≥ 18 years) smokers wanting to quit were randomized in a 1 : 1 ratio. Mean age for the total sample was 40.8 years, with 53.4% being male. Participant baseline characteristics (ethnicity, educational level, number of previous quit attempts, nicotine dependence) were evenly balanced between treatment groups. INTERVENTION AND COMPARATOR: The intervention was the ACE method of stopping smoking. This centres on a 4.5-6-hour session of group-based support, alongside subsequent text messages and top-up sessions if needed. It aims to make it easy to stop smoking by convincing smokers that smoking provides no benefits for them. The comparator was a specialist stop smoking service (SSS) providing behavioural and pharmacological support in accordance with national standards. MEASUREMENTS: The primary outcome was self-reported continuous abstinence for 26 weeks from the quit/quit re-set date verified by exhaled breath carbon monoxide measurement < 10 parts per million (p.p.m.). Primary analysis was by intention to treat. Secondary outcomes were: use of pharmacotherapy, adverse events and continuous abstinence up to 4 and 12 weeks. FINDINGS: A total of 468 participants attended treatment (255 ACE versus 213 SSS, P < 0.05). Of those who did attend treatment, 100 completed 6-month measures (23.7% ACE versus 20.7% SSS). Continuous abstinence to 26 weeks was 19.4% (60 of 310) in the ACE intervention and 14.8% (46 of 310) in the SSS intervention [risk difference for ACE versus SSS 4.5% (95% confidence interval (CI) = -1.4 to 10.4%, odds ratio (OR) = 1.38)]. The Bayes factor for superiority of the ACE condition was 1.24. CONCLUSION: There was no clear evidence of a difference in the efficacies of the Allen Carr's Easyway (ACE) and specialist smoking cessation support involving behavioural support and pharmacotherapy.

Selective attentional bias to food-related stimuli in healthy individuals with characteristics towards orthorexia nervosa.

PURPOSE: It has been argued that orthorexia nervosa (ON) is a unique type of disordered eating of food considered by the individual to be healthy. Given that in other eating disorder populations attentional preference for food-related cues influences eating behaviours, is it also likely that these biases may be a characteristic of ON tendency. METHODS: Eighty healthy individuals completed the ORTO-15 questionnaire (ON tendency), a modified Stroop task containing words related to healthy and unhealthy foods and perceived hunger levels pre- and post-testing. The ORTO-15 was used to identify participants within this sample who demonstrated more or less of the characteristics of ON. RESULTS: Results suggest that the presence of attentional bias to healthy, but not for unhealthy food-related stimuli independently predict increased ON tendency. Increased attentional bias towards healthy food-related stimuli is associated with increased scores on the ORTO-15. CONCLUSION: Attentional bias, as a deficit in information processing, towards healthy food-related stimuli accounts for variability in ON characteristics. LEVEL OF EVIDENCE: Level I, experimental study.

Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing.

Individuals with clinically elevated social anxiety are especially vulnerable to alcohol-related problems, despite not drinking more than those with less anxiety. It is therefore important to identify contexts in which socially anxious persons drink more to inform intervention efforts. This study tested whether social anxiety was related to greater drinking before, during, or after a social event and whether such drinking was related to the psychosocial factors anticipatory anxiety or post-event processing (PEP; review of the social event). Among past-month drinkers, those with clinically elevated or higher social anxiety (HSA; n = 212) reported more anticipatory anxiety, more pre-event drinking to manage anxiety, and PEP than those with normative or lower social anxiety (LSA; n = 365). There was a significant indirect effect of social anxiety on pre-drinking via anticipatory anxiety. Social anxiety was related to more drinking during the event indirectly via the serial effects of anticipatory anxiety and pre-drinking. Unexpectedly, PEP did not mediate or moderate the relation between social anxiety and post-event drinking. In sum, anticipatory anxiety was related to more drinking before, during, and after a social event and HSA drinkers were especially vulnerable to drinking more to manage this anxiety, which increased drinking before and during the event. This effect was specific to anticipatory anxiety and not evident for another social anxiety-specific risk factor, PEP. Thus, anticipatory anxiety may be an important therapeutic target for drinkers generally and may be especially important among HSA drinkers.

Understanding women's feelings about safety and hazards of street drinking in London through interpretative phenomenological analysis.

AIMS: Drinking alcohol in outdoor public places (e.g. streets and parks) and outside of formally organised events is perceived and reported as antisocial behaviour and may be indicative of a problematic relationship with alcohol, and other clinical needs. This paper aims to address a lack of qualitative research on street drinking in the United Kingdom and develop a textured understanding of the lived-experience of how some women engage in street drinking, in the context of one London borough. METHOD: The authors collected semi-structured interviews as part of a larger mixed methods study on street drinking from April to August 2018. A sub-set of interviews (n = 3) with women who were accessing local drug and alcohol services and had a history of street drinking behaviour were selected as a case series for triangulating analysis with a smaller, homogenous sample. These data were analysed using Interpretative Phenomenological Analysis with a reflexive, feminist, social constructionist approach. RESULTS: The authors developed and named a superordinate theme, Constellations of Safety and Hazards for Women Drinking in Public and Private. Within this, four themes were defined and illustrated from the data: Drinking outdoors to be away from hazards at home; Women's awareness of geo-temporal factors to moderate risk; Women identifying risks of accepting drinks from strangers; and Threats of untreated trauma within histories of heavy drinking. Definitions and illustrations from participants aid explanations of how the texts add detail or disruption to dominant discourses. CONCLUSION: The case studies illustrating how these women have experienced alcohol misuse and behaviour change provide reflexive accounts of exercising agency in managing embodied and affective states of vulnerability. This was demonstrated by asserting choice around environmental spaces and friendships, even when still in positions deemed as 'risky'. These three women's decisions around drinking in public, outdoor spaces were shaped by complex interactions of interpersonal, intrapersonal, socio-economic, and cultural structures. Understanding behaviours is improved with data that situates people in contexts where they experience and make sense of their lives.

Pre-partying Amongst Students in the UK: Measuring Motivations and Consumption Levels Across Different Educational Contexts.

We sought to explore the motivations for pre-partying amongst UK student drinkers who reported pre-partying at least once per month. Two distinct educational settings were included: colleges, where the majority of students are below the legal age for drinking, and university, where all students would be legally allowed to drink. A cross-sectional correlational design was adopted. Ninety-four college (16-18 years) and 138 university students (18-28 years) from the UK completed an online survey, of whom 54.7% and 86.9% reported pre-partying at least once per month, respectively. Alcohol use was measured using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) and pre-partying motivations were assessed using the Pre-partying Motivations Inventory (PMI). Frequency of pre-partying behavior and the number of units consumed was also recorded. Hierarchical regression analyses showed that, for college students, AUDIT-C positively predicted pre-partying frequency, while gender and AUDIT-C positively predicted the units of alcohol consumed but Barriers to Consumption (BC) negatively predicted units consumed. Among university students AUDIT-C and Interpersonal Enhancement predicted pre-partying frequency, and AUDIT-C predicted the amount of pre-partying units consumed. Different motives for pre-partying motives were identified across two distinct educational settings. The finding that BC negatively correlated with the amount of alcohol consumed amongst younger college students requires further study, as it contradicts previous work in this area, but is consistent with findings that availability predicts alcohol intake. Understanding differences in drinking behavior between age groups is a key finding, which will allow future research to track developmental influences on the effectiveness of interventions.

The effects of food craving and desire thinking on states of motivational challenge and threat and their physiological indices.

PURPOSE: Food craving has been shown to induce states of psychological challenge, indexed by increases in adrenaline but not cortisol production. The study aimed to test the relationship between challenge and (1) desire thinking (the active processing of the pleasant consequences of achieving a desired target and planning how to do so) and (2) craving. METHODS: Participants (N = 61) self-reported their levels of craving and desire thinking. They were then presented with situations in which their craving would be fulfilled or not via a false feedback practice task (a wordsearch task). During this period psycho-physiological measures of challenge and threat were taken. RESULTS: Higher levels of craving were linked to challenge only when the craved object was likely to be obtained. Whilst anticipating reward fulfillment, higher levels of craving were linked to higher levels of desire thinking. In turn, higher levels of desire thinking were related to lower levels of challenge. In contrast, during the processes of reward fulfillment, desire thinking was linked to increased challenge (i.e., a positive indirect effect). CONCLUSIONS: Craving is linked to increased levels of psychological challenge when the object of the craving can be obtained, but it is unrelated to craving when it is not. The research also highlights the importance of desire thinking as an important, but complex, mediator in the relationship between craving and motivational states: desire thinking inhibited challenge when anticipating craving fulfillment, but encouraging it during the process of fulfillment itself. LEVEL OF EVIDENCE: I: Evidence obtained from at least one properly designed randomized controlled trial.

STI-protective self-efficacy and binge drinking in a sample of university students in the United Kingdom.

OBJECTIVE: Alcohol use has consistently been shown to be related to sexual risk-taking behaviours. To assess what factors may contribute to the sexual risk decision-making process, this study examined the relationships among alcohol use (frequency, quantity, and binge drinking), cognitive appraisals of sexual risk taking, sex-related alcohol expectancies, and STI-protective self-efficacy. METHOD: 138 sexually-active university students who drink alcohol completed scales measuring alcohol consumption, appraisals of consequences, sex-related alcohol expectancies, and items regarding STI-protective self-efficacy. RESULTS: Increasing levels of binge drinking were negatively associated with STI-protective self-efficacy. A moderated mediation analysis revealed that for binge drinkers, stronger appraisals of the positive consequences for having sexual intercourse while intoxicated predicted lower STI-protective self-efficacy indirectly through increasing rates of sex-related alcohol risk expectancies. CONCLUSION: Findings provide evidence of a need to target binge drinkers and increase their STI-protective self-efficacy by shifting their focus from positive consequences to negative risk consequences of engaging in sexual intercourse while intoxicated.

Understanding drinking among midlife men in the United Kingdom: A systematic review of qualitative studies.

OBJECTIVES: This study reviews qualitative research into the sociocultural meanings and subjective experiences that midlife men in the United Kingdom (UK) associate with their drinking. In the UK, average weekly alcohol consumption is highest among midlife men, and they are disproportionately affected by alcohol harm. There is increasing recognition that public health messages to support behaviour change must be based on an in-depth understanding of drinking motivations and experiences. STUDY DESIGN AND METHODS: Systematic literature review of studies exploring motivations for and experiences of drinking among UK men aged 45-60 using qualitative methodology. Medline, PsycINFO and the Social Science Citation Index were used, along with manual searches of key journals, Google searches and a call for evidence. The Critical Appraisal Skills Programme tool was used to quality-assess papers. Thematic synthesis was used to combine and analyse the data. RESULTS: From 5172 titles and abstracts (1995-2018), 11 publications were included, representing 6 unique studies. Five themes were identified: 'Drinking Motivations'; 'Drinking Justifications'; 'Drinking Strategies and Control'; 'Social Norms and Identity' and 'Harm'. Motivations for drinking among midlife men were associated with relaxation, socialising and maintenance of male friendships. They justified drinking as a choice and emphasised their ability to meet responsibilities, which they contrasted with 'problem drinkers'. Social norms governed drinking behaviours as an expression of masculinity. CONCLUSION: This review highlights the significance of the meanings and social importance of alcohol consumption among midlife men. Interventions using information and guidance should consider these when aiming to effectively influence the way this group drinks.

Parents' drinking motives and problem drinking predict their children's drinking motives, alcohol use and substance misuse.

The aim of the current study was to test the direct and indirect influence of parents' drinking motives and problem drinking on their children's drinking motives, alcohol use and substance misuse. Cross-sectional analysis of parent and child drinking patterns and motives, derived from the nationally representative Drinkaware Monitor panel survey. The sample comprised a total of 148 couples of parents and child. Path analysis revealed that children's alcohol use and substance misuse were influenced by their own drinking motives and parents' problem drinking. Parents' conformity motives were linked to their children's conformity motives. Finally, parental drinking problems mediated the effect of their coping motives on their childrens' alcohol use and substance misuse. In conclusion, parental drinking styles relate to their children's alcohol use and substance misuse through problem drinking and drinking motives.

Impact of lower strength alcohol labeling on consumption: A randomized controlled trial.

OBJECTIVE: Labels indicating low/light versions of tobacco and foods are perceived as less harmful, which may encourage people to consume more. There is an absence of evidence concerning the impact on consumption of labeling alcohol products as lower in strength. The current study tests the hypothesis that labeling wine and beer as lower in alcohol increases their consumption. METHOD: Weekly wine and beer drinkers (n = 264) sampled from a representative panel of the general population of England were randomized to one of three groups to taste test drinks in a bar-laboratory varying only in the label displayed; Group 1: verbal descriptor Super Low combined with 4% alcohol by volume (ABV) for wine/1% ABV for beer; Group 2: verbal descriptor Low combined with 8% ABV for wine/3% ABV for beer; Group 3: no verbal descriptors of strength (Regular). Primary outcome was total volume (ml) of drink consumed. RESULTS: The results supported the study hypothesis: the total amount of drink consumed increased as the label on the drink denoted successively lower alcohol strength, BLin = .71, p = .015, 95% CI [0.13, 1.30]. Group contrasts showed significant differences between those offered drinks labeled as Super Low (M = 213.77) compared with Regular (M = 176.85), B = 1.43, p = .019, 95% CI [0.24, 2.61]. There was no significant difference in amount consumed between those offered drinks labeled as Low compared with Regular. CONCLUSIONS: These results suggest that labeling drinks as lower in strength increases the amount consumed. Further studies are warranted to test for replication in non-laboratory settings and to estimate whether any effects are at a level with the potential to harm health. TRIAL REGISTRATION: ISRCTN15530806. (PsycINFO Database Record

Aspects of alcohol use disorder affecting social cognition as assessed using the Mini Social and Emotional Assessment (mini-SEA).

BACKGROUND: Alcohol Use Disorder (AUD) is associated with problems with processing complex social scenarios. Little is known about the relationship between distinct AUD-related factors (e.g., years of problematic drinking), aspects of cognitive function and dysfunction in individuals diagnosed with AUD, and the relative impact these may have on social cognition. AIMS: To explore differences in social cognition between a group of participants diagnosed with AUD and controls, using a clinical measure, the Mini Social and Emotional Assessment (mini-SEA). The mini-SEA was used to evaluate social and emotional understanding through a facial emotional recognition task and by utilising a series of social scenes some of which contain a faux pas (social error). METHODS: Eighty-five participants (individuals with AUD and controls) completed demographic questions and a general cognitive and social cognitive test battery over three consecutive days. RESULTS: Between group analyses revealed that the participants with AUD performed less well on the faux pas test, and differences were also revealed in the emotional facial recognition task. Years of problematic alcohol consumption was the strongest predictor of poor ToM reasoning. CONCLUSION: These results suggest a strong link between AUD chronicity and social cognition, though the direction of this relationship needs further elucidation. This may be of clinical relevance to abstinence and relapse management, as basic social cognition skills and ability to maintain interpersonal relationships are likely to be crucial to recovery.

Environmental Context Influences Visual Attention to Responsible Drinking Messages.

AIMS: Responsible drinking messages (RDMs) are used as a key tool to reduce alcohol-related harms. A common form of RDM is in a poster format displayed in places such as bars, bus stops and toilet cubicles. However, evidence for the effectiveness of RDMs remains limited. Moreover, it is not known how environmental contexts (e.g. the number of alcohol-related cues in the environment) impact how such RDMs are interacted with, nor how this in turn affects their efficacy. METHODS: One hundred participants completed a pseudo taste preference task in either in a bar laboratory (alcohol cue rich environmental context) or a traditional laboratory. The walls of the laboratory displayed either RDM or control posters during this task and eye tracking was used to assess participant attention to the posters. RESULTS: Participants looked at the RDM posters less in the bar laboratory where the environmental context is rich in alcohol cues compared to a traditional laboratory where alcohol cues are sparse. Neither poster type or environmental context affected the amount of 'alcohol' consumed and the amount of visual attention given to RDMs was unrelated to the amount of 'alcohol' consumed. CONCLUSIONS: These findings provide experimental evidence that RDMs do not influence drinking behaviour in the direction intended (reduced consumption in situ). In addition, locating RDMs in alcohol-cue rich environments may result in sub-optimal behavioural responses to the RDM materials (e.g. visual attention to content). To maximize the potential impact of RDMs, the optimal location for RDMs is in environments where pre-existing alcohol cues are sparse to non-existent. SHORT SUMMARY: Responsible drinking messages (RDMs) aim to reduce alcohol consumption, however, the findings of this study show that they may not influence in situ consumption. These findings also suggest that the optimal location for RDMs is in environments with few or no other alcohol-related cues.

The Science of Absent Evidence: Is There Such Thing as an Effective Responsible Drinking Message?

AIMS: To review the effectiveness of responsible drinking messages (RDMs). METHODS: We searched PsycINFO, MEDLINE and Google Scholar to June 2016 for studies evaluating the effectiveness of RDMs. Only eight studies met the inclusion/exclusion criteria. Due to a small number of search results and broad inconsistency in methods and outcome measures, quantitative synthesis was not possible so a narrative summary of findings was conducted. RESULTS: A review of findings from these articles suggested a disjointed approach in terms of the format and content of RDMs evaluated, as well as the dependent variables used to judge their effectiveness. An overall pattern emerged suggesting that RDMs may have beneficial effects across various outcome measures, including reducing prospective alcohol use. However, due to the inconsistent approach to both the development and evaluation of RDMs, it was not possible to draw any clear conclusions in terms of effectiveness, or indeed the potential size of any effects. CONCLUSIONS: A systematic approach to the development and evaluation of RDMs is recommended to ensure that a clearer evidence base is established in this area, particularly in light of the substantial public funds which are often spent on RDM campaigns. SHORT SUMMARY: A systematic review of studies evaluating the effectiveness of responsible drinking message campaigns reveals an inconsistent approach to message design and evaluation. Findings of the review suggest the need for a more consistent approach to aid in the development of a clearer evidence base in this area.