How do people drink alcohol at a low-risk level?

Reducing the risks associated with drinking is an ongoing public health goal. Approximately two-fifths of Australian adults consume alcohol within low-risk guidelines, yet little is known about their drinking patterns or practices. In this paper, we use social practice theory to consider low-risk drinking at home as a routinised social practice with material, meaning and competence dimensions. We analysed open-text survey responses from 252 Australian adults (30-65, 89% female) who were considered low-risk drinkers. A low-risk drinking occasion was typically closely linked to other practices such as eating dinner or connecting with family or friends. Drinking alcohol, even in small amounts, was associated with enjoyment. Being attuned to bodily sensations and applying some self-imposed rules were competencies that allowed low-risk drinkers to avoid intoxication. Low-risk drinking practices entail some elements that can inform health promotion, including encouraging efforts to limit drinking to times of the day (e.g. during meals) and to attend to bodily feelings of sufficiency. The study also shows how low-risk drinking is entangled with gendered and age-related norms about drinking, and facilitated by rarely being in 'intoxigenic' environments. These factors are imbricated with individual decisions in our respondents' capacity to consume alcohol moderately.

Parents' management of alcohol in the context of discourses of 'competent' parenting: A qualitative analysis.

How parents manage potential tensions between normative discourses of 'competent parenting' and their desires to consume alcohol has received little attention. In this article, we explore the elements that encourage or constrain parents' drinking and investigate how parents consider and manage their alcohol use in the context of multiple social roles with sometimes conflicting demands and expectations around 'competent parenting'. Our analysis draws on 30 semi-structured interviews with Australian parents, conducted as part of a broader project which aimed to explore how home drinking is integrated into everyday life. While parents' accounts of drinking alcohol highlighted effects such as embodied experiences of relaxation and facilitating shared adult moments, many participants described drinking less than they otherwise would if their children were not present. Participants discussed various social roles and routines which constrained consumption, with drinking bounded by responsibility. As such, drinking emerged as something needing to be actively negotiated, particularly in light of discourses that frame expectations of what constitutes 'competent parenting'. When considering parents' alcohol consumption in the future, we argue that it is important to destigmatise their consumption by acknowledging the importance of adults' pleasure and wellbeing, alongside children's needs for safety and modelling of safer alcohol consumption.

Affordances of home drinking in accounts from light and heavy drinkers.

Home drinking contributes substantially to health harms associated with alcohol consumption. Drawing on practice theory and new materialism, we argue that drinking is a social practice that allows particular sets of effects, or affordances, when it takes place in a person's home. Qualitative interviews were conducted by telephone with 40 Australian adult home drinkers, of whom 20 drank at a level designated as low risk and 20 at a level which exposed them to a higher likelihood of harm. Our analyses identified four substantive affordances of home drinking practice. The first two concern transformations of home life. Home drinking allowed both celebration and smoothing of dissatisfaction with domestic relationships. Through producing subtly different affective states at home compared to in other locations, drinking practice rendered domestic settings home-like: as places of comfort and respite. The second two affordances of home drinking concern how home as a place acts in the co-constitution of drinking patterns. This entailed routinising alcohol consumption alongside other home-based practices and loosening constraints on intoxication. Importantly for our argument, each of these operated with greater intensity for participants who drank at a heavier level than for those who drank more moderately. For example, heavy drinkers expressed a greater imperative to alter relationships and affective states at home and emphasised how being at home produced opportunities for, and removed obstacles to, heavy drinking. We show that home drinking is patterned with other activities and entwined in domestic wellbeing and the emergence of home as a space of privacy, autonomy and relaxation for Australians in our study sample. Understanding home drinking as deeply embedded in the constitution of contemporary western domestic life helps to explain heavy alcohol consumption in these settings. It also supports the need for targeted public health responses such as restrictions on home delivery of alcohol.

Subgroups of adults who drink alcohol at low-risk levels: Diverse drinking patterns and demography.

INTRODUCTION: A significant minority of Australians drink within the 2009 national guidelines. Despite encouragement of low-risk drinking as opposed to consumption patterns associated with greater harm, little is known about the drinking patterns of this group. This paper identifies subgroups of low-risk drinkers and their distinguishable characteristics. METHODS: Data were sourced from the 2016 National Drug Strategy Household Survey, specifically 8492 adults (18+) who consumed 1-730 Australian standard drinks (ASD; 10 g ethanol) in the past year, and never 5+ ASD on a single occasion. Cluster analysis enabled identification of subgroups from drinking variables. Drinking patterns, socio-demographic characteristics, drinking context and alcohol-related perceptions of subgroups were examined. RESULTS: Three subgroups were identified. Special occasion drinkers (64.6%) drank low to moderate amounts very infrequently. Regular moderates (19.6%) and Regular sippers (15.8%) drank 5-6 days a week on average, with the average number of ASD per day 1.2 and 0.5, respectively. Special occasion drinkers tended to be younger than members of more regular drinking subgroups. Perceptions of regular alcohol use also differed between Special occasion drinkers and members of the other subgroups. DISCUSSION: Alcohol consumption patterns among low-risk drinkers are not homogeneous. Younger drinkers who consume at low-risk levels are more likely to report infrequent consumption than moderate regular consumption. A better understanding of low-risk drinkers may help increase the prominence and acceptability of this type of drinking, challenge the normativity of heavier drinking norms and help target campaigns as new information emerges on health risks associated with low-level drinking.

Adult low-risk drinkers and abstainers are not the same.

BACKGROUND: Alcohol consumption, even at low-levels, can not be guaranteed as safe or risk free. Specifically, the 2009 Australian National Health and Medical Research Council drinking guidelines recommend that adults should not drink more than two standard drinks on any day on average, and no more than four drinks on a single occasion. Nearly 40% of Australians aged 12 years and older drink alcohol but don't exceed these recommended limits, yet adult low-risk drinkers have been largely overlooked in Australian alcohol survey research, where they are usually grouped with abstainers. This paper examines the socio-demographic profile of low-risk drinking adults (18+ years old), compared to those who abstain. METHODS: Data from the 2013 National Drug Strategy Household Survey were used. In the past 12 months, 4796 Australians had not consumed alcohol and 8734 had consumed alcohol at low-risk levels, accounting for both average volume and episodic drinking (hereafter low-risk). RESULTS: Multivariate logistic regression results indicated that low-risk drinkers were more likely to be older, married, Australian-born, and reside in a less disadvantaged neighbourhood compared with abstainers. There was no significant difference by sex between low-risk drinkers and abstainers. CONCLUSIONS: The socio-demographic profile of low-risk drinkers differed from that of abstainers. Combining low-risk drinkers and abstainers into a single group, which is often the practice in survey research, may mask important differences. The study may support improved targeting of health promotion initiatives that encourage low-risk drinkers not to increase consumption or, in view of increasing evidence that low-risk drinking is not risk free, to move towards abstinence.

Strategies associated with low-risk drinking: a population-based study.

OBJECTIVE: To examine the relative frequency of use of seven strategies to moderate drinking (SMD) among low-risk and risky drinkers. METHODS: Cross-sectional data from the 2013 National Drug Strategy Household Survey was used. The analytical sample included 11,462 Australians aged 18-64 who had consumed alcohol in the previous year. Logistic regression was used. RESULTS: Analyses indicated a curvilinear relationship between use of SMD and alcohol consumption. Across the seven SMD, constant use of a strategy, compared with never using a strategy, was associated with low-risk drinking. Never using a strategy, compared with using one rarely, was also associated with low-risk drinking. When used occasionally, strategies that implied less alcohol consumed per hour (e.g. refuse unwanted drinks) increased the likelihood of low-risk drinking, whereas less direct strategies (e.g. counting drinks) increased the likelihood of risky drinking. CONCLUSIONS: Adult Australians who drink at low levels use a range of strategies to moderate their alcohol consumption. Overall, consistent use of one or more SMD was associated with low-risk drinking patterns. IMPLICATIONS: Public health responses to risky drinking may be enhanced by promoting the consistent use of SMD as a way to reduce overall alcohol consumption.

Self-Medication Practice and Associated Factors among Residents in Wuhan, China.

BACKGROUND: This study aims to examine the prevalence and predictors associated with self-medication, and related consequences in Wuhan, China. METHODS: Two-hundred-sixty residents were interviewed from randomly selected four districts of Wuhan, China. A modified version of Anderson's health behavioral model was used in the survey to collect information of self-medication behavior. Multivariable logistic regression analyses were used to measure correlates of the prevalence of self-medication. RESULTS: Nearly half of the respondents would select self-medication, and 39.1% would see a doctor if they felt sick. The most common self-medicated illnesses were cold and cough, cardiovascular disease and gastrointestinal disease. The main reasons for self-medication were that the illness was not severe (enough) to see the doctor (45%); the patient did not think that the trouble of seeing a doctor was worth the effort (23%); the patient had no time to see the doctor (12%), and the patient did not want to pay high medical costs (15%). Logistic regression results suggested that respondents tended to select self-medication if the illness was minor or short-term (less than seven days). CONCLUSIONS: Our findings suggest that more strict regulation on over-the-counter medicines may be required to reduce health risks related to self-medication. Targeted health education on the risks of self-medication should be considered.

Stigma of mental illness and substance misuse in sub-Saharan African migrants: A qualitative study.

Stigma of mental illness and substance misuse can deter help seeking, especially in immigrants who are often reluctant to seek help early for these issues. The aim of the present study was to explore the stigma experience surrounding mental illness and substance misuse, and its implications for improving help seeking, for youths and parents from sub-Saharan African immigrant communities. A qualitative, descriptive design was used. Individual interviews were undertaken with 28 youths, and focus group discussions were held with 41 parents and community leaders in Melbourne, Australia. The findings indicated that public stigma and self-stigma were common and deterred participants' help seeking within sub-Saharan African communities. There was concern about the consequences of disclosure. Personal shame, fear of community rejection, and being labelled a 'lunatic' deterred help seeking. Programmes are needed to address stigma, promote help seeking, and increase mental health knowledge. Mental health nurses and other clinicians in the mental health and alcohol and other drug fields can make an important contribution. Steps are needed to employ more sub-Saharan African immigrant clinicians to help increase help seeking from their communities.

Substance use outcomes following treatment: Findings from the Australian Patient Pathways Study.

BACKGROUND AND AIMS: Our understanding of patient pathways through specialist Alcohol and Other Drug treatment and broader health/welfare systems in Australia remains limited. This study examines how treatment outcomes are influenced by continuity in specialist Alcohol and Other Drug treatment, engagement with community services and mutual aid, and explores differences between clients who present with a primary alcohol problem relative to those presenting with a primary drug issue. METHOD: In a prospective, multi-site treatment outcome study, 796 clients from 21 Alcohol and Other Drug services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. A total of 555 (70%) completed a follow-up assessment of subsequent service use and Alcohol and Other Drug use outcomes 12-months later. RESULTS: Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients with meth/amphetamine (66%) as their primary drug of concern and lowest among clients with alcohol as their primary drug of concern (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist Alcohol and Other Drug care was associated with higher rates of abstinence than fragmented Alcohol and Other Drug care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance (odds ratio = 2.5) and community service engagement (odds ratio = 2.0) for clients with alcohol as the primary drug of concern, and completion of the index treatment (odds ratio = 2.8) and continuity in Alcohol and Other Drug care (odds ratio = 1.8) when drugs were the primary drugs of concern. CONCLUSION: This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in Alcohol and Other Drug services. Results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to maximise outcomes.

Sub-Saharan African migrant youths' help-seeking barriers and facilitators for mental health and substance use problems: a qualitative study.

BACKGROUND: Many young migrants and their parents are reluctant to seek help for mental health and substance use problems. Help-seeking delays can result in longer duration of untreated problems and poorer outcomes. In this study, we aimed to identify the help-seeking barriers and facilitators for anxiety, depression and alcohol and drug use problems in young people from recently established sub-Saharan African migrant communities. METHODS: A qualitative study, incorporating individual, in-depth interviews and focus group discussions, was undertaken in Melbourne, Australia. Twenty-eight young sub-Saharan African migrants participated in the individual interviews, and 41 sub-Saharan African-born parents and key community leaders participated in 4 focus groups. All participants were aged 16 years or over. A thematic analysis of the data was undertaken. RESULTS: Themes and related sub-themes were abstracted from the data, reflecting the young people's, parents' and key community leaders' beliefs about barriers and facilitators to help-seeking for mental health and substance use problems. Four help-seeking barriers were identified: stigma of mental illness, lack of mental health literacy in parents and young people, lack of cultural competency of formal help sources, and financial costs deterring access. Five help-seeking facilitators were abstracted: being open with friends and family, strong community support systems, trustworthiness and confidentiality of help-sources, perceived expertise of formal help-sources, increasing young people's and parents' mental health literacy. CONCLUSION: Programs that identify and build on help-seeking facilitators while addressing help-seeking barriers are needed to address mental health issues among young sub-Saharan African migrants. Strategies to address help-seeking barriers should consider counteracting stigma and increasing mental health literacy in sub-Saharan African communities, increasing health providers' cultural competency and perceived trustworthiness, and addressing financial barriers to accessing services.

Characteristics of individuals presenting to treatment for primary alcohol problems versus other drug problems in the Australian patient pathways study.

BACKGROUND: People seeking treatment for substance use disorders often have additional health and social issues. Although individuals presenting with alcohol as the primary drug of concern (PDOC) account for nearly half of all treatment episodes to the Australian alcohol and other drug (AOD) service system, previous treatment cohort studies have focused only on the profile of Australian heroin or methamphetamine users. While studies overseas indicate that clients seeking treatment primarily for their drinking are less likely to experience social and economic marginalisation than those seeking treatment primarily for illicit or pharmaceutical drug use, very little research has directly compared individuals presenting with alcohol as the PDOC to those primarily presenting with other drugs as their PDOC. METHODS: Seven hundred and ninety-six participants were recruited at entry to specialist AOD treatment in Victoria and Western Australia, and completed measures of demographic and social factors, substance use, quality of life, service use, and criminal justice involvement. We compared those with alcohol as their PDOC to those with other drugs as their PDOC using Pearson chi-square and Mann-Whitney U tests. RESULTS: Rates of social disadvantage, poor quality of life, high severity of substance dependence, and past-year AOD, mental health, acute health, and social service use were high in all groups. However, participants with alcohol as the PDOC were older; more likely to have an educational qualification; less likely to report criminal justice involvement, housing/homelessness service use, tobacco smoking, or problems with multiple substances; and reported better environmental quality of life; but were more likely to have used ambulance services, than those with other drugs as their PDOC. CONCLUSIONS: While those seeking treatment primarily for alcohol problems appear less likely to suffer some forms of social and economic disadvantage or to use multiple substances than those with a primary drug problem, they experience similarly high levels of substance dependence severity and mental health and AOD service use. These findings reinforce the need for AOD services to integrate or coordinate care with programs that address the many complexities clients frequently present with, while also acknowledging differences between those seeking treatment for alcohol versus other drug problems.

Seeking help because of others' drinking.

INTRODUCTION AND AIMS: Many individuals contact and are assisted by community and emergency services because of someone else's drinking. Previous studies have focused on family members accessing services, such as Alcoholics Anonymous due to significant others' drinking; however, little is known about service use in the broad community. This paper aims to estimate the prevalence of contacting the police and seeking help from health services because of others' drinking and to compare the profiles of individuals seeking services with those who did not contact a service. DESIGN AND METHODS: A total of 2649 adult Australians were surveyed about their experience of harm from others' drinking, including use of emergency and community services. RESULTS: In the 12 months prior to the survey, 13% of respondents had contacted the police and 5% had sought help from a health-related service. Using logistic regression, being older and having a secondary school education were associated with a decreased likelihood of contacting police because of others' drinking, whereas residing in a non-metropolitan location was positively associated with using health-related services. Having a partner was negatively associated with use of health-related services. The extent of self-reported harm from others' drinking was the only factor associated with use of both police and health-related services. DISCUSSION AND CONCLUSION: Results suggest differences in the profile of respondents who call the police and those who seek health-related services due to others' drinking. This supports the need for tailored services to support and address the needs of people experiencing harm from others' drinking.

Factors contributing to the sustainability of alcohol and other drug interventions in Australian community health settings.

This study identifies factors that support the sustainability of interventions implemented to enhance responses to alcohol and other drug misuse in Australian community health settings. Eight completed projects that had received time-limited funding were sampled to reflect a mix of project types, contexts and success in meeting funding objectives. Projects were investigated using a case study approach involving thematic analysis. Project records were analysed and interviews were conducted with stakeholders to identify intervention elements that continued after funding ceased, and factors that supported this sustainability. Key factors identified were: embedding changes in the operations of the agency; filling a critical gap in the sector; building support from key individuals and agencies; and planning realistically for future ownership. We argue that complexity theory provides a framework to understand both the context-bound nature of intervention sustainability and differences within the literature as to how sustainability is typologised. Each factor associated with intervention sustainability identified in this study reflects an astute understanding of project context and a capacity to adapt. These factors could assist people designing interventions with time-limited funding to maximise ongoing impact of interventions. They should optimally be implemented within an overall approach of flexibility and sensitivity to context.

Factors that enable and hinder the implementation of projects in the alcohol and other drug field.

OBJECTIVE: Few studies systematically explore elements of successful project implementation across a range of alcohol and other drug (AOD) activities. This paper provides an evidence base to inform project implementation in the AOD field. APPROACH: We accessed records for 127 completed projects funded by the Alcohol, Education and Rehabilitation Foundation from 2002 to 2008. An adapted realist synthesis methodology enabled us to develop categories of enablers and barriers to successful project implementation, and to identify factors statistically associated with successful project implementation, defined as meeting all funding objectives. Thematic analysis of eight case study projects allowed detailed exploration of findings. RESULTS: Nine enabler and 10 barrier categories were identified. Those most frequently reported as both barriers and enablers concerned partnerships with external agencies and communities, staffing and project design. CONCLUSION: Achieving supportive relationships with partner agencies and communities, employing skilled staff and implementing consumer or participant input mechanisms were statistically associated with successful project implementation. IMPLICATIONS: The framework described here will support development of evidence-based project funding guidelines and project performance indicators. The study provides evidence that investing project hours and resources to develop robust relationships with project partners and communities, implementing mechanisms for consumer or participant input and attracting skilled staff are legitimate and important activities, not just in themselves but because they potentially influence achievement of project funding objectives.

Implementing alcohol and other drug interventions effectively: How does location matter?

OBJECTIVE: To identify enabler and barrier mechanisms that impact project implementation, from a review of 127 completed projects intended to reduce harms associated with problematic alcohol and licit drug use in Australia. DESIGN: Data comprised archival material (proposals, reports). A coding framework was developed from the literature and a sample of projects; two researchers developed and refined the framework. Open coding was used to identify factors impacting implementation, followed by pattern coding to identify underlying mechanisms. SAMPLE: Project categories were developed from funding orientation and main activities projects were: enhancing organizational systems and processes (39), training and workforce development (18), community education and prevention (37) and client engagement and treatment (33). Thirty-five projects (28%) were in non-capital city locations. RESULTS: Nine enabler and ten barrier mechanisms were identified, for example, 'project planning and design' and 'wider service system challenges'. Three enabler mechanisms were more likely to be identified for non-capital city projects; 'external communication and relationships' (83% vs 70%), 'sensitivity to service users and settings' (49% vs 40%) and 'funding and resourcing' (40% vs 35%). Most barrier mechanisms were identified for a higher proportion of non-capital city projects, particularly 'identifying and retaining personnel' (54% vs 34%), 'engaging communities and partners' (46% vs 26%) and 'organizational governance and capacity' (29% vs 5%). CONCLUSIONS: Project implementation in non-capital city locations requires particular attention to project planning and design, staffing and organizational well-being. Policy initiatives and planning proposals might consider enabler mechanisms along with strategies to minimize barrier mechanisms to support successful implementation.

Surveying the range and magnitude of alcohol's harm to others in Australia.

AIMS: This study aims to document the adverse effects of drinkers in Australia on people other than the drinker. DESIGN: Cross-sectional survey. SETTING: In a national survey of Australia, respondents described the harmful effects they experienced from drinkers in their households, family and friendship networks, as well as work-place and community settings. PARTICIPANTS: A randomly selected sample of 2,649 adult Australians. MEASUREMENTS: Problems experienced because of others' drinking were ascertained via computer-assisted telephone interviews. Respondent and drinker socio-demographic and drinking pattern data were recorded. FINDINGS: A total of 70% of respondents were affected by strangers' drinking and experienced nuisance, fear or abuse, and 30% reported that the drinking of someone close to them had negative effects, although only 11% were affected by such a person 'a lot'. Women were more affected by someone they knew in the household or family, while men were more affected by strangers, friends and co-workers. Young adults were consistently the most negatively affected across the majority of types of harm. CONCLUSIONS: Substantial proportions of Australians are affected by other people's drinking, including that of their families, friends, co-workers and strangers. These harms range in magnitude from noise and fear to physical abuse, sexual coercion and social isolation.

The drinker's effect on the social environment: a conceptual framework for studying alcohol's harm to others.

The paper considers conceptual and methodological issues in studying the scope of alcohol's harm to others. Reasons are suggested for the relative neglect of the topic. The approaches in two relevant research traditions are considered: population surveys on alcohol problems, and economic cost of alcohol studies. Ways of conceptualizing and measuring aspects of the drinker's effects on others are considered, in terms of main types of relationship with the other, and in terms of major societal response institutions. The main types of data tend to measure different levels of severity, with population survey data dominated by less severe problems, and response institution data by more severe problems; so both are needed for a three-dimensional view. Research questions for the field and its policy significance are noted.

The acceptability and feasibility of peer worker support role in community based HCV treatment for injecting drug users.

Hepatitis C is the most common blood borne virus in Australia affecting over 200 000 people. Effective treatment for hepatitis C has only become accessible in Australia since the late 1990's, although active injecting drug use (IDU) remained an exclusion criteria for government-funded treatment until 2001. Treatment uptake has been slow, particularly among injecting drug users, the largest affected group. We developed a peer-based integrated model of hepatitis C care at a community drug and alcohol clinic. Clients interested and eligible for hepatitis C treatment had their substance use, mental health and other psychosocial comorbidities co-managed onsite at the clinic prior to and during treatment. In a qualitative preliminary evaluation of the project, nine current patients of the clinic were interviewed, as was the clinic peer worker. A high level of patient acceptability of the peer-based model and an endorsement the integrated model of care was found. This paper describes the acceptability of a peer-based integrated model of hepatitis C care by the clients using the service.