Protective Behavioural Strategies To Reduce Binge Drinking Among Men

Binge drinking is a behaviour defined by the pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0. 08 gram-percent or above. This pattern corresponds to consuming five or more drinks for the typical adult male and four or more drinks for the typical adult female, over a period of two hours. There are a number of issues when comparing outcomes from different studies regarding binge drinking. One of them is the disagreement regarding the amount of drinks used to define this behaviour. It is therefore important to highlight the word “drink” which henceforth equates to one 10 g serving of absolute alcohol, defined by The World Health Organization. This provides a concise definition of a ‘standard’ drink thus avoiding any problems that may arise in countries where serving sizes differ (in terms of their pure ethanol content). Another issue regarding binge drinking is the cut-off used for the number of drinks: five drinks for the adult male and four for the adult female have been decided. Hence, a clear definition as mentioned above regarding binge drinking is imperative, in order to limit any ambiguity.

Binge drinking is a major public health concern having a considerable impact on the individual’s health, due to its association with a range of adverse outcomes; some with long lasting effects, such as irreversible disabilities, or others being fatal. Notably, binge drinking provokes symptoms that are directly related to the state of intoxication manifesting in nausea, vomiting, hangovers and memory loss. In addition, this pattern of drinking “may lead to involuntary and unprotected sexual activity”, which makes binge drinking a contributing factor in the transmission of HIV and other sexually transmitted diseases. As a direct result of altered cognitive and psychomotor effects on reaction time, poor cognitive processing, and coordination, alcohol misuse is responsible in the occurrence of injuries, motor vehicle accidents and other traumas. Besides unintentional injuries, binge drinking may also cause “intentional injuries such as self-inflicted harm and suicide” as well as “violence and homicide”.

Due to the disinhibiting effect of alcohol, binge drinking may harm others through interpersonal violence. This disinhibiting effect of alcohol, influences the decision to use force instead of conflict avoidance. Furthermore, the effects of alcohol may lead to the misinterpretation of cues from others because of a lack of attention and cognitive processing, which may lead to fights and sexual violence. Amongst women, drastic long-term consequences for the unborn may also be a consequence of frequent binge drinking episodes. Binge drinking is “not just inoffensive social fun”, as stated by Petit et al. (2014). If maintained, it may contribute to the start of cerebral disorders, causing alcohol dependence later in life. Therefore, we can identify binge drinking with all of the long-term repercussions recognized in heavy, chronic or even dependent drinkers.

With regards to the prevalence of binge drinking, it has been estimated that for the population of 15- year olds and older, 7. 5% binge drink at least every week. This has been concluded in an attempt to come to a consistent estimate of binge drinking (60 g on an occasion at least once in the past 30 days) worldwide, as it is relatively difficult to distinguish cultural variations from variations linked to diverse measurements, time frames and restriction of age groups regarding binge drinking, making the prevalence rates differ across countries. This proportion of the worldwide population also differs considerably across regions. Clear evidence is shown in gender differences where binge drinking is more common among men than women. However, some narrowing gender differences have been found in the past twenty years. As for binge drinking regarding differences in different neighbourhoods, people in the most deprived neighbourhoods are more likely to binge drink than in the least deprived neighbourhoods, particularly in young and middle-aged men.

In regards to alcohol related deaths, there is an association between deaths related to alcohol and socioeconomic deprivation, where groups with a lower socioeconomic status are considered to have 1. 5 to 2 times higher mortalities related to alcohol, this shown in a study conducted by Probst, et al. Another study, showed a 5. 5 higher rate of mortalities related to alcohol in the most deprived quintile of local authorities in England in comparison to the least deprived. Another study conducted by The University of Sheffield, (2012), shows that the 20% most socio-economically disadvantaged population of England and Wales account for 32% of alcohol-related deaths among men and 26% of alcohol-related deaths among women, whereas, the least disadvantaged 20% of the England and Wales population accounted for a lower percentage of deaths related to alcohol, 11% for men and 14% for women. Within health care services, health policy is considered to be a key factor in order to attain specific health outcomes within society. Binge drinking is a governance priority, since the governance recognise binge drinking as a burden on individuals, families as well as a drain on hospital resources and public money.

Drinking within moderate guidelines is not directly damaging, however if an individual were to drink to the point where he or she became intoxicated it could become a cause for concern. If not controlled, binge drinking has been found to be a factor in continued alcohol abuse and alcohol dependence. There are multiple reasons for people to binge drink and these are relatively varied. However, there are a few common causes for this behaviour. Reasons such as drinking because it is fun, is one of the most common and often cited. Secondly, people have a need to socialize and to feel more self-confident. This is especially true for shy or introvert people who find socializing difficult, unless they drink because it helps them to feel more relaxed; people tend to let go of their inhibitions thus easing the burden of expectations and pressure.

Alcohol has a tendency to make one feel more uninhibited. Another often cited cause for people to binge drink is the attempt to forget personal problems. This receives more attention from scientist and support groups as it might indicate an underlying problem for the individual. Binge drinking to let go of stress is a frequent occurrence as well, however, indulging in this behaviour on a regular basis can make an individual susceptible to the danger of alcohol abuse leading to a dependence of the substance as a coping mechanism. Peer pressure and peer acceptance issues are another reason to add to the list. Not fitting in, is a common fear seen in a lot of individuals. Binge drinking for some people is seen as a behaviour that can lead one to be accepted by others. Curiosity is also a reason for people to binge drink, as they want to experience what others experience. Alcohol increases the release of dopamine, the so-called feel good hormone, into the brain. The more an individual drinks, the larger the amount of dopamine released, thus blocking those negative emotions of stress, fear, insecurity and anxiety. However the large amount of dopamine release can lead to fights, inappropriate sexual behaviour, criminal activity, use of other drugs and other violence.

As the prevalence of binge drinking demonstrates the differences in gender, ages and countries, it is important to mention that these predictors are not considered as modifiable, which means no interventions may be applied at this level, as one cannot change the gender of someone, his/her age nor his/her nationality in order to reduce their binge drinking behaviour. Which brings us to reasons for binge drinking which are modifiable, and are being modified with the help of health psychology interventions, in order to support this behaviour change. One of them for example is the lack of self-confidence that one has in one’s abilities, power, and judgment. For example, a lack of belief an individual has regarding his or her ability to deal with specific situations, such as being social, fitting in with others or afraid of not being accepted by their peers. It is therefore and for all of the above reasons regarding the effects of binge drinking on the individual, that interventions to reduce binge drinking are needed in order to reduce the potential risks associated with it. Little has been mentioned thus far regarding men in deprived neighbourhoods. Therefore, this research question has been suggested; “Does Protective Behavioural Strategies with Motivational Interviewing reduce binge drinking among young and middle-aged men (aged from 18 years old to 50 years old) in a deprived neighbourhood?” If enough participants are recruited to be part of the study, a randomised control trial might be possible to execute the intervention. In this case, the intervention group would receive a Protective Behavioural Strategy combined with Motivational Interviewing.

The control group would receive a presentation on health and how alcohol consumption affects their health. However, it may be difficult to recruit and target sufficient participants from this specific population that are interested in such a study. A potential lack of participants willing to engage might be the case, which means that a randomised control trial will not be carried out easily. Instead, a pilot study will be executed. The intervention will be carried out on the participants recruited via a charity for alcohol abuse. The intervention will be a 30-minute, face-to-face session, every two weeks, for a period of three months. A follow-up after three months will be conducted and one after 6 months, in order to measure the outcomes of the intervention. The outcome measures will be concluding to what extent the intervention reduced binge drinking. It may also be of interest to review the modifiable predictors. Has the intervention been able to change the modifiable predictors in order to reduce binge drinking? If the results of the pilot study are promising, a potential study in the future might be carried out with a larger population where a randomised control trial will be possible.

The intervention used is a combined method of Protective Behavioural Strategies that is to say behaviours that decrease the negative consequences of alcohol use. These behaviours are mentioned as “alcohol reduction strategies”, “behavioural self-control strategies” and “drinking control strategies”. The aim is to limit the level of alcohol consumption through the setting of drinking limits. With that, a skills training is required, which will provide the participants with useful advice on how to consume alcohol in a safer way. Examples for this are learning to say no, avoiding heavy drinking or high-risk situations and abstaining from excessive drinking. The second method is a Motivational Interviewing Intervention. This is a “focused and goal-directed counselling style”, where the focus is to trigger the inherent motivation of the drinker in the direction of action, which is changing his drinking behaviour, this by exploring and resolving the patient’s ambivalent feelings. As mentioned previously, there are different reasons for people to binge drink. Therefore, it is important to understand and to underline the specific reasons for each participant to binge drink and to control them by manipulating the individual’s motivation to change his own behaviour.

Following the Theory of Planned Behaviour, intentions in order to change a behaviour are predicted by three constructs; attitude, perceived behavioural control and subjective norms. Consequently, it is important in order to reduce binge drinking in our specific population, to increase and prolong the motivation of the participants to have the intention to decrease their binge drinking behaviours, this by focusing on the 3 components. Thereby, changing the individual’s attitude towards binge drinking, increasing his perceived behavioural control and controlling the individual’s normative beliefs and his motivation to comply to it, are important in order to change the individual’s intention and eventually to modify his behaviour towards binge drinking.

Motivational Interviewing Intervention is not based on one specific theory but rather on a set of principles, derived from different theories, such as the importance of self-efficacy. The self-efficacy concept is part of the Social Cognitive Theory. This theory suggests that behaviour is determined by motivation and expectancies. It suggests that “behaviours are changed when a person identifies control over the outcome, confront external barriers, and feels confident in their own ability” to confront them. Having a high self-efficacy is a significant predictor of behaviour change. Another principle derives from the Self-Determination Theory, where the client’s self-awareness is increased, by supporting the patient’s autonomy, reflective listening to what the patient has to say, and summarizing what the patient says. This increase in self-awareness, will facilitate and inspire the patient in making more autonomous choices, and eventually to change their behaviour. “Patients who experience autonomy-supportive counsellors, benefit more from the treatment”. Regarding Protective Behavioural Strategies they are described as a combination of cognitive and behavioural strategies. All these psychological principles underpin the intervention.

It is important to bear in mind that one crucial aspect of conducting research is the ethical issue. There are four commonly accepted principles of health care ethics, excerpted from Beauchamp and Childress (2008), these four principles include the respect for autonomy, the principle of non-maleficence, the principle of beneficence and the principle of justice. Regarding the respect of autonomy there is a need to inform the participants in order to have an informed voluntary consent; it is necessary to give the participants information about the intervention that they are going to go through; it is important to clearly specify that the participant is allowed to withdraw at any moment of the intervention. The intervention will take place only after informed written consent is obtained from the participants, and total confidentiality is assured. Regarding the principle of beneficence, if the intervention has been successful, the participants will have reduced their episodes of binge drinking, and this will be beneficent for them. This intervention is considered to promote well-being, as its goal is to reduce the pattern of binge drinking. The principle of non-maleficence focuses on how the participants are going to be kept safe. It is important to make sure that the intervention will not increase the drinking pattern of the participants.

Therefore, it is important to carefully monitor the participant’s behaviour and to be able to identify at an early stage if there are any symptoms of alcohol withdrawal such as tremors, nausea, vomiting, loss of appetite, confusion, irritability, mood swings and sweating. It is important to ascertain how much each participant has been drinking to be able to reduce the amount of binge drinking gradually and not all of a sudden, this in order to avoid an abrupt alcohol withdrawal or even the reverse reaction such as to binge drink more. In this case, it is important to have a specialised general practitioner in alcohol withdrawal on the multidisciplinary team. As for the principle of justice, it is worth noting that traditionally the burden research has often been on students and wealthier populations but not on this population; young and middle-aged men in deprived areas, therefore research tackling deprived communities is important in order to raise awareness of those living in these communities. This might reduce the gap between health inequalities as alcohol mortality grows with socioeconomic deprivation.

Regarding the governance frameworks, the participants will be recruited via charity so ethical approval for the intervention will be recruited from the School of Health Science Research Ethics Committee. The role of the Health Psychologist is to promote and improve the health and wellbeing of the general public as well as to promote and improve the health care system and to formulate and inform health policy; all of this by applying psychological knowledge, research evidence and interventions. The role of the Health Psychologist consists furthermore of different tasks such as planning, developing, delivering and evaluating interventions. It also includes dealing with psychological and emotional aspects of health and illness as well as supporting people with chronic illness. Health Psychologists work alongside other health care professionals and together are part of a so-called multi-disciplinary team. An important role of the Health Psychologist is to assure that the interventions are sensitive to the needs of the clients this within different populations and cultures. Interventions can be executed face-to-face with one patient, so at an individual level or with different patients together, in a group.

Interventions can also indirectly be executed through media or online interventions. It is important to outline the importance of the role of the Health Psychologists, as Health Psychology is still a relatively young discipline that does not receive enough attention. Regarding the intervention mentioned in this essay, strategies for promoting healthy behaviours, such as alcohol reduction strategies, behavioural self-control strategies and drinking control strategies, accompanied with the aim to activate the intrinsic motivation of the participant in order to reduce his binge drinking pattern, is considered one of the many tasks of the Health Psychologist in order to improve the health outcomes of the participants. According to Hallas (2004), other responsibilities of the work tackled by a health psychologist are “the provision of direct patient care, health education, minimizing the distress related with the medical procedures and helping the patients with their decision-makings”.

In this essay the Health Psychologist provides personalized education on how to consume alcohol in a safer way, how to prevent having binge drinking episodes by saying no, educates the participants about their limits, by giving practical advice, and activates the intrinsic motivation for the drinker to change his drinking behaviour. The strategies used for the intervention targeting binge drinking in young and middle aged men, in deprived neighbourhoods, are based on behaviour change models, as the aim of the intervention is to change the drinking behaviour of these participants.

Behaviour plays a crucial role in the development of numerous long-term conditions, it is therefore important to focus on behaviour change, as it is compulsory for prevention and for the treatment of long-term conditions.

10 December 2020
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