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  • Transient elastography and video recovery narrative access to support recovery from alcohol misuse: Development of a novel intervention for use in community alcohol treatment services

    Rennick-Egglestone, Stefan; Jones, Katy A. (2023)
    BACKGROUND: Mortality from alcohol-related liver disease has risen significantly for 3 decades. Transient elastography (TE) is a noninvasive test providing a numerical marker of liver disease. Preliminary evidence suggests that TE can reduce alcohol consumption. The KLIFAD (does knowledge of liver fibrosis affect high-risk drinking behavior?) study has developed a complex intervention wherein people receiving alcohol treatment are provided with access to TE, accompanied by scripted feedback tailored to their disease state, and access to video narratives describing alcohol misuse recovery after receiving TE. Recovery narratives are included due to preliminary evidence from mental health studies which suggest that access to digital narratives describing recovery from mental health problems can help people affected by mental health problems, including through mechanisms with the potential to be transferable to an alcohol treatment setting, for example, by increasing hope for the future, enabling learning from the experience of others, or promoting help-seeking behaviors. OBJECTIVE: We aimed to develop the KLIFAD intervention to the point that it could be delivered in a feasibility trial and to produce knowledge relevant to clinicians and researchers developing interventions making use of biomarkers of disease. METHODS: In research activity 1, standardized scripted feedback was developed by this study, and then iterated through focus groups with people who had experienced alcohol misuse and TE, and key alcohol workers with experience in delivering TE. We report critical design considerations identified through focus groups, in the form of sensitizing concepts. In research activity 2, a video production guide was coproduced to help produce impactful video-based recovery narratives, and a patient and public involvement (PPI) panel was consulted for recommendations on how best to integrate recovery narratives into an alcohol treatment setting. We report PPI recommendations and an overview of video form and content. RESULTS: Through research activity 1, we learnt that patient feedback has not been standardized in prior use of TE, that receiving a numeric marker can provide an objective target that motivates and rewards recovery, and that key alcohol workers regularly tailor information to their clients. Through research activity 2, we developed a video production guide asking narrators what recovery means to them, what helped their recovery, and what they have learned about recovery. We produced 10 recovery narratives and collected PPI recommendations on maximizing impact and safety. These led to the production of unplanned videos presenting caregiver and clinician perspectives, and a choice to limit narrative availability to alcohol treatment settings, where support is available around distressing content. These choices have been evaluated through a feasibility randomized controlled trial [ISRCTN16922410]. CONCLUSIONS: Providing an objective target that motivates and rewards recovery is a candidate change mechanism for complex interventions integrating biomarkers of disease. Recovery narratives can contain distressing content; intervention developers should attend to safe usage. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2021-054954.
  • Application and extension of the alcohol recovery narratives conceptual framework

    Rennick-Egglestone, Stefan (2023)
    Recovery narratives are personal stories of health problems and recovery. A systematic review proposed a conceptual framework characterising alcohol misuse recovery narratives, consisting of eight principal dimensions, each with types and subtypes. The current study aims to apply and extend this preliminary conceptual framework. Semi-structured interviews were conducted to collect alcohol misuse recovery narratives from adult participants. A two-stage inductive and deductive thematic analysis approach was used to assess the relevance of the dimensions and types included in the preliminary conceptual framework and identify new components. The sample consisted of 11 participants from diverse socioeconomic backgrounds who had previously displayed varying degrees of alcohol misuse. All conceptual framework dimensions (genre, identity, recovery setting, drinking trajectories, drinking behaviours and traits, stages, spirituality and religion, and recovery experience) were present in the collected narratives. Three dimensions were extended by adding types and subtypes. Whilst the existing conceptual framework fitted the collected narratives, a new dimension describing the alcohol environment was required to fully characterise narratives. Types included in the alcohol environment dimension were policy and practice and social dynamics. The extended framework could guide the production of resources enabling clinicians to engage with narratives shared by their clients.
  • Characteristics of alcohol recovery narratives: Systematic review and narrative synthesis

    Jones, Katy A.; Llewellyn-Beardsley, Joy; Rennick-Egglestone, Stefan (2022)
    BACKGROUND AND AIMSNarratives of recovery from alcohol misuse have been analysed in a range of research studies. This paper aims to produce a conceptual framework describing the characteristics of alcohol misuse recovery narratives that are in the research literature, to inform the development of research, policy, and practice.METHODSSystematic review was conducted following PRISMA guidelines. Electronic searches of databases (Ovid MEDLINE, EMBASE, CINHAL, PsychInfo, AMED and SCOPUS), grey literature, and citation searches for included studies were conducted. Alcohol recovery narratives were defined as "first-person lived experience accounts, which includes elements of adversity, struggle, strength, success, and survival related to alcohol misuse, and refer to events or actions over a period of time". Frameworks were synthesised using a three-stage process. Sub-group analyses were conducted on studies presenting analyses of narratives with specific genders, ages, sexualities, ethnicities, and dual diagnosis. The review was prospectively registered (PROSPERO CRD42021235176).RESULTS32 studies were included (29 qualitative, 3 mixed-methods, 1055 participants, age range 17-82years, 52.6% male, 46.4% female). Most were conducted in the United States (n = 15) and Europe (n = 11). No included studies analysed recovery narratives from lower income countries. Treatment settings included Alcoholic Anonymous (n = 12 studies), other formal treatment, and 'natural recovery'. Eight principle narrative dimensions were identified (genre, identity, recovery setting, drinking trajectory, drinking behaviours, stages, spirituality and religion, and recovery experience) each with types and subtypes. All dimensions were present in most subgroups. Shame was a prominent theme for female narrators, lack of sense of belonging and spirituality were prominent for LGBTQ+ narrators, and alienation and inequality were prominent for indigenous narrators.CONCLUSIONSReview provides characteristics of alcohol recovery narratives, with implications for both research and healthcare practice. It demonstrated knowledge gaps in relation to alcohol recovery narratives of people living in lower income countries, or those who recovered outside of mainstream services.PROTOCOL REGISTRATIONProspero registration number: CRD42020164185.
  • "Drunk people are on a different level": A qualitative study of reflections from students about transitioning and adapting to United Kingdom university as a person who drinks little or no alcohol

    Davies, E. Bethan (2021)
    Background: Though sobriety in young people is on the rise, students who drink little or no alcohol may experience social exclusion at University, impacting well-being. We aim to understand the social experiences of United Kingdom (UK) undergraduate students who drink little or no alcohol. Methods: A mixed-methods study using semi-structured, one-to-one interviews and the 24-Item Social Provisions Scale and Flourishing Scale with 15 undergraduate students who drink little or no alcohol. Descriptive statistics are presented for quantitative data and thematic analysis for qualitative. Results: Eight main themes and four subthemes were generated from thematic analysis summarised in two sections 'views of drinkers from non-drinkers' and 'how peer pressure feels and how people deal with it.' The initial transition to University represented a challenge, where participants struggled to find their 'true' friends. However, students generally had high levels of social provision, well-being and enjoyed close friendships with fewer casual acquaintances. All students experienced some kind of peer pressure (of a varying extremity) and developed coping strategies when in social situations involving alcohol. Fear of missing out on the 'typical' University experience heightened self-imposed expectations to drink. Despite participants acknowledging their counter-normative behaviour, some felt they were subject to stigmatisation by drinkers, doubting their non-drinker status, causing feelings of exclusion or being 'boring.' Their desire to 'be like everyone else' exposed some insight into the negative stereotypes of sobriety, including frustration behind alcohol's status elevation. Conclusion: Students adopt strategies to minimise peer pressure and to fit in. Future research should interrogate drinkers' perceptions of their sober peers to deepen understanding, better break down 'us and them,' and mitigate future expectations within the University drinking culture.
  • Does knowledge of liver fibrosis affect high-risk drinking behaviour (KLIFAD)? protocol for a feasibility randomised controlled trial

    Jones, Katy A.; Rennick-Egglestone, Stefan (2021)
    INTRODUCTIONHeavy drinkers in contact with alcohol services do not routinely have access to testing to establish the severity of potential liver disease. Transient elastography by FibroScan can provide this information. A recent systematic review suggested providing feedback to patients based on markers of liver injury can be an effective way to reduce harmful alcohol intake. This randomised control trial (RCT) aims to establish the feasibility of conducting a larger national trial to test the effectiveness of FibroScan advice and Alcohol Recovery Video Stories (ARVS) in changing high-risk drinking behaviour in community alcohol services common to UK practice.METHODS AND ANALYSISThis feasibility trial consists of three work packages (WP). WP1: To draft a standardised script for FibroScan operators to deliver liver disease-specific advice to eligible participants having FibroScan. WP2: To create a video library of ARVS for use in the feasibility RCT (WP3). WP3: To test the feasibility of the trial design, including the FibroScan script and video stories developed in WP1 and WP2 in a one-to-one individual randomised trial in community alcohol services. Semi-structured interviews will be conducted at 6 months follow-up for qualitative evaluation. Outcomes will be measures of the feasibility of conducting a larger RCT. These outcomes will relate to: participant recruitment and follow-up, intervention delivery, including the use of the Knowledge of LIver Fibrosis Affects Drinking trial FibroScan scripts and videos, clinical outcomes, and the acceptability and experience of the intervention and trial-related procedures. Data analysis will primarily be descriptive to address the feasibility aims of the trial. All proposed analyses will be documented in a Statistical Analysis Plan.ETHICS AND DISSEMINATIONThis trial received favourable ethical approval from the West of Scotland Research Ethics Service (WoSRES) on 20 January 2021, REC reference: 20/WS/0179. Results will be submitted for publication to a peer-reviewed journal.TRIAL REGISTRATION NUMBERISRCTN16922410.
  • The role of negative urgency in risky alcohol drinking and binge-eating in United Kingdom male and female students

    Jones, Katy A. (2020)
    Identifying students at risk of developing binge-eating and alcohol use disorders is a priority in the United Kingdom (UK). Although relationships between negative urgency (impulsive behavior during times of negative emotion), risky drinking, and binge-eating have been established in students from other countries, these links have yet to be replicated in male and female UK students. UK students aged 18-30 (n = 155) completed the: (1) the Urgency, Pre-meditation, Perseverance, Sensation Seeking (UPPS-P) negative urgency subscale; (2) Alcohol Use Disorders Identification Test (AUDIT); and (3) Binge-Eating Scale (BES). For categorical analysis, participants were assigned to one of four groups as a function of AUDIT and BES clinical cut-off scores: (1) no risk (28%); (2) risky drinkers (47%); (3) binge-eaters (6%); and (4) risky drinkers + binge-eaters (19%). For dimensional analysis, across students with non-zero AUDIT and BES scores (n = 141), BES, AUDIT, gender, and their interactions were entered as predictors in the same block of a regression. UPPS-P negative urgency was the dependent variable. Categorical results indicated that binge-eaters with and without risky drinking endorsed significantly higher negative urgency than students with no risk. Dimensional results showed that although higher BES and AUDIT scores were positively linked to higher negative urgency, but only the BES was significantly associated. Furthermore, BES shared substantially more variance with negative urgency than the AUDIT, and the BES-negative urgency relationship was stronger in male students than female students. High risk students may benefit the most from interventions that help regulate negative emotion.
  • Willingness to adhere to current UK low-risk alcohol guidelines to potentially reduce dementia risk: A national survey of people aged 50 and over

    de Oliveira, Deborah; Jones, Katy A.; Orrell, Martin (2019)
    BACKGROUND: People over 50 are increasing their alcohol intake, potentially increasing their risk of dementia. OBJECTIVE: This study investigates whether people would be willing to adhere to current United Kingdom (UK, "low-risk") alcohol guidelines to reduce dementia risk. METHODS: A national cross-sectional online survey recruited a non-probabilistic sample of 3,948 individuals aged 50 and over without dementia in the UK. Self-reported willingness to comply with low-risk guidelines was predicted using logistic regression. Other relevant self-reported variables included physical health, lifestyle, and current alcohol intake. RESULTS: Majority of the sample (90%, n = 3,527) reported drinking alcohol at least once a month with 23% (n = 795) exceeding the low-risk guidelines (> 14 units per week). A larger proportion of men, those who were overweight, and people without a partner reported drinking above the recommended level. Most people who consumed alcohol (n = 2,934; 74.3%) appeared willing to adhere to low-risk guidelines if they were told that their risk of having dementia could be reduced. Increased willingness was found in women (OR 1.81; CI 1.47-2.23), in people who had at least one child (OR 1.36; CI 1.09-1.70), and those who slept well (OR 1.45; CI 1.06-2.00). People who were obese (OR 0.72; CI 0.54-0.95), those who drank alcohol above limits (OR 0.13; CI 0.11-0.16), and those who were smokers (OR 0.56; CI 0.36-0.88) were less willing to adhere to current guidelines. CONCLUSION: Men and people with more lifestyle risk factors for common chronic diseases (e.g., smoking, obesity, and excess alcohol consumption) are less willing to adhere to current alcohol low-risk guidelines to reduce dementia risk.
  • The link between early adolescent alcohol abuse and adult antisocial behaviour: A hypothesis revisited

    Howard, Richard C. (2016)
    Ten years ago the author advanced a novel hypothesis that proposed a causal link between childhood conduct disorder (CD) and early alcohol abuse in the genesis of adult antisocial behavior. In the context of antecedent CD, progressive and accelerating use of alcoholand other drugs in adolescence was said to result in increasing disinhibition and progressive misuse of alcohol. Exposure of the vulnerable adolescent brain to excessive amounts of alcohol and other substances putatively results in structural and functional changes in the brain, particularly in those areas involved in emotional selfregulation. As a consequence, such individuals emerge into adulthood as emotionally impulsive and at high risk of serious antisocial conduct. Evidence is here reviewed that supports several propositions. arising from this hypothesis: 1. The transition from childhood conduct disorder (CD) to adult antisocial behavior is mediated and moderated by early alcohol abuse. 2. Emotional impulsiveness is a core feature of severe personality disorder. 3. Severe personality disorder and emotional impulsiveness are associated with severe criminal violence. 4. Reoffending in patients with personality disorders is associated with severe drug and alcohol abuse, adult antisocial personality with severe CD, and severe borderline personality disorder. 5. Emotional impulsiveness as seen in severe personality disorder commonly manifests in anger. 6. An emotionally impulsive brain can be trained to be less impulsive.
  • WHO alcohol brief intervention training manual for primary care

    Holmes, Mark (2017)
    Alcohol contributes significantly to the disease and mortality burden in the WHO European Region, and primary health care systems play an important role in reducing the impact of harmful alcohol use. Screening and brief interventions (SBIs) for alcohol are an evidence-informed approach to addressing the needs of the many patients presenting in primary care who may benefit from reducing their alcohol consumption. This manual provides information to plan training and support for primary care practitioners to confidently deliver SBI for alcohol problems to their patients. The manual outlines the background and evidence base for SBI, and gives practical advice on establishing an implementation programme as well as detailed educational materials to develop the knowledge and skills of participants in organized training
  • Multi-agency care for people with alcohol-related long-term conditions

    Holmes, Mark (2017)
    In Nottinghamshire, a dedicated team cares for people with alcohol-related chronic ill health. This initiative won the award for Managing Long-term Conditions in the 2016 Nursing Times Awards
  • Using online tools to treat alcohol misuse

    Holmes, Mark (2016)
    Many people with alcohol problems find it difficult to access traditional services, due to stigma or practical difficulties. Online tools offer the option to avoid face-to-face consultations and can be made available at convenient times, overcoming some of these issues. This article reports on two services that have increased access to alcohol services and attracted users who are less likely to access traditional services.
  • Dying for a drink: Alcohol across the lifespan

    Holmes, Mark (2013)
    We are a nation with an alcohol-induced dichotomy: we have a love affair with alcohol but are increasingly aware of its dangers. The pub has been a cornerstone of our society, providing a source of relationships and artistic imagination. However, our nation's favourite drug is also responsible for as many life-years lost as tobacco, but with additional psychological and socio-economic costs.
  • Health checks: Could we be left with a hangover?

    Holmes, Mark (2010)
    Alcohol misuse costs �2.7 billion a year to the NHS. Mark Holmes and Jamie Waterall ask whether the NHS Health Check programme has missed a chance to help reduce the health risks of alcohol misuse
  • Alcohol and the NHS Health Check programme: Could we be left with a hangover?

    Holmes, Mark (2010)
    Alcohol misuse costs the NHS in the order of �2.7 billion per year; the total annual cost to the UK economy has been calculated at up to £25.1 billion. This article will examine if the Department of Health?s NHS Health Check programme policy launched in April 2009 has missed an important opportunity to contribute to tackling the growing health and economic burden of alcohol misuse. The authors believe that alcohol 'identification and brief advice' (IBA) should be a standard requirement for this programme. Consequently the article also provides a practical over view of the principles of IBA.
  • It's just the tonic

    Holmes, Mark (2014)
    An alcohol-free month offers the opportunity to think about your lifestyle and wellbeing, says Mark Holmes. Imagine what the UK would look like if we all took a month off from drinking alcohol? I am sure staff in busy emergency departments across the country would welcome the concept with open arms.
  • Role model: Strengthening emotional care

    Holmes, Mark (2013)
    Award-winning nurse Mark Holmes created a new community role to offer service users a supportive alcohol liaison service
  • Alcohol misuse: The need to take a preventative approach

    Holmes, Mark (2013)
    Consuming alcohol within moderate and recommended amounts can have its benefits. These include: social inclusion, socialising, positive impacts it can have on providing employment and to the economy. However, not all people drink in moderation. Alcohol misuse (AM) is increasingly becoming a cause for concern in public health, medical reports and criminal justice systems. Reports and strategies continue to highlight the risks and dangers that AM poses for those who engage in harmful drinking. Alongside the risks to the individual, other costs include discord within families and society and further financial pressure on healthcare systems. However, often AM does not come to the attention of health practitioners until it is in its advanced stages, yet it is preventable and is an issue that impacts all age groups from children to older people. Community nurses can play a pivotal, proactive and preventative role in detecting and offering information and brief advice for those in their care. Though this may be challenging and requires innovative thinking in identifying the most suitable approaches to best match the needs of their patients, it is an issue that can be prevented and have untold benefits for individuals, families and societies.

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