Evaluation of a novel therapeutic education programme for people with alcohol use disorder in France: a mixed-methods intervention study protocol (ETHER)

Background ETHER (“Education THEérapeutique pour la Réduction des dommages en alcoologie” or Therapeutic education for alcohol-related harm reduction) is a multicentre community-based mixed-methods study, which aims to evaluate the effectiveness of the innovative therapeutic patient education (TPE) programme ‘Choizitaconso’ in a sample of French people with alcohol use disorder (people with AUD). Choizitaconso teaches people with AUD psychosocial skills to help them (re)establish controlled drinking and reduce alcohol-related harms. Recruitment started in October 2019. We present here the protocol of the ETHER study. Methods ETHER’s quantitative component involves a 6-month controlled intervention study which evaluates Choizitaconso’s effectiveness by comparing 30 people with AUD following the programme with a control group of 60 people with AUD not enrolled in it, using a questionnaire co-constructed by the research team and members of the people with AUD community. Thirty-four alcohol-related harms are assessed and summed to provide an individual measure of the ‘harm burden’ from consuming alcohol (primary outcome). Secondary outcomes are anticipated and internalized stigma, alcohol consumption measures, craving for alcohol, coping strategies, health-related quality of life, self-confidence to control or abstain from drinking, treatment self-regulation, anxiety and depressive symptoms, alcohol-related neuropsychological impairments, and capabilities (a measure of wellbeing in adults). Data will be collected in face-to-face and phone-based interviews at enrolment and 6 months later. Linear regression models will be used to assess the impact of the TPE programme on changes in the primary and secondary outcomes, while adjusting for other correlates and confounders. The study’s qualitative component comprises semi-structured interviews with 16 people with AUD who have already completed the TPE programme at least 6 months before the interview. Qualitative interviews will be analysed using thematic analysis. Results and conclusions ETHER is the first evaluation study of an innovative TPE programme specifically designed to reduce alcohol-related harms and reach controlled drinking in France. The involvement of the people with AUD community in selecting which experienced and perceived alcohol-related harms to measure ensures that ETHER will provide healthcare staff and researchers with a relevant set of harm reduction criteria for use in future research. Finally, ETHER will provide scientific justification for implementing novel alcohol-related harm reduction approaches and champion controlled drinking as a therapeutic goal. Trial registration ClinicalTrials.gov, NCT03954054. Registered 17 May 2019—Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03954054?cond=alcohol&cntry=FR&city=Marseille&draw=1&rank=1.

Equity impact of minimum unit pricing of alcohol on household health and finances among rich and poor drinkers in South Africa

IntroductionSouth Africa experiences significant levels of alcohol-related harm. Recent research suggests minimum unit pricing (MUP) for alcohol would be an effective policy, but high levels of income inequality raise concerns about equity impacts. This paper quantifies the equity impact of MUP on household health and finances in rich and poor drinkers in South Africa.MethodsWe draw from extended cost-effectiveness analysis (ECEA) methods and an epidemiological policy appraisal model of MUP for South Africa to simulate the equity impact of a ZAR 10 MUP over a 20-year time horizon. We estimate the impact across wealth quintiles on: (i) alcohol consumption and expenditures; (ii) mortality; (iii) government healthcare cost savings; (iv) reductions in cases of catastrophic health expenditures (CHE) and household savings linked to reduced health-related workplace absence.ResultsWe estimate MUP would reduce consumption more among the poorest than the richest drinkers. Expenditure would increase by ZAR 353 000 million (1 US$=13.2 ZAR), the poorest contributing 13% and the richest 28% of the increase, although this remains regressive compared with mean income. Of the 22 600 deaths averted, 56% accrue to the bottom two quintiles; government healthcare cost savings would be substantial (ZAR 3.9 billion). Cases of CHE averted would be 564 700, 46% among the poorest two quintiles. Indirect cost savings amount to ZAR 51.1 billion.ConclusionsA MUP policy in South Africa has the potential to reduce harm and health inequality. Fiscal policies for population health require structured policy appraisal, accounting for the totality of effects using mathematical models in association with ECEA methodology.

Removing Temptation: New Zealand's Alcohol Restrictions, 1881-2005

<p>This thesis provides an historical overview of the legal restrictions placed on access to alcohol in New Zealand and details some consequences of these restrictions. It questions whether the historical evidence from New Zealand supports the availability theory of alcohol. The availability theory contends that for most societies the per capita consumption of alcohol can be reduced by restricting its availability, thereby reducing alcohol-related harm. The theory was propounded in detail by the international alcohol research community from the 1970s but was also implicit in 'restrictionist' approaches increasingly adopted in a variety of countries, including New Zealand, in the nineteenth and early twentieth centuries. The thesis focuses primarily on the period from 1881 onwards, when a new Licensing Act formalised the restrictionist principles that were to dominate liquor policy for much of the next century. Until the passing of 1989 Sale of Liquor Act New Zealand's liquor laws were characterised by strict controls on licence numbers, uniform hours of sale, regular polls on liquor issues and legal obligations to provide accommodation for travellers. The availability theory was tested by assessing the effect of the rapid changes in alcohol availability that resulted from tax and policy changes that increased or decreased restrictions on access. Large liquor tax increases in 1921 and 1958 were followed by significant and sustained reductions in per capita alcohol consumption. The lowering of the minimum legal age of purchase in 1969 and 1999 was followed by increased alcohol consumption. Both these findings are consistent with the availability theory. However, neither the banning of liquor sales after six pm from December 1917 ('six o'clock closing') nor the resumption of ten o'clock closing from October 1967 had any apparent effect on liquor consumption. Rapid changes in the number of liquor outlets from 1894 to 1910 and from 1990 to 1995 were inversely correlated with changes in per capita alcohol consumption, a finding that is strongly at odds the availability theory. The findings have relevance for contemporary debates on access to alcohol in Australia (outlet numbers) Great Britain (drinking hours and liquor taxes) and New Zealand (the drinking age). This thesis also attempts to explain why strict controls remained in place for so long given that restrictions on outlet numbers and. hours of sale had no apparent impact on liquor consumption. Six o'clock closing lasted for 50 years. A freeze on public house numbers instituted in 1894 remained largely in place for almost 70 years. It is argued that liquor restrictions were maintained primarily because of political inertia engendered by three main factors. Firstly, political parties avoided addressing liquor issues as they tended to threaten party unity. Secondly, repeated referendums provided politicians with a regular reminder of the strength of the temperance lobby, making them wary of reform. Thirdly, there was little lobbying for reform because the restrictions advantaged vested interests within the liquor industry, the controls were commonly believed to reduce alcohol consumption, and the isolation of New Zealand contributed to a lack of exposure to alternatives.</p>

Removing Temptation: New Zealand's Alcohol Restrictions, 1881-2005

<p>This thesis provides an historical overview of the legal restrictions placed on access to alcohol in New Zealand and details some consequences of these restrictions. It questions whether the historical evidence from New Zealand supports the availability theory of alcohol. The availability theory contends that for most societies the per capita consumption of alcohol can be reduced by restricting its availability, thereby reducing alcohol-related harm. The theory was propounded in detail by the international alcohol research community from the 1970s but was also implicit in 'restrictionist' approaches increasingly adopted in a variety of countries, including New Zealand, in the nineteenth and early twentieth centuries. The thesis focuses primarily on the period from 1881 onwards, when a new Licensing Act formalised the restrictionist principles that were to dominate liquor policy for much of the next century. Until the passing of 1989 Sale of Liquor Act New Zealand's liquor laws were characterised by strict controls on licence numbers, uniform hours of sale, regular polls on liquor issues and legal obligations to provide accommodation for travellers. The availability theory was tested by assessing the effect of the rapid changes in alcohol availability that resulted from tax and policy changes that increased or decreased restrictions on access. Large liquor tax increases in 1921 and 1958 were followed by significant and sustained reductions in per capita alcohol consumption. The lowering of the minimum legal age of purchase in 1969 and 1999 was followed by increased alcohol consumption. Both these findings are consistent with the availability theory. However, neither the banning of liquor sales after six pm from December 1917 ('six o'clock closing') nor the resumption of ten o'clock closing from October 1967 had any apparent effect on liquor consumption. Rapid changes in the number of liquor outlets from 1894 to 1910 and from 1990 to 1995 were inversely correlated with changes in per capita alcohol consumption, a finding that is strongly at odds the availability theory. The findings have relevance for contemporary debates on access to alcohol in Australia (outlet numbers) Great Britain (drinking hours and liquor taxes) and New Zealand (the drinking age). This thesis also attempts to explain why strict controls remained in place for so long given that restrictions on outlet numbers and. hours of sale had no apparent impact on liquor consumption. Six o'clock closing lasted for 50 years. A freeze on public house numbers instituted in 1894 remained largely in place for almost 70 years. It is argued that liquor restrictions were maintained primarily because of political inertia engendered by three main factors. Firstly, political parties avoided addressing liquor issues as they tended to threaten party unity. Secondly, repeated referendums provided politicians with a regular reminder of the strength of the temperance lobby, making them wary of reform. Thirdly, there was little lobbying for reform because the restrictions advantaged vested interests within the liquor industry, the controls were commonly believed to reduce alcohol consumption, and the isolation of New Zealand contributed to a lack of exposure to alternatives.</p>

Māori perspectives on alcohol

ABSTRACTAimMāori suffer disproportionately from alcohol-related harm in Aotearoa New Zealand. With the view toward informing potential alcohol interventions for Māori, this study synthesises studies on alcohol and alcohol-related harm. MethodsUsing a Māori-centered approach, a narrative review of qualitative studies of Māori perspectives on alcohol was conducted. Journal databases, repositories, and websites were searched for relevant studies published since 2000. A thematic analysis was conducted and emergent themes were synthesised. ResultsEight studies were identified for inclusion. Whanaungatanga was identified as a contributor to alcohol use in included studies. Other motivations were ‘fitting in’, escape from stress, achieving ‘the buzz’, and coping with historical trauma. Among included literature, a strong cultural identity was a deterrent to alcohol overuse. Māori voiced a desire to be involved with local alcohol policy decisions. ConclusionAlthough Māori are a high-priority group, there remains a substantial gap in research on Māori perspectives toward alcohol interventions which is reflective of an underinvestment in Kaupapa Māori research. Future interventions for Māori may be more effective if these interventions focus on enhancing whanaungatanga without the presence of alcohol, consider the variable motivations for drinking, and utilise culturally appropriate methods to encourage reduced harm from alcohol use.