Binge drinking is a behaviour defined by thepattern of drinking alcohol that brings blood alcohol concentration (BAC) to0.08 gram-percent or above (The National Institute on Alcohol Abuse andAlcoholism (NIAAA), 2004). This patterncorresponds to consuming five or more drinks for the typical adult male andfour or more drinks for the typical adult female, over a period of two hours(NIAAA, 2004). There are a number of issues when comparing outcomes from different studies regarding binge drinking. Oneof them is the disagreement regarding the amount of drinks used to define thisbehaviour. It is therefore important to highlight the word “drink” which henceforthequates to one 10 g serving of absolute alcohol, defined by The World HealthOrganization (Kalinowski & Humphreys, 2016). This provides a concisedefinition of a ‘standard’ drink thus avoiding any problems that may arise incountries where serving sizes differ (in terms of their pure ethanol content).
Another issue regarding bingedrinking is the cut-off used for the number of drinks: five drinks for theadult male and four for the adult female have been decided (NIAAA, 2004). Hence, a cleardefinition as mentioned above regarding binge drinking is imperative, in orderto limit any ambiguity.Binge drinkingis a major public health concern having a considerableimpact on the individual’s health, due to its association with a rangeof adverse outcomes; some with longlasting effects, such as irreversible disabilities, or others being fatal(Anderson, 2007; Courtney & Polich, 2009; Dawson et al., 2008; Gmel et al.,2003; Ham & Hope, 2003; Plant & Plant, 2006, as cited in Kuntsche, 2017).Notably, binge drinking provokes symptoms that are directly related to thestate of intoxication manifesting in nausea, vomiting, hangovers and memoryloss. In addition, this pattern of drinking “may lead to involuntary and unprotectedsexual activity” (Perkins, 2002), which makes binge drinking a contributing factorin the transmission of HIV and other sexually transmitted diseases. As adirect result of altered cognitive and psychomotor effects on reaction time,poor cognitive processing, and coordination (Gmel et al.
, 2003, as cited inKuntsche, 2017), alcohol misuse is responsible in the occurrence of injuries,motor vehicle accidents and other traumas. Besides unintentional injuries (Hingson & Zha, 2009), binge drinkingmay also cause “intentional injuries such as self-inflicted harm and suicide” (Borges& Loera, 2010; Norstrom & Rossow, 2016; Schaffer, Jeglic, , 2008, as cited inKuntsche, 2017) as well as “violence and homicide” (Brewer & Swahn,2005). Due to the disinhibiting effectof alcohol, binge drinking may harm others through interpersonal violence(Perkins, 2002). This disinhibiting effect of alcohol, influencesthe decision to use force instead of conflict avoidance. Furthermore, theeffects of alcohol may lead to the misinterpretation of cues from others becauseof a lack of attention and cognitive processing, which may lead to fights (Giancola,Josephs, Parrott, & Duke, 2010; Townshend, Kambouropoulos, Griffin, Hunt,& Milani, 2014, as cited in Kuntsche, 2017) and sexual violence (Abbey,McAuslan, & Ross, 1998). Amongst women, drastic long-termconsequences for the unborn may also be a consequence of frequent bingedrinking episodes (Gmel et al., 2011, as cited in Kuntsche, 2017).
Binge drinking is “not justinoffensive social fun”, as stated by Petit et al. (2014). If maintained, itmay contribute to the start of cerebral disorders, causing alcohol dependencelater in life (Petit et al., 2014). Therefore, we can identify binge drinkingwith all of the long-term repercussions recognized in heavy, chronic or evendependent drinkers.
With regards to the prevalence of bingedrinking, it has been estimated that for the population of 15- year olds andolder, 7.5% binge drink at least every week (World Health Organization, 2014).This has been concluded in an attempt to come to a consistent estimate of bingedrinking (60 g on an occasion at leastonce in the past 30 days) worldwide, as it is relatively difficult to distinguishcultural variations from variations linked to diverse measurements, time framesand restriction of age groups regarding binge drinking, making the prevalencerates differ across countries.
This proportion of the worldwide population alsodiffers considerably across regions. Clear evidence is shown in genderdifferences where binge drinking is more common among men than women (WorldHealth Organization, 2014). However, some narrowing gender differences have beenfound in the past twenty years (Keyes, Li, & Hasin, 2011; Kuntsche et al.,2011). As for binge drinking regarding differences in different neighbourhoods,people in the most deprived neighbourhoods are more likely to binge drink thanin the least deprived neighbourhoods, particularlyin young and middle-aged men (Fone DL, Farewell DM, White J, et al 2013).
In regards to alcoholrelated deaths, there is an association between deaths related to alcohol andsocioeconomic deprivation, where groups with a lower socioeconomic status areconsidered to have 1.5 to 2 times higher mortalities related to alcohol, thisshown in a study conducted by Probst, et al. (2014, as cited in Smith, 2014).Another study, showed a 5.
5 higher rate of mortalities related to alcohol inthe most deprived quintile of local authorities in England in comparison to theleast deprived (Department of Health, 2012). Another study conducted by TheUniversity of Sheffield, (2012), shows that the 20% most socio-economicallydisadvantaged population of England and Wales account for 32% ofalcohol-related deaths among men and 26% of alcohol-related deaths among women,whereas, the least disadvantaged 20% of the England and Wales populationaccounted for a lower percentage of deaths related to alcohol, 11% for men and14% for women. Within health care services, health policy is considered to be akey factor in order to attain specific health outcomes within society. Bingedrinking is a governance priority, since the governance recognise bingedrinking as a burden on individuals, families as well as a drain on hospitalresources and public money (Department of Health and Social Care, 2015).
Drinking withinmoderate guidelines is not directly damaging, however if an individual were todrink to the point where he or she became intoxicated it could become a cause forconcern (Morrow, 2017). If not controlled, binge drinking has been found to bea factor in continued alcohol abuse and alcohol dependence(Morrow, 2017). There are multiple reasons for people to binge drink andthese are relatively varied (Morrow, 2017). However, there are a few common causes for thisbehaviour. Reasons such as drinking because it is fun, is one of the mostcommon and often cited. Secondly,people have a need to socialize and to feel more self-confident. This is especiallytrue for shy or introvert people who find socializing difficult, unless theydrink because it helps them to feel more relaxed; people tend to let go oftheir inhibitions thus easing the burden of expectations and pressure. Alcohol has a tendency to make one feel moreuninhibited.
Another often cited cause for people to binge drink is the attempt toforget personal problems. This receives more attention from scientist andsupport 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 individualsusceptible to the danger of alcohol abuse leading to a dependence of thesubstance as a coping mechanism. Peer pressure and peer acceptance issues are another reason toadd 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 beaccepted by others. Curiosity is also a reason for people to binge drink, asthey want to experience what others experience. Alcohol increases the releaseof dopamine, the so-called feel good hormone, into the brain. The more anindividual drinks, the larger the amount of dopamine released, thus blockingthose negative emotions of stress, fear, insecurityand anxiety. However the large amount of dopamine release can lead to fights, inappropriate sexual behaviour,criminal activity, use of other drugs and other violence (Weis, 2015). As the prevalence of binge drinking demonstratesthe differences in gender, ages and countries, it is important to mention thatthese predictors are not considered asmodifiable, which means no interventions may be applied at this level, as onecannot change the gender of someone, his/her age nor his/her nationality inorder to reduce their binge drinking behaviour.
Which brings us to reasons forbinge drinking which are modifiable, and are being modified with the help of healthpsychology interventions, in order to support this behaviour change. One ofthem 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 regardinghis 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 bingedrinking on the individual, that interventions to reduce binge drinking are neededin order to reduce the potential risks associated with it. Little has been mentionedthus far regarding men in deprived neighbourhoods. Therefore, this researchquestion has been suggested; “Does Protective Behavioural Strategies with Motivational Interviewing reducebinge drinking among young and middle-aged men (aged from 18 years old to 50years old) in a deprived neighbourhood?”If enough participants are recruited to be part of thestudy, a randomised control trial might be possible to execute theintervention. In this case, the intervention group would receive a ProtectiveBehavioural Strategy combined with Motivational Interviewing.
The control groupwould receive a presentation on health and how alcohol consumption affectstheir health. However, it may be difficult to recruit and target sufficientparticipants from this specific population that are interested in such a study.A potential lack of participants willing to engage might be the case, whichmeans 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 theparticipants recruited via a charity for alcohol abuse. The intervention willbe a 30-minute, face-to-face session, every two weeks, for a period of threemonths.
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 willbe concluding to what extent the intervention reduced binge drinking. It mayalso be of interest to review the modifiable predictors. Has the interventionbeen able to change the modifiable predictors in order to reduce bingedrinking? If the results of the pilot study are promising, a potential study inthe future might be carried out with a larger population where a randomisedcontrol trial will be possible. The intervention used is a combined method of Protective Behavioural Strategies(Pearson, 2013) that is to say behaviours that decrease the negativeconsequences of alcohol use (Martens, Pederson, LaBrie, Ferrier, & Cimini,2007).
These behaviours are mentioned as”alcohol reduction strategies” (Bonar et al., 2011), “behavioural self-controlstrategies” (Werch & Gorman, 1988) and “drinking control strategies”(Sugarman & Carey, 2007). The aim is to limit the level of alcoholconsumption through the setting of drinking limits. ?With that, a skillstraining is required, which will provide the participants with useful advice onhow to consume alcohol in a safer way. Examples for this are learning to sayno, avoiding heavy drinking or high-risk situations and abstaining fromexcessive drinking. The second method is a Motivational Interviewing Intervention(Miller & Rollnick, 2002).
This is a “focused and goal-directed counsellingstyle”, where the focus is to trigger the inherent motivation of the drinker inthe direction of action, which is changing his drinking behaviour, this byexploring and resolving the patient’s ambivalent feelings. As mentioned previously, there are differentreasons for people to binge drink. Therefore, it is important to understand andto underline the specific reasons for each participant to binge drink and to controlthem by manipulating the individual’s motivation to change his own behaviour. Followingthe Theory of Planned Behaviour (Ajzen, 1991), intentions in order to change abehaviour are predicted by three constructs; attitude, perceived behaviouralcontrol and subjective norms.Consequently, it is important in order to reduce binge drinking in ourspecific population, to increase and prolong the motivation of the participantsto have the intention to decrease their binge drinking behaviours, this byfocusing on the 3 components. Thereby, changing the individual’s attitudetowards binge drinking, increasing his perceived behavioural control and controllingthe individual’s normative beliefs and his motivation to comply to it, areimportant in order to change the individual’s intention and eventually to modifyhis behaviour towards binge drinking. Motivational Interviewing Intervention is not based onone specific theory but rather on a set of principles, derived from differenttheories, such as the importance of self-efficacy.
The self-efficacy concept ispart of the Social Cognitive Theory (Bandura 1986). This theory suggests thatbehaviour is determined by motivation and expectancies. It suggests that “behavioursare changed when a person identifies control over the outcome, confront externalbarriers, and feels confident in their own ability” to confront them (Bandura,1986, as cited in So?derlund, 2010). Having a high self-efficacy is asignificant predictor of behaviour change (Armitage & Conner, 2000, ascited in So?derlund, 2010). Another principle derives from theSelf-Determination Theory (Deci & Ryan, 2002), where the client’sself-awareness is increased, by supporting the patient’s autonomy, reflectivelistening to what the patient has to say, and summarizing what the patientsays. This increase in self-awareness, will facilitate and inspire the patientin making more autonomous choices, and eventually to change their behaviour (Vansteenkiste& Sheldon, 2006). “Patients who experience autonomy-supportive counsellors,benefit more from the treatment” (Williams, 2002; Sheldon, Joiner, Petit, , 2003, as cited in So?derlund, 2010).
Regarding ProtectiveBehavioural Strategies they are described as a combination of cognitive and behaviouralstrategies (Martens et al., 2004). All these psychological principles underpinthe intervention. It isimportant to bear in mind that one crucial aspect of conducting research is theethical issue. There are four commonly accepted principles of health careethics, excerpted from Beauchamp and Childress (2008), these four principlesinclude the respect for autonomy, the principle of non-maleficence, the principle ofbeneficence and the principle of justice.Regarding the respect of autonomy thereis a need to inform the participants in order to have an informed voluntaryconsent; it is necessaryto give the participants information about the intervention that they are goingto go through; it is important to clearly specify that the participant isallowed to withdraw at any moment of the intervention.
The intervention willtake place only after informed written consent is obtained from theparticipants, and total confidentiality is assured. Regarding the principle of beneficence,if the intervention has been successful, the participants will have reducedtheir episodes of binge drinking, and this will be beneficent for them. Thisintervention is considered to promote well-being, as its goal is to reduce the patternof binge drinking.
The principle ofnon-maleficence focuses on how the participants are going to be kept safe. Itis important to make sure that the intervention will not increase the drinkingpattern of the participants. Therefore, it is important to carefully monitorthe participant’s behaviour and to be able to identify at an early stage ifthere are any symptoms of alcohol withdrawal such as tremors,nausea, vomiting, loss of appetite, confusion, irritability, mood swings andsweating. It is important to ascertain how much each participant has been drinkingto be able to reduce the amount of binge drinking gradually and not all of asudden, this in order to avoid an abrupt alcohol withdrawal or even the reversereaction such as to binge drink more.
Inthis case, it is important to have a specialised general practitioner inalcohol withdrawal on the multidisciplinary team. As for the principle ofjustice, it is worth noting that traditionally the burden research has oftenbeen on students and wealthier populations but not on this population; youngand middle-aged men in deprived areas, therefore research tackling deprivedcommunities is important in order to raise awareness of those living in thesecommunities. This might reduce the gap between health inequalities as alcoholmortality grows with socioeconomic deprivation (Probst et al.
, 2014, as citedin Smith, 2014). Regarding the governance frameworks, the participants will berecruited via charity so ethical approval for the intervention will berecruited from the School of Health Science Research Ethics Committee. The role of the Health Psychologist is to promote andimprove the health and wellbeing of the general public as well as to promoteand improve the health care system and to formulate and inform health policy; allof this by applying psychological knowledge, research evidence and interventions(British Psychological Society, n.d.).
The role of the Health Psychologistconsists furthermore of different tasks such as planning, developing,delivering and evaluating interventions. It also includes dealing withpsychological and emotional aspects of health and illness as well as supportingpeople with chronic illness. Health Psychologists work alongside other healthcare professionals and together are part of a so-called multi-disciplinaryteam. An important role of the Health Psychologist is to assure that theinterventions are sensitive to the needs of the clients this within differentpopulations and cultures. Interventions can be executed face-to-face with onepatient, so at an individual level or with different patients together, in agroup. Interventions can also indirectly be executed through media or onlineinterventions (Health Careers, n.d.
). It is important to outline the importanceof the role of the Health Psychologists, as Health Psychology is still arelatively young discipline (Bayne & Horton, 2003, p. 86) that does notreceive enough attention. Regarding the intervention mentioned in this essay, strategiesfor 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 participantin order to reduce his binge drinking pattern, is considered one of the many tasksof the Health Psychologist in order to improve the health outcomes of theparticipants. According to Hallas (2004), other responsibilitiesof the work tackled by a health psychologist are “the provision of directpatient care, health education, minimizing the distress related with themedical procedures and helping the patients with their decision-makings”(Hallas 2004, as cited in Abraham, Conner, Jones, & O’Conner, 2016). Inthis essay the Health Psychologist provides personalized education on how toconsume alcohol in a safer way, how to prevent having binge drinking episodesby saying no, educates the participants about their limits, by giving practicaladvice, and activates the intrinsic motivation for the drinker to change hisdrinking behaviour.
The strategies used for the intervention targeting bingedrinking in young and middle aged men, in deprived neighbourhoods, are based onbehaviour change models, as the aim of the intervention is to change thedrinking behaviour of these participants. Behaviour plays a crucial role in the development of numerouslong-term conditions, it is therefore important to focus on behaviour change,as it is compulsory for prevention and for the treatment of long-termconditions (Khaw et al., 2008; Mokdad, Marks, Stroup, & Gerberding, 2004, ascited in O’Carroll, 2014).