Adam Winstock

The country-level effects of drinking, heavy drinking and drink prices on pre-drinking: An international comparison of 25 countries.

INTRODUCTION AND AIMSnThe practice and adverse consequences of pre-drinking have been documented within a dozen countries, but little remains known about the differences between countries or the country-specific determinants of pre-drinking. This study aims to estimate the percentage of pre-drinkers in different countries and the impact of country-level indicators such as the price of alcohol and the prevalence of drinkers and of heavy drinkers.nnnDESIGN AND METHODSnUsing data from the Global Drug Survey, the percentage of pre-drinkers was estimated for 25 countries from 65xa0126 respondents. Bivariate and multivariate multilevel models were used to model the impact of the on-premise/off-premise drinks price ratio, the prevalence of current drinkers and of heavy drinkers on the percentage of pre-drinkers.nnnRESULTSnThe estimated percentage of pre-drinkers per country ranged from 17.7% (Greece) to 85.4% (Ireland). Across all countries, the higher the prevalence of current drinkers, the higher the percentage of pre-drinkers. In addition, an interaction between the prevalence of heavy drinkers and the price ratio was found. In countries with a low price ratio, the higher the prevalence of heavy drinkers, the higher the percentage of pre-drinkers. The opposite effect was observed in countries with high price ratios.nnnDISCUSSION AND CONCLUSIONSnPre-drinking appears to be a worldwide phenomenon. The significant effects of all three indicators demonstrate the role of country-level determinants underpinning the prevalence of pre-drinking across countries. Policy makers could use the reported findings for initiating campaigns to reduce pre-drinking behaviour. [Labhart F, Ferris J, Winstock A, Kuntsche E. The country-level effects of drinking, heavy drinking and drink prices on pre-drinking: An international comparison of 25 countries.

Motivations for reducing alcohol consumption: an international survey exploring experiences that may lead to a change in drinking habits

AIMSnBrief interventions delivered by doctors and other healthcare practitioners might be meaningfully enhanced by understanding what individual experiences might lead patients to cut down. The aim of the current paper was to explore the experiences that might lead people to reduce their alcohol consumption and to compare these findings between respondents from 21 different countries.nnnMETHODSnGlobal Drug Survey is an online cross sectional, opportunistic anonymous survey. This paper includes 72,209 respondents from 21 counties with over 250 respondents (60.8% male).nnnRESULTSnAlmost a third (32.9%) of participants reported that they would like to drink less alcohol over the next 12months, and a third thought their GP would tell them to cut down if they were honest about their drinking. The primary experiences that were rated as most likely to lead to a change in behaviour were related to physical health, sexual assault and having to seek emergency medical treatment. Respondents from Germany were more likely to select embarrassment as a motivation to reduce drinking than those from other counties. Females were more likely to report indicate motivations related to sexual regret, sexual assault or seeking treatment. Older participants and those in the low risk audit category were more likely to report embarrassment or forgetfulness as potential motivation for change.nnnCONCLUSIONnUnderstanding the different motivations that may lead individuals to change their drinking behaviours can be used to inform targeted brief interventions and targeted public health guidance.

Pharmacological cognitive enhancement among non-ADHD individuals—A cross-sectional study in 15 countries

BACKGROUNDnPsychoactive substance use aiming at increased performance at work or while studying, usually referred to as pharmacological cognitive enhancement (PCE), has been extensively researched in recent years. While large scale national studies have tried to assess the prevalence of PCE among the general population, cross-cultural comparisons have been hampered by the different definitions and designs included. In addition, the non-medical use of prescription drugs indicated to treat the symptoms of the Attention Deficit Hyperactivity Disorder (ADHD) has been the focus of discussion, yet no study has addressed the association between ADHD rates, prescribing behaviour and PCE yet.nnnMETHODSnThe Global Drug Survey is an annually conducted anonymous web survey on substance use. Two data sets from male and female Global Drug Survey (GDS) participants aged 16 to 65 years with no previous ADHD diagnosis were analysed to assess12-month PCE in 15 countries. GDS2015 (nu202f=u202f79,640) examined the patterns of and motives for stimulant PCE, while GDS2017 (nu202f=u202f29,758) focused on both the use of stimulant and sedative drugs for PCE RESULTS: When comparing the study samples 2015 and 2017, PCE with prescription and illegal stimulants and modafinil increased across all countries. People who used stimulant drugs and modafinil for PCE rated the perceived effect on cognitive performance most beneficial, while alcohol was the substance with the most adverse effect.nnnCONCLUSIONnThe analysis of data on stimulant use for PCE in the largest global sample highlights relatively low-risk PCE use patterns except for participants with illegal stimulant use for PCE. The globalisation of ADHD, physicians prescribing behaviour and changes in drug policy are likely to influence the country-specific rate of PCE among non-ADHD individuals what calls for further investigation.

Personalized Digital Interventions Showed no Impact on Risky Drinking in Young Adults: A Pilot Randomized Controlled Trial

AimnTo assess the effectiveness of two personalized digital interventions (OneTooMany and Drinks Meter) compared to controls.nnnMethodnRandomized controlled trial (AEARCTR-0,001,082). Volunteers for the study, aged 18-30, were randomly allocated to one of two interventions or one of two control groups and were followed up 4 weeks later. Primary outcomes were AUDIT-C, drinking harms and pre-loading. Drinks Meter provided participants with brief screening and advice for alcohol in addition to normative feedback, information on calories consumed and money spent. OneTooMany presented a series of socially embarrassing scenarios that may occur when drinking, and participants were scored according to if/how recently they had been experienced.nnnResultsnThe study failed to recruit and obtain sufficient follow-up data to reach a prior estimated power for detecting a difference between groups and there was no indication in the analysable sample of 402 subjects of a difference on the primary outcome measures (Drinks Meter; AUDIT-C IRR = 0.98 (0.89-1.09); Pre-loading IRR = 1.01 (0.95-1.07); Harms IRR = 0.97 (0.79-1.20); OneTooMany; AUDIT-C IRR = 0.96 (0.86-1.07); Pre-loading IRR = 0.99 (0.93-1.06); Harms IRR = 1.16 (0.94-1.43).nnnConclusionnFurther research is needed on the efficacy of such instruments and their ingredients. However, recruitment and follow-up are a challenge.

The impact of drug policy liberalisation on willingness to seek help for problem drug use: A comparison of 20 countries

BACKGROUNDnWhile the impact of changing drug policies on rates of drug use has been investigated, research into how help-seeking behaviour changes as drug policies become more public-health focused is limited. This paper investigates reported changes in confidence to utilise drug services following hypothetical changes in national drug policy among a sample of individuals who report recent illicit drug use. We predict that liberalising national drug policy will increase the propensity for people who take illegal drugs to utilise health services.nnnMETHODSnThe data were drawn from a sample of self-reported responses to the 2014 Global Drug Survey. Respondents were asked if they would be more confident seeking help if each of the following policy changes were made in their country; a) drugs were legalised; b) penalties for possession of small amounts of drugs were reduced to a fine only; c) drugs were legally available through governments outlets. Multiple correspondence analysis and multinomial logistic regression with post-estimation linear hypothesis testing were conducted.nnnRESULTSnIndividuals residing in countries with relatively liberal drug policy regimes report their help-seeking behaviour is unlikely to change given the hypothetical policy amendments. Individuals from countries with prohibition-based drug policies reported a far greater propensity for changing their help-seeking behaviour in the event of hypothetical policy amendments, citing reduced fear of criminal sanctions as the major reason. Age and sex differences were also found.nnnCONCLUSIONnThe current study demonstrates the capacity for national drug policy reform to influence drug use risk by facilitating or impeding health service engagement among individuals who use illicit substances. We suggest national drug policy requires careful consideration of both prevention goals and the needs of individuals already engaged in illicit substance use; more liberal drug policies may actually encourage the adoption of harm reduction strategies such as health service engagement.

Drug-related police encounters across the globe: How do they compare?

BACKGROUNDnDrug law enforcement subsumes the majority of drug policy expenditure across the globe. Fuelled by knowledge that much of this investment is ineffective or counter-productive there have been increasing calls for cross-national comparisons to identify where policing approaches differ and what types of approaches may be more effective. Yet, to date cross-national comparison of drug law enforcement has proven a methodologically hazardous affair. Using a new drug policing module added to the 2017 Global Drug Survey, this study seeks to provide the first cross-national comparison of the incidence, nature and intensity of illicit drug-related police encounters amongst people who use drugs.nnnMETHODSnThe Global Drug Survey was administered in late 2016. Across 26 countries including Australia, Germany, Italy, Mexico, Switzerland, the UK and the USA a total of 45,942 people who had recently used drugs completed the drug policing module. Key variables assessed included the incidence and frequency of drug-related police encounters in the last 12 months that involved: a) being stopped and searched; b) encountering a drug detection dog; c) being given a caution or warning; d) being charged and arrested; and e) paying a bribe. Multi-level models were used to control for pre-existing national differences in drug use prevalence and non-drug specific policing (including the total number of police personnel in each country).nnnRESULTSnDrug-related police encounters were most commonly reported in Italy and Scotland. Conversely, police encounters were most likely to lead to arrest in Norway, Finland and Sweden. The type and locations of encounters further differed across countries, with for example stop and search most reported in Greece and Colombia, and encounters with drug detection dogs most reported in Scotland, Italy, UK and Australia. Multi-level models showed that the incidence of reported policing encounters continued to differ significantly across countries after controlling for pre-existing national differences in drug use prevalence and policing, and that drug policing encounters were 4 to 14 times more common in some nations than others.nnnCONCLUSIONnThe findings unearth significant cross-national differences in the incidence and nature of drug-related policing of people who use drugs. This suggests that there may be opportunities for countries to learn from each other about how and why they differ, and the potential benefits of switching to lower intensity modes of drug policing.

User characteristics of a smartphone app to reduce alcohol consumption

Digital interventions are available to help people reduce their alcohol consumption, but it is not known who uses these interventions and how this treatment-seeking group compares with the general population of drinkers. The study objective was to compare the socio-demographic and drinking characteristics of users of the ‘Drinks Meter’ smartphone app with the general population of drinkers in England and website users of the same intervention. Data were used from the Drinks Meter app and website, and a nationally representative cross-sectional survey in England (Alcohol Toolkit Study). Participants were drinkers aged 16+ in England. Data were collected on participants’ age, gender, region, sexual orientation, social grade and AUDIT score. Regression analyses were conducted to assess differences in socio-demographic and drinking characteristics between samples. Drinks Meter app users, compared with drinkers of the general population, were younger, more likely to be from the South, not heterosexual, less likely to be of a lower social grade and had a higher mean AUDIT score. Drinks Meter app users were younger than website users and reported greater alcohol consumption and related harms. Drinkers using the Drinks Meter app are more likely to be younger and report greater alcohol consumption and related harms compared with the general population of drinkers in England and website users of the same intervention. Apps that provide feedback on drinking appear to be reaching those who report greater alcohol consumption and related harms.

Genie in a blotter: A comparative study of LSD and LSD analogues' effects and user profile.

This study aimed to describe self‐reported patterns of use and effects of lysergic acid diethylamide (LSD) analogues (AL‐LAD, 1P‐LSD, and ETH‐LAD) and the characteristics of those who use them.

Acceptability of targeting social embarrassment in a digital intervention to reduce student alcohol consumption: A qualitative think aloud study

Objective Increasing knowledge about alcohol-related harms, changing social norms, or encouraging drinking within safe unit levels often fails to change behaviour in young people. A novel intervention called ‘OneTooMany’ was developed, which targets the short-term social, and potentially, embarrassing consequences of drinking alcohol. The aim of this paper was to explore its acceptability, and to determine any features that might influence its effectiveness as a means of reducing alcohol consumption. Methods Participants were 23 young adults (aged 18–30) currently studying at university (nu2009=u200918) or in the first six months following graduation (nu2009=u20095). A think aloud interview approach was employed. Three main themes were identified in a deductive thematic analysis. Results Embarrassing experiences were a normalised part of drinking occasions, while some were actively avoided, others were celebrated. Humour served as a device to engage and interest participants, but could also diminish intervention messages. OneTooMany prompted reflections on many regrettable drinking experiences, but the participants did not see themselves as the target audience for this intervention. Conclusions Interventions may benefit from focusing on some of the short term, embarrassing consequences of excessive alcohol consumption. Further research is needed to ensure that reflections on past behaviour are helpful in addressing future behaviour.

Are ecstasy induced serotonergic alterations overestimated for the majority of users

Background: Neuroimaging studies imply that the regular use of ±3,4-methylenedioxymethamphetamine (MDMA), the major constituent of ecstasy pills, alters the brain’s serotonergic system in a dose-dependent manner. However, the relevance of these findings remains unclear due to limited knowledge about the ecstasy/MDMA use pattern of real-life users. Aims: We examined the representativeness of ecstasy users enrolled in neuroimaging studies by comparing their ecstasy use habits with the use patterns of a large, international sample. Methods: A systematic literature search revealed 10 imaging studies that compare serotonin transporter levels in recreational ecstasy users to matched controls. To characterize the ecstasy use patterns we relied on the Global Drug Survey, the world’s largest self-report database on drug use. The basis of the dose comparison were the Usual Amount (pills/session), Use Frequency (sessions/month) and Dose Intensity (pills/year) variables. Results: Both the average Usual Amount (pills/session) and Use Frequency (sessions/month) of neuroimaging study participants corresponded to the top 5–10% of the Global Drug Survey sample and imaging participants, on average, consumed 720% more pills over a year than the Global Drug Survey participants. Conclusions: Our findings suggest that the serotonin brain imaging literature has focused on unusually heavy ecstasy use and therefore the conclusions from these studies are likely to overestimate the extent of serotonergic alterations experienced by the majority of people who use ecstays.