Betsy Thom

Binge drinking: an exploration of a confused concept

Binge drinking is a matter of current social, media and political concern, and the focus of much policy activity in the UK. Binge drinking is associated with causing a wide range of harm to individuals (e.g. accidents), and the wider community (e.g. crime and disorder). Within the current discourse, binge drinking is seen primarily as a youth issue. Binge drinking is sometimes portrayed as a recent phenomenon, but we know from history that heavy drinking has been endemic in British society over many centuries. Using a contemporary history perspective, this paper explores the concept of binge drinking. It considers the definitions in use, recent shifts in meaning and also the way in which different definitions of binge drinking impact on perceptions of the extent and nature of binge drinking. The paper concludes with some thoughts and questions about the usefulness of the concept of binge drinking as it currently used, and areas for further research.

Fast screening for alcohol misuse

UNLABELLED The Fast Alcohol Screening Test (FAST) has been developed from the AUDIT questionnaire. AUDIT The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva, Switzerland: World Health Organization for use in very busy medical settings. One feature of the FAST is its ease and speed of administration, especially since one question identifies over 50% of patients as either alcohol misusers or not. This study further explores the sensitivity and specificity of the FAST across ages, gender, and locations using the AUDIT as the gold standard. Two other quick tests are also compared with the AUDIT and the FAST, namely the Paddington Alcohol Test and the CAGE. All tests were quicker to administer than the AUDIT with the FAST taking just 12 s on average. All tests identified drinkers who would accept a health education booklet (over 70% of those identified) or 5 min of advice (over 40%). The FAST was consistently reliable when sensitivity and specificity were tested against AUDIT as the gold standard.

Research and policy: What determines the relationship?

Abstract The relationship between research and policy is a matter of much current interest to policy makers in health. This paper uses historical approaches and case studies to examine the nature of the interrelationship. Drug policy (the evaluation of methadone maintenance in the 1970s and of needle exchange in the 1980s) and alcohol policy (the changing fortunes of the Ledermann hypothesis relating total alcohol consumption to population based harm) provide examples of how the relationship operates. Research can provide the legitimation for particular policy alliances; the role of medical civil servants and medical experts in the UK has historically played a crucial gatekeeping’ role.

Binge Drinking: A Confused Concept and its Contemporary History

Binge drinking is a matter of current social, political and media concern. It has a long-term, but also a recent, history. This paper discusses the contemporary history of the concept of binge drinking. In recent years there have been significant changes in how binge drinking is defined and conceptualised. Going on a ‘binge’ used to mean an extended period (days) of heavy drinking, while now it generally refers to a single drinking session leading to intoxication. We argue that the definitional change is related to the shifts in the focus of alcohol policy and alcohol science, in particular in the last two decades, and also in the role of the dominant interest groups. The paper is a case study in the relationship between science and policy. We explore key themes, raise questions and point to a possible agenda for future research.

Substitution Treatment in the Era of “Recovery”: An Analysis of Stakeholder Roles and Policy Windows in Britain

Based on documentary analyses and interviews with twenty key informants in 2012, this paper analyses the shift in British drugs policy towards “recovery” from the perspectives of major stakeholders. The processes involved in reopening the debate surrounding the role of substitution treatment and its re-emergence on to the policy agenda are examined. Drawing on Kingdons work on agenda-setting, the ways in which methadone maintenance was challenged and defended by key stakeholders in the initial phase of policy development and the negotiation of a “recovery” focus as the organizing concept for British drugs policy are explored. Study limitations are noted.

Disruptive innovations: the rise of the electronic cigarette.

The history of psychoactive substances is replete with examples of technologies that change the production and consumption of drugs, alcohol and tobacco. Business analysts use the term ‘disruptive innovation’ to describe innovations that lead to relatively rapid and dramatic transformations in manufacture, marketing, and consumer behaviour (Christensen, 2003). A classic instance is the ‘Kodak moment’ when, with the rise of digital processes, photographic film manufacturers were left with an obsolete technology. But as we will suggest, disruption is far broader than the technical impact of the innovation, for it has social ramifications affecting a wide range of social groups. This is especially the case with psychoactive substances where innovations can challenge the position of powerful groups and established wisdoms.

Stigma as a public health tool: Implications for health promotion and citizen involvement

Stigma is a social mechanism by which individuals and groups re discredited; it reduces social status and creates ‘spoiled idenities’ (Goffman, 1963). Stigma can operate at an individual and tructural level; and be imposed externally or be self-perceived by ndividuals who apply negative stereotypes to themselves (Link & helan, 2001). In the field of substance use, debates around stigma end to be divided between studies which assess the harms that tigma carries for health and identity, and an alternative body of ork that ‘views stigma more benignly, as a form of social control’ Room, 2005). We argue that if, as the second body of literature sugests, stigmatising measures are adopted widely in the substance se field their deleterious impact risks exacerbating substance use roblems, particularly amongst the least well off. Furthermore, the trategy may impede the commitment to empowerment which has een fundamental to health promotion since the publication of the ttawa Charter in 1986.

Local responses to the Alcohol Licensing Act 2003: The case of Greater London

This paper describes a preliminary study of local implementation of the Licensing Act 2003 in Greater London. The study investigated variability in local polices, perceptions of the opportunities afforded by the changes in the licensing system and perceptions of barriers and problems arising in the initial implementation process during 2005. The research was conducted in two stages: an analysis of the licensing policies of the 33 London boroughs and open discussion, in-depth interviews conducted in five London boroughs with licensing officers and chairs of licensing committees (elected councillors). From the policy analysis and interviews it was evident that licensing authorities varied in their level of engagement in licensing matters. Although there were reservations, the majority of respondents welcomed the changes in the administration and procedures, in particular the opportunity to have more control of licensing in their locality. Overall respondents did not report major problems or difficulties arising from the new arrangements and the extension of hours. However, it was recognized that it was still too early in the process to draw firm conclusions.

Stakeholders in opioid substitution treatment policy: similarities and differences in six European countries.

Based on the research papers within this special issue, this overview discusses similarities and differences in stakeholding in drug user opioid substitution treatment policy in Britain, Denmark, Italy, Austria, Poland, and Finland. It explores factors that have influenced stakeholder activity, including the importance of crisis, the impact of evidence, the availability of resources, the wider political context, the influence of moral frameworks and ideologies, and the pressure of external influences. The paper highlights the important differences in the emergence and evolution of stakeholder groups and in the political, cultural, and economic circumstances, which both constrain and enable their activities.

The relationship between research and policy: case studies from the postwar history of drugs and alcohol

Virginia Berridge. a senior lecturer in history. co-directs the AIDS Social History Programme at the London School of Hygiene and Tropical Medicine (Keppel St.• London WC1E 7HT. England). She is the author ofa history of the Society for the Study of Addiction 1884-1988 (1990), of Drug Research in Europe (1989), co-author of Opium and the People: Opiate Use in 19th Century England (1981). and joint editor and author ofAIDS and Contemporary History (1993). Betsy Thom, a sociologist who heads the training unit at the Centre for Research on Drugs and Health Behaviour. Charing Cross and Westminster Medical School. London University, has published on womens use ofalcohol and drugs. the management ofalcohol problems in primary care, and the history ofalcohol treatment services.