Rachel Herring

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.

“But no one told me it’s okay to not drink”: a qualitative study of young people who drink little or no alcohol

Young people’s drinking is a matter of social, media, and political concern and the focus of much policy activity within the United Kingdom. Little consideration has been given to the fact that some young people choose to drink little or not all and our knowledge and understanding of their choices and how they manage not drinking is limited. Nor has much attention been paid to the possibility that the insights of young light and non-drinkers could be useful when thinking about how to change the prevailing drinking culture, but if we are to gauge and engage with the current culture of consumption then we need to understand all parts of it. This qualitative study of young people (aged 16–25) who drink little or no alcohol aimed to further understanding of their lives and choices. The results highlight that choosing not to drink or drink lightly is a positive choice made for diverse reasons with the strongest messages and influences coming from real-life observations. Young people develop strategies to manage not drinking or drinking lightly. Alcohol education messages need to present not drinking as a valid option to young people, parents, and society more broadly.

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.

Perceptions on the role of evidence: an English alcohol policy case study

This paper explores the competing influences which inform public health policy and describes the role that research evidence plays within the policy-making process. In particular it draws on a recent English alcohol policy case study to assess the role of evidence in informing policy and practice. Semi-structured interviews with key national, regional and local policy informants were transcribed and analysed thematically. A strong theme identified was that of the role of evidence. Findings are discussed in the context of competing views on what constitutes appropriate evidence for policy-making.

The Alcohol Improvement Programme: Evaluation of an Initiative to Address Alcohol-Related Health Harm in England

Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs). Methods: The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions. Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts.

Delivering alcohol Identification and Brief Advice (IBA) in housing settings: A step too far or opening doors?

Abstract Within the UK, there is a drive to encourage the delivery of alcohol screening (or identification) and brief advice (IBA) in a range of contexts beyond primary care and hospitals where the evidence is strongest. However, the evidence base for effectiveness in non-health contexts is not currently established. This paper considers the case of housing provided by social landlords, drawing on two research studies which were conducted concurrently. One study examined the feasibility of delivering alcohol IBA in housing settings and the other the role of training in delivering IBA in non-health contexts including housing. This paper draws mainly on the qualitative data collected for both studies to examine the appropriateness and feasibility of delivering IBA in a range of social housing settings by the housing workforce. Findings suggest that while it is feasible to deliver IBA in housing settings, there are similar challenges and barriers to those already identified in relation to primary care. These include issues around role inadequacy, role legitimacy and the lack of support to work with people with alcohol problems. Results indicate that the potential may lie in focusing training efforts on specific roles to deliver IBA rather than it being expected of all staff.

The role of training in IBA implementation beyond primary health care settings in the UK

Abstract There has been a considerable drive to encourage a wide range of professional groups to incorporate alcohol screening (or identification) and brief advice (IBA) into their everyday practice. This article aims to examine the role of training in promoting IBA delivery in contexts outside primary care and other health settings. The data are drawn mainly from a structured online survey supplemented by illustrative material from nine qualitative interviews and insights from an expert workshop. Findings support the results from other research that issues relating to role relevance and role security continue to act as barriers to professional change. Furthermore, issues of organisational commitment and organisational barriers are insufficiently addressed in strategy to promote wider use of IBA. The article concludes that development of appropriate training for alcohol IBA needs to take account of the role of IBA within a complex interactive system of related services and help seeking pathways and consider how training can contribute to changing both professional attitudes and behaviours and organisational approaches to implementing and sustaining IBA in everyday professional practice.

Partnerships: survey respondents’ perceptions of inter-professional collaboration to address alcohol-related harms in England

Tackling alcohol-related harms crosses agency and professional boundaries, requiring collaboration between health, criminal justice, education and social welfare institutions. It is a key component of most multi-component programmes in the United States, Australia and Europe. Partnership working, already embedded in service delivery structures, is a core mechanism for delivery of the new UK Government Alcohol Strategy. This article reports findings from a study of alcohol partnerships across England. The findings are based on a mix of open discussion interviews with key informants and on semi-structured telephone interviews with 90 professionals with roles in local alcohol partnerships. Interviewees reported the challenges of working within a complex network of interlinked partnerships, often within hierarchies under an umbrella partnership, some of them having a formal duty of partnership. The new alcohol strategy has emerged at a time of extensive reorganisation within health, social care and criminal justice structures. Further development of a partnership model for policy implementation would benefit from consideration of the incompatibility arising from required collaboration and from tensions between institutional and professional cultures. A clearer analysis of which aspects of partnership working provide ‘added value’ is needed.

Workforce development: is there a paradigm shift?

Editorial for a Special Issue on Workforce Development in the alcohol and other drugs field published in Drugs: Education, Prevention & Policy.