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Birmingham Untreated Heavy Drinkers Project Birmingham Alcohol, Drugs, Gambling and Addiction Research Collaborative Group for the study of Alcohol, Drugs, Gambling & Addiction in Clinical and Community Settings School of Psychology, University of Birmingham & Birmingham & Solihull Mental Health NHS Foundation Trust Birmingham Untreated Heavy Drinkers Project Final Report November 2009 Commissioned by THE DEPARTMENT OF HEALTH Authors: Alison Rolfe, Jim Orford and Oonagh Martin The Birmingham Untreated Heavy Drinkers Project Final Report Research Team 2008-2009 Professor Jim Orford Head of Project Dr Alison Rolfe Research Fellow Oonagh Martin Research Assistant Julie O’Connell Project Secretary Steering Committee Dr Alex Copello Professor Christine Godfrey Dr Christine Griffin Mr Clive Henn Dr John Kemm Dr Duncan Raistrick Ms Alison Tingle Previous members of the research team Sue Dalton Research Fellow – Waves 1 to 4 Elizabeth Hartney Research Associate, Wave 1 Wave One interviewers: Maria Ferrins-Brown, Cicely Kerr, Jennifer Maslin Wave Two interviewers: James Cawley, Maria Ferrins-Brown, Mya Krishnan, Mani Mehdikhani Wave Three interviewers: Kerry Gutridge, Antonia Rich, Clare Rose Wave Four interviewers: Catherine Painter, Heather Webb, Nicola Jones-Morris Wave Five interviewers: Sophie Chappell, Felicity Hughes, Victoria Thursfield Wave Six interviewers: Brinder Bains, Nicky Knights, Oonagh Martin Acknowledgements The researchers would like to thank everyone who has helped and worked on this project over the past two years. Special thanks go to the participants, without whose contribution and commitment this study would not have been possible. Disclaimer This work is commissioned and funded by the Department of Health. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health. 2 CONTENTS EXECUTIVE SUMMARY………………………………………………………….……………..12 Key messages……………………………………………………………………………………....13 Note on terminology………………………………………………………………………………..16 PART ONE: INTRODUCTION …………………………………………………………………...17 1.1 Recruiting the sample………………………………………………………………………….17 1.2 Research methods……………………………………………………………………………...21 1.3 Minimizing attrition……………………………………………………………………………21 1.4 Comparing the final sample with the initial sample…………………………………………...23 PART TWO: CONTINUITY AND CHANGE IN HEAVY DRINKING OVER TIME………….27 2.1 Change in drinking volume over time, by volume groups………………………………...27 2.2 Mean change in drinking volume over time……………………………………………….29 2.3 Change over time at an individual level…………………………………………………...30 2.4 Frequency of heavy drinking………………………………………………………………31 2.5 Dependence on alcohol…………………………………………………………………….33 2.6 Readiness to Change……………………………………………………………………….35 2.7 Drink types………………………………………………………………………………...37 2.8 Knowledge of recommended daily and weekly drinking limits…………………………...41 2.9 Analysis of change over time using advanced statistical techniques……………………...42 PART THREE: HEALTH………………………………………………………………………….48 3.1. Health, drinking and change over time…………………..………………………………...48 3.2. Mortality…………………………………………………………………………………...51 3.3. Use of GP services…………………………………………………………………………52 3.4. Use of other primary care services………………………………………………………...55 3.5. Inpatient admissions……………………………………………………………………….57 3.6. Use of A&E and outpatient services……………………………………………………….60 PART FOUR: RISKY AND HARMFUL BEHAVIOURS………………………………………..64 4.1. Smoking……………………………………………………………………………………64 4.2. Drug use……………………………………………………………………………………65 4.3. Gambling…………………………………………………………………………………..69 4.4. Risky behaviours…………………………………………………………………………..71 4.5. Intoxicated behaviours……………………………………………………………………..73 4.6. Qualitative accounts of violence and abuse………………………………………………..77 3 4.7. Contacts with criminal justice system……………………………………………………..78 PART FIVE: EXPLANATIONS FOR HEAVY DRINKING……………………………………..80 5.1. What do we know about the chronic heavy drinkers? …………………………………….80 5.2 Reasons for heavy drinking: qualitative analysis………………………………………….81 5.2.1 Environmental factors…………………………………………………………….82 5.2.2 Individual / cognitive factors……………………………………………………...83 5.2.3 Social factors……………………………………………………………………...83 5.2.4 Pub and community……………………………………………………………….85 5.3 Case studies of chronic heavy drinkers……………………………………………………88 PART SIX: PATHWAYS TO REDUCING DRINKING…………………………………………92 6.1. Seeking help with a drinking problem……………………………………………………..92 6.2. Receiving treatment………………………………………………………………………..94 6.3. Reasons for reducing to abstinence or low risk drinking………………………………….95 6.4. Life events and change in drinking………………………………………………………...99 6.5. Seeking change with or without professional help……………………………………….102 6.6. Case studies of those who have reduced drinking………………………………………..105 PART SEVEN: STORIES OF CHANGE OVER TIME: A QUALITATIVE APPROACH…….108 PART EIGHT: INTERVIEWS WITH RELATIVES OF PARTICIPANTS……………………..119 CONCLUSIONS………………………………………………………………………………….124 REFERENCES……………………………………………………………………………………127 PUBLICATIONS LIST…………………………………………………………………………...129 APPENDICES Appendix A: Details of recruitment………………………………………………………………131 Appendix B: Additional tables and figures……………………………………………………….136 Appendix C: Details of interview content and measures used……………………………………186 4 TABLES & FIGURES Tables Table 1: Numbers interviewed and retained at each wave…………………………………………22 Table 2: Total number of research interviews attended by those interviewed at wave six………...22 Table 3: Areas of significant difference at Wave One, between those participants interviewed at Wave Six (n=259) and those NOT interviewed at Wave Six (n=241)…………………………..25 Table 4: Change in consumption group, based on unit consumption in the week before interview 1997-2007…………………………………………………………………………………………..29 Table 5: Comparison of LDQ scores from Raistrick et al. (1994) with the BUHD sample………..34 Table 6: Stage of change by unit level consumption groups for the sample in 2007………………37 Table 7. Baseline and linear change on four key drinking variables for each of four clusters of participants based on multilevel mixture modelling…………………………………………….….45 Table 8: Mean SF-36 scores 1997 and 2007 - comparison to general population…………………49 Table 9: Known deaths amongst the BUHD sample……………………………………………….51 Table 10: Frequency (and percentage) reporting whether their GP had recommended treatment and whether they had agreed to go for treatment, amongst those who received a comment about their drinking (2003-2007)……….………………………………………………………………...55 Table 11: Mean number of nights spent in hospital as an inpatient in the year before interview and comparison to the general population (aged 16+) 1997-2007……………………………………...59 Table 12: Reason for hospital inpatient stay (frequency) 2003-2007………………………………59 Table 13: Comparison of sample and general population* (aged 16+) attendance at outpatients and/or A&E departments in the last three months before interview 2001-2007…………………...62 Table 14: Numbers and percentage of sample smoking at least 1 and at least 20 cigars or cigarettes per day and mean number smoked 1997 -2007 (n = 259)……………………………….64 Table 15: Frequency (and percentage) who reported engaging in different numbers of gambling activities in the year before their interview in 2001 and 2007 (n=259)……………………………71 Table 16: Proportion of sample receiving help or advice for a drink problem, and changes in their drinking, 1999-2007…………..………………………………………………………………93 Table 17: Mean unit levels of drinking, by gender, in the week before interview in 2001 and 2003 and LDQ scores in 2001 and 2003 for the self-directed change group and the professional help group…..…………………………………………………………………………………………..104 Table 18: Relationship of participating family members to their heavy drinking relatives………119 Table 19: Coping questionnaire (CQ) scores of close family members of untreated heavy drinkers compared to those of identified problem substance users………………………………………...120 Table 20: The benefits and drawbacks of heavy drinkers’ drinking, according to heavy drinkers and family…………………………………………………………………………………………121 Figures Figure 1: Bus advertisement ………………………………………………………………………19 Figure 2: Newspaper advertisement……………………………………………………………….19 5 Figure 3: Percentage of participants allocated to drinking volume groups based on units consumed in week before interview – 1997-2007……………………………………………………………..27 Figure 4: Mean unit consumption by gender, 1997-2007………………………………………….28 Figure 5: Units consumed in week before wave six interview (n=259) …………………………...29 Figure 6: Change in weekly units between 1997 and 2007 (n=259) ………………………………30 Figure 7: Mean number of ‘heavy’ drinking days per week by gender 1997-2007………………..31 Figure 8: Mean number of ‘very heavy’ drinking days per week by gender 1997-2007…………..31 Figure 9: Leeds Dependence Questionnaire (LDZ) score 1997-2007 (n=259).................................33 Figure 10: Percentage of sample allocated to the three stages of change groups 1997-2007 (n=259) ………………………………………………………………………………...35 Figure 11: Men’s predominant drink type 1997-2007……………………………………………...37 Figure 12: Women’s predominant drink type 1997-2007………………………………………….38 Figure 13: Predominant type of drink consumed in the week before interview, 2007, heavy drinking men (n=132) ………………………………………………………………………39 Figure 14: Predominant type of drink consumed in the week before interview, heavy drinking women, 2007 (n=55) ……………………………………………………………………………….39 Figure 15: Estimates of DoH recommended daily units for men, 2003-2007……………………..40 Figure 16: Estimates of DoH recommended daily units for women,
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