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Title: Community management of determined drinkers
Author: Cameron, Douglas
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 1990
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1. The 1970's were times of considerable change in our understanding and beliefs about the nature of 'problem drinking'. The 'Disease Concept of Alcoholism' had been shown to have limited value and no validity. The hazards of inappropriate use of the 'Alcoholism' label had been highlighted. There was no clear successor to the disease concept, although the hybrid model of 'The Alcohol Dependence Syndrome' seemed to be the nearest there was to a consensual view. But it adhered to the older notion of Inexorability, re-expressed as 'Restitution after Abstinence' , in spite of growing evidence of Reversibility. There was a need for the development of new models of alcohol problems. The Author has developed a method of examining Models of Alcohol Problems and has been able to derive the profile of the Alcohol Dependence Syndrome using this method. 2. Views about Treatment have also changed. Hospitalbased treatment for 'problem drinkers' had been shown to be of little value: minimal interventions appeared as effective. The use of: Involvement of Spouse, Therapeutic Community Milieu, Antabuse (for an Abstinence Goal) and Vigorous Follow-up differentiated more successful from less successful agencies. Assessment procedures were believed to be of great importance although the 'problem drinker' tended to be seen as an object of study and not as a participant in the process, whose views might also be of importance and value. The logic of matching the individual needs of the 'problem drinker' with what service is offered was advocated but had not been implemented systematically. Multidisciplinary Community-based Services were being suggested, but none had been established for long enough for an evaluation of efficacy to be undertaken. 3. Abstinence was no longer regarded as the major criterion of successful treatment outcome. Experimental controlled drinking programmes appeared to be promising. 4. Ho treatment system had been shown to make any impact on the prevalence of alcohol problems in a community. It was believed that gross per capita consumption of alcohol in that community was the major modifiable influence on that prevalence. By the late 1970's, no other attempt had been made to operate the major alcohol treatment resource of a whole community along the lines of the changes noted in 1 - 3 (above). 5. "The Leicestershire Community Alcohol Services" were instituted in 1978. For a population of just under one million, they provided a non-abstinence oriented, multidisciplinary community-based response. They attempted to maintain the "customers" in their own living and working environment and to reinforce their beliefs in their own essential normality and continuing responsibility for personal conduct. 6. Referral rates into the Leicestershire Services have risen greatly since their inception. "Customers" using the services had typical demographic and alcohol use characteristics of users of alcohol services in Britain generally. Mean consumption per drinking day was the alcohol equivalent for men of a bottle of spirits, for women a bottle of fortified wine (Sherry, Martini). At the time of presentation to the services, they were judged to show a high degree of insight into their drinking and other problems. At follow-up, most saw themselves as 'ex-problem drinkers', whether they continued to drink or not. 7. Using the same method as he used to derive the profile of the Alcohol Dependence Syndrome, the Author attempts to explore a new model of alcohol problems, "Determined Drinking" based predominantly on the self reports of the "customers" of the Leicestershire Community Alcohol Services. It incorporates an acceptance of Reversibility. 8. A short-term uncontrolled follow up of a sample of users of the Leicestershire Services was carried out. There was a high rate of attrition from the study, particularly of less stably housed men. But this study appeared to indicate that six months after cessation of contact, consumption of alcohol had either ceased (24.4%) or reduced to approximately half reported intake at initial assessment. Patterns of consmption had changed from all-day solitary facultative drinking to drinking in the company of family and friends in the evening. 9. Using data collected from Hospital Records, Death Certificates and Police Records, a wide range of indirect indicators of alcohol problems were compared in a natural experimental design. Three counties in the East Midlands of England, with similar demography and drinking patterns, but different styles of Alcohol Services: Derbyshire (effectively generic only), Nottinghamshire (In-patient Alcohol Treatment Unit and 'outreach') and Leicestershire (Community Alcohol Services) were compared over time. Using a mathematical modelling method of data analysis that incorporated change over time as a factor, significant differences in the time series between the three counties were found. Some baseline differences were present. But with the development of the alternative styles of alcohol services, further significant changes over time occurred. In general, compared with one or both of its neighbours, concomitant with a burgeoning usage of its Community Alcohol Services, there has been a flattening off or an actual reduction in alcohol related morbidity and criminality in Leicestershire. One possible explanation of these findings is the difference in the style of provision of Alcohol Services in the three counties. Other passible explanations, such as differences in demography, alcohol use, general medical services' or policing practices would appear unable to account for the wide spectrum of differences reported. Thus the policies and practices of the "Leicestershire Community Alcohol Services" appear to offer a timely and promising model of service provision for alcohol problems in a whole community. They now merit further examination and evaluation locally as do similar services established elsewhere, particularly in areas with very different drinking practices and prevalences of alcohol problems.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available