Faculty of Medicine and Health University of Leeds Charles ...

Faculty of Medicine and Health University of Leeds Charles ...

Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Using brief electronic personalised feedback to reduce use of alcohol and other drugs Dr Bridgette M Bewick Associate Professor Society for Study of Addiction Travelling Scholar Recipient of the SSA 2012 Fred Yates Prize

SSA Annual Symposium York, 2012 Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Acknowledgements UNIQoLL: Michael Barkham, Mags Bradley; Judith Slaa; Karen Trusler Student drinking: Cheryl Craigs; Duncan Radley; Jan Gill; Fiona OMay

Unitcheck: Michael Barkham; Andrew J Hill; Brendan Mulhern; Karen Trusler; Robert West What the Flock?: Ged Savva; Becky Edlin; Tim Knighton; Carolyn Montana ChangeDrinking: Duncan Raistrick; Gillian Tober; Kat Rumball; Jakki Birtwistle Doctorate of Clinical Psychology students: Sarah Marley and Cheryl Barass (co-supervisors: Hilary Bekker and Carol Martin respectively) The above is a list of key individuals who contributed to material subsequently included in this presentation. Acknowledgement is given that unfortunately it is not possible to list everyone who has had any input in to the projects therefore thanks to all that contributed in some shape or form.

Thanks to participants, student union executive members, university staff; Leeds Addiction Unit staff, and National Health Service (NHS) staff who gave their time to be involved in the projects. Conflicts of interest: In the past Bewick has received funding from the European Research Advisory Board, and has received reimbursement from Anheuser-Busch. d Care for Leeds, York and Bradford. The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. The NIH Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

Thanks to support from ... ChangeDrinking was independent research funded by the National Institute of Health Research (NIHR) through the NIHR Collaboration for Leadership in Applied Health Research and Care for Leeds, York and Bradford. The views expressed throughout this presentation are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. The NIHR had no role in the study design, collection, analysis or interpretation of the data, writing the presentation, or the decision to submit the article for dissemination. The views and opinions expressed in this presentation are those of the authors and not necessarily those of the NHS, the Department of Health, or the NIHR.

Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Solving the puzzle: the story so far ... Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences How much do students drink?

Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences <14/<21 52% /=0 10%

n=7542 year 1 n=3068, year 2 n=2444, year 3 n=2030 35/50 6% <21/<28 16%

<35/<50 16% Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences 26% 44% 12%

Craigs et al. (2011) 19% The online questionnaire was completed by 119 students; the majority were from the Faculty of Health (59%) with 35% from the Faculty of Sport and Education. Leeds Institute of Health Sciences

Academic Unit of Psychiatry and Behavioural Sciences What does this mean for the individual? Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Although initially, Amy said she dropped a module due to her work load, she later contradicted this and said that she dropped the module in order to have the same

days off as the other heavy drinkers in her household: like especially becausewell like going out a bit ridiculously, quite a lot and I think now Ive dropped that module (thats a Friday module) so it means Ive got Thursday/Friday off. Ive just got a four-day weekend, which I think is really good because I can still go out And also, mythe three people I call like the heavier drinkers in our house, now that Ive dropped Thursday/Friday off, they have exactly the same as me

Barrass (2012) Doctoral Thesis Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences The following extract is an example of what would happen if Susan met with some friends and they had not been drinking: Usually if we were just like sitting together just chatting it would be like

all sitting around staring at the floor like awkward, but when youre like out, everyone, like, its easier to talk to people and stuff.. She provides another example of this when she spoke about going out and meeting boys: Yeah, I mean if I was sober I wouldnt really, I wouldn't usually have enough confidence. .but when youre[drunk]..it does...makes you more at ease around people and boys

Barrass (2012) Doctoral Thesis Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences In the following story Susan talks about a night out two weeks ago when she had too much to drink and her Dad came to pick her up: I got really drunk just before we went out and then was like really, really drunk and then ended up.. Somehow leaving the club on my own, and

ended up in a hotel lobby like, with like 2 policeman trying to look after me on the phone to my Dad... so they were like on the phone to my Dad, trying to get my Dad to like come and rescue me Barrass (2012) Doctoral Thesis Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Amy explains that she feels that she is in control of her drinking, as she has an inner moral line

which prevents her from doing anything to feel embarrassed about. Amy feels that this is good because it makes me think theres some part of my integrity still intact (when she is drinking). Amy later reflects on an occasion when this perceived self-control was disregarded: um, well with this um, guy. Hes my best friends boyfriend and theyd just broken up. And I remember him getting really, really weird with me. And like to trying to touch me and stuff and then I do not remember this until like a few days later. I started having little flashbacks and it was horrible. So I dont really know likeyou know it makes you feel quite guilty but then youre not quite sure that its right. That kinda thing. I guess I shouldnt

have been so drunk! [Chuckles] so I know I talk about my moral line so [laughs a little] but I think if I hadnt drunk that much or let him give me as much alcohol, then I definitely would have been able to react more to what was going on Barrass (2012) Doctoral Thesis Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

Helens drinking has been continuous from a young age but has increased since attending university. She explains how she fully intended to drink a lot in her first year: I never thought, Oh God. Im drinking too much. I probably maybe should have Um, I dont know but I just thought if Immaybe because I fully expected last year to be the year of my life that I drank the most and I also do not intend after that point, to ever drink anywhere near that much again

Barrass (2012) Doctoral Thesis Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Could web-based personalised feedback work? Leeds Institute of Health Sciences

Academic Unit of Psychiatry and Behavioural Sciences Unitcheck: Complex intervention Screening and brief intervention (instant personalised feedback) that included information informed by the social norms approach Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

Personalised feedback Alcohol consumption Units consumed per week Number of alcohol free days Binge drinking behaviour Social norms The percentage of students who drink less than them

Perceived negative effects of alcohol perceived by other students who consume a similar amount of alcohol. Information on support services Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

Personalised feedback Personalised information Personalised feedback (based on social norms) Personalised information (based on social norms) Personalised feedback

Personalised feedback (social norms by gender) Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Personalised feedback Personalised information

Personalised feedback Personalised feedback (based on social norms) Personalised feedback Personalised feedback Personalised feedback (based on social norms)

Personalised information Personalised feedback Personalised feedback (based on social norms) Personalised feedback

Personalised information Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences * Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

(Bewick et al., 2010) Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences How do students process the information? Leeds Institute of Health Sciences

Academic Unit of Psychiatry and Behavioural Sciences Active thinking Participants engaged with the data and related it to their own experience. This often resulted in an evaluation of their own drinking behaviour. (Marley, 2012)

Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences ...that's your life that's like life recommendations to you and it's saying that I'm it's putting it that I weekly, yeh have arguments with my girlfriend, I break the law, but you know that's and they are because of drinking yeh, arguments with the Mrs are definitely because of drinking she said on our one year

anniversary she said that I had a drinking problem, I was like well and I think that's literally that's just hit me now.. which is s***, yeh, its literally just hit me. (P7, MA) (Marley, 2012) Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

This evaluative process started early on in the Unitcheck programme. 17 out of 21 participants negatively evaluated some aspect of their drinking behaviour before receiving any feedback. Um, so that would be 100ml um, 200ml er, lets call it . . . 15 actually and then I had a couple of shots when I got to the club as well. God that's really bad! (P16, MB) (Marley, 2012)

Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Comparison with others Encapsulates the cognitive and emotional reaction of participants when comparing their own drinking behaviour with that of a specific reference group. The process of comparison:

begins with participant estimates of where their drinking rates in comparison to other student groups; continues with their initial cognitive and emotional appraisal of the normative feedback they receive; and concludes with their evaluation of the feedback and the specific normative reference group used. (Marley, 2012) Leeds Institute of Health Sciences

Academic Unit of Psychiatry and Behavioural Sciences 19 of the 21 participants estimated that they were average in terms of student drinking 13 of the 21 participants described being shocked or surprised by the actual normative feedback Yeh, I just think like ...I am just shocked...I guess I thought I drank pretty much the same as the majority of people and according to the results they've got on there I don't at all, I drink more than the majority. (P5,FA)

7 out of 21 participants stated that they did not believe the normative feedback specifically comparing their own drinking with that of other students At least 75% . . . they drink less than me are you sure?! Only 20% of female university students drink... Really? I don't know if I believe it. Um, a female I really don't believe it actually (P3, FA) (Marley, 2012) Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

8 participants specifically commented on the use of normative comparative data as interesting and worthy of further consideration um, I guess it's more useful to be told in comparison to other students because I know what I'm drinking (aware of what I'm drinking) and I already know what I do when I get drunk like so it's just knowing what other people do. 'Cause I guess this is an assumption that everyone else just does the same things (P10,FB)

5 participants from the sex specific feedback group commented on the use of sex specific feedback as a positive distinction. there is quite a big difference between males and females. It's good to get that comparison rather than with people overall (P20, FA) (Marley, 2012) Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

Could e-interventions encourage early help-seeking? Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Bewick et al (submitted) Leeds Institute of Health Sciences

Academic Unit of Psychiatry and Behavioural Sciences How can we encourage engagement? Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Reported use of substances (last 3 months)

Montana et al. (2009) n=4309 participants Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences www.whattheflock.org.uk

Bewick et al. (revisions submitted) Personalised feedback Tailored information (based on social norms) Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

10.10.10 1.2.11 n=2549 completed online quiz The pieces are coming together ... Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences

Thanks for listening Faculty of Medicine and Health, School of Medicine, Charles Thackrah Building 101 Clarendon Road, Leeds, United Kingdom. LS2 9LJ [email protected] www.leeds.ac.uk/lihs +44 (0) 113 343 0809

Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences Student alcohol consumption Barrass, C.J. (2012). Drinking experiences of first year female students: Using narratives to explore the transition to university life. Doctoral of Clinical Psychology, University of Leeds. Bewick, B.M, Mulhern, B., Barkham, M., Trusler, K., Hill, A.J. and Stiles, W.B. (2008). Changes in undergraduate student alcohol consumption as they progress through university. BMC Public Health, 8, 163, Doi:10.1186/1471-2458-8-163. Craigs, C.L., Bewick, B.M., Gill, J., OMay, F. and Radley, D. (2011). UK student alcohol consumption: A cluster analysis of

drinking behaviour typologies. Health Education Journal, Doi:10.1177/00i7896911406967. Unitcheck Bewick, B.M., Trusler, K., Barkham, M., Hill, A.J., Cahill, J. and Mulhern, B. (2008). The effectiveness of web-based interventions designed to decrease alcohol consumption a systematic review. Preventive Medicine, Doi:10.1016/j.ypmed.2008.01.005. Bewick, B.M., West, R.M., Gill, J., OMay, F., Mulhern, B., Barkham, M. and Hill, A.J. (2010). Providing web-based feedback and social norms information to reduce student alcohol intake: a multi-site investigation. Journal of Medical Internet Research. Bewick, B.M. Trusler, K., Mulhern, B., Barkham, M. and Hill, A.J. (2008). Feasibility and effectiveness of a web-based

personalized feedback and social norms alcohol intervention in UK university students: a randomized control trial. Addictive Behaviors, Doi:10.1016/j.addbeh.2008.05.002. Marley, S.L. (2012). Understanding the role of social norms in a web-based personalised, feedback intervention for alcohol use. Doctoral of Clinical Psychology, University of Leeds. Leeds Institute of Health Sciences Academic Unit of Psychiatry and Behavioural Sciences What the flock Bewick, B.M., Bell, D., Crosby, S., Edlin, B., Keenan, S., Marshall, K. and Savva, G. (revisions submitted). Promoting

improvements in public health: Using a Social Norms Approach to reduce use of alcohol, tobacco, and other drugs. Montana, C. and Bewick, B. (2009) Student substance use and well-being: Results of an online audit commissioned by Leeds Student Substance Use and Mental Health Group. Internal report prepared by University of Leeds, UK. ChangeDrinking Bewick, B.M., Rumball, K., Birtwistle, J.C., Shaw, J.R., Johnson, O., Raistrick, D. and Tober, G. (submitted). Developing a web-based intervention to increase motivation to change and encourage uptake of specialist face-to-face treatment by hospital inpatients: ChangeDrinking Other resources Haines, M.P., Perkins, H.W., Rice, R.M. and Barker, G. (2005). A guide to marketing social norms for health promotion in

schools and communities. National Social Norms Resource Center. (www.socialnorm.org) McAlaney, J., Bewick, B.M. and Bauerle, J. (2010). Social Norms Guidebook: A guide to implementing the social norms approach in the UK. University of Bradford, University of Leeds, Department of Health: West Yorkshire, UK. (electronic copy available: www.normativebeliefs.org.uk; www.uksocialnorms.org). McAlaney, J., Bewick, B.M., Hughes, C. (2010). The international development of the Social Norms approach to drug education and prevention. Drugs: Education, Prevention and Policy.

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