Exploring trends, patterns, and potential non-pharmacological interventions to reduce alcohol misuse in students
This thesis is concerned with the recognition, assessment, management, and potential non-pharmacological treatment of hazardous and harmful alcohol use, and alcohol dependence in students. A systematic review carried out by Degenhardt et al. (2018) analysed the global burden of disease attributable to alcohol and drug use in 195 counties. Globally it was found that alcohol use disorders were the most prevalent of all substance use disorders, with 100.4 million estimated cases in 2016. In 2017, among adults aged 16 years and over, alcohol was consumed by 57% of the population in Great Britain, equating to approximately 29.2 million people. Additionally, 9.6% of adults drank frequently, consuming alcohol on five or more days, equating to 4.9 million people within the UK population (Office for National Statistics, 2017). Alcohol intoxication, particularly in Western cultures, is now increasingly regarded as a socially acceptable behaviour. Its easy accessibility has paved the way to alcohol currently dominating as the most consumed and normalised substance of abuse. Problematic alcohol consumption is a growing, global phenomenon which is becoming an increasing burden on public health authorities. In 2016, approximately three million global deaths (5.3% of all deaths) were attributed to alcohol misuse (World Health Organization, 2018).
Previous research has found that the highest rate of alcohol use occurs among young adults aged 18-29 (Nazareth et al., 2011; Tavolacci et al., 2019). This sub-group largely consists of students and hazardous alcohol use has been identified as a leading concern among universities, with many students embracing heavy drinking habits for the first time during their first year at university (Turrisi et al., 2006). Elliot and Ainsworth (2012) reported that 45-69% of UK students admit to partaking in weekly binge drinking sessions, and that these statistics are generally higher in the male student population. Previous research has identified that individuals who present with alcohol use disorders during adolescence and young adulthood are at higher risk for maintaining problematic drinking patterns in later life increasing the risk of comorbidity (Rohde et al., 2001). Consequently, it is vital to analyse in greater detail current trends in student drinking behaviours and explore potential interventions that may aid in reducing rates of hazardous alcohol consumption in students.
An in-depth literature review was initially conducted, and this was an important step to understanding previous research, prior to undertaking any new research. A review of the literature allowed specific research questions to be identified. Next, using a longitudinal meta-analysis, twelve cross-sectional studies carried out over the past decade that reported the prevalence of hazardous alcohol consumption in students from Loughborough University were collated and analysed. Hazardous alcohol use showed an upward trend over the years, an increase from 52% in 2009 to 82% in 2018. A meta-analysis of these studies suggested a 20% higher risk of use in male students. In the following study, significant positive associations between common mental health disorders and increased alcohol use were found. It was hypothesised that students may be self-medicating; using alcohol as a coping mechanism to relieve symptoms of anxiety and depression. Barriers to engaging in help-seeking behaviours were significantly associated with higher anxiety, depression, and alcohol use, and analyses further demonstrated that anxiety, depression, and barriers to help-seeking significantly predicted alcohol misuse. The three key barriers that students reported to engage in help-seeking behaviours were ‘the desire to solve the problem independently’, ‘the belief that the problem would get better by itself’, and ‘a dislike of talking about their feelings, emotions, or thoughts’. The most prominent barrier within the treatment subscale was ‘feeling embarrassed or ashamed’. Next, possible intervention methods were explored. A review of online brief screening and web-based interventions in students provided limited support for any effective online intervention for the reduction of alcohol use, however wider literature findings were mixed. A lack of literature exploring the effect of online interventions on alcohol craving was identified. As craving plays a central role in the acquisition and maintenance of alcohol misuse it was hypothesised that reducing craving may reduce alcohol consumption.
The effect of a brief screening and online-information-based intervention vs. an active control using distraction (watching an online painting tutorial) were compared. No statistically significant difference was found in craving score between groups after intervention, and the online intervention was not found to reduce craving. In addition, while mood decreased, and anxiety increased in the online information-based intervention, mood increased, and anxiety decreased in the painting tutorial group. Next, exercise was explored as a potential method to reduce alcohol craving, and this was hypothesised to target underlying craving mechanisms. This study included three groups: exercise, colouring and control. It was found that a short exercise circuit significantly reduced alcohol craving, whilst also eliciting beneficial effects on mood and anxiety. Colouring, an active distractive mechanism of art engagement, significantly increased mood, and decreased anxiety but did not affect craving. Results showed that the exercise-based approach was the most effective method of intervention to reduce craving significantly. This suggests that the physiological changes induced by exercise provide more benefit than the effects of distraction alone. More extensive research is needed to explore the success of these interventions on long-term alcohol craving and consumption.
- Sport, Exercise and Health Sciences
Rights holder© Aleksandra Gawor
NotesA Doctoral Thesis. Submitted in partial fulfilment of the requirements for the award of the degree of Doctor of Philosophy of Loughborough University.
Supervisor(s)Eef Hogervost ; Thom Wilcockson
This submission includes a signed certificate in addition to the thesis file(s)
- I have submitted a signed certificate