tag:theconversation.com,2011:/fr/topics/alcohol-intake-27049/articlesAlcohol intake – The Conversation2020-02-25T06:20:37Ztag:theconversation.com,2011:article/1316512020-02-25T06:20:37Z2020-02-25T06:20:37ZIf you’re ageing and on medication, it might be time to re-assess your alcohol intake<figure><img src="https://images.theconversation.com/files/316776/original/file-20200224-116138-c9xbnj.jpg?ixlib=rb-1.1.0&rect=3%2C0%2C2471%2C1651&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-friends-having-fun-doing-barbecue-1104408533">Shutterstock</a></span></figcaption></figure><p>Drinking patterns tend to change as we age. The older we get, the <a href="http://www.nceta.flinders.edu.au/files/4614/4892/9660/EN605.pdf">more likely we are to drink on a daily basis</a>. But older adults often perceive that drinking is only a problem if a person appears drunk. </p>
<p>Australia’s <a href="https://www.nhmrc.gov.au/health-advice/alcohol">draft alcohol guidelines</a> recommend healthy adults drink no more than ten standard drinks per week and no more than four in a day. This is down from 14 standard drinks per week in the <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">previous guidelines</a> and no more than two standard drinks in any one day. </p>
<p>Anything above this is considered risky drinking because it <a href="https://www.nhmrc.gov.au/health-advice/alcohol">increases the risk of alcohol-related diseases</a>, such as cancer, and injuries.</p>
<p>Between 2007 and 2016, there was a <a href="https://ro.ecu.edu.au/ecuworkspost2013/5672/">17% increase</a> in risky drinking among Australians aged 60-69. In 2016, <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/data">18.2% of 60-69 year olds</a> drank at risky levels. </p>
<p>Among women, <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-key-findings/contents/alcohol-use">those aged 50-59 years</a> are now more likely to drink at risky levels (13%) than any other age group, including women aged 18 to 24 years (12.8%).</p>
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Read more:
<a href="https://theconversation.com/older-australians-drinking-on-the-rise-and-they-dont-know-the-risks-50660">Older Australians' drinking on the rise and they don't know the risks</a>
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<p>Older adults are more vulnerable to alcohol’s interactions with medicines, medical conditions that can be made worse by alcohol, and age-related changes in the metabolism of alcohol that mean we become more intoxicated from drinking the same amount of alcohol. Alcohol can also increase the risk of falls. </p>
<p>For some older people, this means that maintaining their current levels of alcohol consumption as they age inadvertently places them at risk. </p>
<h2>Alcohol and many medications don’t mix</h2>
<p>Older adults are <a href="https://onlinelibrary.wiley.com/doi/pdf/10.5694/mja2.50244">more likely</a> to be taking a number of medications; about two-thirds take <a href="https://www.ncbi.nlm.nih.gov/pubmed/20073039">four or more</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331237/">Many of these medications</a> can interact with alcohol. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/31769178">Our research</a> among risky drinkers aged 58 to 87 found 92% were taking medications that when combined with large amounts of alcohol could lead to serious adverse effects. This included common medications prescribed for high blood pressure.</p>
<p>For 97% of the people we studied, drinking alcohol reduced the effectiveness of the medication. This included Nexium, a medication commonly prescribed to treat gastric reflux.</p>
<h2>Why are older Australians drinking more?</h2>
<p>While age-related factors such as <a href="http://www.nceta.flinders.edu.au/files/4614/4892/9660/EN605.pdf">bereavement</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28382628">retirement</a> can increase the likelihood of drinking at risky levels, most often alcohol is part of an enjoyable social life as people age. </p>
<p>In <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.12110">our research</a>, alcohol use was closely linked to social engagement: more frequent opportunities to socialise were associated with more frequent drinking. </p>
<p>Among retirement village residents, having access to a social group “on tap” also encouraged more frequent drinking. </p>
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<img alt="" src="https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">For many older drinkers, alcohol is part of their social life.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thai-old-woman-drinking-beer-czech-740350804">Shutterstock</a></span>
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<p>In a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.12991">recent study of Australian and Danish women drinkers</a> aged 50 to 70, those who were drinking at risky levels said overwhelmingly their drinking was a normal, acceptable and enjoyable part of their lives, so long as they appeared to be in control. </p>
<p>In doing so, they were able to mentally distance their drinking from current and future health problems. </p>
<h2>Recognising heavy drinking as a health issue</h2>
<p>Australia’s <a href="https://www.nhmrc.gov.au/health-advice/alcohol">draft alcohol guidelines</a> don’t provide any specific recommendations for older adults, beyond those recommended for adults in general. </p>
<p>Rather, they recommend older adults speak with their GP to determine an appropriate level of drinking based on their medical history and medications they are taking. </p>
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Read more:
<a href="https://theconversation.com/cap-your-alcohol-at-10-drinks-a-week-new-draft-guidelines-128856">Cap your alcohol at 10 drinks a week: new draft guidelines</a>
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<p>But <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijpp.12255">our research</a> found only 30% of older men and 20% of older women could recall their GP asking about their alcohol use over the past 12 months, regardless of what medication they were taking. </p>
<p>Even fewer could recall their community pharmacist asking about their alcohol use. </p>
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<img alt="" src="https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Pharmacists should be asking about alcohol use when dispensing medicine.</span>
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<p>Promisingly, almost all participants were open to their GP asking about their alcohol use, particularly in relation to medication. </p>
<p>And more than half believed it was OK for their community pharmacist to raise this issue with them when being dispensed medication. </p>
<h2>So what can we do about it?</h2>
<p>Recognising the social context to older adults’ drinking and other drug use, and understanding how they make sense of these behaviours, is an important first step in preventing and minimising harm. </p>
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Read more:
<a href="https://theconversation.com/hazardous-drinking-research-finds-that-40-of-people-over-50-drink-too-much-104062">Hazardous drinking: research finds that 40% of people over 50 drink too much</a>
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<p>At a population level, public health messages must resonate with older people by reflecting the context in which they drink.</p>
<p>At a community level, GPs and community pharmacists are well placed to help older adults minimise the risk of harm, but may require further training to develop their skills and confidence in broaching this topic with patients. </p>
<p>For older adults experiencing alcohol-related issues, Australia’s first older adult-specific service, called Older Wiser Lifestyles (OWL), has effectively identified and engaged with <a href="https://www.publish.csiro.au/ah/ah17013">more than 140 people</a> who didn’t realise their drinking could be placing their health at risk. </p>
<p>This Victorian initiative asks patients at GP clinics to complete a screening test on a iPad and notifies the GP if risks are identified. The person can then participate in an OWL early intervention program of education, brief counselling and harm-reduction advice. </p>
<p>So far the program has led to participants reducing their alcohol consumption and having fewer problems with medicines that interact with alcohol. </p>
<p>Such a scheme could be replicated across the country, and has the potential to improve lives, reduce preventable disease and premature deaths, and save the health system money.</p><img src="https://counter.theconversation.com/content/131651/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The number of older people who drink heavily is increasing. Here’s why that’s a problem.Stephen Bright, Senior Lecturer of Addiction, Edith Cowan UniversityJulie Dare, Senior Lecturer, Health Promotion, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1020592018-08-28T08:46:46Z2018-08-28T08:46:46ZThe hidden costs of a hangover<figure><img src="https://images.theconversation.com/files/233477/original/file-20180824-149490-1h5opai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If you drink alcohol, it’s likely you’re familiar with some of the effects of a hangover. Headaches, nausea and fatigue are just some of the unpleasant but common experiences of the morning after the night before. But have you ever wondered how a hangover may influence your thoughts and behaviour?</p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/add.14404/full">Our research</a> shows that hangovers may influence essential cognitive processes which are important for everyday living. We found evidence of impairments in memory (short and long term), the ability to sustain attention, and psychomotor skills. But performance in some kinds of thought processes – such as the ability to divide attention between tasks – did not show an overall decline following a night of heavy alcohol consumption.</p>
<p>The impairments caused by hangovers have implications for lots of us – from parents to health care professionals, teachers to business owners. When referring to memory, students are a good example of a group who need to retain information. With poorer memory during a hangover, you might think it wise for students to stay in the night before an exam. But we found that evidence comparing performance on a multiple choice test showed no difference between the scores of those who were hungover and those who weren’t. Having said that, the learning of this material was done while participants were sober, suggesting that retrieval of information is relatively unaffected. </p>
<p>By comparison, our review found that it could be the learning aspect of memory, rather than recall, that is impaired during a hangover. When studies asked participants to both learn and recall information while hungover, their memory was poorer. This could explain why exam performance is relatively unaffected – as the information was already learned. It also suggests it might be a good idea not to go out drinking the night before an important lecture, where material for the exam is learned.</p>
<p>Being able to concentrate on one task, or sustain attention, is vital in many circumstances. Anyone who needs to keep their wits about them and pay attention to a task may find this difficult while experiencing a hangover. Impairment of sustained attention following alcohol consumption may be due to fatigue – a major and common symptom of being hungover. Fatigue can influence our ability to maintain focus and lower our “mental resource”, making engaging in tasks more difficult.</p>
<p>Maintaining attention is an important aspect of driving. Of the 19 studies we reviewed, only three assessed driving ability. One looked at the speed at which people drove during a hangover and found no effect. But two studies found impairments in an individual’s ability to handle a vehicle during a hangover – and one of the studies compared the level of impairment when people are hungover to when people are under the influence of alcohol. They reported that hangover-related driving impairments are the equivalent of having a 0.05 – 0.08% blood alcohol concentration (BAC).</p>
<p>Drink driving limits for most European countries are 0.05% BAC and in the UK it is 0.08%. This means that hangover-related impairments in driving may be at the sort of level that is currently unacceptable by law during alcohol intoxication. Our finding of reduced psychomotor skills during hangover may also contribute to driving impairments experienced following an evening of heavy alcohol consumption. </p>
<h2>Delayed reactions</h2>
<p>Psychomotor skills involve the informational process related to movement, such as hand-eye co-ordination. When we combined all studies in our review that had investigated psychomotor skills we found that reaction times were reduced during a hangover. This could contribute to a delay in correcting the swerve of a vehicle, or reacting to other drivers.</p>
<p>Our review has highlighted brain activity fundamental to processing information are impaired in hangover. But what about “higher” thought processes such as decision making, inhibition, or being able to manage our moods?</p>
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<p>Here’s where there is a serious gap in the scientific literature. <a href="https://academic.oup.com/alcalc/article/43/2/163/122637">Despite calls for more research</a> to examine a hangover’s impairment of higher thought processes involved in completing goals (“executive functions”) ten years ago, few studies have explored this area. </p>
<p>Understanding these processes could provide insight into why some people decide not to turn up to work with a hangover, or why <a href="https://www.jsad.com/doi/abs/10.15288/jsa.1997.58.37">being hungover is associated</a> with increased conflict with supervisors and colleagues and poorer performance. </p>
<p>Hangovers are estimated to cost the UK economy almost £2 billion a year in absenteeism and lost productivity – so this is definitely something worth knowing.</p><img src="https://counter.theconversation.com/content/102059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our brains work differently the morning after the night before.Craig Gunn, PhD Candidate, University of BathSally Adams, Lecturer in Health Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/827532017-08-23T05:39:44Z2017-08-23T05:39:44ZBeer, bongs and baby boomers: the unlikely tale of drug and alcohol use in the over 50s<figure><img src="https://images.theconversation.com/files/183066/original/file-20170822-13660-1p7ity1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Baby boomers who drink and take drugs risk a range of physical and mental problems that younger substance users don't necessarily face.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/496022509?src=J4JwkXDIzM9va_WIHJgxBQ-2-62&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>If you ask someone what a typical heavy drinker or drug user looks like, they’re probably more likely to evoke images of Gen Ys with tattoos and piercings than greying baby boomers. </p>
<p>But recent Australian data, outlined in our <a href="http://www.bmj.com/content/358/bmj.j3885">British Medical Journal editorial today</a>, shows rates of alcohol and drug use are actually decreasing among younger age groups, while increasing dramatically in people over the age of 50.</p>
<p>Not only is there a rise in the proportion of older people who regularly drink at risky levels, there are also more older people using cannabis.</p>
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Read more:
<a href="https://theconversation.com/maybe-moderate-drinking-isnt-so-good-for-you-after-all-72266">Maybe moderate drinking isn't so good for you after all</a>
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<p>So, it’s not surprising Australia’s <a href="https://www.hcasa.asn.au/documents/555-national-drug-strategy-2017-2026/file">recently released National Drug Strategy 2017-2026</a> identifies older people as a priority group for attention.</p>
<p>The data has implications not only for the health of the over 50s, but also for health professionals that diagnose and manage substance use or misuse, and the complications that can arise from it.</p>
<p>Evidence shows we can no longer view drug and alcohol issues purely as a young person’s concern.</p>
<h2>Why is alcohol and drug use rising in older Australians?</h2>
<p>Low birth rates and extended life expectancy have resulted in large increases in the <a href="https://aifs.gov.au/facts-and-figures/ageing-australia">proportion of older Australians</a> and higher absolute numbers of older people who drink and use drugs.</p>
<p>For example, the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">one in four 50-59 year-olds</a> drinking at risky levels (five or more standard drinks in a single session) corresponds to <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Sep%202016?OpenDocument">about 755,394</a> people.</p>
<p>Baby boomers (born between 1946 and 1964) have <a href="http://www.bmj.com/content/343/bmj.d6761">higher rates</a> of alcohol and drug use than earlier cohorts of older Australians and many continue this use into their older years.</p>
<p><a href="http://nceta.flinders.edu.au/files/3514/1679/0404/EN557.pdf">Improvements in health care and treatments for substance use</a> mean more people survive into old age, drinking and taking drugs for longer.</p>
<p>Older Australians today also have more disposable income than in previous generations, making access to alcohol and drugs <a href="http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0021-25712012000300004">more affordable</a>.</p>
<h2>What does the evidence say?</h2>
<p>Our research, using data from the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/about-ndshs/">National Drug Strategy Household Survey</a>, shows high-risk drinking (11 or more standard drinks on a single occasion) in the over 50s increased significantly between 2004 and 2013. People living in regional or remote areas or who smoke tobacco were more likely to drink this way.</p>
<p>The <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">newly released 2016 data</a> indicates this upward trend is continuing even more strongly.</p>
<p><a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">In 2016</a>, 11.9% of 50-59 year olds drank at high-risk levels at least yearly (up from 9.1% in 2013). A total of 5.8% did so at least monthly (up from 4.1%).</p>
<p>Cannabis use among the over 50s <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajag.12357/abstract">more than doubled</a> between 2004 and 2013, from 1.5% to 3.6%. Unmarried men who smoked, drank alcohol, and used other drugs were particularly likely to use cannabis.</p>
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Read more:
<a href="https://theconversation.com/remind-me-again-how-does-cannabis-affect-the-brain-40641">Remind me again, how does cannabis affect the brain?</a>
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<p>There is little reliable data on other illicit drug use in older people. But our data shows older people are using more pharmaceuticals, like <a href="http://onlinelibrary.wiley.com/doi/10.1002/pds.1899/abstract">sedatives</a> and <a href="https://www.mja.com.au/journal/2011/195/5/prescription-opioid-analgesics-and-related-harms-australia">opioids</a>, than before.</p>
<p>And <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">in 2016</a>, 4.1% of 50-59 year olds and 4.5% of people 60 and over used pharmaceutical drugs for non-medical purposes.</p>
<p>Older people often use pharmaceuticals to treat pain (both physical and emotional) or sleep problems. This can also result in balance problems, falls/injuries, reduced ability to function, and even death.</p>
<p>You can find out more about the prevalence of substance use among older Australians in the <a href="http://nadk.flinders.edu.au/">National Alcohol and Drug Knowledgebase</a>.</p>
<h2>Why is all this concerning?</h2>
<p>Growing use of alcohol, cannabis, and prescription drug misuse among older Australians is concerning for a number of reasons.</p>
<p>Older people are more sensitive to the toxic effects of substances such as alcohol. This is because ageing <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">reduces the body’s capacity</a> to metabolise, distribute, and excrete alcohol and drugs.</p>
<p>Older people are also more likely to have <a href="http://nceta.flinders.edu.au/files/3514/1679/0404/EN557.pdf">existing physical or psychological conditions</a>, or to take medicines that may <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">interact</a> with alcohol and drugs.</p>
<p>So older people who use alcohol and/or drugs may be more <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">likely to have</a>: falls and other injuries, diabetes and cardiovascular disease, mental health problems (including suicide), obesity, liver disease, <a href="https://pdfs.semanticscholar.org/b8ed/eefa7da25bb2656bc0335cc6768d62b9f039.pdf">early-onset dementia and other brain injury</a>, sleep disorders, and blood borne diseases.</p>
<h2>Not all older people have problems with drugs and alcohol</h2>
<p>Not all older people who use alcohol and/or drugs have problems. Older people, like other age groups, use alcohol or drugs in many different ways and for many different reasons, as we show with this “<a href="http://nceta.flinders.edu.au/files/7014/1679/1083/EN559.pdf">typology of older users</a>”:</p>
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<li><p><strong>maintainers</strong> continue with their previously unproblematic use as they get older. But age-related changes (like those already outlined) result in increased harms later in life</p></li>
<li><p><strong>survivors</strong> begin using alcohol/drugs early in life. They have a long history of substance use problems that persist into older age and this often results in other physical and/or mental health problems</p></li>
<li><p><strong>reactors</strong> begin using alcohol/drugs in their 50s or 60s, often due to <a href="http://au.wiley.com/WileyCDA/WileyTitle/productCd-1118993772.html">stressful events</a>, like grief, retirement, marital breakdown, social isolation (<a href="http://press.psprings.co.uk/bmj/august/substancemisuse.pdf">particularly older women</a>), or due to pain.</p></li>
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<h2>Do treatments work for older people?</h2>
<p>The good news is, research shows substance use treatment is <a href="http://nceta.flinders.edu.au/files/9814/2250/4969/Hunter_2010.pdf">just as effective</a> for older people as it is for younger age groups. </p>
<p>Treatment programs adapted specifically for older people have <a href="http://www.sciencedirect.com/science/article/pii/S1878764915001394">even better outcomes</a>.</p>
<p>This is important, as the number of older people who require treatment for alcohol or drug problems is increasing substantially, <a href="http://press.psprings.co.uk/bmj/august/substancemisuse.pdf">both in Australia</a> <a href="http://www.tandfonline.com/doi/abs/10.1080/13607863.2013.793653?tab=permissions&scroll=top">and</a> <a href="https://academic.oup.com/ije/article/43/2/304/675582/Substance-use-disorders-and-psychiatric">overseas</a>.</p>
<h2>Not everyone gets treatment</h2>
<p>Unfortunately, there are <a href="http://nceta.flinders.edu.au/files/1314/1679/1662/EN561.pdf">barriers</a> that can <a href="http://alcoholresearchuk.org/downloads/finalReports/FinalReport_0085">make it harder</a> for older Australians to access treatment or support.</p>
<p>Health-care practitioners and family members may:</p>
<ul>
<li><p>be reluctant to ask older people “embarrassing” questions about substance use</p></li>
<li><p>not know alcohol/drug use is common in older people, or how to address it</p></li>
<li><p>incorrectly attribute symptoms of problem substance use to “just getting older”</p></li>
<li><p>incorrectly believe older people are too old to change.</p></li>
</ul>
<p>Older people may also be reluctant to seek help because of embarrassment, logistical problems (like a lack of transport), inappropriate treatment services for older people, or they do not know where to turn for help.</p>
<p>To combat these problems, we developed a <a href="https://www.peninsulahealth.org.au/wp-content/uploads/AODPenHealth_150915.pdf">free guide</a> to preventing and reducing alcohol and drug related harm among older people for health and welfare professionals.</p>
<h2>What needs to change</h2>
<p>Health-care services and the aged care sector need to work better together to prevent problem substance use among older people. They also need to provide age-appropriate treatment and harm minimisation services to people who need them. </p>
<p>Clinicians also need to better identify and treat alcohol, cannabis, and prescription drug misuse in their older patients.</p>
<p>Finally, we need more research into the best approaches for helping older people with substance use problems.</p>
<hr>
<p><em>If you would like to talk to a professional about your own or someone else’s alcohol or drug use, contact the free Alcohol and Drug Information Service in your <a href="http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/CA12F53389330BD1CA2577EC007DEAFB/$File/ADIS.pdf">state or territory</a>.</em></p><img src="https://counter.theconversation.com/content/82753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The National Centre for Education and Training on Addiction receives funding from the Commonwealth Department of Health.</span></em></p>More Australians over 50 are drinking and taking drugs than ever before. Here’s why that can be a problem.Ann Roche, Professor and Director of the National Centre for Education and Training on Addiction, Flinders UniversityVictoria Kostadinov, Research officer, National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/781392017-06-26T13:38:43Z2017-06-26T13:38:43ZWhy you should be wary of going to work with a hangover<figure><img src="https://images.theconversation.com/files/175586/original/file-20170626-32766-eix11r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not fully functioning.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-hangover-medicines-messy-room-after-620391044?src=PHwpfIJGzmfIYZUZfVaY5Q-2-19">Shutterstock</a></span></figcaption></figure><p>If you have ever drunk alcohol, there’s a good chance you’ve also had a hangover. As a widely experienced result of alcoholic consumption, hangovers have a broad variety of familiar negative effects: vomiting, fatigue, headache and increased blood pressure are common physical reactions. Psychological symptoms can also include irritability, anxiety and depression. </p>
<p>But as familiar as these symptoms may be, a lack of research means hangovers remain something of a scientific mystery. While acute intoxication has been the subject of <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=alcohol+intoxication">tens of thousands of research papers</a>, only a handful have ever investigated its <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=alcohol+hangover">after-effects</a>. </p>
<p>Hangovers are often mistakenly thought to be caused solely by dehydration. However the physical symptoms are <a href="https://pubs.niaaa.nih.gov/publications/arh22-1/54-60.pdf">caused by several factors</a>, including dehydration and electrolyte imbalance (the thirst and light-headedness), inflammation of the stomach and intestines (the nausea and vomiting), disturbance of sleep and alcohol metabolism (the sweating). The cause of the psychological consequences is less well known, but it is likely that the cognitive and mood effects of hangover involve c<a href="http://www.chemistryviews.org/details/ezine/1080019/Chemistry_of_a_Hangover__Alcohol_and_its_Consequences_Part_3.html">hanges in neurotransmitter function</a> in the brain. </p>
<p>Hangovers clearly have a negative impact on health. Yet they are often ignored in public health messages on the use of alcohol. Hangovers also bring a significant economic cost – and it is a cost which is difficult to quantify. The British government estimates that hangovers (and other alcohol-related illnesses) cost the UK economy <a href="http://news.bbc.co.uk/1/hi/health/3121440.stm">17m working days of absenteeism</a> every year. But what about the people who do show up for work after a night of drinking?</p>
<p>A recent survey revealed that on any given work day around <a href="http://www.ias.org.uk/uploads/pdf/Factsheets/Alcohol%20in%20the%20workplace%20factsheet%20March%202014.pdf">200,000 British workers turn up to work hungover</a>. How productive or professional can they be while their bodies are busy processing the physical impact of the wine or beer they consumed the night before?</p>
<p>Hangovers have also <a href="https://occup-med.biomedcentral.com/articles/10.1186/1745-6673-5-13">been linked to</a> increased conflicts at work, reduced job completion and inefficiency. <a href="http://www.ias.org.uk/uploads/pdf/Factsheets/Alcohol%20in%20the%20workplace%20factsheet%20March%202014.pdf">A recent survey</a> showed 83% of employees felt that being hungover made a difference to their work. Of these, 22% admitted making mistakes as a result of being hungover and a third admitted that they “drift off and don’t work at their usual pace”. </p>
<p>Alcohol intoxication itself impairs major elements of brain function, and affects our capabilities to assess risk and make decisions. It also cuts attention levels and memory. It is not fully understood how these effects might continue during the recovery process.</p>
<p>The trouble is, measuring a hangover and its effects on work performance is not easy. Surveys often rely on people’s own assessment of hangover symptoms and opinion of their work performance. </p>
<p><a href="https://academic.oup.com/alcalc/article-lookup/doi/10.1093/alcalc/agm160">One research review</a> found that of 13 studies examining the effect of alcohol hangover on brain function, only five showed a detrimental effect from hangovers. They found impairment in recall, long-term memory, focus and management. But the low number of studies which showed the harmful effects of hangovers may just be down to poor research methods. </p>
<p>Finding subjects can be tricky. The last thing someone suffering from a hangover might want is to go through a series of complicated tests. These studies involve participants being given a controlled amount of alcohol in a laboratory setting to induce a hangover. Or they may be asked to engage in a normal evening’s drinking before arriving at the laboratory the next morning. They are then asked to perform a range of computerised tasks designed to probe cognition levels. But so far, scientists have not yet been able to fully explore the effects of alcohol on cognitive processing in the hangover phase. </p>
<h2>The journey after the night before</h2>
<p>Another area in need of investigation is the <a href="https://link.springer.com/article/10.1007%2Fs00213-014-3474-9">hangover’s influence on driving behaviour</a>. Most drivers will judge that they are safe to drive after an episode of drinking by estimating when there is no alcohol in their system. This is also the point at which hangover begins to take hold. Hangover is defined by most experts as the point when an individual’s blood alcohol concentration is zero, when all the alcohol has left the bloodstream. </p>
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<p><a href="https://link.springer.com/article/10.1007%2Fs00213-014-3474-9">Motorists have indicated</a> that their driving quality is poorer and less safe when they were hungover. In tests using driving simulators, they swerved more and had increased lapses of attention when hungover. But with just one study examining the impact of hangovers on driving, it is essential that further research is undertaken. </p>
<p>What we do know suggests that hangovers affect our ability to carry out everyday activities and we may have to adjust our understanding of the impact of hangovers on our lives. A hangover at work may become as frowned upon as turning up drunk at the office. Hungover driving might be seen as widely unacceptable as drink driving has become. It’s a sobering thought.</p><img src="https://counter.theconversation.com/content/78139/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally Adams does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The science is still hazy - but our abilities are clearly affected during the recovery period.Sally Adams, Lecturer in Health Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/785972017-05-31T20:15:49Z2017-05-31T20:15:49ZThree charts on: Australia’s changing drug and alcohol habits<p>Australians are using less alcohol, tobacco and other drugs than they did a decade ago, new results from the <a href="http://www.aihw.gov.au/">Australian Institute of Health and Welfare’s</a> (AIHW) National Drug Strategy Household Survey show.</p>
<p>Although the drug of most concern to the general public is methamphetamine, the rate of methamphetamine use has been showing a steady decline since 1998 and, at 1.4%, is now at its lowest point since the survey began, down from 2.1% three years ago.</p>
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<p>So why are people worried? The data over the past several years has shown a decrease in people who prefer to use the lower purity methamphetamine speed and an increase in people preferring to use the more potent crystal form, “ice”. </p>
<p>This trend continues in this survey. The drop in the proportion of people who use methamphetamine overall appears to be driven by fewer people using speed. </p>
<p>With an increase in crystal methamphetamine as the preferred form has come significant increases in harms. </p>
<p>Recent <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/aodts-nmds-2015-16/">treatment data </a>show an increase in treatment presentations - methamphetamine now represents close to 25% of drug treatment episodes - and there has been increases in ambulance call outs, hospital separations and deaths due to methamphetamine.</p>
<p>The trends in methamphetamine use and harms highlight why policies should focus on harms and harm reduction rather than use and use reduction.</p>
<p>In fact, illicit drug use more generally has decreased, mainly driven by a reduction among teenagers, suggesting that fewer young people are trying illicit drugs. This is also continuing a trend seen over the past decade.</p>
<h2>Age of first drug use is on the rise</h2>
<p>Not only are fewer people using illicit drugs, those who do are trying them later. Specifically methamphetamine, cannabis and hallucinogens showed an increase in the age of first use:</p>
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<p>People aged 35-55 years have increased their use of illicit drugs significantly, driven primarily by increases in use of cannabis, methamphetamine and cocaine. We don’t know whether these are people new to using illicit drugs or people who have a history of use who have moved into an older age group.</p>
<p>Traditionally harm reduction messages have been primarily targeted at young people, but an important growing group of people at risk of harms is now those in middle age.</p>
<p>The proportion of people using illicit drugs in their 60s has also been increasing over time. Although the increase is relatively small from 2013 to 2016, people in their 60s have had the largest increase since 2001. This is mostly accounted for by use of pharmaceuticals for non-medical purposes. Careful monitoring of pharmaceutical prescriptions and over-the-counter medicines are part of a harm reduction solution.</p>
<h2>More people report being non-drinkers</h2>
<p>Despite a lot of media interest in illicit drugs, it is still the legal drugs, alcohol and tobacco that cause most harm in the community.</p>
<p>The good news is that there was a decline in drinking that increases risk of harm over a lifetime (such as chronic health problems). For healthy men and women, drinking no more than two standard drinks on any day <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">reduces the lifetime risk</a> of harm from alcohol.</p>
<p>There was no overall change in drinking that increases risk on a single drinking occasion (such as injuries), but younger people under 30 years old showed a significant decline in risky drinking. For healthy men and women, drinking no more than four standard drinks on a single occasion <a href="https://www.nhmrc.gov.au/health-topics/alcohol-guidelines">reduces the immediate risk</a> of alcohol-related harm. Alcohol-related incidents also decreased, and the proportion of people who reported never having a full glass of alcohol grew.</p>
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<p>Nearly 94% of 12-15 year olds and 58% of 16-17 year olds did not drink at all, both increases from the previous survey.</p>
<p>There was an increase in the proportion of the population who have never smoked and who are ex-smokers, with a significant increase in teenagers who do not smoke.</p>
<p>Overall, legal and illegal drugs are showing a stable or downward trend in proportion of population who use them over the last decade or more. However, while fewer young people are using, the proportion of people using alcohol and other drugs in the older age groups has increased.</p>
<p><em>CORRECTION: This article was corrected on June 1 to change “a significant decrease in teenagers who do not smoke” to “a significant increase in teenagers who do not smoke.” The Conversation apologies for the error and thanks readers who picked it up.</em></p><img src="https://counter.theconversation.com/content/78597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the public, private and not for profit health sector to support treatment and policy implementation. She has previously been awarded grants by the state and federal government, NHMRC and other public funding bodies for alcohol and other drug research.</span></em></p>The proportion of population who use legal and illegal drugs has remained stable or trended down. Fewer young people are using, but the proportion of older people using drugs and alcohol has grown.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/674542016-10-24T22:33:52Z2016-10-24T22:33:52ZWomen’s alcohol consumption catching up to men: why this matters<figure><img src="https://images.theconversation.com/files/142989/original/image-20161024-28380-wrtsvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alcohol use is traditionally higher among men than women but new evidence suggests this is changing.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Women are catching up to men in rates of alcohol consumption and this has important implications for how we think about our community response to harmful alcohol use.</p>
<p>Historically, men have been more likely to drink alcohol than women and to drink in quantities that damage their health. However, evidence points to a significant shift in the drinking landscape with <a href="http://www.sciencedirect.com/science/article/pii/S0376871607003559">rates of alcohol use appearing to converge</a> among men and women born more recently. In a bid to quantify this trend, <a href="http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2016-011827">we pooled data</a> from 68 studies in 36 countries with a total sample size of over four million men and women.</p>
<p>All of the studies we looked at reported data on both men’s and women’s drinking across at least two time periods. Some data were available from men and women born in the early 1900s, other data from men and women born in the late 1900s, but each data point represented the ratio of men’s to women’s alcohol use for those born within a specific five-year time window. Taken together we were able to map ratios across the entire period from as early as 1891 right up to the year 2000 and everything in between. </p>
<p>We grouped data according to three broad definitions: any alcohol use (in other words being a drinker or not), problematic alcohol use (binge or heavy episodic drinking) and alcohol-related harms (negative consequences as a result of drinking such as accidents or injuries or a diagnosis of an alcohol use disorder).</p>
<p>What we found was that the gap between the sexes has narrowed over time. Among cohorts born in the early 1900s men were just over two times more likely than women to drink, three times more likely to drink in ways suggesting problematic alcohol use and three-and-a-half times more likely to experience alcohol-related harms. </p>
<p>Among those born in the late 1900s these ratios had decreased to almost one. This means that by the end of the last century men’s and women’s drinking had almost reached parity.</p>
<p>We did not seek to quantify by how much alcohol use is falling among men and/or increasing among women. However, of the 42 studies that showed converging alcohol use, most reported this was driven by increases in the rates of female drinking. </p>
<p>A small proportion (5%) of the individual sex ratios was less than one, the majority of which came from cohorts born after 1981. This suggests women born after this time may, in fact, be drinking at <em>higher</em> rates and in <em>more</em> harmful ways than their male counterparts. </p>
<h2>What’s changed in the last 100 years?</h2>
<p>We don’t have a definitive answer to what has driven the rise in alcohol consumption among women but in many countries around the world we have seen substantial developments in broader social, cultural and economic factors for women and increasingly accepting societal norms around female drinking. </p>
<p>It is likely <a href="https://dx.doi.org/10.2147/SAR.S21343">sex differences in alcohol use are linked</a>, probably in complex ways, to these societal changes. Most people would argue these changes have been positive. However, increased exposure to alcohol for women also means increased exposure to the <a href="http://www.sciencedirect.com/science/article/pii/S0376871615016166">physical and mental health risks associated</a> with drinking too much.</p>
<p>Regardless of the reasons behind these changes, it’s clear alcohol use and associated problems are not problems that only affect men. </p>
<p>This matters because often the focus in the media and public debate is on young men and alcohol. It matters because universal prevention can be an effective strategy to reduce harmful alcohol use among women. It matters because, while women seek treatment for almost every other physical and mental health problem at higher rates than men, women who experience problems related to alcohol generally don’t seek treatment. </p>
<p>The sooner we structure our education campaigns as well as our prevention, early intervention and treatment programs around this notion, the better our community response to harmful alcohol use will be. </p>
<p>We need to ensure education campaigns addressing the harms of alcohol use are <a href="http://www.positivechoices.org.au">designed to appeal to both men and women</a>. We need to target adolescents before drinking patterns are entrenched and deliver high quality, evidence-based <a href="http://anp.sagepub.com/content/50/1/64.abstract">universal prevention and early intervention programs</a>. We need to reduce the structural barriers (such as cost and location) as well as negative attitudes that get in the way of women <a href="http://www.sciencedirect.com/science/article/pii/S0376871614019735">seeking treatment for alcohol problems</a>. </p>
<p>Many of the men and women who are contributing to these changing drinking patterns are only now in their 20s or 30s. We need to keep tracking population trends in drinking as these cohorts age into their 40s, 50s and beyond. We need to keep asking the question: how can we do better to prevent alcohol related harms?</p><img src="https://counter.theconversation.com/content/67454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Slade receives funding from the NHMRC, the ARC and the Australian government.</span></em></p><p class="fine-print"><em><span>Cath Chapman receives funding from the NHMRC and the Australian government.
</span></em></p><p class="fine-print"><em><span>Maree Teesson is a director of CLIMATESchools Pty Ltd. An Australian company that distributes evidence based educational materials to schools. She receives funding from the NHMRC, the Australian government and the NSW government.</span></em></p>Women are catching up to men in rates of alcohol consumption and this has important implications for how we think about our community response to harmful alcohol use.Tim Slade, Associate Professor, UNSW SydneyCath Chapman, Senior Research Fellow, UNSW SydneyMaree Teesson, Professor at the National Drug and Alcohol Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/593862016-07-13T19:40:04Z2016-07-13T19:40:04ZTrying to cut your drinking? There’s an app for that<figure><img src="https://images.theconversation.com/files/130175/original/image-20160712-9289-lzhw4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Technology can help cut your alcohol use.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/mr_t_in_dc/8309908321/">Flickr/Mr TinDC</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Australia is known to be a nation of drinkers with almost <a href="http://nadk.flinders.edu.au/kb/alcohol/consumption-patterns/risky-consumption/">18%</a> having a drink on a daily basis at a level that is considered risky. </p>
<p>But the ill-effects of such behaviour extend to <a href="http://www.tacklingbingedrinking.gov.au/internet/tackling/publishing.nsf">binge drinking</a>, impacts on <a href="https://drinkwise.org.au/#q=alcohol%20and%20your%20health&r=true">health and well-being</a>, <a href="http://www.aic.gov.au/publications/current%20series/rip/1-10/04.html">assaults</a> <a href="http://www.aic.gov.au/publications/current%20series/tandi/461-480/tandi472.html">drink driving</a> with resulting car accidents and many others. </p>
<p>Various <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-drugs-alcohol-index.htm">governments</a> and organisations have launched campaigns and policies to combat problem drinking, such as <a href="http://www.abc.net.au/news/2016-04-22/danny-green-coward-punch-one-punch/7351798">Danny Green’s Coward Punch Campaign</a> and the lock out laws in <a href="http://www.nsw.gov.au/alcohol-and-drug-fuelled-violence-initiatives">New South Wales</a> and <a href="https://www.business.qld.gov.au/industry/liquor-gaming/liquor/compliance-licensees/trading-hours/late-trading">Queensland</a>.</p>
<p>Lock out laws have met with some success in <a href="https://www.mja.com.au/journal/2015/203/9/presentations-alcohol-related-serious-injury-major-sydney-trauma-hospital-after">reducing alcohol-related serious injuries in some regions</a>. But they have also been criticised with claims the laws are <a href="http://www.theaustralian.com.au/life/lockout-laws-nsw-premier-mike-baird-bombarded-on-facebook-and-twitter/news-story/0f627e978dd2002d9a86db9f460da65e">harming businesses</a> or that the cultural image of a high profile and vibrant urban centre such as Sydney is being <a href="https://www.theguardian.com/australia-news/2016/feb/05/sydneys-fun-police-have-put-out-the-light-of-the-nightlife-the-citys-a-global-laughing-stock">distorted</a>. </p>
<p>But there might be another way to tackle the problems related to the over-consumption of alcohol that doesn’t require large-scale government intervention.</p>
<h2>Install an app</h2>
<p>When it comes to overcoming bad behavioural habits, such as drinking too much, technology can help by providing a subtle and more personalised solution to the problem.</p>
<p>Smartphone apps can provide real-time intervention on the go. They allow people to get the right information at the right time regarding their drinking habits.</p>
<p>Popular alcohol control apps include examples such as Stop Drinking with Andrew Johnson (for <a href="https://itunes.apple.com/au/app/stop-drinking-andrew-johnson/id365566955">Apple</a> or <a href="https://play.google.com/store/apps/details?id=com.hivebrain.andrewjohnson.drinking&hl=en">Android</a>) which relies on relaxation and hypnotism and other apps which simply count the intake of alcohol (<a href="https://play.google.com/store/apps/details?id=com.voilaweb.mobile.sobrietycounter">Sobriety Counter</a> is one such app for Android).</p>
<p>Such mediated, anonymous and indirect interaction can also help people suffering from a drinking problem who are otherwise reluctant to visit rehabilitation and facility centres. </p>
<p>In this way technology can facilitate a change in behaviour through persuasion but not coercion. This is known as persuasive technology, a term originally coined by Stanford University researcher <a href="http://www.bjfogg.com/">BJ Fogg</a>. </p>
<p>Such technologies have already helped with other problems, such as obesity, bullying and racism by motivating people, providing knowledge, supporting decision making and ultimately facilitating behaviour change. </p>
<p>There is growing realisation of the importance of persuasive technology in mitigating the harmful side effects of <a href="http://healthland.time.com/2013/12/17/fighting-holiday-overdrinking-why-many-women-may-be-better-off-with-apps-over-aa/">alcohol</a> and other <a href="https://psmag.com/the-invisible-manipulative-power-of-persuasive-technology-df61a9883cc7#.hswxsg3hs">bad habits</a>.</p>
<p>There are a number of <a href="http://www.acar.net.au/control_your_drinking_online.html">web</a> and <a href="http://www.adin.com.au/about-us/latest-news/69-drug-and-alcohol-app-reviews-for-iphone-and-android">mobile</a> applications that help people with their alcohol intake. But web-based applications usually cannot be accessed at a user’s own discretion as they require some form of synchronisation with the user’s phone.</p>
<h2>Which app is best?</h2>
<p>While mobile apps may be best suited to tackle drinking problems there isn’t much of an understanding as to which are more suitable or what features people prefer. </p>
<p>The National Health Service in the UK does provide a <a href="http://www.nhs.uk/tools/pages/toolslibrary.aspx">list of apps</a> that can assist in tackling health related problems. But there is no government or other reputable organisation that maintains a similar list in Australia.</p>
<p>There are some <a href="http://www.techguide.com.au/reviews/apps/smartphone-apps-that-can-save-you-from-drunken-embarrassment/">online rankings</a> of alcohol control apps, but these are not maintained by official health services.</p>
<p>This motivated us to <a href="http://link.springer.com/chapter/10.1007%2F978-3-319-31510-2_9">analyse</a> more than 200 user reviews of apps available on the iTunes store so we could better establish design recommendations for such apps.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1065&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1065&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1065&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1338&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1338&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125623/original/image-20160607-15034-1f877yh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1338&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Quit That app indicating alcohol consumption trends and money saved.</span>
<span class="attribution"><a class="source" href="https://itunes.apple.com/au/app/quit-that!-track-how-long/id909400800?mt=8">Screenshot</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We focused on 18 apps, such as <a href="https://itunes.apple.com/us/app/quit-that/id909400800?ls=1&mt=8">Quit That</a>, that were meant to reduce alcohol intake through behavioural change strategies. We specifically excluded apps that were purely for facilitating alcohol intake, such as alcohol recipe apps. </p>
<p>We noticed that there were two main types of strategies that were prevalent in such apps. Some used motivation and others self-control to help reduce or monitor alcohol intake. The former rely on different persuasive strategies such as praise and reward mechanism, social interaction with avatars, competitions, reminders and notifications, etc. </p>
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<a href="https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1065&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1065&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1065&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1338&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1338&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125624/original/image-20160607-15045-smqswr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1338&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Step Away app highlights the usage of warnings as a persuasive strategy - an example of a motivational app.</span>
<span class="attribution"><a class="source" href="https://itunes.apple.com/us/app/step-away-mobile-intervention/id688669242?mt=8">Screenshot</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Self-control apps mostly rely on users to monitor and manage their intake by providing information, such as blood alcohol concentration levels. Self-control apps do not explicitly inform the user when their alcohol intake crosses a level of high risk. </p>
<h2>What users want</h2>
<p>Our results showed that users preferred self-control apps, possibly because they did not want to be controlled by an app that was too insistent or fast in its interaction. </p>
<p>Users not only preferred gradual notifications from the apps but they also wished to have full control over how the app interacted with them. We found that a key design guideline for these apps is the ability to customise the way users interact with them. </p>
<p>We noticed that a number of users preferred apps that provided incremental targets. This allows them to attain positive milestones on each step of the behavioural change process. A number of users also stated the importance of sharing their progress on social media.</p>
<p>Implementing persuasive applications is a fraught with challenges, particularly for contexts such as alcohol intake, where real-time monitoring can be difficult. </p>
<p>But there is great potential to use mobile technology to promote positive alcohol behavioural change, particularly if the apps follow certain design features. </p>
<p>If the appropriate governmental authorities can benchmark and recommend apps based on the proposed guidelines, that will go a long way in assisting many in overcoming their alcohol related problems.</p><img src="https://counter.theconversation.com/content/59386/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Omar Mubin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Smartphone apps can help people cut back on the amount of alcohol they drink. But is it nagging apps or gentle persuiasion that people prefer?Omar Mubin, Lecturer in human-centred computing & human-computer interaction, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/584422016-04-29T04:26:55Z2016-04-29T04:26:55ZKenyans and Ugandans need to change their ways to arrest lifestyle diseases<figure><img src="https://images.theconversation.com/files/120251/original/image-20160426-1327-i6eocx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Reuters/Siegfried Modola </span></span></figcaption></figure><p>More than 90% Kenyans consume less than five servings of fruits and vegetables on most days. Nearly a quarter always add salt to their food before eating or during their meals. And 28% always add sugar to beverages. </p>
<p>More than half of the adult Kenyan population have never had their blood pressure tested. Yet one in four people has high blood pressure. Diabetes testing has even worse adherence, with only one in ten adults ever being tested.</p>
<p>The majority have never had their cholesterol levels tested, while 27% are either overweight or obese.</p>
<p>These are the results from the newly released <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">2015 Kenya STEPwise Survey</a>, a nationwide study that looked at how non-communicable diseases are affecting the country. </p>
<p>What the results show is that non-communicable diseases such as diabetes, cancer, heart disease and chronic respiratory illness have all skyrocketed in the country over the past ten years in the same way that they have in sub-Saharan Africa. </p>
<p>Globally, more than 16 million people die from non-communicable diseases. Of these, 80% are in low- and middle-income countries. And according to the World Health Organisation’s projections for the next ten years, <a href="http://www.afro.who.int/en/clusters-a-programmes/dpc/non-communicable-diseases-managementndm/npc-features/1236-non-communicable-diseases-an-overview-of-africas-new-silent-killers.html">28 million people</a> in sub-Saharan Africa will die from a chronic disease. </p>
<p>Responsibility to address the situation does not only lie with governments. The choices individuals make also have a huge role to play. </p>
<h2>Kenyans and Ugandans are too unhealthy</h2>
<p>Non-communicable diseases are linked to a number of risk factors, including:</p>
<ul>
<li><p>unhealthy diets;</p></li>
<li><p>smoking;</p></li>
<li><p>alcohol intake; and</p></li>
<li><p>a lack of exercise.</p></li>
</ul>
<p>These all significantly increase the individual’s risk of dying from a non-communicable disease.</p>
<p>Though the picture isn’t pretty in Kenya, the country is not alone. In Uganda, the <a href="http://www.who.int/chp/steps/Uganda_2014_STEPS_Report.pdf">2014 Uganda STEPwise Survey</a> shows figures that are as bad. </p>
<p>Here, 88% of the population consume less than five servings of fruits and vegetables on most days. And while 70% have never had their blood pressure measured, just under a quarter suffer from high blood pressure. More than 90% have never had their diabetes or cholesterol tested. And about 19% are overweight or obese.</p>
<p>The two surveys paint a shocking picture of how East Africans are exposing themselves to the mounting risks of non-communicable diseases. </p>
<p>These surveys must be a wake-up call to governments to find better solutions to the growing crisis of non-communicable illness. But they also suggest that individuals should and can be doing more.</p>
<h2>How to change behaviour</h2>
<p>So where do individuals start? </p>
<p>These days healthy food has been replaced with tasty and, most often, easy food. Grabbing food on the run means that only <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">6% of Kenyan adults</a> get their recommended five-a-day servings of fruits and vegetables. In <a href="http://www.who.int/chp/steps/Uganda_2014_STEPS_Report.pdf">Uganda</a> the figure is 13% for women and 12% for men. </p>
<p>Maintaining a healthy diet can help to reduce the risk of some cancers as well as the chances of being obese – which itself is a marker for all sorts of non-communicable diseases, including heart disease and diabetes.</p>
<p>A healthy diet also restricts salt intake, which for Kenyans is even more of a challenge than adding fruit and vegetables. One in four Kenyans and Ugandans add salt to their food before they even taste it. Every shake of that salt shaker carries with it a risk of high blood pressure and lasting damage to the heart, kidneys and brain.</p>
<p>High consumption of alcohol can also have an effect on weight and the organs most vulnerable to disease: the heart, the liver, the stomach and the pancreas. One in four Kenyan men <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">drink alcohol daily</a> and one in eight are <a href="http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf">heavy drinkers</a>. </p>
<p>This means that half of men who are daily drinkers are daily heavy drinkers. Beyond the long-term damage of over-consumption, heavy drinking can also mean you – and others who share the road with you – are at higher risk of traffic accidents leading to serious injury or death.</p>
<p>Another risk factor is tobacco – smoking or being around smokers. The Tobacco Control Act in Kenya has been around since 2013. Yet one in four Kenyans is still exposed to tobacco in the workplace or in the home. </p>
<p>More than 13% of Kenyans currently smoke. And in Uganda 40% are exposed to second-hand smoke. Passive smoking – when a person is exposed to someone who smokes, even if he or she doesn’t smoke – is equally dangerous, as it heightens the risk of cancer, chronic respiratory conditions or <a href="http://www.who.int/tobacco/research/secondhand_smoke/en/">heart disease</a>.</p>
<h2>Taking action</h2>
<p>What all this means is that individuals have the responsibility to remove the risks from their lifestyles. </p>
<p>Governments, too, have a responsibility to develop systems to help people mitigate the risks.</p>
<p>Without concerted action at the systems level, the burden on overstretched health services will be even greater, and the costs of inaction will stymie economic growth and development.</p>
<p>Damage to a person’s health and body happens over the long term. It may manifest as a treatable condition, such as being overweight, or having high blood pressure or diabetes, but it can quickly deteriorate into a degree of suffering that can only be managed, not cured.</p><img src="https://counter.theconversation.com/content/58442/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Kyobutungi receives funding from International Development Research Centre (IDRC).
</span></em></p>Non-communicable diseases are skyrocketing in Kenya and Uganda. Though the countries’ governments have a responsibility to tackle the problem, individuals need to take action too.Catherine Kyobutungi, Director of Research, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.