Category: Alcohol

Alcohol: poets’ love affair

Spoken word events often take place in bars. Poets who perform at and attend these events are over the legal limit for drinking. But what if an underage poet wants to join them? Their chances to avoid the alcohol culture are grim.

Poetry slam at Accent’s drink-free venue


Young talented poets are forced to perform in alcohol temples. There, they listen to the established artists talking about their drinking. They watch older poets drink one beer after another, which is nothing new in the poetry art. Poetry has a long-established love affair with alcohol, not only in Ireland. For example, W. B. Yeats, an Irish poet and playwright, would have had experiences with the drinking culture. Perhaps they contributed to his Drinking Song:

“Wine comes in at the mouth
And love comes in at the eye;
That’s all we shall know for truth
Before we grow old and die.
I lift the glass to my mouth,
I look at you, and I sigh.”
Being open about alcohol is good – we live in an alcohol-soaked society after all. Denial and silence doesn’t work. Harm reduction approaches to drug use works. Adolescence is a period of experimentation which includes drugs and other risky behaviors. Parents of teen poets could use, for example, Marsha Rosenbaum’s Safety First reality based approach. This approach helps teenagers to make responsible decisions by honest, science-based information, encouraging moderation, understanding consequences and putting safety first.
In addition to education, drink-free venues for arts and poetry events should be promoted. For example, Accents Coffee & Tea Lounge is an alcohol-free place in Dublin City centre. It was created by Anna Young as a cozy environment for people to meet and as an alternative to a pub. Before they opened, there weren’t many places where you could buy coffee late at night in Dublin. It is the only café in Dublin opened till 11 pm. Accents is the home to two poetry events, a poetry slam competition on the first Sunday of the month (See picture), and A-Musing gig, Stand-up comedy and poetry night on the last Sunday of every month.
I hope that there will be more venues like this for aspiring poets. In the meantime, support a poet by “buying him or her beer”.

The truth about drugs found in a cornershop

Our local corner shop sells alcohol. They also sell groceries, such as garlic, which I went to buy last week. I noticed a booklet by the cash register just as I was paying: The truth about drugs. It looked unattractive – dark colors, scary statements – but I took it to learn more about the drug free world as promised on the cover.
The brochure was full of mistakes, contradictions and misrepresentations of drugs. Most of them were myths which are not supported by the evidence and have been perpetuated for decades:
1) MYTH: Drugs have been part of our culture since the middle of the last century.
                FACT: Drugs have been here since ever. They are at least as old as the humankind.
2) MYTH: Young people today are exposed earlier than ever to drugs.
                FACT: This is a favorite headline of most prevention programs. Finding increased rates of drug use among the youths is not difficult. Finding reasons for this increase is difficult and requires knowledge of drug markets. Young people may be using drugs as much as before. They may be using different drugs than in the past, but that’s a matter of drug availability and supply.
3) MYTH: People take drugs because they want to change something about their lives. [] They think drugs are a solution.
                FACT: People take drugs for all sorts of reasons. For alcohol, these reasons can be broadly divided into: social, coping, enhancement conformity and motives. Coping with problems and solution-seeking is just one of the reasons.
4) MYTH: A small amount acts as a stimulant (speeds you up). [] This is true of any drug.
                This is UNTRUE for depressants (downers) and some other drugs. Although, the brochure lists sedative effects of depressants later, I don’t understand why it misleads the readers.
5) MYTH: Drugs make a person feel slow and stupid…
                FACT: Same as above. Cocaine hardly makes people feel slow. It is hard to discern why false statements, such as this one, made it into the brochure. There’s almost no wheat among the weeds.
6) MYTH: Marijuana [] can also be brewed as a tea.
                FALSE: The active compounds are not water soluble. THC is fat soluble though.
7) MYTH: people take drugs to get rid of unwanted situations or feelings (p.13)
                FACT: People take drugs for all sorts of reasons. See point 3 above.
8) UNDERSTATEMENT: the long-term effects of alcohol are understated on p.15 – Alcohol is a hard drug.
9) MISTAKE: Cocaine and crack cocaine can be taken orally…
                Yes, BUT it takes ages to start acting and it’s harder to estimate the right dose – the risk of overdose is higher. That’s why people don’t eat cocaine. Coca leaves are chewed not ingested.
10) DEPRESSION can drive anybody to suicide, not just people who use cocaine. Suicidal thoughts (p.19) are one of depression’s symptoms.
11) TOBACCO: no information in the booklet, although my local store sells cigarettes. They are stored very close to the booklets. Most people tried smoking.

Violence

The brochure’s information about the effects of drugs on violence is inconsistent. Moreover, most people use multiple drugs whose effects on relationships synergize. It’s difficult to separate effects of individual drugs. The brochure states:
  • Heroin – violence and crime are linked to its use
  • Inhalants – users may also suddenly react with extreme violence
  • Crystal meth – causes aggression and violent or psychotic behavior
  • Alcohol – can lead to violence and conflicts in personal relationships
  • Alcohol is ‘more harmful than heroin’ say Prof Nutt, King and Williams in the Lancet journal. Watch BBC News interview.

Target group and choice

The brochure’s target group is unclear. Technical terms are used widely alongside academic references. In two places, it mentions development of “Teenage bodies”, and “teens” surveyed about drugs. It misleads the reader to believe that they can make a decision about drugs. The truth is that the only option provided in this booklet is to live drug-free.
The wide availability of this pamphlet worries me most. Despite wrong information, it’s available at the most exposed spot in 24/7 stores – at the cash register. How come those government health promotion brochures are not there (http://healthpromotion.ie/)? Or the excellent Safety First brochure: reality-based approach to teens, drugs and drug education (www.drugpolicy.org/docUploads/safetyfirst.pdf‎)?

The safest life-choice is to not to use any drugs. Drug-free is a world for some, but not for all. Most of us will use some drugs, legal or illegal, at some point in our lives.

The mystery of change (-ing others): article in the Irish Psychologist

How may I help you– change you?* 

“Change is the Law of Life. And those who look only to the past or present are certain to miss the future.” – John F. Kennedy


Trying to help somebody to change their bad habits is an admirable act of kindness. It shows our compassion and care for the less fortunate. The best is when it comes from the person’s own initiative. Motivated helpers are assumed to be good helpers. Some of us help others pro bono, while others do it as part of their job description. But what if the professional helper doesn’t want to help? How do you help the helper with change in others?

Encouraging professional helpers to address excessive drinking is a complex problem. It’s so complex and resistant to change, that their unwillingness to adopt these new practices can be viewed as a bad habit. Many experts called for complex strategies to persuade their clinician colleagues to address alcohol. But complex strategies did not help.
Professors Anderson, Laurant, Kaner, Wensing and Grol reviewed available scientific evidence and claimed it was possible to increase the engagement of doctors in screening and advice-giving for excessive drinking. They saw a potential in programs which were specifically focussed on alcohol and that were multi-component. Later, some of the original team tested this theory by doing a clinical trial, which is a type of study considered as a golden-standard by many experts. Their Swedish experiment “failed to show an effect and proved difficult to implement”. Are the Swedish too stubborn to embrace change? Let’s not be harsh by accepting this cultural stereotype as a plausible explanation for their negative findings, before we look at more perplexing findings from other countries.
When scientists ask doctors and other professional helpers about what’s so difficult in talking alcohol with their patients, they give the same reasons all over the world. The World Health Organisation (WHO) commissioned a multi-state study, at the beginning of the millennium, which documented all of these reasons – the myths about alcohol care. The myths were lack of time, inadequate training, a view that alcohol is not a matter that needs to be addressed by medical doctors, conviction that doctors’ advice won’t work and fear of talking about such sensitive issue. It seems that the next twist in the story of change brings us to helpers’ beliefs.
Recent research at the University of Michigan, cardiovascular centre demonstrated how doctors’ confidence in their ability to advise patients on diet and exercise correspond with their own personal health and fitness levels. Could this apply to alcohol too? Would it help if we use some evidence-based strategy to boost their confidence or ambivalence about drinking behaviours?
Motivational enhancement therapy (MET) is an evidence-based treatment which targets person’s ambivalence about unwanted behaviours including their attitudes and beliefs. A team supervised by Professors Hettema and Sorensen used this Swiss-army knife of addiction counselling to help doctors-to-be to resolve their ambivalence around managing alcohol and drug problems. They’ve put a group of nine medical residents through a brief MET therapy before they learned more about alcohol consulting and advice-giving. Five weeks later, their consulting and advice-giving went up, but due to the small numbers, the researchers called for caution with interpretation of their results.
Resident education was combined with a team-based approach to systems change in the Richmond clinic – a busy family practice in the south-east Portland, Oregon. Dr Muench led his team to change the way they deal with drinking issues – from receptionists, through medical assistants to physicians.
Dr Muench is a slim, middle-aged physician with a passion for teaching young doctors and helping patients from difficult backgrounds. Explaining their approach to practice change, he points out, ‘we’ve strengthened our practice systems, but the system leaks at three points. They are at the front desk, in the consultation room and in the teaching modules.’ In making these comments, Dr Muench argues that while their project led to many improvements, there are things that can be improved. Ultimately, Muench conveys a positive message about systems change being possible, although not without some obstacles. In the Richmond team-based approach, the receptionists should give patients alcohol check-ups while they wait for the consultation, but they often forget because the PC fails to remind them of this. When the receptionist doesn’t forget to hand out the form, and the patient brings it to a medical assistant, she frequently forgets to complete the full assessment. It is no surprise then that the next ‘cog in the machine’ – the doctors – ‘forget’ to discuss alcohol with patients.
What science tells us about implementing change is reassuringly similar to the traditional knowledge of common folk. If you can’t change others, change yourself. “We must become the change we want to see”, said Gandhi. Richmond truly became the change they wanted to see in others. And yet, the project’s 75% yardstick of engaging patients into alcohol discussions wasn’t met. Why was Richmond below targets? Embracing change in healthcare requires system changes and education on several levels – multi-level changes.

*This is a shortened version of my article published in the Irish Psychologist, Volume 40, Issue 2/3. Dennis McCarty, PhD gave me feedback on drafts of this blog post.

Citation for the full version of this article:

Klimas, J. (2013). The mystery of change(ing) others. Irish Psychologist, 40(2-3), 78-79. http://www.psihq.ie/irish-psychologist-journal-of-psychology

Black fish: how whales and researchers form groups

The eight of us met on Monday, December 2 for a second attempt to create a research group in primary care at University of Limerick. Our discussions brought us to whales and we found ourselves surprised about how they form groups – similar to ours.
Whales form natural groups and families. If you put them together in captivity and expect them to act as a group, they won’t. It’s not natural. What we learned from today’s meeting of the primary mental healthcare research group is that researchers are not so different than whales. If you put them together in a room and expect them to act as a team, they won’t. Social psychology teaches us that people need to have a vision to identify with. Group cohesion can be strengthened by promoting common goals, something that all can identify with. Organizers of the st patrick’s parade in Belfast know it well. They give a tricolored ribbon to all paraders. The ribbon makes them feel part of the parade.
After brief introductions of group members and a lunch with our PI, we went on with finding out how we can help to improve primary care. Our key research question: “what is the role of primary care in managing mental and substance use disorders?” is addressed by the current projects:

Towards early intervention for youth mental health in primary care: a mixed methods study from two perspectives
PINTA – Psychosocial interventions for problem alcohol use among problem drug users: controlled feasibility study in primary care
SPIRIT – Supporting practice integration with research and integration with information technology
EMMES – Establishing minimum medical education support standards
OPTIMIST – Towards optimum mental disorders treatment: a mixed methods study in general practice

For these questions, we use key methodological approaches:
  • Health services research
  • Epidemiology
  • Qualitative and mixed methods
  • Systematic and non-systematic reviews of literature
  • Training and education


Researching primary health in worsening economic situation is becoming increasingly difficult. Through pooling our resources we can make it easier and more effective.

Interested in knowing more about how whales form groups in nature compared to captivity?
check out: http://blackfishmovie.com/
http://www.greenpeace.org.uk/blog/oceans/blackfish-movie-when-whales-turn-killers-20130724

Facing the fear: alcohol and mental health conference in Ireland (#facingthefear)

On Wednesday, 20 November 2013, I’ve attended this conference in the Royal College of Physicians in Dublin, Ireland. The conference was organized by alcohol action Ireland. What were the fears that the presenters encouraged us to face? Read about them below

Dr Bobby Smyth started his talk with a brief intro into the ways by which culture and language shape attitudes about drinking – a cultural learning to drink. He saw teens as apprentice adults, learning by observation. The age when they start to drink has gradually lowered during the Irish boom. Who’s fault is that? The alcohol industry and crazy sports sponsorships play a role. Also, “our culture encourages us to drink to overcome low mood”.

Teens learn to wipe on the shoulder of vodka. If they continue to “bathe” their brain in alcohol soup, they are rolling the dice – can we stop it rolling or roll it safely? Dr Smyth provided their book as a guide for dealing with some of these issues (see Fig 1).

One of the key drinking motives is the social motive – alcohol is a social lubricant. This is reflected in the language too. Eskimos are surrounded by snow all year round and have 100 words for it. There are 120 words for the state of alcohol intoxication in Ireland. People have stopped having fun sober. Moral language of industry-sponsored sites is often substituted for more effective strategies. Slogans like drink sensibly can hardly foster behavior change.

Prof Ella Arensman spoke about the focused on health& women, especially on the seasonal patterns of self-harm and public holidays.

Dr Conor Farren addressed the relationship between alcohol and mental health issues, including depression. He also showcased his book (see Fig 2).

Dr Philip McGarry spoke about alcohol’s impact on mental health in Northern Ireland.

After lunch, the delegates came back for a panel discussion featuring Dr Claire Hayes, John Higgins and Fr Pat Seaver.

Watch the speakers’ presentations here