Binge long lasting effects, such as irreversible disabilities,

Binge drinking is a behaviour defined by the
pattern of drinking alcohol that brings blood alcohol concentration (BAC) to
0.08 gram-percent or above (The National Institute on Alcohol Abuse and
Alcoholism (NIAAA), 2004). This pattern
corresponds to consuming five or more drinks for the typical adult male and
four or more drinks for the typical adult female, over a period of two hours
(NIAAA, 2004). There are a number of issues when comparing outcomes from different studies regarding binge drinking. One
of them is the disagreement regarding the amount of drinks used to define this
behaviour. It is therefore important to highlight the word “drink” which henceforth
equates to one 10 g serving of absolute alcohol, defined by The World Health
Organization (Kalinowski & Humphreys, 2016). This provides a concise
definition of a ‘standard’ drink thus avoiding any problems that may arise in
countries where serving sizes differ (in terms of their pure ethanol content). Another issue regarding binge
drinking is the cut-off used for the number of drinks: five drinks for the
adult male and four for the adult female have been decided (NIAAA, 2004). Hence, a clear
definition as mentioned above regarding binge drinking is imperative, in order
to limit any ambiguity.

Binge drinking
is a major public health concern having a considerable
impact on the individual’s health, due to its association with a range
of adverse outcomes; some with long
lasting effects, such as irreversible disabilities, or others being fatal
(Anderson, 2007; Courtney & Polich, 2009; Dawson et al., 2008; Gmel et al.,
2003; Ham & Hope, 2003; Plant & Plant, 2006, as cited in Kuntsche, 2017).
Notably, binge drinking provokes symptoms that are directly related to the
state of intoxication manifesting in nausea, vomiting, hangovers and memory
loss. In addition, this pattern of drinking “may lead to involuntary and unprotected
sexual activity” (Perkins, 2002), which makes binge drinking a contributing factor
in the transmission of HIV and other sexually transmitted diseases. As a
direct result of altered cognitive and psychomotor effects on reaction time,
poor cognitive processing, and coordination (Gmel et al., 2003, as cited in
Kuntsche, 2017), alcohol misuse is responsible in the occurrence of injuries,
motor vehicle accidents and other traumas. Besides unintentional injuries (Hingson & Zha, 2009), binge drinking
may also cause “intentional injuries such as self-inflicted harm and suicide” (Borges
& Loera, 2010; Norstrom & Rossow, 2016; Schaffer, Jeglic, &
Stanley, 2008, as cited in
Kuntsche, 2017) as well as “violence and homicide” (Brewer & Swahn,
2005).  Due to the disinhibiting effect
of alcohol, binge drinking may harm others through interpersonal violence
(Perkins, 2002). This disinhibiting effect of alcohol, influences
the decision to use force instead of conflict avoidance. Furthermore, the
effects of alcohol may lead to the misinterpretation of cues from others because
of a lack of attention and cognitive processing, which may lead to fights (Giancola,
Josephs, Parrott, & Duke, 2010; Townshend, Kambouropoulos, Griffin, Hunt,
& Milani, 2014, as cited in Kuntsche, 2017) and sexual violence (Abbey,
McAuslan, & Ross, 1998). Amongst women, drastic long-term
consequences for the unborn may also be a consequence of frequent binge
drinking episodes (Gmel et al., 2011, as cited in Kuntsche, 2017). Binge drinking is “not just
inoffensive social fun”, as stated by Petit et al. (2014). If maintained, it
may contribute to the start of cerebral disorders, causing alcohol dependence
later in life (Petit et al., 2014). Therefore, we can identify binge drinking
with all of the long-term repercussions recognized in heavy, chronic or even
dependent drinkers.

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With regards to the prevalence of binge
drinking, it has been estimated that for the population of 15- year olds and
older, 7.5% binge drink at least every week (World Health Organization, 2014).
This has been concluded in an attempt to come to a consistent estimate of binge
drinking  (60 g on an occasion at least
once in the past 30 days) worldwide, as it is relatively difficult to distinguish
cultural variations from variations linked to diverse measurements, time frames
and restriction of age groups regarding binge drinking, making the prevalence
rates differ across countries. This proportion of the worldwide population also
differs considerably across regions. Clear evidence is shown in gender
differences where binge drinking is more common among men than women (World
Health Organization, 2014). However, some narrowing gender differences have been
found in the past twenty years (Keyes, Li, & Hasin, 2011; Kuntsche et al.,
2011). As for binge drinking regarding differences in different neighbourhoods,
people in the most deprived neighbourhoods are more likely to binge drink than
in the least deprived neighbourhoods, particularly
in young and middle-aged men (Fone DL, Farewell DM, White J, et al 2013). In regards to alcohol
related deaths, there is an association between deaths related to alcohol and
socioeconomic deprivation, where groups with a lower socioeconomic status are
considered to have 1.5 to 2 times higher mortalities related to alcohol, this
shown in a study conducted by Probst, et al. (2014, as cited in Smith, 2014).
Another study, showed a 5.5 higher rate of mortalities related to alcohol in
the most deprived quintile of local authorities in England in comparison to the
least deprived (Department of Health, 2012). Another study conducted by The
University of Sheffield, (2012), shows that the 20% most socio-economically
disadvantaged population of England and Wales account for 32% of
alcohol-related deaths among men and 26% of alcohol-related deaths among women,
whereas, the least disadvantaged 20% of the England and Wales population
accounted for a lower percentage of deaths related to alcohol, 11% for men and
14% for women. Within health care services, health policy is considered to be a
key factor in order to attain specific health outcomes within society. Binge
drinking is a governance priority, since the governance recognise binge
drinking as a burden on individuals, families as well as a drain on hospital
resources and public money (Department of Health and Social Care, 2015). 

Drinking within
moderate guidelines is not directly damaging, however if an individual were to
drink to the point where he or she became intoxicated it could become a cause for
concern (Morrow, 2017). If not controlled, binge drinking has been found to be
a factor in continued alcohol abuse and alcohol dependence
(Morrow, 2017). There are multiple reasons for people to binge drink and
these are relatively varied (Morrow, 2017). However, there are a few common causes for this
behaviour. Reasons such as drinking because it is fun, is one of the most
common and often cited. Secondly,
people have a need to socialize and to feel more self-confident. This is especially
true for shy or introvert people who find socializing difficult, unless they
drink because it helps them to feel more relaxed; people tend to let go of
their inhibitions thus easing the burden of expectations and pressure.  Alcohol has a tendency to make one feel more
uninhibited. Another often cited cause for people to binge drink is the attempt to
forget personal problems. This receives more attention from scientist and
support groups as it might indicate an underlying problem for the individual.
Binge drinking to let go of stress is a frequent occurrence as well, however,
indulging in this behaviour on a regular basis can make an individual
susceptible to the danger of alcohol abuse leading to a dependence of the
substance as a coping mechanism. Peer pressure and peer acceptance issues are another reason to
add to the list. Not fitting in, is a common fear seen in a lot of individuals.
Binge drinking for some people is seen as a behaviour that can lead one to be
accepted by others. Curiosity is also a reason for people to binge drink, as
they want to experience what others experience. Alcohol increases the release
of dopamine, the so-called feel good hormone, into the brain. The more an
individual drinks, the larger the amount of dopamine released, thus blocking
those negative emotions of stress, fear, insecurity
and anxiety. However the large amount of dopamine release can lead to fights, inappropriate sexual behaviour,
criminal activity, use of other drugs and other violence (Weis, 2015).

As the prevalence of binge drinking demonstrates
the differences in gender, ages and countries, it is important to mention that
these predictors are not considered as
modifiable, which means no interventions may be applied at this level, as one
cannot change the gender of someone, his/her age nor his/her nationality in
order to reduce their binge drinking behaviour. Which brings us to reasons for
binge drinking which are modifiable, and are being modified with the help of health
psychology interventions, in order to support this behaviour change. One of
them for example is the lack of self-confidence that one has in one’s abilities,
power, and judgment. For example, a lack of belief an individual has regarding
his or her ability to deal with specific situations, such as being social,
fitting in with others or afraid of not being accepted by their peers.
It is therefore and for all of the above reasons regarding the effects of binge
drinking on the individual, that interventions to reduce binge drinking are needed
in order to reduce the potential risks associated with it. Little has been mentioned
thus far regarding men in deprived neighbourhoods. Therefore, this research
question has been suggested;
“Does Protective Behavioural Strategies with Motivational Interviewing reduce
binge drinking among young and middle-aged men (aged from 18 years old to 50
years old) in a deprived neighbourhood?”

If enough participants are recruited to be part of the
study, a randomised control trial might be possible to execute the
intervention. In this case, the intervention group would receive a Protective
Behavioural Strategy combined with Motivational Interviewing. The control group
would receive a presentation on health and how alcohol consumption affects
their health. However, it may be difficult to recruit and target sufficient
participants from this specific population that are interested in such a study.
A potential lack of participants willing to engage might be the case, which
means that a randomised control trial will not be carried out easily. Instead,
a pilot study will be executed. The intervention will be carried out on the
participants recruited via a charity for alcohol abuse. The intervention will
be a 30-minute, face-to-face session, every two weeks, for a period of three
months. A follow-up after three months will be conducted and one after 6 months,
in order to measure the outcomes of the intervention. The outcome measures will
be concluding to what extent the intervention reduced binge drinking. It may
also be of interest to review the modifiable predictors. Has the intervention
been able to change the modifiable predictors in order to reduce binge
drinking? If the results of the pilot study are promising, a potential study in
the future might be carried out with a larger population where a randomised
control trial will be possible.

The intervention used is a combined method of Protective Behavioural Strategies
(Pearson, 2013) that is to say behaviours that decrease the negative
consequences of alcohol use (Martens, Pederson, LaBrie, Ferrier, & Cimini,
2007).  These behaviours are mentioned as
“alcohol reduction strategies” (Bonar et al., 2011), “behavioural self-control
strategies” (Werch & Gorman, 1988) and “drinking control strategies”
(Sugarman & Carey, 2007). The aim is to limit the level of alcohol
consumption through the setting of drinking limits. ?With that, a skills
training is required, which will provide the participants with useful advice on
how to consume alcohol in a safer way. Examples for this are learning to say
no, avoiding heavy drinking or high-risk situations and abstaining from
excessive drinking. The second method is a Motivational Interviewing Intervention
(Miller & Rollnick, 2002). This is a “focused and goal-directed counselling
style”, where the focus is to trigger the inherent motivation of the drinker in
the direction of action, which is changing his drinking behaviour, this by
exploring and resolving the patient’s ambivalent feelings. As mentioned previously, there are different
reasons for people to binge drink. Therefore, it is important to understand and
to underline the specific reasons for each participant to binge drink and to control
them by manipulating the individual’s motivation to change his own behaviour. Following
the Theory of Planned Behaviour (Ajzen, 1991), intentions in order to change a
behaviour are predicted by three constructs; attitude, perceived behavioural
control and subjective norms.

Consequently, it is important in order to reduce binge drinking in our
specific population, to increase and prolong the motivation of the participants
to have the intention to decrease their binge drinking behaviours, this by
focusing on the 3 components. Thereby, changing the individual’s attitude
towards binge drinking, increasing his perceived behavioural control and controlling
the individual’s normative beliefs and his motivation to comply to it, are
important in order to change the individual’s intention and eventually to modify
his behaviour towards binge drinking.  


Motivational Interviewing Intervention is not based on
one specific theory but rather on a set of principles, derived from different
theories, such as the importance of self-efficacy. The self-efficacy concept is
part of the Social Cognitive Theory (Bandura 1986). This theory suggests that
behaviour is determined by motivation and expectancies. It suggests that “behaviours
are changed when a person identifies control over the outcome, confront external
barriers, and feels confident in their own ability” to confront them (Bandura,
1986, as cited in So?derlund, 2010). Having a high self-efficacy is a
significant predictor of behaviour change (Armitage & Conner, 2000, as
cited in So?derlund, 2010). Another principle derives from the
Self-Determination Theory (Deci & Ryan, 2002), where the client’s
self-awareness is increased, by supporting the patient’s autonomy, reflective
listening to what the patient has to say, and summarizing what the patient
says. This increase in self-awareness, will facilitate and inspire the patient
in making more autonomous choices, and eventually to change their behaviour (Vansteenkiste
& Sheldon, 2006). “Patients who experience autonomy-supportive counsellors,
benefit more from the treatment” (Williams, 2002; Sheldon, Joiner, Petit, &
Williams, 2003, as cited in So?derlund, 2010).

Regarding Protective
Behavioural Strategies they are described as a combination of cognitive and behavioural
strategies (Martens et al., 2004). All these psychological principles underpin
the intervention. 


It is
important to bear in mind that one crucial aspect of conducting research is the
ethical issue. There are four commonly accepted principles of health care
ethics, excerpted from Beauchamp and Childress (2008), these four principles
include the respect for autonomy, the principle of non-maleficence, the principle of
beneficence and the principle of justice.

Regarding the respect of autonomy there
is a need to inform the participants in order to have an informed voluntary
consent; it is necessary
to give the participants information about the intervention that they are going
to go through; it is important to clearly specify that the participant is
allowed to withdraw at any moment of the intervention. The intervention will
take place only after informed written consent is obtained from the
participants, and total confidentiality is assured. Regarding the principle of beneficence,
if the intervention has been successful, the participants will have reduced
their episodes of binge drinking, and this will be beneficent for them. This
intervention is considered to promote well-being, as its goal is to reduce the pattern
of binge drinking. The principle of
non-maleficence focuses on how the participants are going to be kept safe. It
is important to make sure that the intervention will not increase the drinking
pattern of the participants. Therefore, it is important to carefully monitor
the participant’s behaviour and to be able to identify at an early stage if
there are any symptoms of alcohol withdrawal such as tremors,
nausea, vomiting, loss of appetite, confusion, irritability, mood swings and
sweating. It is important to ascertain how much each participant has been drinking
to be able to reduce the amount of binge drinking gradually and not all of a
sudden, this in order to avoid an abrupt alcohol withdrawal or even the reverse
reaction such as to binge drink more.  In
this case, it is important to have a specialised general practitioner in
alcohol withdrawal on the multidisciplinary team. As for the principle of
justice, it is worth noting that traditionally the burden research has often
been on students and wealthier populations but not on this population; young
and middle-aged men in deprived areas, therefore research tackling deprived
communities is important in order to raise awareness of those living in these
communities. This might reduce the gap between health inequalities as alcohol
mortality grows with socioeconomic deprivation (Probst et al., 2014, as cited
in Smith, 2014). Regarding the governance frameworks, the participants will be
recruited via charity so ethical approval for the intervention will be
recruited from the School of Health Science Research Ethics Committee.

The role of the Health Psychologist is to promote and
improve the health and wellbeing of the general public as well as to promote
and improve the health care system and to formulate and inform health policy; all
of this by applying psychological knowledge, research evidence and interventions
(British Psychological Society, n.d.). The role of the Health Psychologist
consists furthermore of different tasks such as planning, developing,
delivering and evaluating interventions. It also includes dealing with
psychological and emotional aspects of health and illness as well as supporting
people with chronic illness. Health Psychologists work alongside other health
care professionals and together are part of a so-called multi-disciplinary
team. An important role of the Health Psychologist is to assure that the
interventions are sensitive to the needs of the clients this within different
populations and cultures. Interventions can be executed face-to-face with one
patient, so at an individual level or with different patients together, in a
group. Interventions can also indirectly be executed through media or online
interventions (Health Careers, n.d.). It is important to outline the importance
of the role of the Health Psychologists, as Health Psychology is still a
relatively young discipline (Bayne & Horton, 2003, p. 86) that does not
receive enough attention. Regarding the intervention mentioned in this essay, strategies
for promoting healthy behaviours, such as alcohol reduction strategies,
behavioural self-control strategies and drinking control strategies,
accompanied with the aim to activate the intrinsic motivation of the participant
in order to reduce his binge drinking pattern, is considered one of the many tasks
of the Health Psychologist in order to improve the health outcomes of the
participants. According to Hallas (2004), other responsibilities
of the work tackled by a health psychologist are “the provision of direct
patient care, health education, minimizing the distress related with the
medical procedures and helping the patients with their decision-makings”
(Hallas 2004, as cited in Abraham, Conner, Jones, & O’Conner, 2016). In
this essay the Health Psychologist provides personalized education on how to
consume alcohol in a safer way, how to prevent having binge drinking episodes
by saying no, educates the participants about their limits, by giving practical
advice, and activates the intrinsic motivation for the drinker to change his
drinking behaviour. The strategies used for the intervention targeting binge
drinking in young and middle aged men, in deprived neighbourhoods, are based on
behaviour change models, as the aim of the intervention is to change the
drinking behaviour of these participants.


Behaviour plays a crucial role in the development of numerous
long-term conditions, it is therefore important to focus on behaviour change,
as it is compulsory for prevention and for the treatment of long-term
conditions (Khaw et al., 2008; Mokdad, Marks, Stroup, & Gerberding, 2004, as
cited in O’Carroll, 2014). 


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