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There has been increasing recognition that alcohol may be a source of problems for older people. This has been reflected in the increase in alcohol‐related hospital admissions for people over 65. Although a neglected area in policy and research within the UK, studies from health and social care practice have drawn attention to the complexity of the issues for practitioners. This paper seeks to report on qualitative research which aims to generate a wider evidence base by exploring the circumstances in which older people drink; the meaning that drinking alcohol has for them and its impact; and acknowledging that this can be a pleasurable and positive experience, as well as something that can have adverse health, financial, personal and interpersonal impacts.

A major challenge of the research, given the sensitive nature of the topic, was how to approach older people and ask about their experiences of alcohol use. A participatory methodology was developed in which older people were actively involved in designing and carrying out the research. Older co‐researchers conducted 21 individual interviews and three focus groups with a diverse range of older research participants from different backgrounds and circumstances.

The findings indicate that participants engaged in different drinking styles which are connected to complex relationships between individual biographies, personal circumstances and external factors. Recommendations for practice and policy development are made on the basis of these findings.

This is a sensitive topic involving stigma and practitioners have highlighted issues around lack of training and appropriate referral services as well as difficulties in approaching the topic with older people. In addition, there is a tension in the drive to promote service users' rights to have choices and the question of whether to intervene if those choices involve risky behaviour. Even less is known about the perspectives of older people themselves and more research is needed to understand the social, cultural and economic contexts of older people's drinking behaviour.

Alcohol consumption is on the increase, particularly among women and young men (Waller et al., 2004). The Government, in showing its concern, has published a report on the extent of binge drinking alongside its long awaited alcohol strategy. While the binge drinking report focuses on the problematic nature of alcohol consumption and associated violence, the issue of dealing with the health consequences is often overlooked. Continuing our look at specialist nurses, Jeff Fernandez explores how they can take a key role in treating arguably the UK's biggest substance misuse and health problem ‐ taking care of Britain's drinkers.

The purpose of this paper is to explore current practice, barriers and facilitators to identifying and responding to alcohol problems in memory clinics.

A questionnaire sent to professionals in 55 memory clinics in England, Wales and the Isle of Wight and two focus groups with professionals from three memory clinics in England.

Only 1/35 clinics that responded to the questionnaire was using a standardised alcohol screening tool but all attempted to gain some information about alcohol use. Without screening tools, practitioners found it difficult to determine whether alcohol use was problematic. Barriers to identification/intervention included cognitive impairment, service-user being “on guard” during assessment, presence of family members/carers, time constraints and a perception that brief interventions were not within the remit of memory clinics. Facilitators were obtaining visual clues of problem drinking during home visits and collateral information from family members/carers.

Focus group participants were recruited through convenience sampling and a small number of professionals took part. This means that the findings may be subject to selection bias and limits the generalisability of the findings.

Memory clinics should provide guidance and training for practitioners on how to intervene and respond to alcohol misuse. Further research is required to determine the most effective way to identify alcohol problems in people with cognitive impairment and how to deliver brief alcohol interventions that take account of cognitive deficits.

This is the first study to examine alcohol screening and interventions in memory clinics and identifies a need for guidance, training and further research.

There has been much written on gender in the academic world and its impact on society. Women suffer disproportionately from inequality (Haralambos & Holborn, 2000) and substance use treatment is no different. The workplace and affluence are key areas where this problem has been tackled, though with limiting results. Here Jeff Fernandez asks why women are less likely to seek help for substance use and how, using common psychological techniques, we can entice them back again.

The purpose of this paper is to describe the relationship between migratory status, the use of legal and illegal psychoactive substances and psychological disorders perceived in a sample of minors.

A transversal multicentre study was carried out with interviews with young people aged 13-16 years recruited from middle and high schools in Italy.

The results show the implementation of a process of normalization in terms of the presence of legal and illegal psychoactive substances in the living contexts of the minors, of their widespread early use and of a substantial indifferentiation in the reasons for use (e.g. pleasure, curiosity, fun). Youths born in Italy with at least one non-native parent are noteworthy for an elevated prevalence of perceived psychological disorders and for particular lifestyles linked to the use of marijuana, alcohol abuse and the intensive consumption of tobacco. Second-generation minors show symptoms of psychological malaise, anxiety and depression before which the use of substances appears to realize a particular form of self-cure.

This study presents some objective limits that indicate prudence in generalizing the results: only those who obtained consent from their parents were interviewed and the information communicated in the interviews could have been influenced by various factors, including the situation and the location. The authors used a standard definition of binge-drinking (Valencia-Martín et al., 2008). Actually, different criteria (i.e. number of drinks, time of consumption, etc.) and formulations of the question are used in different surveys, showing that there is as yet no consensus definition of binge-drinking. Nevertheless, the term has become somewhat confusing as it is often used as a synonym of drunkenness, making cross-cultural comparisons difficult (Beccaria et al., 2014). These are aspects that limit the generalizability of the results to the interviews alone and do not allow for prevalence estimates. Nevertheless, the results offer useful indications for future prevention projects specifically oriented to early adolescence.

The results of the study, on the one hand, document the growing use of legal and illegal proactive substances among minors and the relative cultural trend in this particular age band, testified to by the high number of those who have been present in situations of consumption to whom the substances were offered; on the other, they evidence a subpopulation of youths born in Italy with at least one non-native parent (i.e. second generation of immigrants). These youths stand out for an elevated prevalence of perceived psychological disorders and for their particular lifestyles connected to the use of marijuana, alcohol abuse and the intensive consumption of alcohol. This is also the group with the highest percentage of mothers alone in the family.

A group of adolescents living in a monoparental family, that is, with the mother alone emerges, and as the literature has shown, family structure and poverty are linked (Landale et al., 2011; Svensson and Hagquist, 2009). In fact, such mothers, even those with a high level of education, are mostly unemployed. Adolescents with a single parent often not only face resource deficits but also other risk factors, such as high family stress, inadequate supervision, multiple family transitions and frequent residential moves. Specifically, these second-generation adolescents are female and they manifest sensation-seeking behaviours, but without drug abuse.

The results of the study show new and little-known aspects of the multicultural Italian society that is changing profoundly that should be explored in more detail by targeted research that also focussed on structural factors relatable to specific social positions. In this framework, a particular subgroup, i.e. the second-generation minors, shows symptoms of psychic malaise, anxiety and depression in terms of which substance use seems to realize a form of self-cure.

The treatment of substance use amongst mentally disordered offenders (MDOs) remains a challenge for secure forensic mental health services. The purpose of this paper is to present an integrated three-stage substance use treatment programme (SUTP) for male and female MDO’s in medium security.

In total, 45 (72.6 per cent) MDO’s were referred (39 males/6 females). Standardised outcome measures were administered pre-SUTP, post-SUTP and at one year follow-up. Abstinence rates and location was determined via case notes at three year follow-up.

All MDO’s had a past history of substance use, approximately three-quarters reporting problematic use prior to admission. Over half completed all three SUTP stages, less than 5 per cent dropping out during active treatment. The SUTP supported abstinence throughout the one year follow-up period and significantly improved MDO’s adaptive beliefs about substances and craving by one year follow-up amongst attendees. At three years, most MDO’s were in the community and almost three-quarters were abstinent. There was no significant difference in abstinent rates between community and hospital. There was a non-significant trend suggesting SUTP attendance supported abstinence. Both male and female participants appear to have benefited from treatment and satisfaction was high, reflecting the specific aims and objectives of treatment.

The small non-randomised sample from one area limits the generalisability of findings and statistical power.

Findings indicate further support for the limited evidence base that small but clinically meaningful and maintained changes to problematic substance use are possible following integrated substance use treatment for male and female MDO’s.

Background: The central issue of this paper is whether the intuitive relation between problematic drinking and seeking professional help holds. To shed light on this issue an ecological study is done in which the relation between different drinking patterns, alcohol‐related harm, and help‐seeking behaviour at the neighbourhood level of Rotterdam, The Netherlands is examined. Two questions are posed:1. Are there geographical differences in drinking patterns, alcohol problems, problem drinking, and number of alcohol clients within the city of Rotterdam?2. Is there a relation between drinking patterns, alcohol‐related harm, and help‐seeking behaviour at the neighbourhood level?Methods: Ecological analyses are conducted based on individual data originating from a survey and person‐based registers. Respondents to the survey were classified as abstainers, light, moderate or excessive drinkers, and were classified as having alcohol‐related problems and/or being a problem drinker. Person‐based registers were used to obtain data on the number of ambulatory and clinical alcohol clients in Rotterdam. The number of ambulatory and clinical clients measured help‐seeking behaviour.Results: The intuitive reasoning that the more problematic drinkers, the more professional help is sought does not stand. No association was found between the number of alcohol clients and the percentage of excessive drinkers and problem drinkers at the neighbourhood level. Large differences between neighbourhoods in prevalence of excessive drinking, alcohol‐related problems and problem drinking were found. The number of alcohol clients, however, varied much less between neighbourhoods. A notable result is that the higher the percentage of abstainers, the lower the number of alcohol clients in a neighbourhood.Discussion: It was concluded that in all neighbourhoods the number of problem drinkers outnumbers those seeking professional help, indicating a friction between need and supply of help with respect to problematic drinking. It is hypothesised that besides drinking behaviour and drinking‐related problems individual, as well as social and cultural factors, play a role in the process of help‐seeking behaviour.

This chapter begins with a brief history of the ways in which alcohol has been ingrained in American culture since the arrival of European settlers and their enslavement of African people. The chapter then addresses important aspects of alcohol and other drug use among college students. Because of the popularity of alcohol and cannabis among college students, they occupy the primary focus of the chapter, although other psychoactive drugs are briefly discussed as well. The chapter draws from data collected by the Healthy Minds Study, the Center for Collegiate Mental Health (CCMH) and the American College Health Association (ACHA) in describing the prevalence of alcohol and cannabis use among college students, as well as trends in the use of both substances. The reasons college students drink and use cannabis are explored, as are the many consequences, including academic, legal, physical and interpersonal. The chapter examines a number of prevention strategies that colleges have used to minimize the negative consequences of substance use, including large-scale scare tactics, educational efforts and norming campaigns, as well as individually tailored programs; the effectiveness of each is reviewed.

This paper reports some of the findings from a survey of 2,027 British adults that was conducted in 2000. This investigation examined self‐reported alcohol consumption and the negative consequences associated with heavy or inappropriate alcohol consumption. In addition, information was elicited on the topic of the positive aspects of drinking. This paper examines the ‘drinking profile’ of those people who reported positive aspects of drinking. Most of the people surveyed reported that their past year's alcohol consumption had been enjoyable regardless of whether it had been associated with adverse consequences. In contrast, a few individuals reported drinking heavily even though they had not enjoyed their recent alcohol consumption. The relationship between alcohol consumption and its negative and positive consequences appears to be complex. There was clearly ambivalence between the adverse consequences associated with drinking and its positive effects. Many people appear prepared to tolerate some negative experiences as the price they pay for enjoying their drinking. This constitutes a major inhibiting factor in relation to preventive initiatives and therapeutic interventions related to problematic alcohol consumption.

It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.

Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.

For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.

Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.

Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.

Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.