Browsing by Person "Chick, Jonathan"

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Author's reply: Suppressing addiction using high-dose baclofen, rather than using substitution therapy
(Sage, 2012-07) Chick, Jonathan; Nutt, D.
Can Part of the Health Damage Linked to Alcohol Misuse in Scotland be Attributable to the Type of Drink and its Low Price (by Permitting a Rapid Rate of Consumption)? A Point of View
(Oxford Journals, 2010) Gill, Jan; Tsang, Catherine; Black, Heather; Chick, Jonathan
This article considers two sets of data describing the extent of consumption of white spirit drinks by a sample of patients who abuse alcohol and the analysis of drink antioxidant content. We present a proposal for discussion that the rapid consumption of alcoholic drinks, low in protective antioxidant compounds, may potentially be more damaging to the body.
Heavy Drinkers and the Potential Impact of Minimum Unit Pricing-No Single or Simple Effect?
(OUP, 2017-09-07) Gill, J.; Black, H.; Rush, Robert; O'May, Fiona; Chick, Jonathan
Aims: To explore the potential impact of a minimum unit price (MUP: 50 pence per UK unit) on the alcohol consumption of ill Scottish heavy drinkers. Methods: Participants were 639 patients attending alcohol treatment services or admitted to hospital with an alcohol-related condition. From their reported expenditure on alcohol in their index week, and assuming this remained unchanged, we estimated the impact of a MUP (50 ppu) on future consumption. (Around 15% purchased from both the more expensive on-sale outlets (hotels, pubs, bars) and from off-sales (shops and supermarkets). For them we estimated the change in consumption that might follow MUP if (i) they continued this proportion of 'on-sales' purchasing or (ii) their reported expenditure was moved entirely to off-sale purchasing (to maintain consumption levels)). Results: Around 69% of drinkers purchased exclusively off-sale alcohol at <50 ppu. Their drinking, post MUP, may reduce by a mean of 33%. For this group, from a population of very heavy, ill consumers, we were unable to show a differential effect across multiple deprivation quintiles. For other drinkers there might be no reduction, especially if after MUP there were many products priced close to 50 ppu. Moving away from on-sales purchases could support, for some, an increase in consumption. Conclusions: While a proportion of our harmed, heavy drinkers might be able to mitigate the impact of MUP by changing purchasing habits, the majority are predicted to reduce purchasing. This analysis, focusing specifically on harmed drinkers, adds a unique dimension to the evidence base informing current pricing policy. Short Summary: From drink purchasing data of heavy drinkers, we estimated the impact of legislating 0.50 minimum unit price. Over two thirds of drinkers, representing all multiple deprivation quintiles, were predicted to decrease alcohol purchasing; remainder, hypothetically, could maintain consumption. Our data address an important gap within the evidence base informing policy.
Heavy drinkers' perspectives on minimum unit pricing for alcohol in Scotland: A qualitative interview study
(2016-07-07) O'May, Fiona; Gill, Jan; Black, Heather; Rees, Cheryl; Chick, Jonathan; McPake, Barbara
The irrefutable consequence of Scottish excessive alcohol consumption has prompted implementation and proposal of alcohol policy measures. The purpose of this study is to explore with heavy drinkers their awareness of and identify potential implications of policy introducing alcohol minimum unit pricing (MUP). Face-to-face semi-structured interviews were conducted with drinkers with alcohol-related harm (n = 20; 15 males, five females; aged 34 to 67 years old) in Scotland's two largest cities (drinkers were participants within a larger quantitative study, through attendance for treatment for alcoholrelated harms at National Health Service [NHS] centers). Median weekly consumption among participants was 130.7 units (range: 28-256.3 U.K. units). Views regarding the impact of increased alcohol prices, through MUP, were mixed. While some drinkers indicated potential reduction in intake, thus possibly reducing alcohol harms in the long term, the expected, or even desired, from a public health perspective, effects on consumption and associated harms might not be fully realized in this group. To mitigate possible unintended short-term detrimental effects of MUP on the most vulnerable, careful planning and appropriate resourcing may be required prior to implementation.
Strong cider sold in Scotland appears to be almost exclusively for dependent drinkers
(Royal College of Physicians, 2016-08-01) Chick, Jonathan; Gill, Jan; Black, Heather; O'May, Fiona
Letter
Substitution therapy for alcoholism: time for a reappraisal?
(Sage, 2012-02) Chick, Jonathan; Nutt, David J.
A number of compounds already in use as medications for various indications substitute for ethanol at clinically relevant brain pathways, in particular, at gamma-aminobutyric acid (GABA) receptors. Nevertheless, although substitute medications have been recognized for heroin and tobacco dependence, patients with alcohol dependence are rarely offered an analogous approach. Benzodiazepines may have paradoxical effects, and abuse and dependence are known. Baclofen (GABAB agonist) has not been associated with dependence or misuse and has been effective in several trials in preventing relapse, although research is required to establish the optimal dosing regimen. GABA-ergic anticonvulsants, helpful in treating withdrawal, have yet to emerge as effective in relapse prevention. Clomethiazole and sodium oxybate, the latter having been shown to be effective in relapse prevention, have incurred a reputation for dependence and abuse. However, data have emerged showing that the risk of abuse of sodium oxybate is lower than many clinicians had foreseen. For a condition where existing therapies are only effective in a proportion of patients, and which has high morbidity and mortality, the time now seems right for reappraising the use of substitute prescribing for alcohol dependence.
Tailored dose baclofen in patients with alcoholic liver disease: A case series with 2-year follow-up of hospitalisation
(2015-11) Heydtmann, Mathis; Macdonald, Benn; Lewsey, James; Masson, Neil; Cunningham, Leona; Irnazarow, Aleksandra; Nardone, Amanda; Cosgrave, Jan; Chick, Jonathan
Introduction: Alcohol addiction is a major health burden with its consequences including liver disease and frequent hospitalisations. We used tailored-dose baclofen in patients with alcoholic liver disease and investigated hospital re-admissions before and after baclofen dose was initiated as well as tolerability and patient-reported alcohol consumption. Methods: Fifty-three hospitalised patients with alcoholic liver disease started tailored dose baclofen (median: 5.05 months, median highest dose before tapering down: 60 mg). Patients were followed-up for hospitalisation data from the health board database (mean hospitalisation follow up: 31 months) and patients were sent standardized questionnaires. Results: Baclofen was generally well tolerated with dose reductions in four patients. In the 2 years after initiation of the treatment, patients spent on an average of 19.1 d in the hospital per year compared to 25.48 d before the treatment initiation (p = 0.59). Respondents (19 patients) reported a reduction in alcohol consumption by an average of 58.7% (240.1 g to 144.09 g). Conclusions: After initiation of the baclofen treatment, there was a trend towards decrease in hospitalisations and in patients who answered the questionnaire, alcohol consumption decreased. 2015 Informa UK Ltd. All rights reserved.
The enigma of 'harmful' alcohol consumption: Evidence from a mixed methods study involving female drinkers in Scotland
(Sage, 2015-09-29) Gill, J.; Rush, Robert; Black, Heather; O'May, Fiona; Chick, Jonathan; Rees, C.; McPake, Barbara
Background/aims: An appreciation of the drinking patterns of population subgroups may usefully inform tailored interventions. For this purpose, research has highlighted a need to better describe the drinking behaviour of UK women. This study aims to characterise the purchasing and consumption behaviour of female heavy, harmed, drinkers in contact with Scottish health services in two cities and to explore the factors that influence the link to harm. Methods: Mixed methods study involving cross-sectional survey questionnaires and one-to-one interviews (5). The questionnaires documented (1) demographic data (including derived deprivation score), last week's (or 'typical' weekly) consumption (type, brand, volume, price, place of purchase), self-reported illnesses, and (2) Alcohol-Related Problem Questionnaire score. A total of 181 patients with serious health problems linked to alcohol were recruited within National Health Service (NHS) hospital clinics (in- and outpatient settings), in two Scottish cities during 2012. Results: Median consumption was 157.6 UK units for the recorded week, with almost exclusive purchase from 'off-sale' retail outlets. Preferred drinks were white cider, vodka and white wine. Increasing problems was positively associated with drinking more in the week, being younger and belonging to Glasgow. Conclusion: For Scottish women, the current definition of 'harmful' consumption likely captures a fourfold variation in alcohol intake, with gender differences less apparent. While current alcohol-related harm is positively associated with dose and being younger, there is clear evidence of an influence of the less tangible 'Glasgow effect'. Future harm concerns are warranted by data relating to pattern, alcohol dose and cigarette use.
The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland
(Wiley Online Library, 2011-12) Black, Heather; Gill, Jan; Chick, Jonathan; The study was funded by the NHS Lothian
Aim To compare alcohol purchasing and consumption by ill drinkers in Edinburgh with wider alcohol sales in Scotland. Design Cross-sectional. Setting Two hospitals in Edinburgh in 2008/09. Participants A total of 377 patients with serious alcohol problems; two-thirds were in-patients with medical, surgical or psychiatric problems due to alcohol; one-third were out-patients. Measurements Last week's or typical weekly consumption of alcohol: type, brand, units (1 UK unit 8 g ethanol), purchase place and price. Findings Patients consumed mean 197.7 UK units/week. The mean price paid per unit was £0.43 (lowest £0.09/unit) (£1 = 1.6 US$ or 1.2€), which is below the mean unit price, £0.71 paid in Scotland in 2008. Of units consumed, 70.3% were sold at or below £0.40/unit (mid-range of price models proposed for minimum pricing legislation by the Scottish Government), and 83% at or below £0.50/unit proposed by the Chief Medical Officer of England. The lower the price paid per unit, the more units a patient consumed. A continuous increase in unit price from lower to higher social status, ranked according to the Scottish Index of Multiple Deprivation (based on postcode), was not seen; patients residing in postcodes in the mid-quintile paid the highest price per unit. Cheapness was quoted commonly as a reason for beverage choice; ciders, especially ‘white’ cider, and vodka were, at off-sales, cheapest per unit. Stealing alcohol or drinking alcohol substitutes was only very rarely reported. Conclusions Because patients with serious alcohol problems tend to purchase very cheap alcohol, elimination of the cheapest sales by minimum price or other legislation might reduce their consumption. It is unknown whether proposed price legislation in Scotland will encourage patients with serious alcohol problems to start stealing alcohol or drinking substitutes or will reduce the recruitment of new drinkers with serious alcohol problems and produce predicted longer-term gains in health and social wellbeing.
The WHO global strategy to reduce the harmful use of alcohol
(Oxford Journals, 2011-05) Chick, Jonathan
Through a glass darkly: Can we improve clarity about mechanism and aims of medications in drug and alcohol treatments?
(Sage, 2012-02) Nutt, David J.; Lingford-Hughes, Anne; Chick, Jonathan
The treatment of addiction and dependence on, and misuse of, alcohol and other drugs is one of the largest unmet needs in medicine today, so the development of new treatments is a pressing need. However, we have seen the development and use of different terminologies for different drug addictions, which confuses prescribers, users and regulators alike. Here we try to clarify terminology of treatment models based on the pharmacology of treatment agents. This editorial covers all drugs that are used for their pleasurable effects and which therefore can lead to harmful/hazardous use, dependence and addiction. These include nicotine, alcohol and abused prescription drugs such as benzodiazepines, as well as opioids and stimulants.
TOO WHITE, TOO CHEAP, TOO FAST: IS HEALTH DAMAGE CAUSED BY ALCOHOL PARTLY ATTRIBUTABLE TO LOW COST WHICH PERMITS RAPID CONSUMPTION OF BEVERAGES LACKING ANTIOXIDANTS?
(Oxford Academic, 2011-09-01) Chick, Jonathan; Gill, Jan; Tsang, Catherine; Black, Heather
Ways to control alcohol price (Letter)
(BMJ Publishing Group Ltd., 2010-12-20) Chick, Jonathan; Gill, Jan; Black, Heather
The proposal that VAT should be less for on sales than for off sales alcohol might help stem the UK trend towards off sales purchasing. 1 Although difficult to prove, drinking in licensed premises may be safer than drinking at home, because higher prices tend to reduce total -_
What price for an extra-ordinary commodity? ( Editorial )
(Oxford Journals, 2010) Chick, Jonathan
The Scottish Government can make laws independently of the London (Westminster) government, but taxation within the UK is not devolved. Thus, the Scottish Government, when proposing measures to reduce harm from alcohol, cannot raise alcohol-tax to increase the price of alcoholic beverages. Instead, especially to reduce the sale of very cheap alcoholic beverages such as industrial cider (Gill et al., 2010), it has proposed legislating a minimum price per unit (e.g. £0.40 or £0.50 per 8 g ethanol; £1 = 1.6 US$ or 1.2€). Very cheap alcohol has been increasingly used as a loss-leader (sold at below cost to attract purchasers of other products) by UK grocery retailers: it has even been reported that the sales tax (VAT) on promotional offers is reclaimed by the retailer because such offers are advertising. (‘taxpayer picks up cheap booze bill’: Bayer, 2009.) …
White Cider Consumption and Heavy Drinkers: A Low-Cost Option but an Unknown Price
(Oxford Journals, 2014) Black, Heather; Michalova, L.; Gill, Jan; Rees, C.; Chick, Jonathan; O'May, Fiona; Rush, Robert; McPake, Barbara
Aims: To compare characteristics of heavy drinkers who do, or do not, drink white cider during their typical drinking week and to contrast white cider drinkers' behaviour with a similar group recruited in comparable settings 4 years previously. To consider if excessive white cider consumption poses a specific health risk. Methods: Cross-sectional survey of alcohol purchasing and consumption by heavy drinkers consuming white cider in Edinburgh and Glasgow during 2012; comparison of purchasing patterns within Edinburgh in 2008-2009 and 2012. Participants were 639 patients (in- and out-patient settings) with serious health problems linked to alcohol, 345 in Glasgow, 294 in Edinburgh in 2012, and 377 in Edinburgh in 2008-2009. Results: In 2012 white cider consumption was reported by 25% of participants (median consumption (all alcohol) was 249 UK units per week-1 UK unit being 8 g of ethanol). They were more likely to be male and younger. They drank more units of alcohol than non-white cider drinkers and reported more alcohol-related problems. The median price paid for white cider in 2012 was 17 ppu. The period 2008-2012 was associated with decreasing affordability of alcohol, but consumption levels amongst the heaviest drinkers were maintained, associated with an increased proportion of units purchased as white cider. Conclusion: White cider makes an important contribution to the weekly intake of heavy drinkers in Scotland, likely facilitated by low price per unit of alcohol. We suggest these characteristics permit this drink to act as a buffer, supporting the continuation of a heavy drinking pattern when affordability of alcohol falls.