Nursing
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Item 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, BarbaraAims: 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.Item What price for an extra-ordinary commodity? ( Editorial )(Oxford Journals, 2010) Chick, JonathanThe 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.) …Item 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 LothianAim 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.Item Ways to control alcohol price (Letter)(BMJ Publishing Group Ltd., 2010-12-20) Chick, Jonathan; Gill, Jan; Black, HeatherThe 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 -_Item 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, JonathanThis 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.Item 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, FionaLetterItem Author's reply: Suppressing addiction using high-dose baclofen, rather than using substitution therapy(Sage, 2012-07) Chick, Jonathan; Nutt, D.Item 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.Item 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, JonathanThe 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.Item 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, JonathanIntroduction: 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.