This week we are pleased to share perspectives on how behaviour change can help tackle harmful drinking from our colleagues Liz Hampson and Nicole Malouf, – This is a short thought piece to be presented at The Global Chief Medical officers Network.
Alcohol abuse is a substantial burden to public health. There are about 3.3 million deaths attributable to alcohol worldwide, representing 5.9 per cent of all mortality.i In 2012, an English Health and Social Care Information Centre survey reported that of those who had consumed alcohol within the last week, 55 per cent of men and 53 per cent of women drank more alcohol than the recommended limit, with 31 per cent of men and 24 per cent of women drinking more than twice the recommended daily amount.ii This high incidence of harmful drinking leads to serious chronic health conditions, disability, and mental illness and the economic burden is equally substantial, with the estimated cost to society of alcohol-related harm in England some £21 billion per year. This includes £3.5 billion in NHS spending, £11 billion in crime-related costs, and £7.3 billion in lost productivity.iii
A 2009 Omnibus survey report on drinking asked respondents whether they had heard of measuring alcohol consumption in units, 90 per cent had, an increase from 79 per cent in 1997. Likewise the percentage of people who had heard of daily drinking limits had increased from 54 per cent in 1997 to 75 per cent.iv Awareness of safer drinking levels is not sufficient to drive behavioural change and, despite rising awareness, alcohol-related deaths have risen by 19 per cent between 2001 and 2012 (with 6,490 deaths in England in 2012).v Nevertheless, there is a growing body of evidence that this harmful behaviour can be changed and recent statistics show that since 2012 there has been a decrease in alcohol related deaths including a measurable reduction in harmful drinking in the 18 year olds.vi
The stages of change model
The science behind the study of behaviour argues that change is possible through deliberate strategy and action planning. Studies show that it takes anywhere from 18 to 254 days (with a mean of 66 days) of actively pursuing a behaviour to form a new habit.vii One model commonly referred to in discussing behaviour change is the Stages of Change Model which assigns five stages to the process. In this scheme people move from a pre-contemplation phase of either unawareness or lack of interest in change; to a contemplation stage with increased appreciation of problems where thoughts about making a change begin to form; to a third or preparation stage where a decision is made to act and planning for the change is strategised. The fourth stage in the model is the action stage, where the planned change is carried out.viii Once action has been taken, the focus shifts to maintenance and prevention of relapse. Unfortunately, it is common for people to cycle through the prior stages as part of a pattern of regression and procession.
Power of social media
Social media has provided a new instrument for facilitating movement through these stages of change as it provides easy access to information and sharing of information from friends and other subscribed links. The e-messenger delivering the information is also more likely to be trusted. This, in turn, makes people more receptive to the message, which can serve to help increase contemplation for change. Indeed, it seems norms are increasingly driven by what is seen online as social media allows for tracking of friends' posted activities and thoughts. Therefore, programmes promoting behaviour change would be expected to have a higher uptake where friends and other social media contacts are also involved. Finally, the act of making an online, public commitment to change a behaviour (whether through a posted statement committing to a change or through a more formal online participation)is, in essence, seen as a social contract. Once a commitment is made there is a drive to succeed in order to satisfy one's ego, thus a commitment to action that is easily made online becomes an effort to sustain a period of positive behaviour change.
Dry January – the way forward?
One example of a successful social media behavioural change program is Alcohol Concern's "Dry January". The campaign seeks to raise awareness and reduce harmful drinking behaviour by challenging people to abstain from alcohol for the month of January. Results have been impressive. During the 2014 campaign, 17,312 people took part online, there were 25,077 likes on the Dry January Facebook page, 3,461 followers of the programme's Twitter account, and 10 online advice sessions with over 10,000 participants. In addition to the large participation rate, the programme demonstrated a meaningful and sustained lifestyle change in the members through long-term reductions in alcohol consumption. Six months on from Dry January, 4 per cent of surveyed participants were still alcohol-free and 23 per cent of participants who had "harmful" rates of consumption prior to the programme were in the "low risk" classification. Although those responding to the survey will be self-selecting and more likely to have completed the programme, this shows that despite the relatively short length of the Dry January programme, sustainable change has been achieved for some.ix
The Dry January Facebook page shows in the posted comments the feelings of many that completed the challenge and the positive change in attitude and behaviour it is brought to them:
Well I have done dry January and
managed to lose 1 stone 3lb!!!!
I am not stopping either!!! Bring on February!!!
I have been fine and dandy with it and having learned a bit
about
why I am prompted to have a drink, and how nice it feels to
find
alternatives. I am set to carry on with it, so thanks!
New academic research shows that participants who have completed Alcohol Concern's behaviour change campaign are now drinking less, and also drinking in less harmful ways. The evidence shows six months after completing a Dry January, participants are now not only drinking less frequently and drinking less per drinking day, but they're also getting drunk less.
Footnotes
i Global Status Report of Alcohol and Health 2014, World Health Organization 2014 Available at: http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_1.pdf?ua=1
ii Health and Social Care Information Centre. Statistics on Alcohol – England, 2014. May 29.2014. Available at http://www.hscic.gov.uk/catalogue/PUB14184
iii Secretary of State for the Home Department (March 2012), The Government's Alcohol Strategy, HM Government
ivHealth and Social Care Information Centre. Statistics on Alcohol – England, 2014. May 29, 2014. Available at http://www.hscic.gov.uk/catalogue/PUB14184/alc-eng-2014-rep.pdf
v Ibid
vi https://www.gov.uk/government/news/trend-in-alcohol-related-deaths-continues-to-decline
vii P Lally, et al. How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology 2010; 40:998-1009
viii GL Zimmerman, et al. A 'Stages of Change' Approach to Helping Patients Change Behavior. Am Fam Physician 2000;61(5):1409-1416
ix Alcohol Concern. Academic research reveals Dry January leads to less drinking all year round. November 13, 2014. Available at: https://www.alcoholconcern.org.uk/news/academic-research-reveals-dry-january-leads-less-drinking-year-round/
x http://www.ias.org.uk/What-we-do/Publication-archive/Alcohol-Alert/January-2015.aspx
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