Does Occupational Distress Raise the Risk of Alcohol Use, Binge-Eating, Ill Health and Sleep Problems among Medical Doctors? A UK Cross-Sectional Study

Abstract

Objectives: This study aims to assess the prevalence of health problems (eg, insomnia, binge-eating, substance use and ill health) among UK doctors and to investigate whether occupational distress increases the risk of health problems.

Design: This study reports the analysis of data collected at the baseline stage of a randomised controlled trial (protocol #NCT02838290).

Setting: Doctors were invited through medical Royal Colleges, the British Medical Association’s research panel and a random selection of NHS trusts across various UK regions.

Participants: 417 UK doctors with an equivalent split of gender (48% males) and seniority (49% consultants).

Main outcomes and measures: Outcomes were sleep problems (eg, insomnia), alcohol/drug use (eg, binge-drinking), ill health (eg, backache) and binge-eating (eg, uncontrollable eating). Predictor variables were occupational distress (psychiatric morbidity, burnout, job effort, work-life imbalance, coping with stress through self-blame or substances) and work factors (workplace and years practising medicine).

Results: 44% of doctors binge-drank and 5% met the criteria for alcohol dependence; 24%–29% experienced negative emotions after overeating and 8% had a binge-eating disorder; 20%–61% had some type of sleep problem and 12% had severe/moderate insomnia; 69% had fatigue and 19%–29% experienced other types of ill health problems. The results show that occupational distress and job factors increase the odds of doctors using substances, having sleep problems, presenting with frequent symptoms of ill health and binge-eating. For example, burnout increased the risk of all types of sleep problems, eg, difficulty falling/staying asleep, insomnia (OR ≥1.344; p≤0.036). Even taking into consideration whether or not a doctor works in a hospital, the risk of health problems still rises when doctors have signs of occupational distress.

Conclusion: Early recognition of occupational distress can prevent health problems among UK doctors that can reduce the quality of patient care because of sickness-related absence.

Global Research Mapping of Substance Use Disorder and Treatment 1971–2017: Implications for Priority Setting

Abstract

Background

Globally, substance use disorders are prevalent and remain an intractable public health problem for health care systems. This study aims to provide a global picture of substance use disorders research.

Methods

The Web of Science platform was used to perform a cross-sectional analysis of scientific articles on substance use disorders and treatment. Characteristics of publication volume, impact, growth, authors, institutions, countries, and journals were examined using descriptive analysis and network visualization graphs.

Results

Thirteen thousand six hundred eighty-five papers related to illicit drugs (5403), tobacco (4469), and alcohol (2137) use disorders and treatment were published between 1971 and 2017. The number of publications on Mindfulness and Digital medicine topics had the highest increase with more than 300% since 2003–2007 despite later presence than other methods. The number of papers on other non-pharmaceutical therapies (behavioral therapy, cognitive behavioral therapy, skills training or motivational interviewing) grew gradually, however, the growth rate was lower every 5-year period. The United States is the substance use disorder research hub of the world with the highest volume of publications (8232 or 60.2%) and total citations (252,935 or 65.2%), number of prolific authors (25 of top 30 or 83%) and institutions (24 of top 26 or 92%), formed the most international research partnerships (with 96 distinct countries). The international collaboration followed a pattern based on geographic proximity and cultural similarity.

Conclusions

This study offers a comprehensive picture of the global trend of publications of substance use disorder. Findings suggest a need for research policy that supports the examination of interventions that culturally adhere to different local contexts to address substance use disorder in communities.

Webinar: Alcohol Related Liver Damage

Event Date
City
Webinar

Public Health England will be hosting a webinar to discuss their work to reduce alcohol harm and the latest evidence and best practice examples for improving liver health at 14:00 on 20 May.

Email AlcoholCapitalFund [at] phe [dot] gov [dot] uk if you'd like to attend.

Gender and Alcohol Infographics

Based on recent research, Glasgow Caledonian University, Strathclyde University, SHAAP and Glasgow Centre for Population Health, have produced infographics to tackle stereotypes about men, women and drinking in Scotland.

The infographics highlight the role of societal norms, the media and the alcohol industry in perpetuating these stereotypes and call on policymakers, researchers and alcohol services to monitor and report outcomes by gender. 

Not without my Mobile Phone: Alcohol Binge Drinking, Gender Violence and Technology in the Spanish Culture of Intoxication

Abstract

The practice of binge drinking has in recent decades consolidated what is known as the ‘culture of intoxication’ among young people of Spain. This has coincided with the increase in the use of mobile-phone technology and of social networks within the night-time economy. Our main aim is to explore these new, potentially risky uses and violent behaviours, through an analysis of the discourses of the young people involved. This is a qualitative study with in-depth interviews (n = 24) of young people between the ages of sixteen and twenty-two, resident in two cities in the south of Spain: Granada and Seville. Findings: our results show that gender violence is present in the contexts where alcohol is consumed intensively and is related to the use of the mobile phone in interpersonal or couple relationships. This violence is practiced mainly against the women, who suffer sexual harassment and violation of their public image through information and communication technologies. Our data show that prevention should consider the new vulnerabilities that are generated out of the problematic association between technology and alcohol, using innovative strategies that are adapted to the new patterns of youth behaviour.

Jose Luis Vazquez Martinez

A pesar de lo que dicen algunos mensajes y estudios de baja calidad, no hay pruebas científicas que justifiquen beber o empezar a beber por razones de salud. En este vídeo se explican estas razones y la evaluación del mensaje realizada en Nutrimedia.

Drinking Trends of Young People Not in Education, Employment or Training: A Qualitative Study

Recent trends both in the UK and also more widely in an international context suggest underage drinking is declining amongst young people. However, it is believed some groups of young people are not following this trend.

A recent study has analysed the drinking trends of young people not in education, employment or training (NEET). The main aim of the project was to look at the experience of young people NEET, to see how the characteristics of this group have changed and whether this is reflected in their drinking patterns.

Interviews were conducted with 16 young people (aged 15-19).

The themes that emerged on analysis of the interviews were:

Many of the young people interviewed reported that they drank little or no alcohol.

  • The young people reflected on early experimental drinking behaviour which they had now ‘grown out of.’
  • For a small number drinking was not celebratory but rather a way of coping with stressful life experiences
  • Drinking was linked with being invited to social events and popularity
  • Exposure to drunkenness and risky behaviour tended to occur in their early teens. Where young people used to drink in parks, now there was more street drinking.
  • The influence of social media in encouraging drinking was seen as being mostly on younger teenagers
  • Images of drunkenness and being out of control on social media were given as reasons not to drink rather than being seen as encouraging drinking.

In summary, although young people described as NEET are drinking less, harmful behaviour as a result of alcohol is still happening and at younger ages.

The overall message of young people drinking less should not detract from the minority of young people drinking as a form of coping who require targeted support.

Prevalence of Fetal Alcohol Spectrum Disorder among Special Subpopulations: A Systematic Review and Meta‐Analysis

Abstract

Aim

To collate prevalence estimates of fetal alcohol spectrum disorder (FASD) among special subpopulations (defined by service use).

Design

Systematic literature review and meta‐analysis of original, quantitative studies published between 1 November 1973 and 1 December 2018. The PRISMAGATHER were adhered to. The review protocol [includes FASD prevalence in (a) general and (b) special populations] is available on PROSPERO (registration number: CRD42016033837). Prevalence estimates were collated for all included studies with country‐, disorder‐ [FASD and fetal alcohol syndrome (FAS)] and population‐specific random‐effects meta‐analyses conducted.

Setting and Participants

A number of service‐defined subpopulations globally (see Findings).

Measurements

The main outcome was the prevalence of FASD among special subpopulations. The critical appraisal of each study was conducted using the Joanna Briggs Institute tool.

Findings

We identified 69 studies, comprising 6177 individuals diagnosed with FASD from 17 countries: Australia (n = 5), Brazil (n = 2), Canada (n = 15), Chile (n = 4), eastern Europe (Moldova, Romania and Ukraine; n = 1), Germany (n = 1), Israel (n = 1), Lithuania (n = 1), the Netherlands (n = 1), Poland (n = 1), Russia (n = 9), South Korea (n = 1), Spain (n = 1), Sweden (n = 1) and United States (n = 25). FAS and FASD prevalence rates were collated for the following five subpopulations: children in care, correctional, special education, specialized clinical and Aboriginal populations. The estimated prevalence of FASD in these special subpopulations was 10–40 times higher compared with the 7.7 per 1000 (95% confidence interval = 4.9–11.7) global FASD prevalence in the general population.

Conclusions

Global subpopulations of children in care, correctional, special education, specialized clinical and Aboriginal populations have a significantly higher prevalence of fetal alcohol spectrum disorder compared with the general population, which poses a substantial global health problem.

Gender Differences in the Bidirectional Relationship between Alcohol Consumption and Sleeplessness

Abstract

Background

The degree to which the relationship between alcohol use and sleeplessness is unidirectional or reciprocal is unclear due to great variation among the results of previous studies. The aim of the present study was to investigate if the relationship between alcohol use and sleeplessness is bidirectional by exploring how the change in and stability of alcohol use were related to sleeplessness, and vice versa, how the change in and stability of sleeplessness were related to alcohol use, in a longitudinal study spanning 13 years.

Method

Data were collected from 9941 adults who participated in two waves (T1: 1994–1995, and T2: 2007–2008) of the Tromsø Study, a Norwegian general population health study. Alcohol use was measured by questions asking about the frequency of drinking, amounts of alcohol normally consumed and the frequency of binge drinking, whereas sleeplessness was measured by one item asking about the frequency of experiencing sleeplessness. Variables representing change in and stability of consumption of alcohol and sleeplessness from T1 to T2 were created. Logistic regression analyses, stratified by gender, were used to analyze the data.

Results

Men reporting stable high (OR = 2.11, p. < .001) or increasing (OR = 1.94, p. < .01) consumption of alcohol from T1 to T2 had a significantly higher risk of reporting sleeplessness at T2. Likewise, men experiencing stable (OR = 1.84, p. < .01) or increasing (OR = 1.78, p. < .001) sleeplessness from T1 to T2 had a significantly higher risk of reporting high consumption of alcohol at T2. No significant effects were detected among women.

Conclusion

The findings indicate a bidirectional relationship between high consumption of alcohol and sleeplessness only among men. Thus, healthcare professionals ought to be informed about the health risks associated with excessive drinking and struggling with sleeplessness, especially in men.

Podcast: Alcohol Alerts

This episode focuses on data released ahead of the first anniversary of the Scottish Government's flagship health policy of minimum unit pricing. You might be mistaken in thinking the issue is a simple one – has minimum unit pricing led to a rise or fall in consumption? However, interpretation of the figures available so far suggests the story is more complex.

Alison Douglas of Alcohol Focus Scotland cuts through the headlines to explain what the figures do and do not mean.

Alcohol Misuse in the Armed Forces

Alcohol misuse in the UK armed forces is more than double than that of the general population, yet many of those who drink at harmful levels do not seek help. Preliminary research has shown how effective digital technologies can be used as a health intervention.

In a research project titled ‘Information about Drinking in Ex-serving personnel’ (InDEx), researchers and professionals from the University of Liverpool, King’s College London, Alcohol Research UK and Royal British Legion joined together to developed an app, to help people monitor and manage their alcohol consumption.

A Public Health Approach to Alcohol Use and its Related Harms in Iran

In Iran, alcohol consumption, production, and trade are criminalised for Muslim citizens; however, bootleg alcohol and harmful alcohol consumption is a burden that should not be overlooked.

Currently the Iranian Ministry of Health has developed a national programme that aims to reduce alcohol consumption by 10% between 2015 and 2025 through three main action steps: first, integration of alcohol screening, brief intervention, and referral to treatment in primary health care. Although this is a positive move forward, the rollout of the programme faces several barriers including insufficient resources within health care systems and the lack of first line medical and legal support in the early detection programmes.

Researchers, writing for the Lancet Public Health, outline the changes that might be made to recognise and tackle the issue of harmful alcohol consumption in Iran.

Youth Perspective on Parental Approaches to Substance Use

Reducing the harms of youth substance use is a global priority. Parents have the potential to play a key role in these efforts. However, it is felt that parents are often unsure about how to address substance use with their children. Parent responses to youth substance use are often grounded in abstinence and critiqued as ineffective and unresponsive to youth contexts.

In order to develop effective parent-targeted interventions, it is important to hear young people’s perspective.

A recent study has sought to capture youth perspectives on parental approaches to substance use. The researchers conducted 83 interviews with young people aged 13-18. 

Results were analysed in terms of themes within each research site: The City, The Valley, and The North

The City

  • In the city parents and caregivers were more likely to accept their substance use, but in moderation and with defined limits
  • Young people who were permitted alcohol within limits described resisting consuming excessive alcohol to become drunk
  • Complete freedom was viewed by participants as ineffective for supporting youth in developing strategies for self-management of substance use

The Valley

  • In the Valley, participants’ families were more likely to address substance use through a zero-tolerance or abstinence-based approach
  • Some youth felt their parents were oblivious to the possibility of youth substance use
  • Zero-tolerance approaches were frequently described as a disconnect from the realities of young people’s substance use

The North

  • In The North, youth described substance use as common in town
  • Participants’ descriptions of their community highlighted the prevalence of substance use.
  • Many participants described their parents’ substance use as shaping the family context for substance use
  • Many families attempted to navigate their children’s use by encouraging open communication and responsible use

These results illustrate the view that abstinence-only messages are not realistic in terms of the realities of youth experiences. The findings instead suggest that the most effective messages for reducing alcohol-related harm were the ones that supported youth to use alcohol within limits.

Alcohol Taxation Infographic

Alcohol taxation holds massive potential for global health, for helping achieve the sustainable development goals and also for significantly contributing to financing health and development. 

This infographic, designed by IOGT International, describes the potential benefits of alcohol taxation. The resource provides evidence for improvements that could be achieved in terms of public health, public safety, womens rights, domestic resource, child rights and socioeconomic progress.

Workplace Alcohol and Other Drug Factsheets

To assist workplaces to respond to alcohol and other drug-related harm in the workplace, The National Centre for Education and Training on Addiction, has produced a series of factsheets about commonly used drugs and their impact on safety and well-being of individual employees, and overall safety and productivity of the workplace. 

Fact sheets cover the following topics:

  1. Alcohol and Work
  2. Cannabis and Work
  3. Amphetamine and Work
  4. Ecstasy and Work
  5. Other Illicit Drugs and Work
  6. Prescription Drugs and Work 
  7. Tobacco and Work

Digital Marketing in the Spotlight

Event Date
City
Amsterdam
Country
Netherlands

The Digital Marketing in the Spotlight conference is organised by EUCAM, EUROCARE and the Amsterdam Centre for Health Communication (ECHC) and will take place on the 19th of September in Amsterdam, Netherlands.

The event will open up a conversation about the impact of digital marketing on the drinking behaviour of young people and ways it can be regulated.

Jose Luis Vazquez Martinez

Fuente: Sanvisens, A., Zuluaga, P., Rubio, G., Short, A., Gual, A., Álvarez, F., Torrens, M., Rodríguez de Fonseca, F., Muga Bustamante, R., & Estudio CohRTA, E. (2019). DSM-5 en pacientes que solicitan el primer tratamiento del trastorno por uso de alcohol.