Conceptualising alcohol consumption in relation to long-term health conditions: Exploring risk in interviewee accounts of drinking and taking medications


Autoři: Mary Madden aff001;  Stephanie Morris aff001;  Duncan Stewart aff001;  Karl Atkin aff001;  Brendan Gough aff002;  Jim McCambridge aff001
Působiště autorů: Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, United Kingdom aff001;  School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224706

Souhrn

Background

Alcohol use is a major contributor to the burden of disease, including long-term non-communicable diseases. Alcohol can also interact with and counter the effects of medications. This study addresses how people with long term conditions, who take multiple medications, experience and understand their alcohol use. The study objective is to explore how people conceptualise the risks posed to their own health from their concurrent alcohol and medicines use.

Methods and findings

Semi-structured interviews were conducted with a sample of 24 people in the North of England taking medication for long term conditions who drank alcohol twice a week or more often. Transcripts were analysed using a modified framework method with a constructionist thematic analysis. Alcohol was consumed recreationally and to aid with symptoms of sleeplessness, stress and pain. Interviewees were concerned about the felt effects of concurrent alcohol and medicines use and sought ways to minimise the negative effects. Interviewees associated their own drinking with short-term reward, pleasure and relief. Risky drinking was located elsewhere, in the drinking of others. People made experiential, embodied sense of health harms and did not seem aware of, or convinced by, (or in some cases appeared resigned to) future harms to their own health from alcohol use. The study has limitations common to exploratory qualitative studies.

Conclusions

Health risk communication should be better informed about how people with long-term health conditions perceive health outcomes over time, and how they adopt experience-based safety strategies in contexts in which alcohol consumption is heavily promoted and weakly regulated, whilst medicines adherence is expected. Supporting people to make active and informed connections between medicines, alcohol and potential personal health harms requires more than a one-way style of risk communication if it is to be perceived as opening up rather than restricting choice.

Klíčová slova:

Adverse reactions – Alcohol consumption – Alcoholism – Cardiology – Communication in health care – Drugs – Statins – Women's health


Zdroje

1. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Alcohol and Global Health 1 Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373(9682):2223–33.

2. Ewbank L, Omojomolo D, Sullivan K, McKenna H. The rising cost of medicines to the NHS. What’s the story? London: The Kings Fund; 2018.

3. Britten N. Medicines and Society: Patients, Professionals and the Dominance of Pharmaceuticals. Basingstoke: Palgrave Macmillan; 2008.

4. Kypri K, McCambridge J. Alcohol must be recognised as a drug. Bmj-Brit Med J. 2018;362.

5. Edwards G. Alcohol: The World’s Favourite Drug. London: Penguin; 2000.

6. Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SRM, Tymeson HD, et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018;392(10152):1015–35.

7. Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, et al. The relationship between different dimensions of alcohol use and the burden of diseasean update. Addiction. 2017;112(6):968–1001. doi: 10.1111/add.13757 28220587

8. NHS Digital. Statistics on Alcohol, England 2019 [PAS] Leeds2019 [https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2019/part-4.

9. The National Institute for Health and Care Excellence (NICE). Alcohol-use disorders: prevention (Public health guideline PH24). 2010.

10. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2 22579043

11. World Health Organization. The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. Geneva; 2012. Report No.: WHO/EMP/MAR/2012.3.

12. Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound. London; 2013.

13. Public Health England. Dependence and withdrawal associated with some prescribed medicines. 2019.

14. Holton AE, Gallagher P, Fahey T, Cousins G. Concurrent use of alcohol interactive medications and alcohol in older adults: a systematic review of prevalence and associated adverse outcomes. Bmc Geriatr. 2017;17.

15. Department of Health. UK Chief Medical Officers’ Low Risk Drinking Guidelines London: Department of Health; 2016 [https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf.

16. Scambler G, editor. New Directions in the Sociology of Chronic and Disabling Conditions: Assaults on the Lifeworld. Basingstoke: Palgrave Macmillan; 2010.

17. Davison C, Smith GD, Frankel S. Lay Epidemiology and the Prevention Paradox—the Implications of Coronary Candidacy for Health-Education. Sociol Health Ill. 1991;13(1):1–19.

18. Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, et al. Resisting medicines: a synthesis of qualitative studies of medicine taking. Social Science & Medicine. 2005;61(1):133–55.

19. Rathbone AP, Todd A, Jamie K, Bonam M, Banks L, Husband AK. A systematic review and thematic synthesis of patients’ experience of medicines adherence. Res Social Adm Pharm. 2017;13(3):403–39. doi: 10.1016/j.sapharm.2016.06.004 27432023

20. Webster A, Douglas C, Lewis G. Making Sense of Medicines: ‘Lay Pharmacology’ and Narratives of Safety and Efficacy. Sci Cult-Uk. 2009;18(2):233–47.

21. Lovatt M, Eadie D, Meier PS, Li J, Bauld L, Hastings G, et al. Lay epidemiology and the interpretation of low-risk drinking guidelines by adults in the United Kingdom. Addiction. 2015;110(12):1912–9. doi: 10.1111/add.13072 26212155

22. Khadjesari Z, Stevenson F, Toner P, Linke S, Milward J, Murray E. 'I’m not a real boozer': a qualitative study of primary care patients’ views on drinking and its consequences. J Public Health (Oxf). 2019;41(2):e185–e91.

23. Haighton C, Kidd J, O’Donnell A, Wilson G, McCabe K, Ling J. 'I take my tablets with the whiskey': A qualitative study of alcohol and medication use in mid to later life. Plos One. 2018;13(10).

24. Madden M, Morris S, Atkin K, Gough G, McCAmbridge J. Patient perspectives on discussing alcohol as part of medicines review in community pharmacies. Research in Social and Administrative Pharmacy. 2019.

25. Muhlack E, Carter D, Braunack-Mayer A, Morfidis N, Eliott J. Constructions of alcohol consumption by non-problematised middle-aged drinkers: a qualitative systematic review. BMC Public Health. 2018;18.

26. PSNC. MURs: the basics 2018 [https://psnc.org.uk/services-commissioning/advanced-services/murs/murs-the-basics/.

27. PSNC. New Medicine Service (NMS): Pharmaceutical Services Negotiatinig Committee; 2018 [https://psnc.org.uk/services-commissioning/advanced-services/nms/.

28. Department for Communities and Local Government. English indices of deprivation 2015: research report. London 2015.

29. Bush J, Langley CA, Wilson KA. The corporatization of community pharmacy: implications for service provision, the public health function, and pharmacy’s claims to professional status in the United Kingdom. Res Social Adm Pharm. 2009;5(4):305–18. doi: 10.1016/j.sapharm.2009.01.003 19962674

30. Bradley KA, McDonell MB, Bush K, Kivlahan DR, Diehr P, Fihn SD. The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. Alcohol Clin Exp Res. 1998;22(8):1842–9. doi: 10.1111/j.1530-0277.1998.tb03991.x 9835306

31. Mahler C, Hermann K, Horne R, Ludt S, Haefeli WE, Szecsenyi J, et al. Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany. J Eval Clin Pract. 2010;16(3):574–9. doi: 10.1111/j.1365-2753.2009.01169.x 20210821

32. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. Bmc Med Res Methodol. 2013;13.

33. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101.

34. Holton AE, Gallagher PJ, Ryan C, Fahey T, Cousins G. Consensus validation of the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria. Bmj Open. 2017;7(11).

35. Bryson CL, Au DH, Sun H, Williams EC, Kivlahan DR, Bradley KA. Medication adherence decreases with increasing AUDIT-C alcohol screening scores. J Gen Intern Med. 2008;23:346-.

36. Grodensky CA, Golin CE, Ochtera RD, Turner BJ. Systematic review: effect of alcohol intake on adherence to outpatient medication regimens for chronic diseases. J Stud Alcohol Drugs. 2012;73(6):899–910. doi: 10.15288/jsad.2012.73.899 23036207

37. Stein MD, Friedmann PD. Disturbed sleep and its relationship to alcohol use. Subst Abus. 2005;26(1):1–13. 16492658

38. Hui M, Carr A, Cameron S, Davenport G, Doherty M, Forrester H, et al. The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology. 2017;56(7):E1–E20. doi: 10.1093/rheumatology/kex156 28549177

39. Quirk A, MacNeil V, Dhital R, Whittlesea C, Norman I, McCambridge J. Qualitative process study of community pharmacist brief alcohol intervention effectiveness trial: Can research participation effects explain a null finding? Drug Alcohol Depend. 2016;161:36–41. doi: 10.1016/j.drugalcdep.2016.01.023 26875673

40. Ling J, Smith KE, Wilson GB, Brierley-Jones L, Crosland A, Kaner EFS, et al. The ‘other’ in patterns of drinking: A qualitative study of attitudes towards alcohol use among professional, managerial and clerical workers. BMC Public Health. 2012;12.

41. Teuscher U, Mitchell SH. Relation Between Time Perspective and Delay Discounting: A Literature Review. The Psychological Record. 2011;61(4):613–32.

42. Wilson GB, Kaner EF, Crosland A, Ling J, McCabe K, Haighton CA. A qualitative study of alcohol, health and identities among UK adults in later life. Plos One. 2013;8(8):e71792. doi: 10.1371/journal.pone.0071792 23940787

43. Ahmed H, Naik G, Willoughby H, Edwards AG. Communicating risk. BMJ. 2012;344:e3996. doi: 10.1136/bmj.e3996 22709962

44. Morris S, Madden M, Gough B, Atkin K, McCambridge J. Missing in action: Insights from an exploratory ethnographic observation study of alcohol in everyday UK community pharmacy practice. Drug Alcohol Rev. 2019;38(5):561–8. doi: 10.1111/dar.12960 31317594

45. Rapley T, May C, Frances Kaner E. Still a difficult business? Negotiating alcohol-related problems in general practice consultations. Soc Sci Med. 2006;63(9):2418–28. doi: 10.1016/j.socscimed.2006.05.025 16814441

46. Moriarty HJ, Stubbe MH, Chen L, Tester RM, Macdonald LM, Dowell AC, et al. Challenges to alcohol and other drug discussions in the general practice consultation. Family practice. 2011;29(2):213–22. doi: 10.1093/fampra/cmr082 21987374


Článek vyšel v časopise

PLOS One


2019 Číslo 11