WHY ARE (SOME) AUSTRALIAN WOMEN DRINKING MORE? AND WHAT CAN WE DO ABOUT IT? Dr SALLY HUNT
RESEARCH COLLABORATORS Prof Frances Kay-Lambkin 1 ! Prof Maree Teesson 2 ! Prof Tim Slade 2 ! A/Prof Cath Chapman 2 ! Dr Matthew Sunderland 2 ! 1 The University of Newcastle ! 2 The University of Sydney ! FUNDING SOURCES University of Newcastle Priority Research Centre for Brain and Mental Health !
WHAT THIS TALK ISN’T • ! Judgement laden (I hope) ! • ! A call to curb women’s rights and freedoms ! • ! Implying that hazardous alcohol use by men is any less important !
WHAT THIS TALK IS • Providing information so that women can make an informed choice about what they put in their bodies • Acknowledgement that women have busy, stressful lives and alcohol is part of that • The reasons for use, physical impact and long term consequences of alcohol di ff er between men and women so it is worth considering them separately
WHAT DOES HAZARDOUS DRINKING LOOK LIKE?
WHA WHAT IS A T IS A ST STAND ANDARD ARD DRINK? DRINK? C D A B
AL ALCOHOL COHOL HEAL HEALTH TH GUIDELINES GUIDELINES
ARE AUSTRALIAN WOMEN DRINKING MORE?
HIST HISTORICAL P ORICAL PATTERNS TTERNS OF OF AL ALCOHOL COHOL USE USE • Historically harmful use of alcohol by men almost double that of women (3.8%:2.1%; ABS, 2007) Illustration by Claudine Ryan & Humyara Mahbub
CLOSING THE GAP
CLOSING THE GAP
REASONS FOR THE REASONS FOR THE CL CLOSING OSING GAP GAP • Men are drinking less – Successful health messages – Lock out laws – Responsible service of alcohol • Women are drinking more – Change in traditional gender roles (Seedat et al., 2009) – Change in gender specific attitudes towards drinking (Kuntsche et al., 2011) – Change in drinking contexts & environments (Holmila et al., 2005)
WHY ARE WHY ARE WOMEN OMEN DRINKING MORE? DRINKING MORE? • Delayed motherhood • Change in the mother role
WHY ARE WHY ARE WOMEN OMEN DRINKING MORE? DRINKING MORE? • Work • The myth of balance
WHY ARE WOMEN DRINKING MORE? • ! Equality ! !
WHY ARE WOMEN DRINKING MORE? • ! Social Media ! • ! Abundant permissive attitudes !
WHY W WHY WOMEN DRINK OMEN DRINK RESEAR RESEARCH CH QUESTIONS QUESTIONS • How much are women drinking? • What motivates them to drink? • How can we use this information to develop more e ff ective interventions and public health messages?
REASONS FOR REASONS FOR USE USE I drink to release To relax, to feel like a stress & feel better To relax and different person when I about my life take my mind step out of the mum role off the when the kids are in bed pressures of life Socialising after work - I'm not that interested in drinking but people usually single you out and ask why To wind down in the not drinking (and often assume evening. pregnancy as the reason), so I drink a Have only been drinking small amount to avoid questions! since having a baby before that only socially
WHY IS INCREASED DRINKING A PROBLEM?
SHORT TERM CONSEQUENCES OF HAZARDOUS DRINKING
LONG TERM CONSEQUENCES OF HAZARDOUS DRINKING
WHY IS IT A CONCERN FOR NURSES? PROFESSIONALLY
WHERE DO WHERE DO NURSES NURSES FIT? FIT? • Front line health care provision 1 in 6 1 in 5 (17%) people consume alcohol at (22%) Australians aged 14 and over levels placing them at lifetime risk of reported being a victim of an an alcohol-related disease or injury alcohol-related incident in 2016 1 in 4 1 in 7 (26%) people have consumed (15%) people have consumed 11 or alcohol at levels placing them at risk more standard drinks at least in the of harm on a single occasion, at previous 12 months least monthly Australian Institute of Health & Welfare (2017)
WHERE DO NURSES WHERE DO NURSES FIT? FIT? • Front line health care provision In a sample of rural Delay to seeking treatment Australians only 11% of for AUD was 14 years people with Alcohol Use Kay-Lambkin et al. (2014) Disorder (AUD) sought help for their AUD Kay-Lambkin et al. (2014) This means that nurses in general health settings will see these patients long before drug and alcohol services do!
WHAT CAN YOU DO WHEN AOD ISN’T YOUR CORE BUSINESS?
1. CHANGE IS 1. CHANGE IS HARD HARD • You would think that having a heart attack would be enough to stop eating junk and become more active • You would think that knowing about lung cancer would stop people smoking • You would think that losing your licence or custody of children would stop people drinking • If simply knowing something was harmful was all it took to stop doing it then I’d be out of a job
2. AMBIV 2. AMBIVALENCE ALENCE • People are usually ambivalent about change – they want to stop and they don’t want to stop • Harnessing this ambivalence is how we encourage change
3. PEOPLE ARE MORE 3. PEOPLE ARE MORE PERSU PERSUADED BY WHA ADED BY WHAT T THEY THEY HEAR HEAR THEMSEL THEMSELVES SA VES SAY Y • The trick is to lead the person to their own good reasons for change rather than tell them why you think they should change
WHAT IS WHA T IS MO MOTIV TIVATION TIONAL AL INTERVIEWING INTER VIEWING? ? • Therapeutic definition: “MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion” Miller & Rollnick (2012)
THE THE RIGHTING RIGHTING REFLEX REFLEX “Helpers want to help, to set things right, to get people on the road to health and wellness. Seeing people head down a wrong path stimulates a natural desire to get out in front of them and say, Stop! Go back! Don’t you see? There is a better way over there! and it is done with the best of intentions, with one’s heart in the right place. We call this the RIGHTING REFLEX – the desire to fix what seems wrong with people and to set them promptly on a better course …” Miller & Rollnick (2012)
THE CLIENT’S THE CLIENT’S COMMUNICA COMMUNICATION TION TELLS US WHERE TELLS US WHERE THEY ARE IN THE THEY ARE IN THE CHANGE PR CHANGE PROCESS OCESS LOOK FOR OOK FOR CHANGE CHANGE TALK ALK & SUST SUSTAIN T AIN TALK ALK
SUST SUSTAIN AIN CHANGE CHANGE TALK ALK TALK ALK
CORE CORE MI SKILLS MI SKILLS O PEN QUESTIONS A FFIRMATION R EFLECTION S UMMARY
FOUR FOUR PR PROCESSES OCESSES OF OF MI MI Planning Evoking If they want to, support Focusing Draw out them to plan people’s own changes Engaging Find a useful good direction reasons to Settle in to a change helpful conversation
WHY IS IT A CONCERN FOR NURSES? PERSONALLY
SELF SELF ASSESSMENT ASSESSMENT • Look online for the Alcohol Use Disorders Test (AUDIT) • Measure your alcohol use for a week • Pay attention to particular times/situations when you drink • Is it when coping with stress or negative emotions?
SELF SELF ASSESSMENT ASSESSMENT • Has alcohol become the priority in your life? • Has alcohol has taken control of your life? • Have you found it di ffi cult to stop using alcohol once you have started drinking? • Are you feeling guilty or concerned about your alcohol use? • Are you requiring more alcohol to achieve the desired e ff ect? • Are others in your life expressing concern regarding your alcohol use?
SELF SELF ASSESSMENT ASSESSMENT • Is your participation in social and recreational activities reduced or stopped? • Is alcohol your preferred activity or focus? • Have you failed to follow up, or find it more di ffi cult to co- ordinate your normal roles and responsibilities? • Are there signs of alcohol withdrawal symptoms when you are not able to consume alcohol? Withdrawal signs may include unexplained tremors, increased sweating, headaches, anxiety, diarrhoea or vomiting, and issues sleeping. • Has your mood and motivation changed?
IF THIS RESONATES IF THIS RESON TES PERSONALL PERSON ALLY Y • Try swapping alcohol for another stress reliever • Do a “holiday from alcohol” experiment – What changed? – What was alcohol doing for you? – What was alcohol doing to you? • Sources of support to make a change – GP – Drug and Alcohol Services – Online support e.g. www.eclipse.org.au (mention Sally Hunt in the contact us email and you’ll be sent a log in)
WHA WHAT DOES THIS T DOES THIS ALL ALL MEAN MEAN AND AND HO HOW CAN WE W CAN WE ST STOP THE OP THE CL CLOSING GENDER OSING GENDER GAP GAP? ?
WHA WHAT W T WOULD A GENDER OULD A GENDER SPECIFIC INTER SPECIFIC INTERVENTION VENTION LOOK OOK LIKE? LIKE? • Drinking isn’t seen as a problem by many • Healthy lifestyles rather than an intervention targeting drinking • Support well being and coping strategies • Improved public awareness of health risks
WHAT’S NEXT? A GENDER SPECIFIC INTERVENTION
WELCOME TO THE CIRCUS
sally.hunt@newcastle.edu.au @sally_hunt
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