From a public health perspective, raising awareness of gambling-related harms may activate a sense of personal threat that can encourage positive behaviour change and reduce experienced harm. This study sought to determine existing levels of gambling harm awareness, both in total and by specific harm types, across a nationally representative UK sample of 10,157 adult gamblers (4,951 female). It also explored the relationship between gambling harm awareness and problem gambling severity, after controlling for various demographic variables and gambling motives. Participants were recruited via an online panel survey and provided self-reports of past-year gambling participation, motives, problem gambling severity, and awareness of different types of harms. The harm awareness measure used a prompted vs. unprompted cueing methodology and framed harms as either betting- or gambling-related based on a previously reported semantic distinction. Results showed that prompting significantly increased the number of harms reported, while harm framing did not. Regardless of condition, participants reported greater awareness of resource harms (e.g., financial difficulties) compared to health and relationship harms, and a quarter of the sample did not report any type of betting/gambling harm. Based on the results of a hierarchical linear regression, gambling harm awareness explained significant variability in problem gambling severity scores. Increased gambling severity scores were associated with greater awareness of health harms and decreased gambling severity scores were related to greater awareness of resource and relationship harms. These findings raise concerns about the overall effectiveness of current public health efforts in increasing harm awareness and suggest the need to broaden their focus to support individuals of varying risk levels in recognising and addressing a wider range of gambling-related harms.

Few studies have examined whether specific aspects of group identification predict problematic and non-problematic addictive behaviours and none have focused on gambling. Applying Leach et al.'s (2008) hierarchical model of in-group identification, we tested the associations between components of self-investment (satisfaction, solidarity, and centrality) and components of self-definition (individual self-stereotyping, in-group homogeneity) on distinguishing between problem and non-problem gambling (n = 10,157) and on the severity of problematic gambling behaviour (n = 2,568). Results showed that (i) in-group-based identities are important in predicting problematic vs. non-problematic gambling behaviours; (ii) in-group-based identities are important in predicting the severity of problematic gambling; (iii) how self-invested an individual is with their in-group and aspects associated with self-definition processes are both important predictors; (iv) perceptions related to how chronically salient one's group membership is for the self (centrality) are essential features of the self-investment mechanism; and (v) self-stereotypical beliefs about one's essential similarities to the prototypical gambling group member norm are fundamental for the defining oneself as a gambler.

Health risk information alone is insufficient as a means of reducing alcohol use, particularly when it evokes negative emotional states amongst those for whom it is most personally relevant. Appraisal biases, or ‘defensive processing’, may be employed to mitigate the psychological discomfort posed by such information. Few studies have evaluated the role of defensive processing in people with different levels of alcohol consumption. Online participants (n=597) completed measures of defensive processing of a health risk infographic, perceived susceptibility and severity of alcohol use, efficacy for resisting alcohol use, unrealistic optimism, the Alcohol Use Disorder Identification Test – Consumption (AUDIT-C) and demographics. Results showed that AUDIT-C scores were positively and linearly associated with all defensive processing measures (Pearson’s correlation r from .16 to .36) and unrealistic optimism (r = .50). AUDIT-C scores were also negatively associated with efficacy for resisting alcohol use (r = -.48). As such, people with alcohol use disorder (AUD) engaged in much more defensive processing of alcohol-related messages, offering an explanation for why such messages are limited at eliciting behaviour change. High levels of unrealistic optimism in people with alcohol use disorder may reflect low problem recognition in order to maintain a problem-free drinking identity.

How alcohol problems are represented, including as ‘Alcohol Use Disorder’ (AUD), has a broad set of implications for research, policy and practice. A biopsychosocial approach is commonly offered as a means of taking into account the various environmental and individual level factors that may contribute to so called mental and behavioural disorders including AUD. In this reply we argue that the reference article presents a heavy focus on ‘bio’ factors without sufficiently acknowledging the potential costs of doing so, particularly that a focus on individual level ‘bio’ factors may undermine the utilization of effective environmental policy levers whilst potentially harming AUD recovery processes. Thus, we call for a more balanced focus on the ‘psychosocial’ factors related to AUD.

Narratives around alcohol are important in determining how people decide who or what qualifies as problematic alcohol use. Narratives draw on common representations that are subject to influences including historical and normative influences. We argue that there are two dominant narratives that relate to how alcohol use disorder (AUD) is identified and addressed. The first is the historically embedded narrative of alcoholism as disease, and the second is the more recent narrative of positive or new sobriety. We present an argument that these two dominant narratives alone do not capture the wide and heterogeneous experience of alcohol harms, and as such a more diverse range of relatable narratives are required to reach and resonate with the broader community of people with AUDs. In particular, we reflect on the fact that these dominant narratives are both abstinence focused and therefore exclude many drinkers who are not willing and may not need, to consider lifelong sobriety to reduce their risk or experience of harms. We ask that alcohol policy professionals, researchers and lived experience advocates consider these issues and support diversifying the range of lived experiences, to support goals including public health outcomes, stigma reduction and alternative routes to recovery.

In their recent primer (Hazardous drinking and alcohol use disorders. Nat. Rev. Dis. Prim. 2022 81 8, 1–25 (2022))1, MacKillop and colleagues present an extensive account of hazardous drinking and alcohol use disorder (AUD), purporting to take a biopsychosocial evaluation of causes and treatment. Whilst in agreement with much of the evidence presented, on close reading we wish to challenge the heavy focus on biological factors, particularly concerning the role of genetics. In response, we wish to highlight several additional concepts and issues concerning the aetiology, prevention and treatment of hazardous drinking and AUD.

Abstract Background Lived experience of people directly or indirectly affected by public health issues can provide unique insights into how to improve interventions. Increasing availability of gambling necessitates involving communities in efforts to reduce gambling-related harms. This presentation reports qualitative exploratory research into the value of lived experience across a city-region gambling harm reduction initiative in the UK. Methods Focus groups and interviews were used to explore the practical application of lived experience with participants: advisory panel members, external stakeholders, community project staff, and public health professionals. Collaborative data analysis combined the framework method with theme development inductively (from participants’ accounts) and deductively (from academic and grey literature). Results Four themes were identified: (1) lived experience spans formal and informal settings with different activities and personal impacts; (2) organic and structured pathways to lived experience involvement coexist; (3) the emotional work of people affected by gambling-related harms ranges from frustration at policy inertia to deeper understanding of their own recovery journey; and (4) lived experience encompasses diverse experiential knowledges. Conclusions Involving lived experience in this intervention increased participants’ awareness of the harmful role of the gambling industry and critical reflection on the representativeness of lived experience. Harnessing lived experience at a regional level requires multi-setting support free from stigma and industry influence to ensure the sustained vitality of a diverse lived experience community specialised in gambling-related harms and equipped to navigate conflicting emotions and a challenging policy environment. Key messages • Increasing availability of gambling necessitates involving communities in efforts to reduce gambling-related harms. • The use of lived experience in gambling-related harms prevention efforts and research can inform intervention development.

Objective: This paper presents an evidence informed rationale for focussing on harmful gambling products and industry practices in public health messaging through the example of a recent innovation called 'Odds Are: They Win'. Methods: 'Odds Are: They Win' was initially developed through coproduction involving public health professionals and people with lived experience of gambling harms and implemented across a city-region area. A review of relevant evidence was undertaken, upon which the research team reflected to draw out the implications of 'Odds Are: They Win' for gambling harms messaging. Results: Evidence is mounting that safer gambling campaigns framed in terms of individual responsibility are ineffective and can generate stigma. 'Odds Are: They Win' presents an alternative focus that is not anti-gambling but raises awareness of industry manipulation of the situational and structural context of gambling. This is in-keeping with historical lessons from the stop smoking field and emerging research in critical health literacy. The latter highlights the potential of education on the social and commercial determinants of health to stimulate behaviour change and collective action. Conclusion: 'Odds Are: They Win' is a potentially disruptive innovation for the gambling harms field. Research is required to robustly evaluate this intervention across diverse criteria, target audiences, and delivery settings. Crown Copyright (c) 2023 Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Objective: Harmful drinkers represent an important Alcohol Use Disorder (AUD) group in public health terms, accounting for significant health and social costs. However, harmful drinkers are characterized by low problem recognition; they tend to construct their drinking identity as positive and problem-free, actively setting themselves apart from the stigmatised `alcoholic other'. As such, harmful drinkers rarely engage in treatment and represent an important opportunity for lower threshold interventions and self-change. The present study sought to explore AUD problem framing and stigma effects on problem recognition. Methods: Harmful drinkers without perceived addiction experience recruited online (n = 244, 54% male, 46% female, 96% British) were randomised to one of six conditions comprising beliefs about alcohol problems (control, continuum, binary disease model) and stigma (stigma, non-stigma), and completed measures relating to problem recognition. Results: As predicted, results found that harmful drinkers exposed to binary disease model beliefs and stigmatising language had significantly lower problem recognition than those in other conditions. However, no support was found for the prediction that continuum beliefs would be associated with higher problem recognition. Results suggest that the interaction of binary disease model beliefs and stigma prompted alcoholic label avoidance. Conclusion: These findings suggest that problem framing has important consequences for harmful drinkers. Implications for behaviour change amongst harmful drinkers through mechanisms of problem framing and identity are discussed.

Section II of the book is devoted to criticisms that have been made of the BDMA. The 15 chapters in this section, some reprinted from previous literature but most original works, offer a collection of arguments that challenge the BDMA on four basic grounds: (i) the BDMA has not produced the benefits for the treatment, prevention, and policy on addiction that were promised; (ii) the factual assumptions made by the proponents of the BDMA on the nature of addiction cannot be supported; (iii) the BDMA encourages, if not decrees, a misplaced emphasis on only one of several explanatory dimensions that capture the phenomenon; and (iv) the BDMA exerts a negative influence on our understanding of addiction. Other criticisms of the BDMA by authors who have not contributed chapters to the book are briefly described.

OBJECTIVE:Previous research suggests that exposure to alcohol primes (i.e., stimuli associated with alcohol) affects drinkers' perceptions and behaviors. The present study investigated the effects of an environmental alcohol prime (being in a simulated bar setting) and a safe sex message prime (a public health safe sex message) on sexually active alcohol drinkers.METHOD:Participants (n = 80) were assigned to one of four conditions according to priming allocation and engaged in a simulated video chat with a potential partner. They reported their sex-related self-perceptions and perceptions of a potential partner upon procedural completion.RESULTS:The alcohol-related environmental prime led participants to rate their potential partner as being significantly less inhibited and more sexual. The safe sex message significantly reduced reported sex-related self-perceptions and perceptions of their partners' disinhibition. There was a significant effect of primes on participants' perceptions of their partner's friendliness--participants exposed to either or both prime(s) perceived their partner as being friendlier than participants exposed to no prime.CONCLUSIONS:Results suggest that environmental alcohol primes may strengthen sexually active drinkers' perceptions of a potential partner's disinhibition and sexuality even before alcohol consumption begins, and that a safe sex message may moderate these effects. The presence of safe sex messages in alcohol-related environments may positively influence sexual risk decision making among sexually active drinkers.

In the final section of the book, we move on to a consideration of alternative perspectives on the nature of addiction – alternatives to both the brain disease and so-called moral model of addiction. Chapters include a consideration of fundamental issues about the way we frame our thinking about addiction – in essence, challenging us to ask questions about addiction in different ways. Others take the view that the inherently multidisciplinary nature of our field is part of the reason why debates about the nature of addiction exist. Proposals for integrating concepts and evidence are discussed, with a view to creating a more disciplined approach to the way in which we incorporate findings from diverse disciplines within addiction science. Finally, a number of chapters present positive alternatives to the BDMA, in which some authors attempt to integrate evidence from neurobiology and other fields, while others offer entirely different theoretical frameworks, including some approaches which apply a very pragmatic, therapeutic lens.

Harmful drinkers are characterised by low problem recognition in that they typically see themselves as ‘non-problem’ drinkers, i.e., they describe themselves as free from alcohol-related harms and distinct from the ‘alcoholic other’. Harmful drinkers are currently underserved by interventions, including those promoting self-change, and represent an important opportunity in public health terms. Opportunities to enhance problem recognition amongst this group may include promoting continuum beliefs or other models that avoid threats presented by a disease-based understanding of problem drinking, notably stigma and the expectation lifelong abstinence. A conceptual model for problem recognition factors amongst harmful drinkers is presented.

Objectives: Alcohol use remains a public health concern with accumulating evidence pointing to alcohol-associated prospective memory (PM) deficits. PM is the cognitive ability to remember to perform an intended action at some point in the future. Following PRISMA guidelines, we searched the evidence base to identify and explore the evidence of a relationship between alcohol use and PM. Methods: We conducted a systematic literature search in Medline, Embase, Pubmed, CINAHL, PsycINFO and Web of Science databases. Studies were included if they met the following criteria: English language publication, healthy adult participants (16 years and over), primary data on the effects of alcohol on PM. Results: Eight peer-reviewed studies were eligible for inclusion, of which five were randomized controlled trials examining the acute effects of a mild dose of alcohol and three were cross-sectional studies assessing the long-term effects of different drinking patterns on PM. Four main findings were supported by the literature: (1) compared with placebo, an acute administration of a mild alcohol dose to healthy social drinkers may lead to poorer PM performance, (2) alcohol consumption over the recommended weekly units can be associated with impaired PM function, (3) other cognitive domains can play a contributing role in alcohol-induced PM impairment, and (4) following future event simulation alcohol-induced PM impairment may be improved. Conclusion: Alcohol consumption potentially impairs PM, even at a low modest dose. Considering the small number of studies and their methodological flaws, additional research is needed to decipher the alcohol-PM relationship and provide further supporting evidence.

BACKGROUND:The Capital Card, developed by WDP, is a digital innovation which acts as a form of contingency management, and aims to significantly improve service user outcomes. WDP is a substance misuse treatment provider commissioned by local authorities across the UK to support service users and their families affected by addiction. The Capital Card, much like commercial loyalty cards, uses a simple earn-spend points system which incentivises and rewards service users for engaging with services e.g. by attending key work sessions, Blood Borne Virus appointments or group-work sessions. The Spend activities available to service users are designed to improve overall wellbeing and build social and recovery capital, and include activities such as educational classes, fitness classes, driving lessons, and cinema tickets. METHODS AND FINDINGS:We compared successful completion rates of 1,545 service users accessing one of WDP's London based community services over a two-year period; before and after the Capital Card was introduced. Client demographics (age, sex and primary substance) were controlled for during the analysis. Once client demographics were controlled for, analysis showed that clients with a Capital Card were 1.5 times more likely to successfully complete treatment than those who had not had the Capital Card (OR = 1.507, 95% CI = 1.194 to 1.902). CONCLUSIONS:The results of this initial evaluation are of particular interest to commissioners and policy makers as it indicates that the Capital Card can be used effectively as a form of contingency management to enhance recovery outcomes for service users engaging in community-based substance misuse services.

Potential competing interests: The author(s) declared that no potential competing interests exist.I think this is a very useful definition.My only query would be around the term 'chronic' -is this intended to refer to the length of an 'episode' of the disorder, or in the more usual sense of 'chronic relapsing disorder'?Either meaning is, I think, problematiccertainly the latter (chronic relapsing) isn't true for many.Chronic in the sense of long-lasting is probably less contentious, but I still feel perhaps superfluous for the purposes of definition.

Abstract Background Peer pressure to drink alcohol may influence excessive alcohol consumption, which can have adverse impacts on health and wellbeing. While peer pressure to drink alcohol is extensively studied among youth, less examination exists among adults. This systematic review examined qualitative research studies which explored the role and concept of peer pressure within the context of alcohol consumption in adults living in the UK. Methods Qualitative studies which explored peer pressure within the context of alcohol consumption or alcohol related behaviours and views in adults (age range approximately 18–52 years) living in the UK were included. Systematic searches conducted in Medline, PsycINFO and Web of Science identified 1462 references, of which 13 studies met inclusion criteria. Thematic analysis was conducted. Results Five overarching themes were identified. Four of these themes directly address aspects of peer pressure, including: experiences of peer pressure; consequences of peer pressure; strategies to deal with peer pressure; and conditions perceived to affect peer pressure. The fifth overarching theme explains the wider social context influencing peer pressure. Pressure to drink alcohol affects individuals across the life span and can be experienced as overt and aggressive, or subtle and friendly. Those consuming little or no alcohol are more likely to feel overt forms of peer pressure. Some developed strategies to cope with pressure from drinkers. Peer pressure can result in feelings of social isolation, or giving in by consuming alcohol against ones wishes. Conclusion Peer pressure to drink alcohol is a complex and multifaceted phenomenon experienced across adulthood requiring better understanding to support initiatives to decrease the impact of pressure-inducing environments and develop strategies to deal with perceived pressure conditions. Trial Registration The protocol for this review is registered with PROSPERO ( CRD42019122201 ). Registered 11 February 2019