Intervention Report To Reduce Alcohol Consumption In A Sample Of 400 Office Workers Who Drink Too Much Alcohol

Introduction

Alcohol abuse is something which is of great concern to those in the public domain. It can be something which impinges on one at a domestic level and also adversely affect workplace productivity. Indeed, the work environment can be a risk factor for harmful alcohol use, with a plethora of studies documenting the association between workplace stress and accentuated levels of alcohol consumption (Anderson 2014; Ames & Cunradi 2005; Kimberly et al., 1999). Unsurprisingly, studies have illustrated the negative effects of alcohol consumption on workplace productivity with it being intertwined with absenteeism, late arrival and early leaving or disciplinary suspension (Rehm et al., 2006; Renna, 2009; Richmond et al., 2000). Secondary effects of excessive consumption also constitute inappropriate behaviour in the workplace such as theft and harassment which lead to a discordant working environment (Rehm et al., 2006; Renna, 2009; Richmond et al., 2000).

In essence, the mandate of this paper will outline an appropriate intervention strategy aimed at reducing alcohol consumption in a sample of 400 office workers who drink an inadvisable amount of alcohol. An overview of previous health psychology interventions focused on alcohol consumption will be presented throughout the course of this piece, which will provide the evidence base for this report. Some of the behaviour change techniques which are detailed by Abraham and Michie’s taxonomy (2008) will be scrutinised in further depth and their effectiveness across interventions will be depicted. After communicating the theoretical tenets of the phenomenon being investigated, this paper will then proceed to outline the intervention and rationale behind the chosen intervention design. After this, an evaluation plan will be scribed, which determines the effect of the intervention on the primary outcome (activity or consumption) and secondary outcomes (additional variables targeted by the intervention that are expected change during the intervention), to give a holistic appreciation of the issue and to provide a comprehensive account of the intervention from start to its finality.

Overview of previous health psychology interventions

Alcohol abuse is a multi-faceted issue and one which entails understanding the underpinning aspects of it, such as recognising that it can be a learned habit (French et al., 2010), which is something that previous health psychology interventions have concentrated on and other such general studies have heeded (Drummond, 1990; Matire et al., 2004).

Templeton et al. (2010) note that empirical health psychology interventions in alcohol have tended to focus on supporting the families of those who suffer from alcoholism, with an emphasis on understanding the psychological aspects of what causes a person to become so dependent on alcohol. There have been numerous interventions pertaining to family therapy such as the Parents and Children Together (PACT) intervention (Zohhadi et al., 2006), which worked collaboratively with every single member of families with someone who was suffering from alcohol abuse. Upon receiving the therapy encompassed in the intervention, each family reported an increase in positive behavioural change and increased self-esteem scores on authoritative measures such as the Rosenberg Self-esteem scale. Velleman et al. (2003) reported similar results in an earlier intervention of a similar manner in the UK which delivered a variety of interventions (couple, family and peer support) to the families of someone suffering from alcohol abuse, with again positive changes being reported (such as the children attending school and access to a greater network of support). Whilst there has obviously been a sustained focus on helping the families of those who suffer from alcohol abuse, there have been specific interventions carried out which have focussed particularly on helping the spouses of those who are dependent on alcohol, with counselling, individual stress management and alcohol-focused couples therapy all being instituted as part of such an intervention (Halford et al., 2001; Farid et al., 1986; Dittrich and Trappold, 1984; Dittrich, 1993).

Intervention method

A systematic review of workplace interventions reveals that a vast majority of interventions studies have employed counselling-based interventions which entail techniques like psychosocial skill training, brief intervention and alcohol education (Webb et al., 2010). However, such counselling-based interventions have been generally found by most studies to have a minimal effect (Hermansson et al., 1998; Bennett et al., 2004 and Lapham, Gregory & McMillan, 2003).

Through the argument justified above, this paper is a proponent of an alternative intervention approach, that of peer support programs that concentrate on changing workplace attitudes towards alcohol abuse. The peer support programmes intend to reduce the relapse rates among office workers, develop supportive behaviours and enhance their self-determination and quality of life (Boisvert et al., 2008). The intervention will be delivered in the workplace, as this venue has the potential to reach a broader audience than other interventions, including such individuals who may not have received such a modality of intervention (Ames, 2011).

Evidence base which supports the choice of intervention

This intervention is supplemented by a wide base of psychological theory, which includes which include social learning theory (Bruner, 1966), experiential knowledge (Kolb, 1984), social support, and social comparison theory (Brown and Salzer, 2002). Based on the social learning theory peers are supposed to be credible role models for others, with peer interaction also resulting in positive behaviour change, due to learning through observation and also modelling the behaviour of others, which is certainly something which is feasible in this intervention, with the close interaction between the mentees and the mentors (Bandura, 1995).

Fig. 1 Social learning theory (Bandura, 1995)

This correlates with Abraham and Michie’s (2008) taxonomy of behavioural change as there is a modelling section of the taxonomy which stipulates that behaviour can be enforced by change. Interacting with peers that have successfully coped with similar experience may instil a positive behaviour change among these office workers. Furthermore, this approach is also ratified by Maslow’s (1970) authoritative Hierarchy of Needs model as this strategy recognises that the safety and love/belonging needs must be met (in this case through the intimate social interaction of the mentee and mentors, which is intensified by the shared experiences each will have had) before the mentee can reach higher levels of the hierarchy such as increasing their self-esteem and self-actualisation (fulfilling one’s potential). This seems to infer that the individual can attain a significant improvement if the intervention is undertaken successfully, although the practical aspects of it need to be considered at length.

Figure 2- Maslow’s Hierarchy of Needs (1970)

Allocation of people to groups

To discern the effect of this intervention, it seems apt to have two groups: an intervention group and those who are not receiving the intervention (control group). Here, the sample of 400 office workers who drink an excessive amount of alcohol will be sorted into the two categories described above.

In grouping the office workers, several factors will be considered. Ultimately, randomisation is used to control for potentially confounding factors such as the differences between the two groups. This random grouping will eliminate systematic biases that may potentially exist between the two groups such as some members from one group being excessive drinkers compared to the other group, which is a useful method to deploy (French et al., 2010).

Rowe et al. (2007) discovered that peer support is a useful tool to help mediate the difficulties that those who suffer from alcohol misuse may suffer and provide them with a source of support which is external to their family that may be more advantageous to some individuals. Peer support will be provided to individuals who consume an abundance of alcohol through the provision of emotional and social support, sharing of knowledge and experience and also practical help. Trained supporters will be selected to act in the role of peer mentors and help those who do suffer from alcohol misuse to cope with their emotional distress and enhance their self-esteem, as well as allowing them to harness a greater support network to cope with their problems and increase the interpersonal resources which are at the sufferers’ disposal, which may be particularly pertinent if those who are supporting the alcoholics have been trained suitably, something which needs to be ensured prior to the implementation of the intervention (Cox, 2012).

Delivery approach of peer support

There are a spectrum of methods to deliver peer support services such as professional-led groups, peer coaches, peer-led self-management programmes, web and email based programs and peer mentors (Boisvert et al., 2008). In this particular instance, peer mentors will be instituted. Peer mentors are individuals that have had similar experiences and have found the resources to cope with similar conditions to that of their mentees and is a concept which has been instituted in schools, among other such environments. It is particularly applicable to health psychology as this is a field which is concerned with understanding the psychological and interpersonal aspects of a situation and identifying mechanisms for change (Marks et al., 2010), something which is commensurate with the aims of peer mentoring which aims to change the behaviour of the mentees through role modelling, active listening and other such psychological processes. This peer mentoring process entails a one-on-one session where the mentor meets and listens to the participants, discusses their concerns, provides them with emotional and social support and directs them towards positive behaviour change. The peer mentor will also assist the individuals with self-management programmes which will enable them to self-monitor their progress and how they are developing.

An integral component of the peer support programme is ensuring adequate planning and preparation. This includes identifying the needs of those who are suffering from alcohol abuse and striving to meet those needs (Money et al., 2011). In this intervention process, systematic screening of workers will be performed to identify individuals that can serve as peer supporters. The selection criteria will be based on the leader’s ability, character, communication skills and previous experience (Money et al., 2011).

Evaluation plan of the intervention (including assessing primary and secondary outcomes)

In evaluating the intervention, the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework will be used (French et al. 2010, p.106). Green and Glasgow (2006) and Glasgow et al. (2002) discussed how this framework can be used to assess the intervention.

Reach is the target population involved and how representative it is, with the sample size of 400 participants being a sufficient size of participants to afford some generalisability to the rest of the population. Effectiveness relates to the assessment of primary (level of individuals’ consumption) and secondary outcomes (individuals’ self-esteem, functioning and well-being levels, amongst others, which illustrate how the individual is coping with the intervention in a subsidiary sense), which will measured on a monthly basis, also examining whether the intervention has led to any unintended consequences such as upsetting the participants (Martin et al., 2011). Adoption refers to the degree to which the individuals have changed their behaviour in relation to the function of the intervention. Implementation encompasses the feasibility of using this intervention in a financial and practical sense (French et al., 2010). Maintenance relates to the sustainability of the intervention process, such as whether it is applicable in real-world settings (Martin et al., 2011).

The RE-AIM framework is a useful vehicle for evaluating the effectiveness of this intervention process, due to the holistic and comprehensive nature of this framework, an attribute which other such frameworks seemingly do not possess.

Conclusion

In essence, there are numerous psychological interventions that can be employed to address issues of alcohol abuse, with empirical interventions tending to have a focus on therapy and counselling, although several studies have illustrated such therapeutic interventions tend to have minimal effect. This particular paper has proposed the use of peer support programs with a focus on changing workplace attitudes towards alcoholism. The peer support programmes are intended at reducing the relapse rates among the office workers, developing supportive behaviours and enhancing their self-determination and quality of life. The evidence base for this intervention method stems from it being reaffirmed by numerous eminent health psychology theories such as Maslow’s Hierarchy of needs and adopting some of the characteristics of Abraham and Michie’s (2008) change taxonomy, an authoritative model in the domain of health psychology. Theoretically, interacting with peer mentors will enable alcohol abuse sufferers to try and establish a sense of normalcy and optimism and give them a realistic target to strive towards.

References

Abraham, C. and Michie, S. (2008) ‘A taxonomy of behavior change techniques used in interventions.’ Health Psychology, 27(3), 379–387.

Ames, G. M. (2011) ‘Prevention interventions of alcohol problems in the workplace, a review and guiding framework.’ Alcohol Research & Health, 34(2).

Anderson, P. (2014) ‘Alcohol and the workplace.’ [Online]. Available at: http://www.euro.who.int/data/assets/pdf_file/0009/191367/8-Alcohol-and-the-workplace.pdf (Accessed: 6 January 2015).

Baron, R. C. and Salzer, M. S. (2002) ‘Accounting for unemployment among people with mental illness.’ Behavioral Sciences & the Law, 20(6), 585–599.

Bennett, J., Patterson, C., Reynolds, S., Wiitala, W. and Lehman, W. (2004) ‘Team Awareness, Problem Drinking, and Drinking Climate: Workplace Social Health Promotion in a Policy Context.’ American Journal of Health Promotion, 19(2): 103–113.

Boisvert, R. A., Martin, L. M., Grosek, M. and Clarie, A. J. (2008) ‘Effectiveness of a peer-support community in addiction recovery: participation as intervention.’ Occupational Therapy International, 15(4), 205–220.

Bruner, J. S. (1966) Toward a theory of instruction. Cambridge, Mass: Belkapp Press.

Cox, W. M. (2012) Treatment and Prevention of Alcohol Problems: A resource manual. Florida: Academic Press.

Dittrich J. and Trappold M. (1984) ‘A treatment program for wives of alcoholics: an evaluation.’ Bulletin of the Society of Psychologists in Addictive Behaviours, 3(2), 91-102.

Dittrich, J. (1993) Treating alcohol problems: marital and family interventions. New York: Guildford Press.

Drummond C. (1990) ‘The relationship between alcohol dependence and alcohol-related problems in a clinical population.’ British Journal of Addiction. 85, 357–366.

Farid, B., El Sherbini, M. and Raistrick, D. (1986) ‘Cognitive group therapy for wives of alcoholics – a pilot study.’ Drug and Alcohol Dependence, 17, 349-358

French, D., Vedhara, K., Kaptein, A. A. and Weinman, J. (2010).Health psychology. 2nd edn. United Kingdom: Wiley-Blackwell.

Green, L. W. and Glasgow, R. E. (2006) ‘Evaluating the Relevance, Generalization, and Applicability of Research: Issues in External Validation and Translation Methodology.’ Evaluation & the Health Professions, 29(1), 126–153.

Halford W., Price, J., Kelly, A., Bouma, R. and Young, R. (2001) ‘Helping the female partners of men abusing alcohol: a comparison of three treatments.’ Addiction 2001, 96, 1497-1508.

Hermansson, U., Knutsson, A., Rönnberg, S. and Brandt, L. (1998) ‘Feasibility of Brief Intervention in the Workplace for the Detection and Treatment of Excessive Alcohol Consumption.’ International Journal of Occupational and Environmental Health, 4(2), 71–78.

Kolb, D. A. (1984) Experiential learning: experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall.

Lapham, S. C., Gregory, C. and McMillan, G. (2003) ‘Impact of an alcohol misuse intervention for health care workers – 1: Frequency of binge drinking and desire to reduce alcohol use.’ Alcohol and Alcoholism, 38(2), 176–182.

Marks, D., Murray, P., Evans, B. and Estacio, V. E. (2010) Health Psychology: Theory, Research and Practice. London: SAGE.

Martin, P. R., Cheung, F. M., Knowles, M. C., Kyrios, M., Littlefield, L., Overmier, J. B. and Prieto, J. M. (2011) IAAP handbook of applied psychology. United Kingdom: Wiley-Blackwell.

Martire, L. M., Lustig, A. P., Schulz, R., Miller, G. E. and Helgeson, V. S. (2004) ‘Is It Beneficial to Involve a Family Member? A Meta-Analysis of Psychosocial Interventions for Chronic Illness.’ Health Psychology; 23(6), 599-611.

Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A. and French, D. P. (2011) ‘A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy.’ Psychology & Health, 26(11), 1479–1498.

Pierre, J. (2013) Peer support. [Online]. Available at: http://thecareeurope.com/?c=peer-support (Accessed: 6 January 2015).

Rehm, J., Taylor, B. and Room, R. (2006) ‘Global burden of disease from alcohol, illicit drugs and tobacco.’ Drug and Alcohol Review, 25(6), 503–513.

Renna, F. (2008) ‘Alcohol abuse, alcoholism, and labor market outcomes: looking for the missing link.’ Industrial & Labor Relations Review, 62(1).

Richmond, R., Kehoe, L., Heather, N. and Wodak, A. (2000) ‘Evaluation of a Workplace Brief Intervention for Excessive Alcohol Consumption: The Workscreen Project.’ Preventive Medicine, 30(1): 51–63.

Rowe, M. et al. (2007) ‘A peer-support, group intervention to reduce substance use and criminality among persons with severe mental health illness.’ Psychiatric Services, 58, 7: 995-961.

Templeton L., Velleman, R. and Russell, C. (2010) ‘Psychological Interventions with Families of Alcohol Misusers: A Systematic Review.’ Addiction Research & Theory, 18(6): 616-648.

Velleman, R., Templeton, L., Taylor, A. and Toner P. (2003) Evaluation of the Pilot Family Alcohol Service. Bath: University of Bath.

Walitzer, K. S. and Connors, G. J. (1999) ‘Treating problem drinking.’ Alcohol, Research, & Health, 23(2).

Webb, T. L., Joseph, J., Yardley, L. and Michie, S. (2010) ‘Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy.’ Journal of Medical Internet Research, 12(1).

Zohhadi S., Templeton, L. and Velleman, R. (2006) Parents and Children Together (PACT). Evaluation of the Pilot. Bath: University of Bath.