Intro: This podcast was made on the lands of the Wurundjeri people,
Intro: the Woi Wurrung and the Bunurong. We pay our respects
Intro: to their elders, past and present, and to emerging leaders.
Intro: From the University of Melbourne's School of Psychological Sciences, this
Intro: is Psych Talks.
Cassie: Welcome back. Today we're talking about alcohol use, impulsivity, and
Cassie: why some people move from casual drinking to dependence while
Cassie: others don't. We sometimes think of addiction as a matter
Cassie: of self-control or willpower, but what if the story is
Cassie: more about how we respond to reward, learn from consequences,
Cassie: and think about the future?
Cassie: We're joined by Dr Antoinette Poulton to talk about her
Cassie: research on impulsivity, feedback, and how simple insights into their
Cassie: behaviour might help people change their relationship with alcohol.
Nick: Antoinette is a researcher at the University of Melbourne whose
Nick: work focuses on the brain's executive functions and how they
Nick: relate to substance use and addiction.
Nick: Her research explores why some people are more vulnerable to
Nick: developing problematic alcohol use and how real-time feedback and digital
Nick: tools can support behaviour change. Her work spans experiments, digital
Nick: and pharmacological interventions, and app-based studies that track people's cognition
Nick: and behaviour in everyday life.
Nick: Antoinette, welcome to PsychTalks. So let's start with how you
Nick: got into research in this area. Was it a straight
Nick: path or a winding one?
Antoinette: Well, thanks so much for having me on PsychTalks. Um,
Antoinette: my research journey has been, uh, an incredibly winding path,
Antoinette: in fact, I started my professional career in teaching. Um,
Antoinette: when I first started teaching in Australia, I was teaching
Antoinette: English language to new arrivals, to migrants, to refugees, and
Antoinette: also to international students. And then I spent some time
Antoinette: teaching abroad. I worked in mainstream secondary schools supporting young
Antoinette: people with learning difficulties. Uh, basically I was helping them
Antoinette: access the mainstream curriculum and respond to it.
Antoinette: Um, then I had this extraordinary teaching experience in Spain.
Antoinette: I was employed by a research institute attached to the, um,
Antoinette: Polytechnic University of Valencia.
Antoinette: And their research focused on thermodynamics, thermofluids, and they had
Antoinette: these very lucrative contracts with um European automotive companies, um,
Antoinette: and my students essentially were working on those contracts, and
Antoinette: they needed help to um express their results more fluently
Antoinette: in English, so I was employed, um, to work with
Antoinette: them so that they could speak more clearly and, and
Antoinette: more quickly and fluently.
Antoinette: Um, but they were all PhD students, um, in engineering, physics,
Antoinette: and maths, and during this time I witnessed a very
Antoinette: different attitude to drugs than I had seen as a
Antoinette: young person in Australia. My students were very high achieving,
Antoinette: high performing individuals.
Antoinette: Many had already won very prestigious national awards in their field,
Antoinette: but they were nonetheless engaging in, at least by Australian standards,
Antoinette: a fairly serious recreational drug use. Um, it wasn't uncommon
Antoinette: for them to turn up on a Monday morning and
Antoinette: to tell me about how they'd been high on this
Antoinette: or that across the weekend, um, but they'd front up
Antoinette: to work on Monday, perfectly functional, they'd engage in highly
Antoinette: technical work successfully.
Antoinette: And yeah, it was a little bit unusual. I'd not
Antoinette: witnessed that before in Australia, um, and, and in general
Antoinette: really in Spain, the people I interacted with had a
Antoinette: very relaxed relaxed attitude to drug taking, there was less
Antoinette: stigma and certainly around recreational drug use anyway. So early
Antoinette: on when I was still thinking my career would be
Antoinette: in teaching, um, I was developing this curiosity around different
Antoinette: attitudes to drugs and what constituted addiction.
Antoinette: When I returned to Australia after about 5 years, I
Antoinette: actually continued teaching, and again I was supporting young people
Antoinette: in mainstream schools with learning issues, but after a while
Antoinette: I started to get very bored, very restless, and I thought, well,
Antoinette: a way to combat that would be to do some
Antoinette: psychology subjects. I thought maybe I could look at the
Antoinette: neurobiology underpinning some of the disorders I saw in my students.
Antoinette: Um, so I started taking some undergraduate psychology subjects, and
Antoinette: basically I got hooked very quickly. Within 6 months, I'd
Antoinette: quit school or quit work as a teacher, and I'd
Antoinette: come to the University of Melbourne. I was doing the
Antoinette: graduate diploma in psychology. And during that time, it was
Antoinette: sort of during the 3rd year subjects that I counted
Antoinette: Professor Rob Hester, and he was doing a series of
Antoinette: lectures on addiction and what constituted addiction, and I got very,
Antoinette: very interested. It recalled my experiences in Spain.
Antoinette: Um, and so really from that point on, one thing
Antoinette: led to another very quickly. I did my 4th year
Antoinette: with Rob as supervisor and then undertook a PhD a
Antoinette: couple of years later, also with Rob as supervisor.
Cassie: So a lot of your recent research is about drinking
Cassie: and especially what you call hazardous alcohol use.
Cassie: So it'd be interesting just to talk about what you
Cassie: define hazardous use. Is it a binge on the weekend?
Cassie: Is it a clinical addiction? Is it something else? Is
Cassie: it different here than in Spain?
Antoinette: Yeah, well, hazardous alcohol use actually is defined by the
Antoinette: World Health Organization.
Antoinette: And it involves three core components or core elements. It,
Antoinette: it refers to consumption, so basic quantity, frequency questions around
Antoinette: how much we're drinking, and that can include binge drinking questions.
Antoinette: It also includes symptoms of dependence, so for instance, struggling
Antoinette: to stop drinking once you've started, functional difficulties that we
Antoinette: might experience that I didn't see in Spain, um, and
Antoinette: alcohol related problems like guilt, blackout, if someone's perhaps alerted
Antoinette: you to, um, their concerns about your drinking.
Antoinette: So it's essentially hazardous alcohol use is essentially a pattern
Antoinette: of behaviour that increases an individual's risk for physical or
Antoinette: psychological harm, even if you don't actually yet see those consequences.
Antoinette: They may emerge later, and it's linked to an increased
Antoinette: risk of acute injuries like falls or car accidents or
Antoinette: being the perpetrator or victim of violence, greater likelihood of
Antoinette: developing chronic illness like liver disease or other cancers related
Antoinette: to alcohol.
Antoinette: And critically, this type of alcohol use renders people much
Antoinette: more vulnerable for developing alcohol use disorders or dependence. So
Antoinette: hazardous use is different to addiction, but it can be considered,
Antoinette: at least for some people, a bit of a precursor
Antoinette: to the development of alcohol use disorder. Now, in Australia,
Antoinette: we actually use, we assess consumption using national drinking guidelines
Antoinette: which currently state that um anyone who drinks more than
Antoinette: 10 standard drinks a week or 4 drinks in one day, is, um,
Antoinette: at greater risk of harm.
Antoinette: Uh, but the guidelines do emphasise that actually there's no
Antoinette: level of drinking that's completely safe. Recent national surveys in Australia,
Antoinette: so these are surveys conducted by the Australian Institute of
Antoinette: Health and Welfare, and we've got a big national survey
Antoinette: that comes out every 2 to 3 years, the National
Antoinette: Drug Strategy Household Survey, that shows that about 1 in
Antoinette: 3 Australians are drinking above those Australian guidelines, and if
Antoinette: we look at the group of people under the age
Antoinette: of 25, it's about 40% exceed those guidelines.
Cassie: And there's been some recent news about kids or young
Cassie: people these days drinking less, so is, is hazardous drinking
Cassie: in Australia a bigger problem for younger people than perhaps
Cassie: we're seeing in the news?
Antoinette: It's true that younger people on average are drinking less,
Antoinette: but it's the same amount of alcohol, so there are still,
Antoinette: there are still this group, this sub-cohort of young people
Antoinette: who are drink that are keeping the level, the amount
Antoinette: of drinking elevated. Um, I think just recently, yesterday or
Antoinette: the day before actually,
Antoinette: Um, some results came out about the biggest group of
Antoinette: drinkers are now men in their middle age. Um, it's
Antoinette: definitely true that we see that group at the moment
Antoinette: engaging in greater frequency and quantity of drinking.
Antoinette: But yeah, generally drinking is done by the sort of
Antoinette: hazardous drinking or drinking above guidelines is done by a
Antoinette: relatively small number of people, but they're drinking a lot,
Antoinette: and that's certainly the case for younger people, and, and
Antoinette: causing some harmful consequences,
Nick: I, yeah, yep. I'll have to look out for that
Nick: when I enter middle age. Um, so one idea that's
Nick: really front and centre in your scientific work, Antoinette, is
Nick: this idea of impulsivity, so what do you mean by that?
Antoinette: Um, so broadly we're, we can think about impulsivity as
Antoinette: acting on the spur of the moment or acting quickly,
Antoinette: perhaps too quickly without thinking things through or thinking about consequences.
Antoinette: In the research arena, impulsivity is understood to be multi-dimensional,
Antoinette: and there are two aspects that are particularly relevant in
Antoinette: the area of addiction or addiction research, that's impulsive decision-making
Antoinette: and response inhibition.
Antoinette: Impulsive decision making refers to that tendency some of us
Antoinette: have to favour immediate rewards regardless of whats the outcome,
Antoinette: and if we put that another way, that's sensitivity to
Antoinette: proximate or close reward and insensitive, insensitivity to the delayed consequences.
Antoinette: And we're exhibiting this type of impulsivity when we choose
Antoinette: to keep drinking because it feels good, rather than to
Antoinette: consider how it might impact our ability to perform it
Antoinette: at our job tomorrow or how it might affect our
Antoinette: long-term health. Response inhibition by contrast is thought of as self-control.
Antoinette: It's our ability to think through the consequences and to
Antoinette: inhibit or stop ourselves from drinking in the moment.
Nick: Got it, so a combination of sort of rushing into
Nick: things too quickly without thinking about long-term consequences and not
Nick: resisting or delaying gratification?
Antoinette: Exactly, that's exactly right, and the theory suggests that impulsivity
Antoinette: will emerge when there's an imbalance between those two aspects
Antoinette: of impulsive, you know, impulsive decision making versus the um
Antoinette: inhibitory control processes.
Cassie: It reminds me of another episode we've got this season
Cassie: with Daniel Bennett around gambling, and I guess gambling goes
Cassie: hand in hand with alcohol use both in kind of
Cassie: behaviours but also this impulsivity. Can you tell us a
Cassie: little bit about the brain processes or the mental functions
Cassie: that are responsible for impulsivity?
Antoinette: Yeah, sure, so impulsive decision making is thought to be
Antoinette: mediated by reward sensitive, dopamine rich mid-brain areas, and we're
Antoinette: talking about several areas here. People have probably heard of
Antoinette: the amygdala, which processes emotion.
Antoinette: And biases decision making toward emotionally charged immediate responses, um,
Antoinette: we're talking about the insular as well, which is linked
Antoinette: to craving, that sort of feeling we must have it now. Um,
Antoinette: the ventral striatum is also involved, which is a key
Antoinette: area for reward-processing and risk-taking. Um, response inhibition by contrast
Antoinette: is underpinned by more top-down processes, so it falls under the, um,
Antoinette: overarching umbrella of executive function.
Antoinette: And inhibition in fact is a core element of executive function.
Antoinette: Our executive functions are those higher order skills that enable
Antoinette: us to plan, to organise, um, to enact self-control, to remember,
Antoinette: keep things in mind, our working memory, to shift attention,
Antoinette: to adjust, um, our behaviour in response to changing circumstances,
Antoinette: and these functions are mediated by the prefrontal cortex.
Antoinette: Response inhibition in particular is supported by the dorsolateral prefrontal cortex,
Antoinette: and that's an area where we hold long-term goals in mind,
Antoinette: such as, I need to stay sober.
Nick: So, does being more impulsive make you more likely to
Nick: start using alcohol in hazardous ways, or more likely for
Nick: your hazardous use to progress further, or what?
Antoinette: Yeah, well this is really interesting because there is quite
Antoinette: a raft of evidence that suggests pre-existing impulsivity renders individuals more
Antoinette: vulnerable for problems with alcohol and or drugs, so impulsive
Antoinette: decision making and or response, poor response inhibition in children
Antoinette: and young adults predicts an earlier onset of first alcohol
Antoinette: or drug use. It also predicts a rapid escalation of use, um,
Antoinette: so for instance, from occasional use to heavy.
Antoinette: Use, but we also know though that alcohol and drug
Antoinette: use can exacerbate impulsivity, and there's sort of two arms
Antoinette: to this type of research. There are acute effects, so
Antoinette: when under the influence, people tend to be more impulsive,
Antoinette: and people who had pre-existing higher levels of impulsivity will
Antoinette: be even more impulsive in the moment once they've taken
Antoinette: some alcohol or drugs on board.
Antoinette: But there's also with chronic use, we see structural and
Antoinette: functional changes in the brain, and it's, it's, it's those
Antoinette: brain regions I mentioned involved in decision making and self-control,
Antoinette: which can produce then even greater heightened impulsive behaviour, so
Antoinette: it's sort of a feedback loop starts to develop.
Antoinette: It's worth mentioning that there's evidence that the changes we
Antoinette: see in the brains um related to decision making and
Antoinette: response inhibition are especially prominent in young people who commence
Antoinette: alcohol and drug use quite early. So there's a bit
Antoinette: of research around young people who commence drinking sort of
Antoinette: at around 15, and we see long-term changes in their brain.
Cassie: So you're talking about people having differences in impulsivity from
Cassie: a starting point. So if we know impulsivity is a
Cassie: risk factor for problematic alcohol use, how do we change that?
Antoinette: Yeah, um, so there's a bit of research going on, uh,
Antoinette: in this area at the moment and different research groups
Antoinette: are taking different approaches. Impulsivity does appear to have biological underpinnings, um.
Antoinette: Nonetheless, it's important to remember, that being impulsive doesn't mean
Antoinette: someone will definitely develop problems with drug or alcohol, um,
Antoinette: it's just that they appear to be more vulnerable.
Antoinette: So it might be of benefit to intervene in these cases,
Antoinette: to be able to target these people with early interventions,
Antoinette: early education, maybe some skill building, and I guess it's
Antoinette: probably beneficial to think in terms of managing and reducing
Antoinette: the impact of impulsivity rather than categorically being able to
Antoinette: change it.
Cassie: Would someone know if they're high on impulsivity?
Antoinette: Well, they may do, um, one arm of research just
Antoinette: asks self-report questions about impulsivity, so it's possible to, you know,
Antoinette: go online and have a look, but you, I mean
Antoinette: in testing people, certainly a number of people will indicate
Antoinette: to me prior to testing, oh I think I'm more
Antoinette: impulsive than most people, yeah.
Nick: Yeah, it's so interesting cos when you think about impulsiveness
Nick: from a personality perspective, it just suggests this is something
Nick: that you have or something that you are and you're
Nick: not really gonna change it very much, so, what do
Nick: you do about it?
Nick: But I think what's interesting about your work is you're
Nick: thinking about impulsiveness as something that you can not necessarily overcome, but,
Nick: but there are clever tricks that you can get around
Nick: it if you like, or, or uh uh offer a
Nick: more optimistic, if you like, stance towards recovery.
Nick: So one thing that you've done in your work which
Nick: I think is fascinating, is this idea that simply giving
Nick: people feedback about their drinking can result in reductions in
Nick: hazardous alcohol use. So can you explain what you've done
Nick: on this topic? Yeah, absolutely.
Antoinette: So we've conducted two studies now with two different samples,
Antoinette: and um the results have shown that if we provide
Antoinette: people with personalised information about their drinking, about their level
Antoinette: of impulsivity, and how impulsivity is implicated in hazardous alcohol use,
Antoinette: they appear to reduce their drinking.
Antoinette: So in one study we found that young hazardous drinkers
Antoinette: had reduced their total intake at follow-up, which was at
Antoinette: about 60 days, by 32 to 35%, which is equivalent
Antoinette: to 4 standard drinks per week. And so this was
Antoinette: in response to this feedback, that group of young people,
Antoinette: there was 250 of them, and they're 21, 22 years
Antoinette: of age.
Antoinette: Um, the impact on their drinking was so substantial that
Antoinette: these hazardous drinkers couldn't be distinguished from non-harmful drinkers at follow-up,
Antoinette: and this was on measures of total intake, on binge drinking,
Antoinette: on how much people would drink in any one day.
Antoinette: We could no longer define them as, um, hazardous drinkers.
Antoinette: We've recently replicated this study in a larger multi-part study
Antoinette: which is about to come out in JMIR, and in
Antoinette: this study we follow people at 3 months, and again
Antoinette: we see a 33% reduction in drinking.
Cassie: Does that feedback only reduce the drinking for those who
Cassie: feel they have a problem or who want to reduce it,
Cassie: that have some motivation to drink less when they find
Cassie: out how much they're drinking, or, can anyone kind of
Cassie: see a reduction in their drinking even if they don't
Cassie: have that kind of desire or motivation to drink less?
Antoinette: Well, you would think that motivation might be a key factor,
Antoinette: but that's not actually what we saw in our results.
Antoinette: We were looking in this second study to see if
Antoinette: we could see what was underpinning this reduction in drinking,
Antoinette: and motivation was one of the variables that we included,
Antoinette: but this didn't seem to have any impact on the
Antoinette: actual change, which was actually a surprising finding. There are
Antoinette: some large meta-analysis studies that have come out of the
Antoinette: United States recently.
Antoinette: That that do question whether motivation's an essential element for
Antoinette: this kind of change, but nonetheless I did expect to
Antoinette: see that it might, you know, mediate the results in
Antoinette: some way, but no, we didn't see that this time.
Nick: It's sort of astonishing that just giving feedback even without
Nick: motivation could make such an impact on behaviour change and
Nick: without wanting to get too controversial, you know, this idea
Nick: that you don't have to delve into people's childhoods or
Nick: make them commit to something or appeal to a higher power, uh,
Nick: they're simply giving some accurate knowledge about what people are
Nick: doing could have an effect.
Nick: It also presumably goes against a lot of what some
Nick: people believe about a sort of a brain disease model
Nick: of alcohol. Again, I don't want to be too controversial here,
Nick: but if this was something that you couldn't change, and
Nick: yet your research is showing that a bit of factual
Nick: information can lead to significant change, that's, uh, astonishing.
Antoinette: Well, I mean, it is, it is really astonishing, um,
Antoinette: at least it's the case for young hazardous drinking. We
Antoinette: have to be a little bit circumspect, I suppose. Um,
Antoinette: we need to build on these findings to see if
Antoinette: this type of personalised feedback has the same impact in
Antoinette: the wider community or other cohorts, whether, for example, our,
Antoinette: you know, our, our, our,
Antoinette: men in middle age will react in the same way
Antoinette: to this type of feedback is yet to be seen,
Antoinette: but yeah, that, that's, that's coming work.
Cassie: But it's also fascinating, a lot of the, the models
Cassie: of behaviour change have motivation as a core kind of
Cassie: feature to to dial up or dial down in terms
Cassie: of encouraging a behaviour change.
Cassie: Um, a fascinating part of your research is how you
Cassie: get accurate feedback to these drinkers, and we probably can
Cassie: all reflect on having less than ideal self-reports when we
Cassie: ask someone, you know, how much did you drink in
Cassie: this session or whatever the behaviour is.
Cassie: So how did you develop ways to assess drinking in
Cassie: a real-time, more accurate way than just asking someone on
Cassie: Monday how much they drank on the weekend?
Antoinette: So um during my PhD I designed an app, um,
Antoinette: which it was designed to help researchers capture real-time information
Antoinette: about drinking.
Antoinette: At the time, I was hoping to develop a tool
Antoinette: that would overcome some of the limitations around accurately assessing
Antoinette: alcohol use. At that point we were relying on sort
Antoinette: of summary retrospective measures of alcohol intake, and this is,
Antoinette: as you say, there are disadvantages to that type of assessment.
Antoinette: People find it difficult to conceptualise their intake. They're often
Antoinette: overlooking high intake sessions, so they're sort of applying an
Antoinette: average already to their own drinking.
Antoinette: Um, and obviously there's difficulties with recall, so the information's
Antoinette: not particularly accurate and it's certainly not very nuanced. So
Antoinette: we reasoned that if we had an app, we could
Antoinette: have people recording their drinking as it happened, and we
Antoinette: were hoping that it would provide very, um, accurate and
Antoinette: detailed information.
Antoinette: Um, the app's called Alcohol Capture, and it enables people
Antoinette: to track consumption for a period of days. We typically
Antoinette: use 14 days, but it's variable. They get notifications to
Antoinette: input data a couple of times a day, but they
Antoinette: can also open the app at any time and put
Antoinette: information in. And all Australian drink sizes have been programmed
Antoinette: into the app, so people are not having to make
Antoinette: complicated calculations in their head about standard drink sizes. And
Antoinette: an early paper,
Antoinette: From my PhD showed that participants were recording greater frequency
Antoinette: of drinking on the app and higher intake, as opposed
Antoinette: to when completing the retrospective measures. So that's the app
Antoinette: we've been using in our feedback studies. We're providing people
Antoinette: with this personalised feedback based on data coming from the app, um,
Antoinette: in the hope that it's, it's very accurate and, um,
Antoinette: it's linked quite clearly to actual drinking episodes. We have
Antoinette: simultaneously developed an app to assess cognition in real time,
Antoinette: and this is called CheckCog.
Antoinette: Um, it allows us to assess both inhibit- response inhibition
Antoinette: and working memory several times a day again for 14 days,
Antoinette: and so, um, if you think about what I said before,
Antoinette: we're assessing elements of executive function with this app, and
Antoinette: just this week, in fact, a, a colleague of mine,
Antoinette: Dr Gezelle Dali, has found that day to day fluctuations
Antoinette: in cognition assessed via this app predicts drinking that day.
Antoinette: So, this is great because this is opening up the
Antoinette: door for us to give just in time feedback where
Antoinette: we can potentially tell people about their impulsivity in real
Antoinette: time on the day, in the hope that it influences
Antoinette: drinking later that day.
Cassie: And just on that, I think people wouldn't necessarily be
Cassie: surprised to think that drinking might impact cognition or performance
Cassie: on cognitive tasks, but what you're saying is that it
Cassie: is the other way as well?
Cassie: So if your cognition is declining, you are then more
Cassie: likely to, engage in drinking
Antoinette: Yeah, yeah, so she's found differences in cognition sort of
Antoinette: measured across the two time points in the day, are
Antoinette: predicting that drinking on the day, yeah.
Cassie: And what sort of cognitive tasks are these just so
Cassie: people can imagine?
Antoinette: Yeah, so the response inhibition task is a task called
Antoinette: a stop signal task and it requires people to, um,
Antoinette: respond quickly to what we call a 'go stimulus', and
Antoinette: then every so often there's a 'no go' stimulus. Um,
Antoinette: people don't know when it's coming, uh, the task goes
Antoinette: very quickly, so they're often, um, partway towards responding as
Antoinette: though it's a go stimulus and then they get this
Antoinette: little sound to tell them no, no, stop, and it,
Antoinette: it's quite difficult to stop in that scenario.
Antoinette: I liken it to being at a traffic light, when
Antoinette: you've hit the traffic lights and you see the amber
Antoinette: light go on, and you've got to make that split
Antoinette: decision between stopping there and then or going through the lights,
Antoinette: so the task, it's sort of analogous to that kind
Antoinette: of task.
Cassie: But it's just something they're doing on a computer, like just?
Antoinette: Yeah, sorry, in this case it's on the app and yeah,
Antoinette: there's little letters come up and you're responding to some
Antoinette: and not to the others.
Cassie: And that can predict drinking, that's fascinating.
Antoinette: That's right.
Nick: So just out of interest, uh, compared to your app,
Nick: how much are people typically underreporting their drinking by retrospective self-report,
Nick: if you can just give us a rough estimate, are
Nick: we talking 50%, 20%?
Antoinette: Yeah, well, it was a significant difference. I can't recall
Antoinette: off the top of my head exactly what it was.
Antoinette: My memory is it was about 2 standard drinks per
Antoinette: week difference, so that's not an enormous quantity, but at
Antoinette: the same time over time it is.
Antoinette: And you know, nowadays the guidelines are quite strict and
Antoinette: they've come down even since I, I did that study, so,
Antoinette: you know, 2 drinks in a day, that takes you
Antoinette: from potentially at 4 drinks to not binge drinking to
Antoinette: 6 drinks to binge drinking.
Nick: So I, I find it fascinating also how you develop
Nick: these uh digital interventions that you've been telling us about.
Nick: So in a recent paper you compared some different formats
Nick: for delivering the personalised feedback that you give people, and
Nick: I think you had some formats based on text or
Nick: images and some that were designed by researchers, and I
Nick: think one that was co-designed by researchers and uh users,
Nick: users I should say.
Nick: What did you find?
Antoinette: Yeah, this was also quite surprising. Essentially in our original
Antoinette: feedback study, the feedback we were providing participants was very
Antoinette: text heavy, it arrived via email and it was about
Antoinette: half a page of fairly dense information. And although the
Antoinette: study and the intervention was effective, we had thought that
Antoinette: if we could involve consumers, we might be able to
Antoinette: improve the look and feel of it and maybe in
Antoinette: turn even its effectiveness.
Antoinette: So we consulted with a youth advisory board located at
Antoinette: the Matilda Centre at the University of Sydney and we
Antoinette: developed some prompts to use with focus groups, and then
Antoinette: we held a series of focus groups involving young people
Antoinette: here in Melbourne. And at the end of this rather
Antoinette: convoluted process, we had 3 types of feedback. We had
Antoinette: this original text heavy feedback, we had an image-based feedback
Antoinette: that we had developed with the youth advisory board, but
Antoinette: essentially it was researched and designed.
Antoinette: And then we had the wholly image-based feedback that our
Antoinette: focus group participants had, had designed. Now our focus group
Antoinette: participants were from about 17 to 25, 26 years of age,
Antoinette: and they were from different walks of life in Melbourne.
Antoinette: Um, when we presented the three types of feedback to
Antoinette: a new sample of participants, they certainly preferred the focus
Antoinette: groups designed feedback. It was pretty, it was colourful, yeah,
Antoinette: hands down they preferred that. But then with another group
Antoinette: of people, we actually provided the feedback about their drinking
Antoinette: and impulsivity in one of these 3 formats, and it
Antoinette: didn't impact the reduction in drinking in any way, regardless
Antoinette: of what feedback they saw, they all reduced their drinking
Antoinette: to the same amount.
Antoinette: So likability is certainly an important point for an intervention.
Antoinette: But co-design processes are really time consuming, they're very expensive,
Antoinette: and a lot more work clearly needs to be done
Antoinette: in this area to determine whether co-design adds sufficient value
Antoinette: to the end product and to justify the costs, I think.
Cassie: Yeah, I think it's a really interesting area in, in
Cassie: my field in behaviour change, this difference between an ad
Cassie: or a message that people like, and an ad or
Cassie: a message that is effective are very two different things,
Cassie: and sometimes we put too much weight on,
Cassie: the, the likability and doesn't necessarily impact the effectiveness.
Antoinette: I had wondered actually whether the text-based feedback was effective
Antoinette: because it looked so serious, and, and people attended to it,
Antoinette: but I mean it, it would seem that it doesn't
Antoinette: matter how the feedback comes, it's effective.
Cassie: What, what implications does this work have for just lowering
Cassie: the prevalence and the, and the burden of alcohol use problems?
Cassie: Is it about stopping them before they start to become
Cassie: a problem, or can they also treat long-standing hazardous drinkers?
Cassie: What do you see as the potential for these types
Cassie: of interventions?
Antoinette: Well, I mean, alcohol poses a very significant burden in
Antoinette: most regions of the world, that's 5% of all deaths,
Antoinette: are attributed to alcohol, that's 3 million deaths a year.
Antoinette: In Australia, it accounts for 4 to 5% of the
Antoinette: burden of disease, there's 40 to 4500 people dying each
Antoinette: year due to alcohol-related issues and 150,000 hospital admissions, so
Antoinette: the burden is enormous, it exceeds $66 billion.
Antoinette: So undoubtedly there's a constellation of factors involved in hazardous
Antoinette: alcohol use and the transition to alcohol use disorder. Impulsivity
Antoinette: is just one of these factors. It would appear though
Antoinette: that if we can have people who are engaging in
Antoinette: hazardous drinking, become more aware of their consumption, have them
Antoinette: understand that it may be to do with impulsivity and
Antoinette: that there are these links between impulsivity,
Antoinette: and vulnerability to transition, it seems as though um we
Antoinette: can reduce their consumption. And that would go some way
Antoinette: to reducing the burden if we can reliably do that,
Antoinette: do that, but yeah, as I said, we probably need
Antoinette: to extend this work into other cohorts and other groups
Antoinette: to really definitively, uh I guess address your question.
Nick: And pardon the pun, but those are very sobering statistics. Um, uh,
Nick: and I'm serious about that because obviously the cost here
Nick: is enormous. So we like to finish our episodes with
Nick: some practical takeaways for our listeners, um.
Nick: So let's say they or someone they love or care
Nick: about is engaging in hazardous drinking. What sort of advice
Nick: would you give? Does your work offer any guidance about
Nick: what they could do about it?
Antoinette: Yeah, I think that a first step is to track
Antoinette: your own consumption. So it's an easy thing to do,
Antoinette: maybe over 14 days, 21 days, record things in a
Antoinette: little diary or on your phone, and then have a
Antoinette: look at how it compares with national guidelines. People can
Antoinette: do this themselves, and it could for some people be
Antoinette: enough of a mechanism for them to consider their intake
Antoinette: and to reduce consumption.
Antoinette: I would say if people additionally feel that they might
Antoinette: be more impulsive, that they have a tendency to make
Antoinette: impulsive decisions, or they have a tendency to have difficulties
Antoinette: with control, then I would seek help, uh, I would,
Antoinette: you know, perhaps have a first conversation with a GP
Antoinette: or some other mental health expert, um, and then perhaps
Antoinette: look up some of the um numbers that you're going
Antoinette: to put in the show notes.
Cassie: But I think it's just fascinating that I think a
Cassie: lot of these problems obviously are multifaceted and lots of
Cassie: things can go into it, but a very simple thing
Cassie: that people can do is just track their consumption and
Cassie: look at that, and that might be enough for some
Cassie: people to make a safe change in their behaviour.
Antoinette: Yeah, our research really suggests that that's the case.
Cassie: Fascinating research, Antoinette, thank you for joining us today on PsychTalks.
Antoinette: Thank you, thank you for having me.
Cassie: That was Dr Antoinette Poulton speaking about her research on impulsivity,
Cassie: alcohol use, and how simple feedback can support behaviour change.
Cassie: If you'd like to learn more about Antoinette's work, including
Cassie: her current studies and resources, you can find more information
Cassie: in our show notes.
Cassie: And if you need support on these issues, you can
Cassie: check out Daybreak at hellosundaymorning.org or call the National Alcohol
Cassie: and Other Drug Hotline at 1800-250-015.
Cassie: PsychTalks is produced by Mairead Murray, Gemma Papprill and Celia
Cassie: Harvey with audio engineering by Phil Shaw. It is a
Cassie: production of the University of Melbourne, Australia. Thanks for listening.
Cassie: If you enjoyed this episode, please follow, subscribe or share
Cassie: it with a friend. See you next time.