Improving access to treatment for alcohol dependence in primary care: A qualitative investigation of factors that facilitate and impede treatment access and completion.

BACKGROUND: Timely intervention for people with alcohol dependence in primary care is needed. Primary care services have a key role in supporting adults with alcohol dependence and require appropriate provision of services. OBJECTIVE: To examine the perceptions of both primary care practitioners and adults with alcohol dependence regarding service provision and to describe help seeking behaviours for adults with alcohol dependence. DESIGN AND SETTING: Qualitative study consisting of semi-structured interviews with adults with alcohol dependence, healthcare professionals and staff members of specialist alcohol services who had previous or current experience in the management, treatment, or referral of adults with alcohol dependence in Northwest England. METHOD: Interviews were conducted with ten adults with alcohol dependence and 15 staff. Data were analysed thematically, applying principles of constant comparison. RESULTS: Three themes were identified following inductive thematic analysis. The first theme, point of access relates to current service provision being reactive rather than preventative, the stigma associated with alcohol dependence and a person's preparedness to change. The second theme identified was treatment process and pathways that highlights difficulties of engagement, mental health support, direct access and person-centred support. The third theme was follow-up care and discusses the opportunities and threats of transitional support or aftercare for alcohol dependence, signposting and peer support. CONCLUSION: There are clear opportunities to support adults with alcohol dependence in primary care and the need to increase provision for timely intervention for alcohol related issues in primary care.

Prevalence and incidence of alcohol dependence: cross-sectional primary care analysis in Liverpool, UK.

OBJECTIVES: Liverpool has high prevalence of alcohol use disorders (AUDs) compared with the rest of the UK. Early identification and referral in primary care would improve treatment for people with AUD. This study aimed to identify changes in prevalence and incidence of AUD in primary care in Liverpool, to identify local need for specialist services. DESIGN: Cross-sectional retrospective analysis of electronic health records. SETTING: National Health Service (NHS) Liverpool Clinical Commissioning Group (CCG) primary care. In total, 62 of the 86 general practitioner (GP) practices agreed to share their anonymised Egton Medical Information Systems (EMIS) data from 1 January 2017 to 31 December 2021. PARTICIPANTS: Patients aged over 18 years with a SNOMED code for alcohol dependence (AD) or hazardous drinking (N=4936). Patients were excluded if they had requested that their data was not to be shared, and practices were excluded if they opted out (N=2) or did not respond to the data sharing request (N=22). PRIMARY AND SECONDARY OUTCOMES: Prevalence and incidence of AUD diagnoses in primary care over the 5-year period; demographic profile of patients (sex, age, ethnicity, occupation); GP postcode; alcohol-related medications; and psychiatric and physical comorbidities. RESULTS: There were significant decreases in incidence of AD and hazardous drinking diagnoses over the 5 years (p<0.001 in all cases). Prevalence showed less change over time. Diagnoses were significantly higher in more deprived areas (Indices of Multiple Deprivation decile 1 vs 2-10). Overall pharmacotherapy prescriptions were lower than national estimates. CONCLUSIONS: There are low levels of identification of AUDs in primary care in Liverpool, and this is decreasing year on year. There was weak evidence to suggest patients in the most deprived areas are less likely to receive pharmacotherapy once diagnosed. Future research should seek to investigate practitioner and patient perspectives on barriers and facilitators to management of AUDs in primary care.

Learning vocabulary and grammar from cross-situational statistics.

Across multiple situations, child and adult learners are sensitive to co-occurrences between individual words and their referents in the environment, which provide a means by which the ambiguity of word-world mappings may be resolved (Monaghan & Mattock, 2012; Scott & Fisher, 2012; Smith & Yu, 2008; Yu & Smith, 2007). In three studies, we tested whether cross-situational learning is sufficiently powerful to support simultaneous learning the referents for words from multiple grammatical categories, a more realistic reflection of more complex natural language learning situations. In Experiment 1, adult learners heard sentences comprising nouns, verbs, adjectives, and grammatical markers indicating subject and object roles, and viewed a dynamic scene to which the sentence referred. In Experiments 2 and 3, we further increased the uncertainty of the referents by presenting two scenes alongside each sentence. In all studies, we found that cross-situational statistical learning was sufficiently powerful to facilitate acquisition of both vocabulary and grammar from complex sentence-to-scene correspondences, simulating the situations that more closely resemble the challenge facing the language learner.

A Single Paradigm for Implicit and Statistical Learning.

Implicit learning generally refers to the acquisition of structures that, like knowledge of natural language grammar, are not available to awareness. In contrast, statistical learning has frequently been related to learning language structures that are explicitly available, such as vocabulary. In this paper, we report an experimental paradigm that enables testing of both classic implicit and statistical learning in language. The paradigm employs an artificial language comprising sentences that accompany visual scenes that they represent, thus combining artificial grammar learning with cross-situational statistical learning of vocabulary. We show that this methodology enables a comparison between acquisition of grammar and vocabulary, and the influences on their learning. We show that both grammar and vocabulary are promoted by explicit information about the language structure, that awareness of structure affects acquisition during learning, and awareness precedes learning, but is not distinctive at the endpoint of learning. The two traditions of learning-implicit and statistical-can be conjoined in a single paradigm to explore both the phenomenological and learning consequences of statistical structural knowledge.