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Numerous studies have examined the impact of the COVID-19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms.We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self-reported changes in alcohol use associated with COVID-19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random-effects meta-analyses of proportional differences in alcohol use changes. Variations by time, sub-region and study quality were assessed in subsequent meta-regressions. Additional 16 reports identified were summarised narratively.Compiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00-7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7-13.2%), quantity consumed (12.2%, 95% CI 8.3-16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6-21.8%). Among people with pre-existing high drinking levels/alcohol use disorder, high-level drinking patterns appear to have solidified or intensified.Pandemic-related changes in alcohol use may be associated with pre-pandemic drinking levels. Increases among high-risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health-care services.Our findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high-quality studies examining specific change mechanisms at the population level are lacking.

Aim\ud \ud To evaluate the impact of the introduction and withdrawal of financial incentives on alcohol screening and brief advice delivery in English primary care.\ud \ud \ud \ud Design\ud \ud Interrupted time–series using data from The Health Improvement Network (THIN) database. Data were split into three periods: (1) before the introduction of financial incentives (1 January 2006–31 March 2008); (2) during the implementation of financial incentives (1 April 2008–31 March 2015); and (3) after the withdrawal of financial incentives (1 April 2015–31 December 2016). Segmented regression models were fitted, with slope and step change coefficients at both intervention points.\ud \ud \ud \ud Setting\ud \ud England.\ud \ud \ud \ud Participants\ud \ud Newly registered patients (16+) in 500 primary care practices for 2006–16 (n = 4 278 723).\ud \ud \ud \ud Measurements\ud \ud The outcome measures were percentage of patients each month who: (1) were screened for alcohol use; (2) screened positive for higher‐risk drinking; and (3) were reported as having received brief advice on alcohol consumption.\ud \ud \ud \ud Findings\ud \ud There was no significant change in the percentage of newly registered patients who were screened for alcohol use when financial incentives were introduced. However, the percentage fell (P < 0.001) immediately when incentives were withdrawn, and fell by a further 2.96 [95% confidence interval (CI) = 2.21–3.70] patients per 1000 each month thereafter. After the introduction of incentives, there was an immediate increase of 9.05 (95% CI = 3.87–14.23) per 1000 patients screening positive for higher‐risk drinking, but no significant further change over time. Withdrawal of financial incentives was associated with an immediate fall in screen‐positive rates of 29.96 (95% CI = 19.56–40.35) per 1000 patients, followed by a rise each month thereafter of 2.14 (95% CI = 1.51–2.77) per 1000. Screen‐positive patients recorded as receiving alcohol brief advice increased by 20.15 (95% CI = 12.30–28.00) per 1000 following the introduction of financial incentives, and continued to increase by 0.39 (95% CI = 0.26–0.53) per 1000 monthly until withdrawal. At this point, delivery of brief advice fell by 18.33 (95% CI = 11.97–24.69) per 1000 patients and continued to fall by a further 0.70 (95% CI = 0.28–1.12) per 1000 per month.\ud \ud \ud \ud Conclusions\ud \ud Removing a financial incentive for alcohol prevention in English primary care was associated with an immediate and sustained reduction in the rate of screening for alcohol use and brief advice provision. This contrasts with no, or limited, increase in screening and brief advice delivery rates following the introduction of the scheme.

Background and aims: There is limited evidence on what shapes amphetamine-type stimulant (ATS) use trajectories. This systematic narrative review and qualitative synthesis aimed to identify individual, social and environmental influences shaping key phases in the ATS use trajectory: initiation, continuation, increase/relapse and decrease/abstinence.\ud \ud Methods: MEDLINE, PsycINFO, EMBASE, and PROQUEST (social science premium collection) were searched from 2000 to 2018. Studies of any qualitative design were eligible for inclusion. Extracted data were analysed according to four key phases within drug pathways, and then cross-analysed for individual, social and environmental influences.\ud \ud Results: Forty-four papers based on 39 unique studies were included, reporting the views of 1879 ATS users. Participants were aged 14–58 years, from varied socio-economic and demographic groups, and located in North America, Europe, Australasia and South East Asia. Reasons for initiation included: to boost performance at work and in sexual relationships, promote a sense of social ‘belonging’ and help manage stress. Similar reasons motivated continued use, combined with the challenge of managing withdrawal effects in long-term users. Increased tolerance and/or experiencing a critical life event contributed to an increase in use. Reasons for decrease focused on: increased awareness of the negative health impacts of long-term use, disconnecting from social networks or relationships and financial instability.\ud \ud Conclusions: Amphetamine-type stimulant users are a highly diverse population, and their drug use careers are shaped by a complex dynamic of individual, social and environmental factors. Tailored, joined-up interventions are needed to address users’ overlapping economic, health and social care needs in order to support long-term abstinence.

BACKGROUND AND AIMS: Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow. To clarify whether such an application of BI is justifiable, we conducted a systematic review and meta-analysis on studies testing the impact of BI on alcohol consumption. METHODS: We included peer-reviewed,randomized controlled studies investigating the effects of BI on alcohol consumption in injured and/or intoxicated patients, published January 2002 - September 2015. Changes from baseline in consumption quantity, intensity and number of heavy drinking episodes were assessed at 3, 6 and 12 month follow-up, resulting in 9 separate random-effects meta-analyses of standardized mean differences (SMD). Moderation effects of intervention mode, length, type of interventionist, intensity of control intervention and study quality were assessed using subgroup comparisons and meta-regression. RESULTS: We considered 33 publications (28 separate studies) including 14,456 patients. Six out of nine comparisons revealed small significant effects in favour of BI, with the highest SMD at 0.19 (95% CI: 0.08-0.31). No significant moderators could be identified, and statistical heterogeneity (I(2) ) was below 40%. CONCLUSIONS: In a large meta-analysis of randomized controlled trials in emergency care settings, there was evidence for very small effects of brief interventions on alcohol consumption reductions. More intensive interventions showed no benefit over shorter approaches. Non-face-to-face interventions appear comparably effective, but this finding remains tentative due to the low number of non-face-to-face studies. This article is protected by copyright. All rights reserved. Language: en

The paper entitled, “How do doctors in different countries manage the same patient? Results of a factorial experiment,” contained an omission in the author list. The corrected author list should include Karen Lutfey, Ph.D. as the last author as she made significant contribution to the content of this paper. The corrected list is reprinted below in its entirety: John McKinlay, Ph.D., New England Research Institutes, 9 Galen Street, Watertown, MA 02472. Carol Link, Ph.D., New England Research Institutes, 9 Galen Street, Watertown, MA 02472. Lisa Marceau, M.P.H., New England Research Institutes, 9 Galen Street, Watertown, MA 02472. Amy O'Donnell, M.P.H., New England Research Institutes, 9 Galen Street, Watertown, MA 02472. Sara Arber, Ph.D., University of Surrey, Guildford, U.K. Ann Adams, Ph.D., University of Warwick, Coventry, U.K. Karen Lutfey, Ph.D., New England Research Institutes, 9 Galen Street, Watertown, MA 02472.