Challenging the public stigma of alcohol use disorder in the UK using video 'education' and 'contact' interventions: a pilot study Authors: Sophie Hytner1#, Daphne Josselin1, David Belin2* & Owen Bowden Jones2* Supplementary Online Materials SOM Table I Feasibility and Acceptability Questionnaire This study is a pilot to prepare for a larger study into public attitudes towards alcohol dependence. To help design this study as effectively as possible, please tell us how much you agree with the following statements: 1. Briefing and questionnaires (*Objective 2: Evaluation and Refinement of Data Collection Procedures and Outcome measures) • The initial information sheet gave me a clear explanation of what taking part in the study would involve Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • The initial instructions and briefing on the questionnaires meant I understood what was being asked of me Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • The questions and statements on the questionnaires were clear and easy to understand Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • I was able to accurately record my feelings towards John using the scoring scale provided on the questionnaires Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • The time it took me to fill out the questionnaires was: Too short About right Too long ☐ ☐ ☐ 2. Video content and format (*Objective 3: Evaluation of Acceptability and Suitability of Intervention and Study Procedures) • The video was clear and easy to follow Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • The content in the video was engaging and interesting Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • The content in the video felt relevant to me Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • I learned information that I didn’t previously know Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • I would choose to watch this video in full in my own time Strongly Disagree Disagree Neither Agree Nor Disagree Agree Strongly Agree ☐ ☐ ☐ ☐ ☐ • The video length was: Too short About right Too long ☐ ☐ ☐ (*Objective 5: Preliminary Evaluation of Participant Responses to Intervention) What did you like about the video? [free text] How could the video be improved? [free text] SOM Table II A) Myths and facts used in the educational video Category Facts Cannot recover People can’t recover from alcohol dependence People can recover from alcohol dependence and go on to lead fulfilling lives. Over half of people in treatment for alcohol use in alcohol services in England stop or reduce their drinking after 6 months of treatment. Only affects certain groups Alcohol dependence only affects certain types of people, like the homeless Anyone can become dependent on alcohol, regardless of their age, gender, ethnicity or background. Most people with alcohol dependence in England are in employment and stable housing. To blame People with alcohol dependence are to blame for their problems A person’s risk of developing alcohol dependence is influenced by lots of biological, psychological and social factors, many of which are outside their control. Biological factors can include a person’s genetics – approximately 50% of the risk for developing alcohol dependence is explained by genes. Psychological factors can include mental health problems (like depression or anxiety) and personality traits (like impulsivity). Social factors can include trauma (like childhood abuse); social isolation; poverty; unemployment; or discrimination. These factors influence each other and can combine to increase someone’s chance of becoming alcohol dependent. Able to control People with alcohol dependence could stop or control their drinking if they wanted to Alcohol dependence leads to changes in the brain that can limit a person’s control over their drinking. For example, when a person becomes alcohol dependent, their brain adapts to heavy alcohol use and can start to need alcohol to maintain its chemical balance. If a person with alcohol dependence stops drinking, this balance can be disrupted and the person may experience harmful symptoms, like anxiety, shaking or seizures. This means that while many people with alcohol dependence try very hard (often repeatedly) to stop drinking, it can be very difficult, and in some cases unsafe, for them to do so without support. Bad character People with alcohol dependence don’t care about others Those with alcohol dependence tend to feel guilty and ashamed about the impact of their actions on other people; and caring about others is a key factor that can lead people to seek treatment. A large number of people with alcohol dependence support other people – 81% of those attending Alcoholics Anonymous groups in the UK volunteer their time to help others. Myths B) Slides from the educational video SOM Table III Interview guide and content for contact video Themes Prompts Interview Questions Included interview content Section 1 Slide 1 (black background with white writing): In the UK, approximately 800,000 people experience alcohol dependence Slide 2: In this video, three people speak about their personal experiences of alcohol dependence Name How would you l ike to introduce yourself? My name is X; I'm Y; I'm Z Diagnosis How would you describe your past relationship with alcohol? E.g. alcoholic, dependent on alcohol Recovery status How would you describe your current relationship with alcohol? E.g. sober, in recovery for x years Heading: How it started Aetiology (e.g. early experiences, first experiences of using substance) What do you believe led you to use alcohol? Function In your view, what did using alcohol give you / what problems did it seem to solve? What do you think kept your alcohol use going? Y: My alcohol use was basically an escape from my reality because of trauma that I experienced in childhood X: My mum left home when I was 14 years old, my dad met someone else and I felt incredibly lonely and rejected Z: I was quite shy and introverted - drinking alcohol gave me confidence, it made me feel as though I had a greater abil ity to be more open with my emotions X: I was dependent on alcohol and I'd l ike to say I'm not dependent on alcohol anymore Y: I'm recovering from alcoholism…I've been completely abstinent now for four and a half years Z: I would class myself as someone who was dependent on alcohol and nowadays I don't drink it at all , I don't think about it very much and my life is very much devoid of alcohol dependence Introductions Background Themes Prompts Interview Questions Included interview content Heading: What it was like First experience and progression of symptoms (e.g. increased use, withdrawal symptoms, preoccupation) What difficulties did you experience as a result of your alcohol use? Challenges Impact of condition (e.g. distress, stigma, impairments in occupational and interpersonal functioning) What challenges / problems did this lead to? Section 2 Heading: Getting help Recognising problem, contemplating and seeking treatment What led you to seek help with your alcohol use? Engaging in treatment (specific approaches) What support did you receive? (E.g. treatment, self-help groups). How long did this last? Learning of coping strategies How was this helpful for you / what did this give you / what did you learn? Y: When I first started drinking, it was a recreational thing. There were lots of difficulties that came as my drinking progressed X: I lost all my self esteem, my anxiety was sky high Z: I was almost always sick, you know, low moods, feelings of l ike self loathing X: It got to quite a critical state really where I was drinking over a l itre of vodka a night at times Y: I ended up becoming homeless Z: What kind of woke me up was I had a health scare - it really shook me up. That same year I actually went for some talking therapy with my local authority. Those two things really l ike planted a seed X: I found my community actually on Instagram and I went to a couple of sober social things that I was petrified to go to, and it was there that I met some really amazing people actually - there's so much support out there Y: Finally, what got me and kept me sober was a combination of a twelve step fellowship and um some really intense trauma therapy Symptoms Acceptance / Treatment Themes Prompts Interview Questions Included interview content Heading: What I've gained Greater control over symptoms What happened to your drinking after that / what changed? Recovery journey How would you describe your recovery journey? What benefits did you experience in the process of recovery? What challenges occurred in the recovery process? How did you overcome these / what helped? Meaningful and satisfactory quality of life How is your l ife different now compared to when you were drinking? What has changed? Examples (e.g. living independently, improved relationships, increased community activities and hobbies) What do you enjoy about l ife without drinking? Heading: What life is like now Successes in recovery What have you achieved that you’re proud of as a result of not drinking? E.g. work, hobbies, community activities, personal progress, relationships with others What other successes / strengths have you gained through your recovery? Recovery Achievements Z: What I've gained from not drinking is all of the things that I got from drinking but from within myself. I don't go out to get smashed - I go out to spend time with people Y: I quite l ike mornings - I get up and you know I now run, I love being outdoors X: I've got a lot more energy, I mean I have a personal trainer 3 times a week now - I would have not even thought about that before, you know, I've lost two stone. My relationships with the family and my wife has improved Z: I would definitely give myself a pat on the back for being an amazing father. I meditate quite a lot and that's also allowed me to sort of build resil ience around the rigors of just everyday l ife Y: I'm now a qualified trauma and addiction recovery coach. I think what recovery has done is it's given me the abil ity to do the job that I do now which is to, to help other people Z: I'm a music journalist - I've done a lot of reviews of festivals, club events, gigs X: I've created my own podcast called 'W' and that's been in the top 10 of the Apple charts. I'm now a qualified coach so I help people stop drinking as well Themes Prompts Interview Questions Included interview content Section 3 Heading: What I have learned Challenges and symptoms during recovery Is there anything you continue to struggle with? If so, what helps you with this? X: It's not all bells and whistles - there are times that I think it would be nice to have a drink Z: If you're tired or you're feeling a bit cranky then it's difficult to pull yourself out of that mode, but you learn to accept your emotions rather than suppressing them Y: One of the biggest things I've learned through my recovery is that I can l ive through pain - what's waiting on the other side of that pain is really something amazing Hope Possible to live with the condition despite challenges (uplifting tone) How would you describe your overall quality of l ife now compared to when you were drinking? Y: It's l ike another world - it's another l ife Contributors insights Is there something you would particularly l ike people to know about alcohol dependence or your experiences that wasn’t covered during this interview? Y: What I would want to say to people is look underneath - don't ask why the addiction, ask why the pain X: If you're a relative or a family member or a loved one, there is support out there, and you need to talk about it and share your experience and there is support out there so reach out for that Final slide: Thank you for watching Ongoing challenges Closing SOM Figure 1 Vignette used with Attribution Questionnaire-27 (AQ-27) and Social Distance Scale (SDS) During the last month, John has started to drink more than his usual amount of alcohol. In fact, he has noticed that he needs to drink twice as much as he used to in order to get the same effect. Several times, he has tried to cut down, or stop drinking, but he can’t. Each time he has tried to cut down, he became very agitated, sweaty, and he couldn’t sleep, so he took another drink. His family has complained that he is often hungover, and has become unreliable— making plans one day, and cancelling them the next. SOM Figure 2 Outliers as assessed by Box Plots SDS AQ SOM Figure 3 Tests of Normality Shapiro Wilk Tests of Normality Kolmogorov-Smirnova Shapiro-Wilk Statistic df Sig. Statistic df Sig. SDS_Pre .138 539 <.001 .935 539 <.001 SDS_Post .106 539 <.001 .964 539 <.001 SDS_FU .095 539 <.001 .967 539 <.001 AQ_Pre .036 539 .085 .992 539 .005 AQ_Post .058 539 <.001 .976 539 <.001 AQ_FU .043 539 .021 .987 539 <.001 a. Lilliefors Significance Correction Histograms Skewness Descriptives Statistic Std. Error SDS_Pre Mean 2.434137291280 148 .0176733543252 53 95% Confidence Interval for Mean Lower Bound 2.399420051335 952 Upper Bound 2.468854531224 345 5% Trimmed Mean 2.459772653650 205 Median 2.571428571428 572 Variance .168 Std. Deviation .4103111955870 86 Minimum .2857142857142 86 Maximum 3.000000000000 000 Range 2.714285714285 715 Interquartile Range .5714285714285 72 Skewness -.924 .105 Kurtosis 1.350 .210 SDS_Post Mean 2.135966074741 585 .0242918947371 98 95% Confidence Interval for Mean Lower Bound 2.088247485345 942 Upper Bound 2.183684664137 228 5% Trimmed Mean 2.156403687015 931 Median 2.142857142857 143 Variance .318 Std. Deviation .5639697020306 58 Minimum .1428571428571 43 Maximum 3.000000000000 000 Range 2.857142857142 857 Interquartile Range .8571428571428 57 Skewness -.449 .105 Kurtosis -.124 .210 SDS_FU Mean 2.198250728862 974 .0220139847665 93 95% Confidence Interval for Mean Lower Bound 2.155006827495 725 Upper Bound 2.241494630230 223 5% Trimmed Mean 2.218835586182 525 Median 2.142857142857 143 Variance .261 Std. Deviation .5110848932797 18 Minimum .5714285714285 71 Maximum 3.000000000000 000 Range 2.428571428571 429 Interquartile Range .7142857142857 14 Skewness -.423 .105 Kurtosis -.180 .210 AQ_Pre Mean 119.353 1.2351 95% Confidence Interval for Mean Lower Bound 116.926 Upper Bound 121.779 5% Trimmed Mean 118.694 Median 118.000 Variance 822.225 Std. Deviation 28.6745 Minimum 47.0 Maximum 225.0 Range 178.0 Interquartile Range 37.0 Skewness .354 .105 Kurtosis .180 .210 AQ_Post Mean 100.694 1.3584 95% Confidence Interval for Mean Lower Bound 98.026 Upper Bound 103.362 5% Trimmed Mean 99.464 Median 98.000 Variance 994.547 Std. Deviation 31.5364 Minimum 32.0 Maximum 211.0 Range 179.0 Interquartile Range 39.0 Skewness .610 .105 Kurtosis .354 .210 AQ_FU Mean 109.237 1.3224 95% Confidence Interval for Mean Lower Bound 106.640 Upper Bound 111.835 5% Trimmed Mean 108.383 Median 108.000 Variance 942.549 Std. Deviation 30.7010 Minimum 39.0 Maximum 206.0 Range 167.0 Interquartile Range 39.0 Skewness .417 .105 Kurtosis .248 .210 Transformed Shapiro-Wilk SDS Tests of Normality Kolmogorov-Smirnova Shapiro-Wilk Statistic df Sig. Statistic df Sig. SDSPreModerateT .120 539 <.001 .959 539 <.001 SDSPostModerateT .088 539 <.001 .973 539 <.001 SDSFUModerateT .082 539 <.001 .975 539 <.001 a. Lilliefors Significance Correction AQ Tests of Normality Kolmogorov-Smirnova Shapiro-Wilk Statistic df Sig. Statistic df Sig. AQPreModerateT .026 539 .200* .999 539 .975 AQPostModerateT .030 539 .200* .996 539 .149 AQFUModerateT .022 539 .200* .997 539 .334 *. This is a lower bound of the true significance. a. Lilliefors Significance Correction SOM Figure 4 Levene’s Tests of Equality of Error Variances SDS Levene's Test of Equality of Error Variances Levene Statistic df1 df2 Sig. SDS_Pre Based on Mean 5.278 3 535 .001 Based on Median 4.038 3 535 .007 Based on Median and with adjusted df 4.038 3 500.298 .007 Based on trimmed mean 4.734 3 535 .003 SDS_Post Based on Mean 6.240 3 535 <.001 Based on Median 6.163 3 535 <.001 Based on Median and with adjusted df 6.163 3 502.590 <.001 Based on trimmed mean 6.460 3 535 <.001 SDS_FU Based on Mean .921 3 535 .430 Based on Median .904 3 535 .439 Based on Median and with adjusted df .904 3 508.647 .439 Based on trimmed mean .934 3 535 .424 Tests the null hypothesis that the error variance of the dependent variable is equal across groups.a a. Design: Intercept + Group Within Subjects Design: Time AQ Levene's Test of Equality of Error Variancesa Levene Statistic df1 df2 Sig. AQPreModerateT Based on Mean 1.236 3 535 .296 Based on Median 1.178 3 535 .317 Based on Median and with adjusted df 1.178 3 528.848 .317 Based on trimmed mean 1.238 3 535 .295 AQPostModerateT Based on Mean 3.608 3 535 .013 Based on Median 3.561 3 535 .014 Based on Median and with adjusted df 3.561 3 525.950 .014 Based on trimmed mean 3.599 3 535 .013 AQFUModerateT Based on Mean 2.679 3 535 .046 Based on Median 2.631 3 535 .049 Based on Median and with adjusted df 2.631 3 518.960 .049 Based on trimmed mean 2.689 3 535 .046 Tests the null hypothesis that the error variance of the dependent variable is equal across groups. a. Design: Intercept + Group Within Subjects Design: Time SOM Figure 5 Mauchly’s Tests of Sphericity SDS Mauchly's Test of Sphericitya Measure: SDS Within Subjects Effect Mauchly's W Approx. Chi- Square df Sig. Epsilonb Greenhouse- Geisser Time .960 22.012 2 <.001 .961 Mauchly's Test of Sphericitya Measure: SDS Within Subjects Effect Epsilon Huynh-Feldt Lower-bound Time .970 .500 AQ Mauchly's Test of Sphericitya Measure: AQTr Within Subjects Effect Mauchly's W Approx. Chi-Square df Sig. Epsilonb Greenhous e-Geisser Huynh- Feldt Lower- bound Time .915 47.201 2 <.001 .922 .930 .500 Tests the null hypothesis that the error covariance matrix of the orthonormalized transformed dependent variables is proportional to an identity matrix. a. Design: Intercept + Group Within Subjects Design: Time Authors: Supplementary Online Materials SOM Table I SOM Table II SOM Table III SOM Figure 1 SOM Figure 2 Outliers as assessed by Box Plots SOM Figure 3 Tests of Normality Shapiro Wilk Histograms Skewness Transformed Shapiro-Wilk SOM Figure 4 Levene’s Tests of Equality of Error Variances SOM Figure 5 Mauchly’s Tests of Sphericity