This thesis provides a broad and diverse investigation into the field of traumatic responses in mentally disordered perpetrators of homicide and group treatment for such offenders. A range of methods including a systematic review, a single case study and a primary phenomenological investigation were used to explore issues in the field. Following an introduction in Chapter 1, Chapter 2 reviews trauma responses in homicide offenders. The results indicate that trauma reactions among homicide offenders as a direct result of the offence are highly prevalent which has implications for potential interventions. The existing literature is obstructed by weak studies using suboptimal scientific designs and future research is recommended. In Chapter 3 a single case study explores a homicide offender’s progress in a group treatment. The group therapy under investigation adopts a recovery oriented approach, addressing both criminogenic need and the well-being of the offender. The impact of the treatment is determined using a range of psychometric measures. The results indicate improvements in the targeted areas with clinically significant change demonstrated. Chapter 4 explores the lived experience of a group treatment for homicide using the principles of Interpretive Phenomenological Analysis. Three areas were discussed: (1) the Group (2) Recovery and (3) Risk. Recurrent themes reflected the importance of shifting narratives and hope for the future in both domains of recovery and risk, lending support to the utilisation of narrative approaches in Index Offence work. The results have implications for clinical practice and are discussed in the context of directions for further research. Chapter 5 evaluates the Inventory of Complicated Grief which was used as an assessment measure in Chapter 3. Finally, Chapter 6 provides a discussion and close to the thesis drawing together the implications of the research.

The importance of family caregiver involvement in (secure) mental health services has been increasingly recognised and there is a wide consensus that family caregivers should be seen by clinicians as partners in the care of patients (Harvey & Ramsay, 2004). Mental health carers however, especially those caring for relatives who are subject to compulsory care and treatment, often feel overlooked and marginalised, caring in complex circumstances with little or no support. This thesis focuses specifically on the views and experiences of parents of adult children in forensic mental health services. A structured review and synthesis of qualitative studies was undertaken to develop insight into the perceived level of involvement in care, from the perspective of family members of mental health service users. The review also examines family carers’ relationships and engagement with mental health professionals. This highlighted that the practices of some professionals contribute to the distress experienced by caregivers in this marginalised group. The empirical research study, employed a qualitative design conducted within the framework of IPA, and explored what it is like for parents with an adult son or daughter with mental illness and offending background detained in a regional medium secure unit. Findings indicated that parents’ experiences were characterised by a strained relationship with mental health services, accompanied by practical difficulties in getting help in the first place, and conflicting emotions felt in response to their unwell family member’s continued detention in the forensic care setting. Following on from this, a case study describes brief family psycho-education in secure care and illustrates how staff in forensic services can collaborate with parents more empathetically and effectively. Afterwards, the Family Relations Test, an instrument that assesses affective relations from the child’s perspective is critically reviewed. The utility of this tool in clinical practice is remarked upon. In the concluding chapter, the ways in which service delivery and research can be influenced by ‘giving a voice’ to parents of forensic clients is explored, and implications of the findings are discussed with reference to the current recognition of family and social inclusion.

Practitioners working within forensic environments will be acutely aware of the diverse risks, complex treatment needs and unique responsivity issues found within the multifaceted marginal group of sexual offenders. Deviant sexual fantasy (DSF) is considered to be important in the assessment and treatment of sexual offenders. Despite the recent growth in research, conclusions remain inconsistent on the significance of fantasy in offending behaviour. Furthermore, the underlying structural components of fantasy remain relatively unexplored. The aim of this thesis was to explore the forensic relevance of the fantasy phenomenon predominantly related to sexual offending populations. This was done by investigating the cognitive components of fantasy in regards to the intersection between fantasy, cognition, personality and self-representation (the latter constructs being considered as reflections of individual internal mental models). Chapter one provided a context to the thesis by presenting an argument that fantasy is forensically relevant in terms of implicit beliefs (offence supportive), cognitions (cognitive distortions, offence supportive beliefs) and personality organisation and functioning (e.g. coping mechanisms). Chapter two detailed a literature review following a systematic approach, exploring the role of fantasy within sexual offending behaviour. Sixteen studies were included in the review. An associative relationship was found between offence supportive fantasy and sex offending behaviour. Personality (among others) was identified as one of the moderating factors within this relationship. However, key methodological limitations with the included studies were discussed. Chapter three utilised a case study approach to consider the complexities of assessment and treatment for a medium risk internet sexual offender (ST). This chapter explored ST’s vulnerabilities in depth (low self-esteem, interpersonal difficulties, emotional dysregulation, rigid cognitive style) and provided a comprehensive assessment and formulation of risk (fantasy experiences reinforce offence supportive attitudes and cognitive distortions). Results suggested that fantasy could be mapped onto personality, organisation and functioning. ST’s fantasy life was considered a latent variable that only became an acute and dynamic risk factor when combined with his distorted attitudes. Chapter four detailed a critique of the MCMI-III. Specific emphasis was placed on assessing the utility of the measure within forensic settings and how this could supplement assessment of fantasy experiences. The tool was found to be psychometrically stable, however it was suggested that use with a sex offender population is approached with caution. Chapter five investigated associations between personality, fantasy proneness and sexual fantasies, in addition to exploring the function and structural components of sexual fantasy. An anonymous electronic questionnaire (containing several psychometric questionnaires e.g. IPIP-50, WSFQ, CEQ) was presented online for a period of 12 weeks. 259 males participated in the study. Links to fantasy proneness, certain personality markers (e.g. agreeableness, intellect/imagination) and early abusive experiences were found. Static fantasy experiences were associated with conscientiousness. Behavioural expression of fantasy was associated with extraversion. ‘Vividness’ of sexual fantasy was explained by the following themes: 1) Boundaries of imagination 2) Context 3) Structure of fantasy and, 4) Fantasy-Reality distinction. Finally, chapter six provides a conclusion to the thesis by summarising the main findings, with particular emphasis on how findings relate more directly to the fantasy phenomenon. The main suppositions and recommendations are as follows: • Fantasies prime self-other associations. Thus, indirect measures of fantasy may be useful and allow the cognitive mapping of fantasy. • A tiered definition of offence related fantasy is recommended pertaining to frequency, vividness, level of intrusion and the risk relevance. • Control (and disintegration of), coping and cognitive capabilities are implicated as important concepts for fantasy prone individuals. To a certain point, offence related fantasy may act as a protective factor for some individuals, until the fantasy can no longer satiate their needs. • The temporal ordering of fantasy function is important in determining risk relevance pertaining to protective factors (emotional regulation), risk inducing factors (priming offender identity) and high risk situations. • Fantasy generation is a skill; the more involvement an individual has with their internal world the more adept they will be at generating complex fantasy experiences and, in turn, the more enmeshed fantasy and reality can become. • Grounding techniques and acceptance commitment therapy may be a useful treatment recommendation for individuals that experience offence related fantasy. Discussion is augmented within contemporary theoretical perspectives in order to consider clinical implications. Limitations of the current thesis and recommendations for future research are also outlined.

This thesis sought to explore the effectiveness of CBT based anger management interventions with offenders. This was achieved in part through a random control trial on a sample of 24 community based male offenders, screened for dysfunctional anger. Statistical analysis revealed significant post-intervention reductions for both Groups in the reported anger symptoms and a substantial overall treatment effect noted (r = .89). The intervention used in the RCT was adapted to provide treatment for a female offender (N=1). An in-depth formulation of the case study facilitated the adaptation of the programme for the female offender. The case study was assessed at baseline, after the intervention and after a period of follow-up. The results obtained indicated clinically significant changes which seemed to justify the formal adaption of the programme. A psychometric critique also delved in the suitability of using the Anger Disorder Scales (Di Giuseppe & Tafrate, 2004) as the main measure of anger in the research and case study. Its reliability and validity and its strengths in terms of developing in-depth formulation of offenders’ anger dysfunction were discussed. The research and case study used psychometric measures to assess the efficacy of interventions. Thus, to compensate for the reliance on self-reported measures, the systematic review and meta-analysis explored the effectiveness of CBT based interventions by analysing long-term behavioural changes of interventions as measured through general and violent recidivism. All the included studies (n=14) were submitted to a quality assessment prior to extracting the required information. An overall risk reduction of 23% was estimated for general recidivism (k = 7; n = 1836; RR = .77; 95% CI .61 to .96) and 28% for violent recidivism (k = 7; n = 1888; RR = .72; 95% CI .55 to .93) following treatment. Furthermore the risk reduction for general recidivism increased to 42% (k = 6; n = 703; RR = .58; 95% CI .39 to .87) and increased to 56% for violent recidivism (k = 6; n = 1029; RR = .44; 95% CI .27 to .71) for those offenders completing treatment compared to treatment drop-outs. The magnitude of effect in the included studies also compared lower intensity programmes such as anger management with more intensive violence prevention programmes. Conclusions of this meta-analysis were discussed in terms of the economic viability of interventions and magnitude of treatment effects.

This thesis explores the role of complex psychological trauma (CPT) and violence within male adult offenders. It aims to investigate the impact of CPT in better understanding the trauma-violence relationship. Chapter 1 provides an introduction to the topic of CPT and violence. Chapter 2 is a systematic review that investigates the prevalence of CPT in violent males and reviews the existing evidence for the trauma-violence relationship. This review provides some evidence for the trauma-violence relationship, finding that CPT correlated with violent outcomes. Physical neglect correctly classified violent offenders by offence status, whilst physical abuse, emotional abuse and sexual abuse were also found to be associated with violent offending. The findings regarding CPT predicting violent offending were mixed, whilst a higher percentage of studies supported the trauma- violence notion, a minority number of studies did not. The evidence for CPT predicting violent behaviour in custody was more consistently shown across studies assessing this outcome. The role of mediating and moderating factors in the trauma-violence relationship were also investigated, finding that psychopathy, age, substance misuse, genetic factors, and positive criminal thinking styles and attitudes accounted for some variances. Following this review, Chapter 3 includes a Thematic Analysis (TA) investigating forensic nursing staff’s perceptions of the impact of CPT on forensic male offenders with a diagnosis of personality disorder, particularly with regards to violent behaviour whilst detained in a mental health high-secure hospital. Nursing staff’s experiences of managing patient distress and violence were also explored. The findings illustrate that nursing staff believed patient distress and violent behaviour were associated with CPT experiences, suggesting that the impact of CPT on attachment, biological, cognitive and affective aspects of functioning during development, served to account for the difficulties that patients faced in adulthood and increased the likelihood of violence. On-going prevention strategies were found to be most important and more effective than short-term risk management steps. The management of patient distress in the context of the therapeutic relationship was illustrated as a significant component for promoting recovery and successfully managing challenging behaviours. Aspects of the secure environment that imitated abuse experiences were also perceived to significantly contribute to the occurrence of violent behaviour. Change with regards to transitioning and progressing through the system was identified to evoke trauma-related fears of moving on. The fear of moving on and its association with trauma experiences was explored in a single case study of a male violent offender with personality disorder, which is presented in Chapter 4. This chapter aimed to identify and outline the offender’s fears about transitioning from a high-secure hospital to a medium-secure unit (MSU), and understanding the factors that contributed to and maintained the client’s fears. The client’s fears were found to relate to previous-trauma related experiences, although interpersonal violence and trauma experiences in the prison environment were found to be a deep rooted aspect of the client’s concerns about moving on. Whilst the client feared being vulnerable to abuse, threat and further ‘persecution’, the fear of being unable to manage his behaviour (e.g. aggression) in response to this and cope with such potential experiences outside of the high-secure environment and subsequent consequences of not being able to cope (arrest and transfer to prison), was perceived to be a more frightening prospect. Upon exploring fears of moving on, the client’s existing cognitive-behavioural relapse prevention (RP) plan was reviewed in assisting the client to revisit skills and coping strategies that can be used to prepare and avoid high-risk situations. This work contributed to understanding the ways to best support the client in making a successful transition to a MSU. Key considerations and recommendations are made at the end of the chapter with regards to the case. Following this, Chapter 5 outlines a critique of the Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1999), which was used in Chapter 4 as it provides a measure of coping with stressful, distressing or painful situations. The CISS is examined with regards to its purpose, reliability and validity in terms of its research uses. Chapter 6 provides a discussion of the thesis findings, outlining the implications of the research and providing recommendations for future research.

The impact of delusional thinking on the violent behaviour of individuals with psychiatric diagnoses has been explored using a variety of investigative methods. The notion that delusions play a role in an individual’s violent offending has been broadly upheld within the work of this thesis. The nature or function of delusions in this process appears to be affected by a range of mediating and moderating factors. The complexity of these was illustrated during the conduction of a case study. Advances in the understanding of mental disorder as a continuum, alongside the developments of risk assessment and management approaches, seem to provide the potential for an optimum vantage point to formulate the true role of delusions in the cognitive process. Future research should avoid utilising the overarching themes of psychiatric diagnoses or sets of symptoms to explore violence and should focus on considering the functions of individual symptoms or characteristics, as many of these overlap with other clinical and nonclinical populations.

Nicotine replacement therapy (NRT) is effective in non-pregnant populations at assisting smoking cessation, but there is no evidence that NRT can help pregnant smokers to stop. Nicotine metabolism increases during pregnancy, and so the nicotine dose delivered by NRT could be insufficient for ameliorating withdrawal symptoms. However, little is known about the level of nicotine substitution provided by NRT or the pattern of nicotine metabolism during pregnancy. Also low adherence to NRT may explain why NRT does not appear to be effective. The overall aim of this thesis was to increase understanding as to why NRT does not appear to be effective during pregnancy. The thesis consists of three studies. The first study involved analysing data on 33 pregnant participants from the NRT arm of a randomised control trial who had stopped smoking and were still using 15mg/16hr nicotine patches 1 month after quitting. Salivary cotinine levels when smoking at baseline were compared with levels on NRT at 1 month. Cotinine levels were lower than those achieved from smoking (median 98.5ng/ml while smoking and 62.8ng/ml while using NRT and remaining abstinent, p = 0.045). The second study involved 101 pregnant smokers, who were asked to provide saliva samples to measure NMR at 8-14 weeks, 18-22 weeks , 32-36 weeks gestation, 4 weeks postpartum and 12 weeks postpartum . Compared with NMR at 12 weeks postpartum, NMR was significantly higher at 18-22 weeks (26% higher, 95% CI 12% to 38%) and 32-36 weeks (23% higher, 95% CI 9% to 35%). There was no difference between the 8-14 weeks gestation or 4 weeks postpartum NMR and 12 weeks postpartum. The third study was a qualitative study that involved semi-structured telephone interviews with 14 pregnant smokers who had recently been prescribed NRT, but self-reported low NRT adherence or discontinuing treatment prematurely. Thematic analysis was used to analyse data. Most smoked regularly while using NRT and many used NRT to cut down their cigarette intake rather than to quit abruptly. Some were concerned that using NRT instead of smoking could actually increase their nicotine dependency or cause greater harm to the fetus, and consequently often underutilised NRT. This thesis supports the hypothesis that NRT at standard doses may be ineffective in pregnancy due to increased metabolism. The effectiveness of NRT may be hindered by the way in which NRT is used in pregnancy.

A number of women continue to smoke in pregnancy despite the associated risks to their health and that of their unborn child. Little is known about their attitudes towards the smoking cessation support which is available to them and this thesis used a Theory of Planned Behaviour (TPB) approach to investigate this further. Study One was a qualitative investigation designed to elicit pregnant women's views about NHS Stop Smoking Services and Nicotine Replacement Therapy (NRT). Interviews were conducted with 18 pregnant smokers, recent quitters and new mothers who smoked in pregnancy, and 18 health professionals working in smoking cessation services. A number of behavioural, normative and control beliefs were generated with respect to these behaviours. As there is evidence for inconsistent smoking cessation advice giving in pregnancy and a lack of confidence amongst health professionals in this area, a theory-based resource to facilitate the communication of smoking cessation information in pregnancy was developed in Study Two and tested in an exploratory randomised controlled trial. The 22 second year medical students who viewed the theory-based resource in preparation for a mock interview were not significantly better at eliciting the salient smoking cessation beliefs of the simulated patient (mean score 8.41) than the 18 second year medical students who received a standard information resource (mean score 7.67). However, the resource showed potential to facilitate the delivery of a more patient centred interview and is worthy of further testing. The themes generated in Study One were used to inform the development of a TPB questionnaire to predict NRT use in pregnancy (NRTP-LF) in Study Three. This questionnaire was completed by 100 pregnant smokers who were recruited from antenatal clinics and Stop Smoking Services. The NRTP-LF significantly predicted intention to use NRT in pregnancy, explaining 41.1% of the variance in the outcome variable, justifying the creation of a short form version of it (NRTPSF). In Study Four, the NRTP-SF was tested on a further sample of 204 pregnant smokers recruited from antenatal clinics and Stop Smoking Services and was also shown to have predictive validity with respect to intention to use NRT in pregnancy. It also significantly predicted interest in participation in a trial testing the efficacy and safety of NRT use in pregnancy. It is envisaged that the theory-based communication resource and the NRTP-SF could have practical utility in health care settings and the potential to increase smoking cessation service use and quit rates in pregnancy.

The literature has struggled to reach an acceptable definition for the construct of impulsivity. Different models have variously suggested that the crux of the impulsivity construct lies in lack of planning, difficulties in concentration, failure of inhibition or attraction to sensation or immediate reward. More recently, research has suggested that impulsivity is increased in conditions of extreme affect, either positive or negative. The development of a novel measure of affective impulsivity, termed the UPPS-P Impulsive Behaviour Questionnaire, has enabled quantitative investigation of the construct. In spite of difficulties in defining impulsivity, there is a broad consensus as to the clinical utility of the construct. It has been shown to be highly predictive of a wide range of so-called impulsive behaviours, which include suicide, binge eating and substance use. At the same time, impulsivity is also an important trans-diagnostic construct. Trait impulsivity is elevated in many psychiatric disorders, including borderline personality disorder and attention deficit hyperactivity disorder. There is also strong evidence that both state and trait impulsivity are elevated in bipolar disorder, and that this elevation may explain a number of common comorbidities and behaviours found within the disorder. The thesis begins with a review of the literature, examining six key perspectives on impulsivity and their corresponding measures within Chapter One. Chapter Three also explores the construct and measurement of emotion-mediated, affective impulsivity. The literature linking impulsivity to behaviour in both clinical and non-clinical samples is reviewed within Chapter Two. Within Chapter Four the evidence supporting continuum models of psychiatric disorder is introduced, with particular discussion of the bipolar spectrum. Chapter Five brings together the preceding chapters, reviewing the literature supporting an interaction between psychiatric disorder, affect, impulsivity and behaviour. The first study of this thesis, a cross-sectional questionnaire study which can be found in Chapter Six, looked to extend these findings by exploring the presence and role of impulsivity in a wider bipolar spectrum sample. Experience of extreme positive mood state, as measured by the Mood Disorder Questionnaire, was found to relate to increased trait impulsivity and elevated engagement in a range of impulsive behaviour. A structural equation model demonstrated that impulsivity could be separated into cognitive and affective components, with affective impulsivity a key predictor of impulsive behaviour. Affective impulsivity was also shown to moderate the relationship between extreme mood experience and impulsive behaviour. The second study, found in Chapter Seven, used semi-structured interviews and thematic analysis to develop an understanding of the individual’s experience of impulsivity and impulsive behaviour. The themes arising from these data (preparatory set, influence of the environment and others, intense emotional state, (lack of) agency, premonitory urge, reflexive action and sensation seeking) suggested that context plays an important role in the prediction of impulsive behaviour, with the physical and social environment of the individual an important factor in their behaviour. Results also supported the validity of the affective impulsivity construct. Individuals described their emotional state as having a large impact upon their decision to act impulsively, either using behaviour as a tool to moderate their affective state or experiencing cognitive difficulties as a result of it. Finally, data suggested a link between impulsivity and loss of control. Models were developed which indicate the presence of a ‘risky mood state’ in which individuals feel unable to control or predict their behaviour. Together the studies highlight the complexity of impulsivity, and the importance of a wide variety of other factors related to the construct. This is particularly true of affective state, which was seen through both studies to have a large impact on both the occurrence and experience of impulsivity and impulsive behaviour. The studies support the validity of the bipolar spectrum, with similar experiences found in our sample as in clinical samples. The finding that impulsivity is related to a wide range of high-risk behaviours, and that many of these behaviours are ego-syntonic, has important implications for the treatment of impulsivity.

Background Harmful use of alcohol is the fifth leading risk factor for global burden of disease, disability and death. While the level of alcohol consumption varies around the world, it causes numerous preventable health and social issues in many countries and around 3.3 million deaths per year globally. In the UK alcohol consumption is decreasing; by contrast, alcohol consumption in Sri Lanka has been rapidly increasing over recent years. However, in both settings alcohol misuse represents a major public health concern. Therefore, it is important to evaluate existing alcohol control policies or contextual factors affecting alcohol consumption in these settings and to identify existing data sources that can be used for alcohol control policy evaluation. This thesis aimed to investigate the suitability of existing data sources in the UK, identify potentially suitable measures and use those measures to evaluate the impact of Licensing Act 2003 in England, which allowed flexible opening hours including 24-hour drinking at on-trade premises in England and Wales from November 2005 onwards. This thesis further aimed to apply the lessons learned from the UK to Sri Lankan context, identifying potential data sources and using these to evaluate the effect the end of conflict in 2009 on alcohol consumption in Sri Lanka. Methods A range of sources of data on alcohol consumption and consequences in the UK were reviewed to identify those appropriate for alcohol control policy evaluation, and in particular for time series analysis which requires consistent data collected at regular intervals for a long period of time. The suitability of UK primary care data on alcohol consumption was assessed by identifying the proportion of patients with a record of alcohol consumption status in the last year, as well as ever since their registration with a practice. The quality of alcohol consumption measures collected by English national surveys was assessed by comparing them with the international guidelines for measuring alcohol consumption in population surveys. Existing data sources on alcohol consumption and consequence in Sri Lanka were also identified and reviewed to identify their suitability for alcohol control policy evaluation. Interrupted time series analysis was then conducted on these measures to establish the effect of the Licensing Act 2003 on alcohol consumption among adults (age≥16) in England, and the end of the conflict on recorded alcohol consumption among adults (age≥15) living in the areas that were not directly affected by the conflict in Sri Lanka. Findings In the UK, there are numerous sources of alcohol consumption and consequence data. However, few provide frequently collected data from large samples over long time periods for time series analysis. The recording of alcohol consumption in primary care remains low, particularly when recent recording within a given year is considered. Moreover, alcohol consumption recording in primary care is higher among at-risk groups such as women in child bearing age, older men and women who are likely to have an illness linked to alcohol. Therefore, primary care data are currently unsuitable for alcohol control policy evaluation. Comparison of the alcohol data collected in English national surveys with recommendations from international guidelines showed that they have failed to maintain the consistency of data collection over time and to collect information on some of the key alcohol consumption measures such as the frequency of binge drinking. However, Health Survey for England (HSE) measured alcohol consumption on the heaviest drinking day of the last week consistently over time and this measure was available on a quarterly basis for a nationally representative sample. Interrupted time series analysis of HSE heaviest drinking day data from 2001 to 2013 showed that prior to the implementation of the Act alcohol consumption among adult male and female drinkers remained constant at around 8.3 units and 5.5 units of alcohol respectively. After the Act, there has been a gradual decline (less than 0.03 units per quarter) in the heaviest drinking day consumption among both male and female drinkers in England. However, it is difficult to attribute this decline in consumption to the Licensing Act as there was no step change in the consumption soon after the Act and the decline in heaviest drinking day consumption was small and gradual over a period of seven years. When compared with the UK, Sri Lanka has a limited number of data sources on alcohol consumption and alcohol consequences. The Department of Excise alcohol sales database was identified as the only data source that can be used for alcohol control policy evaluation in Sri Lanka. However, these population-level data cannot be used to identify the characteristics of people who drink and patterns of drinking such as binge drinking. Interrupted time series analysis showed that recorded alcohol consumption among Sri Lankans living in areas that were not directly affected by the armed conflict increased markedly after the end of the conflict in 2009, with a dramatic acceleration in the trend of adult per capita consumption. Annual adult per capita alcohol consumption among Sri Lankans increased from 1.59 litres of pure alcohol in 1998 to 2.56 litres of pure alcohol in 2013. Prior to the end of war in 2009 adult per capita alcohol consumption was increasing by 0.051 litres of pure alcohol per year (95% CI 0.029-0.074, p < 0.001). After 2009, it increased by 0.154 litres per year (95% CI 0.082-0.226, p=0.001). it increased by 0.166 litres of pure alcohol per year (95% CI 0.095-0.236, p < 0.001), almost a three-fold increment in the increase per year compared to the trend prior to the end of the conflict. Beer consumption showed the highest per capita growth compared with other beverages. Conclusions This thesis identified the existing data sources that can be used for alcohol control policy evaluation purposes in two settings; UK and Sri Lanka. It has highlighted the further improvements required in existing alcohol consumption related data sources in both countries and discussed the potential of applying lessons learned from the UK context to Sri Lankan context. Despite the current trend in alcohol consumption, both countries experience a significant public health burden due to alcohol misuse. Therefore, both countries will require formulation and implementation of new policy measures. However, Sri Lanka does not have high-quality individual level alcohol consumption data to support the monitoring and evaluation of alcohol control policies. Therefore, this thesis has emphasised the need to generate high-quality alcohol consumption data in Sri Lanka and carry out monitoring and evaluation of alcohol control policies to tackle the alcohol-related burden.