The principal aims of the study were to investigate the determinants for alcohol use in adolescence and formulate a framework for intervention design, and to use this framework to design an interactive intervention to prevent alcohol misuse in adolescents. The first study was a focus group study with 27 11-14 year olds to gauge opinions related to alcohol use and the drinking environments. The results of the analysis supported a framework of the combination of the theory of planned behaviour (Ajzen, 1991), the prototype willingness model (Gibbons & Gerrard, 1995, 1997), the social norms approach (Perkins & Berkowitz, 1986). The second study was a pilot of a questionnaire based on the combined model constructs, personality characteristics associated with adolescent alcohol misuse and behavioural measures of frequency and quantity. The first pilot was with 19 adolescents aged 11-15, which indicated that three subscales needed amendment. The participants rated the scale as easy to complete. The second pilot with 31, 16-19 year olds indicated that the subscales were reliable. The third study was a quantitative longitudinal study to evaluate the threats to external validity. The cross sectional analysis (n=239) indicated that past behaviour, subjective norm, affective attitude, drinker image and typical peer frequency predicted intention to drink alcohol. The results of longitudinal study (n=60) indicated that there were no significant differences between variables at baseline. This supported the validity of the questionnaire for intervention evaluation. The most significant predictor of behaviour at follow-up was past behaviour and subjective norm at baseline. The fourth study was a focus group study with 15, 11-14 year old participants to gauge their opinions about computer games and using games for health interventions. The themes that were identified were used to formulate a conceptual framework for an interactive computer game. The fifth study was a quantitative evaluation of a preliminary interactive role-play study to examine interactive scenarios based on the environments identified in the alcohol focus group study and behaviour change techniques from the taxonomy for alcohol use (Michie, et al., 2012). The post-intervention results indicated a significant difference in perceptions of peer drinking norms. Overall, the research supported the use of a combined theory to predict and prevent alcohol use in adolescents and an interactive method for intervention.

Syftet med studien var att studera hur fenomenet självläkning framställdes i nationell och internationell forskning. Studien omfattar tre frågeställningar: (1) Hur definieras alkoholmissbruk i artiklarna? (2) Hur definieras självläkning i artiklarna? (3) Hur framställs självläkningsprocessen i artiklarna? För att besvara dessa frågeställningar gjordes en selektiv kunskapsöversikt och en kvalitativ innehållsanalys användes som metod. Kunskapsöversikten utgjordes av tio forskningsdokument vilka omfattades av kvalitativa och kvantitativa undersökningar mellan åren 1996-2007. Studiens position är postmodern. Studiens resultat analyserades utifrån ett socialkonstruktivistiskt perspektiv. Resultatet visade att tillgång till olika personliga och sociala resurser främjade självläkningsprocessen. Resultatet visade också att innebörden av begreppen självläkning och alkoholmissbruk varierade och att det inte fanns någon enhetlig definition av dessa begrepp. De olika definitionsvariationerna resulterade i att innebörden av fenomenet självläkning blev otydlig. / The purpose of this paper was to study how the phenomenon natural recovery from alcohol misuse is presented in the national and international research. This paper includes three questions at issue: (1) How is alcohol misuse defined in the research documents? (2) How is natural recovery defined in the research documents? (3) How is the process of natural recovery presented in the research documents? To answer these questions a selective qualitative knowledge overview was made and a qualitative content analysis was used as research method. This research overview of knowledge is based on ten research documents including qualitative and quantitative studies conducted between 1996 – 2007. This study has a post modern approach and the results in this study were analyzed on the basis of social constructivist theory. Results showed that the process of natural recovery was promoted by access to personal and social resources. Results also showed that the meaning of the concepts natural recovery and alcohol misuse varied and that there was no uniform definition of these concepts. Due to the various forms of defining these concepts the meaning of the phenomenon natural recovery proved to be indistinct.

Made available in DSpace on 2015-07-22T20:50:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-09-30 / Objetivo: Investigar o desfecho clínico relacionado à violência e mortalidade em dependentes de álcool de um bairro da periferia da Zona Sul de São Paulo submetidos a tratamento ambulatorial especializado. Métodos: Trata-se de um estudo retrospectivo de sete anos, com trezentos e três pacientes adultos que procuraram tratamento da dependência do álcool e foram investigados. Destes, 23 recusaram a participação no estudo e 37 não foram localizados, totalizando 243 sujeitos. Durante esse procedimento, buscamos a associação da violência com o álcool e com a criminalidade por meio do SAAD e de um questionário sobre padrão de consumo alcoólico da WHO/ISBRA, usado em estudo multicêntrico no Brasil. Levantamos os problemas associados ao consumo alcoólico por meio da DrInC-2L e de questionário estruturado para estudo de segmento que investiga variáveis relacionadas ao uso e conseqüências do consumo alcoólico. Também foram explorados os fatores de risco e proteção relacionados à mortalidade e à violência. Resultados: Foi encontrada alta taxa de mortalidade (16.9%) entre homens (19.5%; p=0.012) vivendo abaixo da linha de pobreza (20%; p=0.006). A causa morte principal apontou doenças do fígado e do pâncreas (67.5%), seguida por acidentes e crimes violentos (32.5%). SADD identificou 97.4% da amostra como sendo dependentes de álcool graves. A aderência a um grupo religioso apareceu como um importante fator de proteção relacionado a comportamentos delinqüentes. Conclusões: O alcoolismo na periferia é associado com taxas altas de crime, violência e mortalidade. Uma reforma na política pública brasileira relacionada ao uso de bebidas alcoólicas é mais que urgente e recomendada para diminuir danos aos dependentes de álcool. / Aim: To investigate the outcomes of alcohol related violence within an underprivileged violent suburban area of São Paulo-Brazil. Objective: To investigate the clinic denouement regarding the violence and mortality in alcohol addicted of a neighborhood of São Paulo suburb located in the south zone of the city submitted to the ambulatory specialized treatment. Methods: It is regarding of a retrospective study of seven years with three hundred adult patients that are looked for treatment of alcohol addicteds that were investigated. Twenty three of these addicted refused to participate of this study and thirty seven were not located, 243 persons were contacted. During this period we looked for association of violence and alcohol with crimes by SAAD and a questionnaire about the standards of alcohol consume of WHO/ISBRA, used in a multicentre study in Brazil. We mentioned the problems related to the alcohol consume by DrInC-2L and of a structured questionnaire for the segment study that investigate many variables regarding to the use and its consequences to the alcohol consume. Also it was explored the risk factors and protection related to the mortality and violence. Results: It was founded high mortality rate (16.9%) for men, (19.5%; p=0.012) living below the poverty standard (20%; p=0.006). The main cause of deaths mentioned the liver and pâncreas diseasess (67.5%), followed by violents crimes and accidents (32.5%). SADD related 97.4% of the sample as grave alcohol addicteds. To become part of a religious group seems to be a very important factor of protection related to a delinquent behavior. Conclusion: The alcoholism in the suburbs is associated to the high crimes rates. Violence and mortality. A reform in brazilian public policies related to the abusive use of alcohol is very urgent required and highly touted to decrease damage to the alcohol addicted. / TEDE / BV UNIFESP: Teses e dissertações

Abstract Head injury is the leading cause of death and disability in trauma patients, and alcohol misuse is often associated with such injuries. Despite modern diagnostic facilities, the extent of traumatic brain injury (TBI) is difficult to assess and supplementary diagnostic tools are warranted. The contribution of alcohol misuse to traumas also needs to be elucidated, as the role of different patterns of alcohol drinking in particular has received less attention. We investigated the clinical utility of a novel serum marker of brain damage, protein S100B, as a tool for assessing TBI in patients with trauma. We also investigated the patterns of alcohol drinking among trauma patients and the trauma mechanisms in relation to blood alcohol concentration (BAC), with special emphasis on head traumas. Finally, we studied the early identification of hazardous drinkers among trauma patients. Serum protein S100B was found to be a feasible supplementary method for assessing TBI, as the latter was shown to elevate its levels significantly, the highest values being found in patients with severe injuries. S100B was also found to be elevated in patients with mild head injury, where it was associated with an increased risk of developing post-concussion symptoms (PCSs). Extracranial injuries also increased S100B values in patients with multitrauma. Accordingly, S100B was not specific to TBI. The more severe the extracranial injury, the higher the S100B value that was found. Binge drinking was found to be the predominant pattern in trauma patients. Alcohol intoxication on admission and hazardous drinking patterns were more often present in patients with head injury than in those with other types of trauma. The risk of sustaining a head trauma significantly increased with increasing BAC. The results also demonstrated that BAC on admission is the best marker of alcohol misuse in trauma patients. The BAC test depicts hazardous alcohol drinking better than conventional biochemical markers of alcohol misuse such as gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), carbohydrate-deficient transferrin (CDT), or mean corpuscular volume (MCV) of erythrocytes. The findings support the use of S100B as a supplementary method for assessing TBI and the use of BAC as a marker of alcohol misuse in trauma patients.

Firefighters respond to a wide range of critical incidents in which they face exposure to multiple stressors. Previous studies have reported prevalence rates of various symptomatology and identified some risk factors for firefighters, but accord has not been reached across studies on the extent of vulnerability or resilience and potential predictors of each have not all been identified. Studies with firefighters in the United Kingdom are comparatively rare. The purpose of this series of studies was, therefore, to investigate the prevalence of PTSD symptomatology and that of its associated comorbid conditions (depression, anxiety and alcohol misuse) in UK firefighters. On the basis of a literature review, the role of thought control, counterfactual thinking and humour style in predicting symptoms was examined. Study I examined this together with the demographic, occupational, event-specific and cognitive factors associated with these conditions in a retrospective, cross-sectional analysis of multiple exposure in firefighters. Results indicated that these firefireghters demonstrated high levels of resilience, recording relatively low rates of PTSD, depression, anxiety and alcohol misuse symptomatology. No DSM-IV Criterion A1 exposure variable independently predicted symptomatology of PTSD, but A2 responses of fear and helplessness predicted PTSD symptomatology, and A2 fear predicted alcohol misuse. Individual aspects of A1 exposure did predict symptomatology of depression, anxiety and alcohol misuse; one operating schedule predicted symptomatology of depression and anxiety; and both previous divorce and previous psychiatric diagnosis predicted symptomatology of alcohol misuse. Of the three cognitive predictors, nonreferent counterfactual thinking and self-defeating humour independently predicted higher levels of PTSD symptomatology, whilst self-enhancing humour predicted lower symptomatology of depression. Results were essentially the same in both regression models, indicating no difference between the predictive power of these cognitive constructs between the models where humour was used at work and when used with the person closest to the participant. Study 2 evaluated the same symptomatology in a longitudinal investigation of firefighters exposed to a single critical incident in which the casualty's life could not be saved, again addressing the cognitive factors of thought control strategies, counterfactual thinking and humour style. Results showed high levels of resilience with firefighters recording relatively low rates of PTSD, depression, anxiety and alcohol misuse symptomatology, although symptomatology of depression, anxiety and alcohol misuse increased over time for a small number. Factors associated with development of symptomatology were firefighter type and rank, A2 horror, body recovery, and the use of thought suppression and 'if only' counterfactuals). However, these were not long-lasting. Similarly, associations between depression/anxiety symptomatology and A2 helplessness; anxiety and previous psychiatric diagnosis also had a short term effect on symptoms. Those who were younger and who had not been involved in body handling had higher depression scores at T2 although the sample size was small and these results may be anomalies. Study 3 explored the firefighters' responses to the same critical incident in greater depth in order to draw out any aspects of it which caused distress and any factors which were found to be helpful in coping with such distress. This qualitative exploration was designed to identify the meaning attached to aspects of critical incidents and how firefighters individually experienced such a critical incident response in comparison with other critical incidents. Results showed positive emotions, professional pride and a strong sense of duty were expressed far more than 'negative' emotions, suggesting a high degree of resilience. Identification with the dying or dead is a marker for distress because meaning has been attributed to the event through recognition of the deceased's humanity. Dissonance arose because of the struggle between this recognition and the desire to protect colleagues and it appears that it is this dissonance which adversely affects those with responsibility for making decisions. Feelings of helplessness arose through operational limitations and are also a marker for distress. Avoidance techniques were utilised, but thought suppression was not identified as such, although the transposition of distressing images through humour was reported. Downward counterfactuals were reported more frequently than upward, and the latter related to decision making and operational difficulties. The type of humour commonly used is banter which includes 'taking the piss' out of colleagues and situations although it was not experienced the same way by all firefighters. The purpose of banter is to cope with the stressors inherent in the job of firefighting and to facilitate bonding through its use as a private language. This study identified three 'rules of banter': it is reciprocal, the timing of it is critical, and it has contextual restrictions. Adaptive banter may be expressed as the self-enhancing or affiliative styles of humour and maladaptive as self-defeating, or banter may itself be a separate style of humour. Together, the studies' findings show that these firefighters were resilient to exposure to a range of stressors but that suffering may be seen on a spectrum. This has implications for theory and further research, and for the development of psychoeducational interventions to increase resilience in those first responders who may be at risk of developing symptoms.

There is a great deal of empirical evidence to support the efficacy and effectiveness of cognitive therapeutic approaches such as cognitive behaviour therapy (CBT) and motivational interviewing (MI). In addition to this, research has identified several mechanisms of change thought to underlie these approaches. However, there has been little exploration of the specific cognitive and emotional processes that may underlie change in CBT and MI, or indeed their interactions. This thesis specifically explored the role of reasoning and emotion in relation to MI and CBT.In the first paper, the initial sections provided a narrative review whereby the roles of reasoning and emotion in CBT and MI were critically evaluated in context of existing empirical evidence. Further to this, the literature examining the effects of emotion on deductive reasoning was systematically reviewed. A total of 19 papers were identified and the implications of the studies’ findings discussed in relation to the clinical practice of CBT and MI. The studies varied noticeably in terms of the quality of the methodologies employed. Overall the studies considered, suggested that the effects of emotion on reasoning were complex, and yet to be well understood. However, through extrapolating the findings from the experimental study of cognition and emotion to the clinical practice of CBT and MI, the review demonstrated the potential relevance of such findings, and indicated the need for research exploring the role of reasoning and emotion in these approaches.The second, empirical paper examined the extent to which statements reflecting informal reasoning and the emotional state of the client affected the generation of positive behaviour change statements and positive behaviour change in the context of MI with individuals with psychosis and alcohol use disorders. Participants (n=26) were clients selected from a large randomised controlled trial of integrated MI and CBT for psychosis and substance use. One audio recorded therapy session was selected for each participant. Reasoning and emotion statements were subsequently identified and categorised for each therapy session. It was found that the total number of reasoning statements generated positively predicted the total number of positive behaviour change statements generated. It was also found that negative emotional statements relating to the present, positively predicted the total number of reasoning statements generated. The results suggested that informal reasoning may be a specific cognitive process underpinning the production of behaviour change statements in MI with individuals with psychosis and alcohol use disorders, and provided support for the central role of discrepancy in producing change in MI. The final section provided a critical reflection of the research process. This included a rationale for the development of the literature review and the empirical paper, followed by a critical reflection on the study context and its’ implication to the study methodology. Finally the theoretical and future implications for research in this area were discussed along with the implications to clinical practice.

No description available.

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing 'outcome' data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of 'feminine carer' offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders' stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a 'space' for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the 'other', offenders were able to re-author a more 'moral' and 'worthy' self. Moreover, the ATR has been found to be successful in enabling the offenders' hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.

Introduction : Peu d'études se sont intéressées aux aides à domicile dans l'accompagnement de la vieillesse et moins encore, dans celui concernant les conduites d'alcoolisation à cet âge. Dans cette thèse s'inscrit dans une approche intégrative incluant une méthodologie quantitative et qualitative. Ainsi, nous étudions les aspects psychologiques de ces aides à domicile tout en les comparant à celles accompagnant la maladie d'Alzheimer.Méthode : 99 aides à domicile recrutées en milieu écologique ont répondu à un questionnaire de données professionnelles de 62 items, une échelle d'estime de soi (EES), un questionnaire de satisfaction de vie professionnelle (ESVP), un inventaire d'épuisement professionnel (MBI) et une échelle évaluant la symptomatologie anxio-dépressive (HADS). Les participantes ont été réparties en deux groupes : celles soulignant des difficultés dans l'accompagnement de la maladie d'Alzheimer (n=63) et celles évoquant des difficultés dans l'accompagnement de conduites d'alcoolisation (n=36). Parmi elles, 18 ont accepté de participer à un entretien de recherche enregistré et analysé à l'aide du logiciel QDA Miner 4.Résultats : Les résultats des dimensions psychologiques sont statistiquement significatifs lorsqu'ils sont associés aux caractéristiques professionnelles. Dans l'accompagnement des conduites d'alcoolisation, lorsqu'elles connaissent le diagnostic de la pathologie, l'épuisement émotionnel est plus élevé et celui-ci est corrélé positivement avec l'humeur dépressive et négativement avec la satisfaction de vie professionnelle. L'accomplissement personnel est corrélé négativement avec la symptomatologie dépressive. La satisfaction de vie professionnelle est corrélée positivement avec la relation de satisfaction avec l'entourage. Dans l'accompagnement de la maladie d'Alzheimer, quand elles ne connaissent pas le diagnostic de la pathologie de la personne âgée, leur épuisement émotionnel est plus élevé et celui-ci est corrélé négativement avec la satisfaction de vie professionnelle et positivement avec la symptomatologie anxio-dépressive.Pour les conduites d'alcoolisation, le discours relatant des difficultés avec la personne âgée a un lien de similarité avec les représentations de la maladie, la progression de la maladie, les relations avec les familles et le sentiment d'impuissance de l'aidante face à la pathologie de l'aidé. Le discours sur les satisfactions a un lien de similarité avec ceux évoquant l'expérience pour accompagner, les représentations et les compétences pour parler de la maladie avec les âgés. Concernant la maladie d'Alzheimer, le discours relatant des difficultés avec la personne âgée a un lien de similarité avec ceux évoquant les représentations et la progression de la maladie, ainsi que les identifications de l'aidante face au vieillissement de l'âgé. Le discours sur les satisfactions a un lien de similarité avec l'expérience pour accompagner et les raisons pour lesquelles elles exercent ce métier. Cette étude permet de mieux appréhender les spécificités psychologiques des aides à domicile française et ouvre ainsi, des perspectives de recherche. Des implications cliniques pourraient voir le jour dans la prévention des aspects psychologiques auprès de cette population. / In France, few studies were interested by care social workers in the accompaniment of old age and less still, in that concerning the alcohol misuse at this age. In this thesis, we study the psychological aspects of these professional all while comparing them with those to support the Alzheimer's disease. 99 social care workers answered a questionnaire of 62 professional data, a scale of self esteem (EES), a questionnaire of job satisfaction (ESVP), an inventory of burnout (MBI) and a scale of anxio-depressive symptomatology (HADS). The professionals were divided into two groups: those with the difficulties in the support of the disease of Alzheimer (n=63) and those with the difficulties with alcohol misuse (n=36). Moreover, 18 of whom were interviewed. In the support of alcohol misuse, significant results show that when they know the diagnosis of pathology, emotional exhaustion is higher and this one is correlated positively with depressive mood and negatively with the job satisfaction. The personal achievement is correlated negatively with depressive mood. The job satisfaction is correlated positively with relatives' relations. In the support of Alzheimer's disease, when they don't know the diagnosis of the pathology, emotional exhaustion is higher and this one is correlated negatively with the job satisfaction and positively with anxio-depressive symptomatology. For the alcohol misuse, the interview of difficulties with the elder is related to similarity with those showing the representations and progression of the disease, the family's relations and the feeling of ineffectiveness for supporting the pathology. The discussion of satisfactions is related to similarity with those evoking the professional experience, the representations and skills to speak with the person about the disease. For Alzheimer's disease, the discussion of difficulties with the elder is related to similarity with those evoking the representations and the progression of the disease ¿ and that ¿ with the identifications of the senior. The discussion of satisfactions is related to similarity with those talking the professional experience and the evocation of the personal reasons to work. This study allows considering the specificities of French social care workers. It opens some research perspectives and could have a clinical implication in prevention of this population.

In the UK there has been growing concern about the relationship between levels of alcohol consumption and offending behaviour. The Alcohol Treatment Requirement (ATR) was introduced to the UK in 2007 and was piloted in a District in the north of England in July 2007. The ATR is a coercive form of treatment delivered jointly by the probation service and the National Health Service (NHS) and was funded by the NHS. The ATR centres on supporting offenders to cease their offending behaviour and reduce or end their alcohol misuse. Two female alcohol treatment workers have been appointed to specifically deliver the ATR. Therefore this study aimed to investigate the delivery of the ATR, and more specifically, aimed to explore what impact the ATR might have in relation to positive behaviour change and rehabilitation for offenders with alcohol problems. In order to meet the expectations of producing ¿outcome¿ data for the NHS funders, and indepth theoretical data worthy of an academic PhD, this research took a pragmatic methodological approach which enabled different social realities of the ATR to be explored. To this end, a mixed methods design was employed involving quantitative and qualitative data collection methods. The data for this research was generated in three phases with Phase One aiming to explore quantitatively the characteristics, impacts and outcomes of those sentenced to the ATR. This phase revealed that the ATR is being delivered to predominantly young, male, alcohol dependent, violent, persistent offenders. This analysis further revealed that the ATR was effective in bringing about positive treatment outcomes and in reducing reoffending. In order to explore further how this positive change was occurring, Phase Two consisted of qualitative participant observations of the treatment interaction involving the female alcohol treatment workers and the male offenders. By drawing on positioning theory, the analysis considered the complexity of the gendered interactions that occurred during these encounters. It was found that the two female alcohol treatment workers resisted positions of ¿feminine carer¿ offered up by these young men in order to occupy positions of control. Indeed this analysis provided great insight into the constant flow of negotiations and manoeuvring of positions that occurred between the alcohol treatment worker and the offender, argued to be vitally important in working towards positive behaviour change. During Phase Three ten offenders were interviewed in order to explore through a dialogical lens (Bakhtin, 1982) how they constructed and experienced treatment on the ATR. In exploring the offenders¿ stories dialogically, the analysis highlighted how the ATR was enabling, in that it offered a ¿space¿ for these offenders to engage and internalise a dialogue that draws on the authoritative voice of therapy. Therefore it was revealed that through dialogue with the ¿other¿, offenders were able to re-author a more ¿moral¿ and ¿worthy¿ self. Moreover, the ATR has been found to be successful in enabling the offenders¿ hegemonic masculine identities to be both challenged and protected as a result of the multilayered interactions that occurred during these treatment encounters. This research therefore concludes that coercive treatment, rather than being a concern, should be embraced as a way of enabling change for offenders with alcohol problems. Furthermore, this research has highlighted the value of the relational aspect of treatment in bringing about positive behaviour changes. Finally this research has shown that community sentences offer a more constructive way of engaging with offenders than those who receive a custodial sentence.