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Item Concomitant alcohol and alcohol-interactive medication use by older New Zealanders : investigating the prevalence, and potential associations with health, healthcare utilization, and depression : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand(Massey University, 2021) Barnard, EddieBackground: Older adults are more vulnerable to the adverse effects of alcohol-medication interactions (AMIs) than younger populations, and are more likely to use medications capable of causing an AMI when used with alcohol (alcohol-interactive (AI) medications). Survey findings from the United States (US) and Europe indicate many older adults use alcohol and AI-medications concomitantly. However, the prevalence of this issue in New Zealand is currently unknown, and few observational studies have explored the impact of concomitant alcohol and AI-medication use (concomitant alcohol/AI-medication use) on health outcomes in community samples. Research exploring motivating factors underlying alcohol use by AI-medication users indicates having awareness of AMI risks often motivates reduced alcohol consumption. There is also evidence that depression may increase the likelihood of concomitant alcohol/AI-medication use, particularly when alcohol is used to ‘self-medicate’ depressive symptoms. However, the moderating effects of depression on alcohol use by AI-medication users have not been directly assessed in a large community sample. Design and Methods: Two studies were conducted, both involved secondary analysis of existing survey data and national pharmaceutical claims data. Samples were drawn from a representative sampling frame of older adults living in New Zealand. The first study (study 1) analysed data from a survey of adults aged 54-70 years, and the second study (study 2) analysed data from an augmented sample aged 49-83 years. The prevalence of concomitant alcohol/AI-medication use was explored in both study samples overall, and in subsamples of participants aged ≥65 years. Study 1 investigated the potential impact of concomitant alcohol/AI-medication use on general physical health and healthcare utilization. Study 2 assessed the potential relationships between alcohol use, AI-medication use, and depression. An evidence-based protocol was developed to inform methods of classifying AI-medications and measuring AI-medication use among survey participants using pharmaceutical dispensing records. Relationships between variables of interest were assessed using a series of hierarchical regression models and Chi-squared tests. Results: Alcohol and AI-medications were used concomitantly by approximately one-in-four participants aged 54-70 years, one-in-three participants aged 49-83 years, and two-in-five participants aged 65-83 years. Concomitant alcohol/AI-medication use was not significantly associated with physical health or healthcare utilization, although these non-significant findings may reflect limitations of the outcome measures used in the present research. Alcohol use was negatively associated with AI-medication use, with stronger associations being observed for medications associated with more severe AMIs. These findings are consistent with research and theory indicating AMI awareness may lead to reduced alcohol consumption by AI-medication users. Depression did not influence the relationship between AI-medication use and alcohol use. Conclusions: The present research findings indicate many New Zealand older adults are at risk of AMI. Providing relevant health warnings may help reduce the potential for AMI-related harm, although additional intervention may be needed for many older adults. Future research in this area should include longitudinal health outcome measures that are specific to the effects of AMI, and measures that assess drinking motives directly. The two studies presented in the present thesis were the first to explore the prevalence of concomitant alcohol/AI-medication use by older adults in New Zealand, which is a major contribution of this project overall. Another important contribution was the development of an evidence-based framework for measuring AI-medication use among survey participants.Item Flight of the Kiwi : New Zealanders experiences of cannabis in Amsterdam while on their overseas experience (OE) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Health Psychology at Massey University, Manawatu, New Zealand(Massey University, 2019) Colley, Gabrielle MargaretCannabis consumption and travelling share a number of similarities, such as evoking pleasure or anxiety and, like in the title used to reflect this thesis, represent the experience of “flight” for the “Kiwi” (New Zealander). This thesis therefore explores both the experiences of cannabis consumption, a flight of the mind and travelling a flight of the body. The aim was to understand how New Zealanders experience cannabis in Amsterdam while they are undertaking a working holiday based in the United Kingdom (UK), known within Aotearoa New Zealand as an Overseas Experience (OE). Given Aotearoa New Zealand’s current political debates on cannabis control and the upcoming 2020 public referendum on legalising the substance, this thesis provides an opportunity to explore how New Zealanders experience cannabis within a liberal country that tolerates the sale of soft drugs in licensed premises, while growing up in a country that enforces cannabis prohibition. Statistics on cannabis use illustrate a steady rise in global consumption, however majority of countries still implement prohibition as a method of control, therefore choosing to study New Zealanders use of cannabis in a country without any legal ramification or stigmatisation for personal consumption allowed for greater transparency and in depth exploration. Nine, one-‐on-‐one, in-‐depth interviews were undertaken with New Zealanders, aged between 18-‐30 who were living and working in London. Interviews were recorded, transcribed and analysed using Interpretive Phenomenology Analysis (IPA). Four subordinate themes were identified within the data, along with ten sub-‐themes. The results illustrate the sensible and structured nature cannabis was consumed and enacted abroad. Cannabis was not the sole motivator for the trip to Amsterdam however consuming cannabis to reach a pleasurable level of intoxication was intentionally pursued by all participants whilst in Amsterdam. In order to reach the desired state participants often drew from previous experiences or shared knowledge on the effects of cannabis and would implement certain techniques and practices to ensure they did not reach an undesired level of cannabis intoxication. Future research, with a diverse and larger sample would provide additional insights and could possibly assist in the potential policy change and implementation within the country.Item Effects of a medication reminder calendar on medication compliance in older adults : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 2001) Greyvenstein, June BarbaraThe present study aimed to investigate whether the provision of an individualised medication reminder calendar would improve medication compliance, by acting as a cognitive aid for older adults, who may be suffering the mild memory deficits which tend to be the usual concomitants of normal ageing. The present study also examined medication compliance and error rates and their relationship with the amount of daily medication taken by participants, as well as with selected demographic and socio-economic factors. A convenience sample of community dwelling participants (N = 50), aged between 55 and 84 years (M = 71) who were prescribed an average of five daily medications, was randomly assigned to either calendar or control groups. Medication compliance was assessed via two pill counts conducted, on average, seven and a half weeks apart. The results showed that participants using the calendar and those in the control group did not differ in terms of compliance measures. The average rate of compliance with medication for the sample was 97%. The mean number of errors made by participants during the interval between pill counts was 19 (79% errors of omission and 21% errors of commission). Multivariate analysis indicated that the number of daily tablets taken was positively associated with the number and types of errors made. Women were less compliant than men, while participants of lower socioeconomic status made more errors of commission. Discussion of these results focused on the non-representativeness of the sample and the difficulties associated with obtaining volunteers. Possible directions for future medication compliance research were discussed.Item Traumatic brain injury and substance use in a prison population : lifetime prevalence rates and neuropsychological sequelae : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University(Massey University, 1995) Barnfield, Tracey VThe present study investigated the rates of traumatic brain injury (TBI) and substance use in a prison population, and the effect of these on neuropsychological functioning. The study was conducted in two parts. In the first part, responses to a screening questionnaire indicated that 86.4% of the 118 subjects had sustained TBI, 56.7% reported more than one TBI, and Maori subjects sustained 12 % more TBI than non-Maori. Subjects reported higher rates of illicit substance use than the general population, and Maori reported higher substance use than non-Maori. All subjects reported difficulties with general memory and socialisation on a Problem Rating Scale, but no differences were found in the level of difficulties reported due to severity of TBI sustained. Subjects with more severe substance use histories reported experiencing most problems with interpersonal relationships, family, and finances. In part two, 50 subjects from the original sample with a history of TBI and/or substance use, completed neuropsychological measures of short and long term verbal and visual memory, learning, information processing, motor speed and co-ordination, executive functioning, and malingering. All subjects performed below norms on tests of verbal memory and verbal abstract thinking, but overall, no differences were found due to either severity of TBI or level of substance use. Maori subjects obtained the lowest scores on tests of verbal ability, but also reported higher rates of TBI and substance use, which is presumed to account for this result. In conclusion, prison populations seem to have a disproportionably high TBI rate, recurrent TBI rate, and substance use rate, compared to the general population. Further, there are a group of individuals who have experienced both TBI and substance abuse, and consequently have impairments in verbal memory and learning, abstract thinking, and report problems with general memory and socialisation. These difficulties should be taken into account, since they may affect functioning both in prison and following release.Item "If you only have money for two drinks you might as well have nothing at all" : young people talk about drinking and drug use : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Psychology at Massey University, Wellington, New Zealand(Massey University, 2010) Barclay, Simone M.; Barclay, Simone M.Psychoactive consumption is on the rise. In particular young people’s heavy sessional or ‘binge’ drinking has been highlighted in the media because of the burden it places upon public health resources and the risks it poses to health and social order. Youth intoxication has therefore become a prominent issue for policy makers, health promoters and researchers. Previous research suggests excessive drinking amongst young people can be understood in terms of the contemporary commodification of leisure which contributes to a culture of intoxication and facilitates the pursuit of calculated hedonism. The current study investigated the discourses surrounding the intoxication practices of 18 – 24 year olds. Twenty-one male and female participants took part in four friendship group discussions in Auckland, New Zealand. Their talk was subsequently analysed to gain access to young people’s views on drinking and other drug use in the context of socialising. The data was subjected to a Foucauldian discourse analysis and three discourses were identified in the texts: self-regulation, psychosocial development and pleasure. Together, these constituted a web of meaning which constructed drinking and drug use as a constrained, socially appropriate and culturally embedded practice motivated by enjoyment and social enhancement. Participants deliberately pursued states of intoxication, maintaining specific boundaries of appropriateness, means, frequency and degree of inebriation while simultaneously taking measures to mitigate perceived risks. Widespread conceptions of young adults’ heavy sessional consumption as reckless or out of control did not correspond to the young people’s perceptions of themselves as responsible, risk averse, social drinkers. Participants consistently resisted the positioning afforded them by the public discourse of censure surrounding youth intoxication and in doing so located their behaviour as age-appropriate and shaped by wider societal norms. Occasional excesses were constructed as a necessary and beneficial constituent of the maturation process. Results highlight the degree to which the voices of relevant consumer groups have been marginalised in the policy development process and the credibility gap between young people’s experiences and the health promotion messages directed at them. Findings problematise the notion that education about the risks of drinking and drug use will cause young people to moderate their behaviour out of a desire to avoid them. It is suggested that current focus on youth excess unduly attributes blame at the expense of recognising the more pervasive changes required to modify population-wide detrimental drinking cultures.