It can be concluded that similar to other studies in inner city areas of the UK, problem substance use is common amongst those with severe mental health problems within Northern Birmingham.

The present paper reports results from a larger study of 500 heavy drinkers (men drinking more than 50units of alcohol per week, women more than 35 units), untreated for their drinking within the last ten years, recruited by advertising and snowballing in the English West Midlands. Data on participants' perceived benefits and drawbacks of their own drinking were obtained by I) a computer-administered set of ratings of benefits and drawbacks in thirteen life domains, and 2) open-ended interviewing with a subsample of 50 participants leading to qualitative analysis of post-interview reports and transcripts. The main fmdings were: perceived benefits outweighed drawbacks in both forced-choice ratings and open-ended interview; there was a small but significant correlation between drinking large quantities in a day and perceived drawbacks; social benefits and drawbacks were dominant in open-ended interview; enhancement and coping benefits were linked by the concept of "relaxation" and were difficult to distinguish; becoming argumentative and aggressive with friends and family was the dominant drawback in open-ended interview; in the health domain, toxic and short-term drawbacks were more salient than longer-term illness effects. These findings suggest a model of the perceived benefits and drawbacks of heavy drinking which challenges both conventional health promotion efforts and motivational balance models of alcohol consumption.

Aims. To describe the positions adopted by close family members of a community sample of untreated heavy drinkers. Design. Detailed interview and questionnaire study of a sample of close family members and the heavy drinkers to whom they were related. Sample. 50 close relatives of 50 heavy drinkers drawn from a community cohort of 500 in the English West Midlands. Data. Perceived benefits and drawbacks of drinking checklist (family members and heavy drinkers); readiness to change questionnaire (family members and heavy drinkers); coping questionnaire (family members only); semi-structured interview (family members only). Findings. A wide range of positions towards their relatives' heavy drinking was evident in this sample of family members. Most recognised at least some drawbacks to their relatives' drinking, and some were engaged in efforts to change it. A number of impediments to taking a stand about their relatives' drinking were apparent, including recognising the benefits of drinking, mitigating factors, the wish not to be intolerant, others' support for their relatives' drinking, and sometimes the family member's own heavy drinking. Conclusions. Some light has been thrown on the experiences of a hitherto neglected population of family members, who may face a number of difficulties and dilemmas in deciding how to respond in the face of heavy drinking.

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