Alcohol 'nearly as harmful as heroin'
Britain’s system of classifying dangerous drugs is arbitrary
and unscientific and should be changed to include alcohol and
tobacco,which are more dangerous than many of the drugs that are
presently listed.
These are the conclusions of a team of leading scientists
whose report ranking a range of drugs according to their potential for
causing harm appeared in the medical journal, The Lancet. The report
ranks alcohol as the fifth most dangerous drug of the twenty assessed,
behind heroin and cocaine but as significantly more dangerous than
cannabis, LSD or ecstasy.
The present drug classification under the Misuse of Drugs Act
segregates drugs into three classes, A, B and C that are intended to
indicate the dangers of each drug, class A drugs supposedly being the
most dangerous and Class C the least.
The authors of the new report, including Professor Colin
Blakemore, chief executive of the Medical Research Council and Professor
David Nutt of the Psychopharmacology Unit, University of Bristol,
invited independent groups of experts to assess the harmfulness of drugs
on the basis of a rating scale taking into account physical harm,
dependence and social harm.
The main result of the investigation was the poor correlation
between the rating of harm and the drug’s class according to the Misuse
of Drugs Act. Drugs such as LSD and Ecstasy, both Class A, were ranked
as less dangerous than alcohol and tobacco, neither of which classified
under the Act.
The authors concluded that the results of their study raise
important questions about the validity of the current drug
classification system, in particular that the exclusion of alcohol and
tobacco from the classification has no real scientific rationale. The
fact that the two most widely used legal drugs lie in the upper half of
the ranking of harm is surely, they say, important information that
should be taken into account in public debate on illegal drug use.
David Nutt, Leslie A King, William Salisbury and Colin Blakemore:
Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet.Vol.369. March 24 2007
Top of pageAlcohol related death rate doubles in fifteen years
A new analysis of the mortality statistics for the UK shows
that the death rate from alcohol defined conditions, mainly alcoholic
liver disease,virtually doubled between 1991 and 2004.
It also shows that in Scotland, the death rates for both males
and females were around double those for the UK as a whole. As can be
seen from the table, 15 of the 20 areas with the highest male death rates from alcohol are in Scotland.
Across the UK, the alcohol-related death rate for males was
double the rate for females, and the gap between the sexes has widened
since 1991.
Among both men and women, the alcohol-related death rate rose
most rapidly among those aged 35 – 54 between 1991 and 2004, though the
death rate for both sexes was highest in the 55 – 74 age group.
At a local level, Glasgow City had the highest alcohol-related
death rate among both men and women in 1998-2004. Fifteen of the 20 UK
local areas with the highest male alcohol-related death rates were in
Scotland, with three in England and two in Northern Ireland. Merthyr
Tydfil, the highest-ranked local area in Wales, was 50th in the UK. For
women, 14 of the top 20 local areas were in Scotland, with four in
England and two in Northern Ireland. Denbighshire was the
highest-ranking Welsh local area, at 26th in the UK.
Within England, men aged 55-74 in London had the highest
alcohol-related death rate in both 1991-1997 and 1998- 2004, while women
in the North West had the highest rates in both periods.
New Drinking Styles
The authors of the report suggest that the increase in
alcohol-related mortality may be linked to changing consumption patterns
such as ‘binge drinking’, changes in the type of alcohol consumed and
changing drinking patterns in the young.
However, most scientific commentators would probably point to a
factor not discussed in the report, the increase in the overall level
of alcohol consumption during the period under review. Between 1991 and
2004, average per capita consumption rose by a quarter, from 9.3 to 11.6
litres of pure alcohol.
Social Deprivation
The new analysis shows a strong association between alcohol
death rates and measures of social and economic deprivation. While the
analysis was only undertaken in relation to England and Wales, its
conclusions are consistent with previous research and the factor of
economic deprivation is probably one of the main explanations of the
higher alcohol mortality in parts of Scotland, particularly Glasgow.
In the new analysis, alcohol death rates were more than five
times higher in men, and more than three times higher in women, for
those living in the most deprived areas compared with those living in
the least deprived.
Previous work has found a relationship between deprivation and
deaths from liver cirrhosis, and higher general alcohol mortality has
been reported for men in manual occupations compared to those in
non-manual occupations, especially at younger ages.
Health Statistics Quarterly 33 (Spring 2007).
Scotland up-dates alcohol harm reduction strategy
The publication of the alcohol death figures coincided with the
release of an up-dating of the Scottish alcohol harm reduction
strategy. A main element of the Updated Plan for Action on Alcohol
Problems is the expansion of a test purchasing scheme to crack down on
retailers who sell alcohol to under 18s.
The new Plan sets out a range of action on prevention,
education, treatment, protection and controls. Government will work in
partnership with Alcohol and Drug Action Teams, the NHS and other parts
of the public and voluntary sectors to reduce alcohol-related harm.
The extension of the test purchasing scheme,whereby children
under the legal purchasing age can be used to buy alcohol to check that
licensing laws are being followed, comes after publication of an interim
evaluation report of a successful pilot in Fife.
The Scottish Executive also published details of a new
partnership to engage the drinks industry's resources and expertise in
tackling alcohol misuse and promoting ‘responsible drinking’.
Test Purchasing
Announcing the extension of the test purchasing scheme, Health
Minister Andy Kerr said: “Communities across Scotland are blighted by
the problems associated with underage drinking, and rolling out test
purchasing will give us a valuable tool in the fight against this. I
know that the vast majority of retailers take their responsibility very
seriously but we need to take action against the minority who sell
alcohol without carrying out the proper checks.The findings of an
interim evaluation report on the alcohol test purchasing pilot clearly
show that the scheme can be carried out safely, fairly and effectively
and we now want to replicate that success across Scotland. But as well
as enforcement, we will continue our work to encourage all communities
in Scotland, including young people, to develop a healthier relationship
with alcohol.”
One alcohol death every six hours
Mr Kerr said that in Scotland one person dies every six hours as
a direct result of alcohol, and deaths from liver cirrhosis are rising
at an alarming rate. “Alcohol doesn't just affect the drinker”, he
added. “The links between alcohol misuse, anti-social behaviour and
violence are clear. Alcohol misuse is estimated to cost our economy over
£1 billion a year. This plan outlines a range of government action, as
part of a long term process of cultural change. But that change can only
take place, with the support of the Executive, where individuals are
willing to change their behaviour and in a society where alcohol misuse
is no longer acceptable. We must all take personal responsibility for
our society's excessive consumption. A culture of drinking to get drunk
is not one to be proud of, and we cannot afford to assume it's someone
else's problem. I commend our industry partners for committing to join
our efforts to tackle the problems. I am delighted that I can publish
today the detail of our agreement with them.”
The actions outlined in the Plan include:
On protection and controls
- extending the alcohol test purchasing pilot to all Scotland from 1 May 2007 onwards
- providing support to ensure Licensing Boards can control the spread of licensed premises through the Licensing Act
On prevention and education
- developing a new, research based substance misuse schools education programme to build on existing work
- supporting further development of diversionary activities such as Youth CAFEs (community alcohol free environments)
- completing a national series of public awareness publications about the short and long term effects of drinking alcohol
On Provision of Services
- developing a pilot telephone service to help identify and
support harmful and hazardous drinkers at an early stage when they come
into contact with the NHS
- investing in better research, including research on improving reporting and recording information on alcohol use in pregnancy
- developing an alcohol and drugs work force development
strategy to ensure staff across Scotland have the best possible training
in dealing with people with alcohol problems.
Background
There were 1,513 deaths in Scotland in 2005 where alcohol was
the underlying (direct) cause e.g. mental and behavioural disorders due
to the use of alcohol, alcoholic liver disease, alcoholic pancreatitis.
There were a further 859 deaths where alcohol was a contributory factor.
Between 1950-1954 and 2000-2002 the rate of liver cirrhosis mortality
in Scottish men increased by a factor of six and a factor of four for
Scottish women. Cirrhosis mortality rates in Scotland are now amongst
the highest in Western Europe.
In September last year the Executive announced a formal
partnership with the alcohol industry, in what is hoped to be a long
term, collaborative approach to “fostering a culture which recognises
that responsible, moderate consumption can be part of a healthy
lifestyle.”
Partnership Agreement:
Scottish Executive and the alcohol industry
Initial signatories:
- Scottish Executive
- Scotch Whisky Association
- Tennents
- Diageo
- Scottish & Newcastle
- Scottish Retail Consortium
- Scottish Licensed Trade Association
- BII Scotland
- Scottish Beer & Pub Association
- Scottish Grocers’ Federation
- Wine & Spirits Trade Association
- Gin & Vodka Association
- National Association of Cider Makers
In recognition of our shared aim to reduce alcohol misuse in
Scotland, the Scottish Executive and the alcoholic drinks industry have
agreed a number of actions as a first step in what we hope will be a
long term collaborative approach to fostering a culture which recognises
that responsible, moderate consumption can be part of a healthy
society.
This agreement covers both alcohol producers and retailers
(covering both on and off sales) and the initiatives agreed are designed
to harness the knowledge and expertise of representatives from across
the alcohol industry.
All parties are bringing resources and commitment to the
furthering of the aims of the partnership – with an emphasis on
delivering tangible action and outcomes. The Drinkaware Trust will
promote responsible drinking messages and provide education and
campaigning resources across the UK. This partnership aims to deliver
added value in Scotland and will work with the Drinkaware Trust to
ensure that our activities are aligned and mutually supportive to
achieve greatest impact.
The partnership also jointly recognises the need for
enforcement of current licensing legislation to ensure a zero tolerance
approach to the illegal purchase of alcohol and the resultant alcohol
related disorder.
The Executive commits to taking further action in this
respect, including the roll out of the test purchasing arrangements
currently being piloted in Fife to prevent under age sales.
The Executive recognises that tackling alcohol misuse is not
only a health issue, and, as referred to in the Updated Plan for Action
on Alcohol Problems, commits to delivering resources from across the
Executive to address this.
There are no quick fixes to what is a long term problem
requiring a long term cultural change programme. Neither do the actions
amount to the complete solution, but we believe that by working in
partnership long term cultural change can be effected.We may continue to
broaden this partnership to include others. Participation in this
arrangement will not prevent parties also continuing their own work in
this area.
The agreement is not legally binding. It is complementary to
the Updated Plan for Action on Alcohol Problems and as with the Plan
will be reviewed in due course.
The initiatives outlined below are the first in an ongoing
programme. Others will be added and this list will be continuously
updated and refined.
Specific initiatives already agreed, involving individual partners as appropriate:
We will:
- Build on best practice to develop and promote common core
sensible drinking messages, and information about the incompatibility
of alcohol consumption with certain activities;
- In pursuit of the above, share media and marketing expertise to promote those messages;
- Share consumer research on promoting sensible drinking and responsible retailing;
- Consider the scope for joint events to focus public and
media attention on the dangers of alcohol misuse, alongside wider
messages of personal responsibility.
- Work with the media and other stakeholders to discourage
inappropriate endorsement or legitimisation of inappropriate alcohol
consumption;
- Develop a set of shared Scottish specific Standards,
underpinning and strengthening in Scotland the approach already adopted
at UK level;
- Work with retailers and the National Licensing Forum to
support a comprehensive server training programme in responsible
drinking ahead of the 2009 Licensing Act implementation deadline;
- Develop and implement exemplar alcohol policies in our own
workplaces, which we will also share and promote more widely within the
public and private sectors, including to Small and Medium Size
Enterprises (SMEs);
- Where appropriate, individual companies will pilot low
alcohol alternatives in the Scottish market and use their joint creative
energies to market the principle of consuming low alcohol alternatives,
within the context of making informed choices and unit awareness.
- Investigate the promotion of no alcohol alternatives in the retail sector;
- Develop and produce guidelines to establish best practice on the promotion of alcohol via sponsorship;
- Work together to develop and implement an intensive series
of interventions, including community support, within geographically
focussed pilots to establish the cumulative effect of a multi-faceted
and targeted approach to reducing alcohol harm;
- Produce educational materials for parents to use with their
children outside the school setting, also encouraging parents to
consider their own drinking habits in discussing the issue with their
children;
- Hold a National Awareness Week with support from other partners such as the voluntary sector.
Scottish doctors demand end to ‘ridiculous pricing of alcohol’
Welcoming the publication of the new action plan to tackle
alcohol problems in Scotland, Dr Peter Terry, chairman of the BMA in
Scotland said:“We welcome the concerted efforts of the Scottish
Executive to tackle Scotland’s drinking problem. Alcohol costs our
economy around £1 billion every year, but the human cost is much higher.
Around one in 30 of all deaths in Scotland are caused by alcohol
related illness.
“It is clear that alcohol misuse doesn’t just have an impact
on our health, but it affects society as a whole and we must do what we
can to change the culture where Scots believe they can drink to excess
without any thought to the consequences for their health.
“Doctors in Scotland welcome the extension of the test
purchasing scheme. In a survey last year,97% of doctors said that
tougher enforcement of age restrictions for purchasing alcohol was one
of the most important measures that government could take to tackle
underage drinking in Scotland, as well as tougher measures for
shopkeepers who sell alcohol to children.
“Doctors also want to see an end to the ridiculous pricing of
alcohol for off sales. When alcohol is cheaper than bottled water, we
have to worry about what message we are sending our children.”
The BMA also welcomed plans to develop a new schools education
programme. There has been a 60% increase in reported drinking by 15
year olds and more than a 100% rise in drinking by 13 year olds in
recent years.
“Education on the dangers of alcohol misuse should begin at
primary school, before children are tempted to drink,” added Dr Terry.
The BMA also called for action to be taken to make Scotland’s
roads safer as part of the alcohol action plan with changes to drink
driving limits.
Dr Terry said: “As part of an action plan we would call on the
Scottish Executive to insist that the Westminster government introduce
legislation to reduce drink drive limits to the European norm (from 80mg
to 50mg per 100ml).”
In a survey of BMA Scotland members, doctors said that to
tackle alcohol misuse in Scotland, the following measures should be
taken:
- Apply stricter enforcement of age restrictions, particularly
for off sales. 97% of doctors say this is an important measure to deter
young people from purchasing alcohol.
- Implement stricter measures, such as immediate loss of
license to sell alcohol, to prevent shopkeepers from selling alcohol to
under age children. 96% of doctors support this measure.
- Develop improved alcohol awareness education campaigns for
schools, starting at primary school level. 91% of doctors support such a
campaign.
- Introduce a law that requires alcohol products to carry a
label listing alcohol content, recommended daily units and warnings of
excessive drinking. Products that do not comply should be withdrawn. 83%
of doctors back labelling.
- The price of alcohol should be increased to discourage excessive drinking. 70% of doctors agree.
Top of pageWomen's binge drinking linked to education
British women's binge drinking is clearly defined by their
age and education, suggests a large, long term study in the Journal of
Epidemiology and Community Health.
Educated women binge drink in their 20s, but curb their habits
by their 40s. But the reverse is true of women with little education,
whose binge drinking is more likely to take off in their 40s, shows the
research.
The prevalence of binge drinking remains substantial into
adulthood (31% men and 14% women at 42 years). The social patterns in
binge drinking may have consequences for future health inequalities in
this population.
The findings are based on a representative cohort of more than
11,500 British men and women, all of whom were born during one week in
March 1958. They were monitored throughout childhood and into adulthood,
and surveyed about how much and how often they drank alcohol at the
ages of 23, 33, and 42.
Binge drinking was classified as 10 or more units of alcohol in one sitting for men, and seven or more for women.
Among men, the prevalence of binge drinking fell from 36% at
the age of 23 to 31% by the age of 42. Among women, the equivalent
figures were 18% and 14%.
Less educated men were significantly more likely to be binge
drinkers at all ages, with little change across the decades. But the
same was not true of women. Highly qualified women were about one third
more likely than women with no or few qualifications to binge drink at
the age of 23. But by the time women reached their 40s, it was the less
educated women who were significantly more likely to be the binge
drinkers, while binge drinking in the educated women was less frequent.
Women with no or few qualifications were more than 2.5 times
as likely as their highly qualified peers to be binge drinking by the
age of 42.
The research was carried out at the Centre for Paediatric
Epidemiology and Biostatistics, UCL Institute of Child Health, London by
B. Jefferis,O. Manor and C. Power
[Social gradients in binge drinking and abstaining: trends in a
cohort of British adults - Journal of Epidemiology & Community health 2007; 61: 150-55]
Top of pageBMA calls for gambling treatment on NHS
Problem gambling should be a recognised addiction that
requires treatment on the NHS, according to the British Medical
Association (BMA). This recommendation is part of a set of proposals
aimed at helping healthcare professionals deal effectively with the
growing problem of gambling addiction in the UK,and featured in a report
especially commissioned by the BMA Gambling addiction and its treatment
within the NHS.
A main prompt for the publication of the report is that the
2005 Gambling Act is due to come into force in September 2007. The new
UK legislation will increase gambling facilities and subsequently, the
report says, problem gambling may rise too and health professionals
should be prepared for this.
The BMA expressed particular concern about adolescent problem
gamblers and the report calls for a review on whether slot machine
gambling should be prohibited to anyone under 18.
Fruit machine addiction can lead to behavioural problems such
as truanting, stealing and aggressive behaviour. Studies have shown that
gambling among young people often goes hand in hand with other
addictive activities such as drug taking and alcohol abuse and has been
linked to juvenile crime.
The BMA Head of Science and Ethics, Dr Vivienne Nathanson,
said: “Problem gambling is associated with a number of health problems
and the BMA is concerned that there are insufficient treatment
facilities available. Psychological problems can include anxiety,
depression, guilt and suicidal thoughts. Relationships with family and
friends can also be affected by gambling, sometimes leading to
separation and divorce.
“There needs to be treatment for problem gambling available on
the NHS similar to drug and alcohol services. The BMA is calling on the
Gaming Industry to pay at least £10m per annum via the Responsibility
in Gambling Trust to fund research, prevention and intervention
programmes.”
Contributing author of the report, Professor Mark Griffiths of
the International Gaming Research Unit at Nottingham Trent University,
sees remote gambling as another cause for concern. This includes
gambling via the internet, mobile phone and interactive television
gambling.He said that: “Online gambling in the UK has doubled since 2001
and further research in this area should be seen as a priority.”
Particular problems with remote gambling include:
- the availability of ‘virtual cash‘ – for most gamblers electronic [e-cash] will be easier to part with than ‘real’ cash
- unlimited access and anonymity – there will be no ‘closing time’, a user will be able to gamble privately around the clock
- increased odds of winning practice modes – research shows
that it is significantly more common to win while playing on a ‘demo’ or
‘free play’ game, once gamblers start to play for real with real money,
the odds of winning are considerably reduced.
- the internet provides online customer tracking, this is
worrying as operators could end up knowing more about the gambler’s
playing behaviour than the gamblers themselves.
Key recommendations from the report include:
- Treatment for problem gambling should be provided under the NHS.
- Gambling operators and service providers should pay at least
£10m per annum to fund research, prevention and intervention
programmes.
- Gambling operators and service providers should supply information on gambling addiction, treatment and services to patrons.
- Adolescent problem gambling should be taken as seriously as adult problem gambling.
- Research should be conducted into the association between internet gambling and problem gambling.
- Some specific gambling options such as slot machines should be
specifically reviewed to ensure they are not accessible to adolescents.
Top of pageBritain's top doctor calls for 'total ban' on alcohol advertising
Drastic action is needed to curb Britain’s binge drinking
culture including higher taxes on alcohol, an end to ‘irresponsible’
cheap drink promotions in supermarkets and a complete ban on alcohol
advertising, according to Professor Ian Gilmore, the new president of
the Royal College of Physicians. Professor Gilmore said the ban should
include alcohol sponsorship in sport. His views were immediately
attacked by the alcohol industry’s Portman Group. Michael
Grade,executive chairman of ITV and former head of the BBC,also launched
an attack on the idea of restrictions on advertising, saying it
amounted to `scapegoating’ for society’s problems. He urged broadcasters
and advertisers to join together to fight off further restrictions.
Speaking on BBC Radio 4’s ‘Today’ programme, Professor Gilmore
argued: “The college is giving strong support for the Government’s
national alcohol strategy that came out three years ago. But I have to
say that that strategy relied heavily on voluntary partnerships with the
industry, with public information, [and] is clearly not working.”
In a bid to turn the tide of arising health damage, Professor
Gilmore advised that “we need to look at some evidence-based polices.
Not just advertising, but the major drivers of what we drink, as a
nation, of price, availability and advertising.”
On advertising, Professor Gilmore said that it struck him as
bizarre that a watershed of 9pm was being introduced for the advertising
of unhealthy foods like crisps, but alcohol was being advertised 24
hours a day.
Also, speaking to the London Evening Standard, Professor Gilmore identified alcohol sports sponsorship as a particular problem.
An estimated £800million was spent on advertising alcohol and
on sponsorship deals in 2004 and it is feared that a ban would cause
major problems to the media and in sport.
Carling is a major football backer while Liverpool are sponsored by Carlsberg and Everton by Thai beer Chang.
Heineken sponsors the biggest rugby union club competition and
Stella Artois sponsors the tennis championships at Queen’s Club.
Professor Gilmore said he was “uncomfortable” that his nephew, aged
nine, has a Liverpool shirt with Carlsberg emblazoned across it.
Professor Gilmore, a consultant gastroenterologist, said: “It sends out
the wrong message.” He said that Britain should follow the French
example, where there is no broadcast advertising of alcohol and no
alcohol sponsorship of sport. France had seen a fall in drinking levels -
in contrast with Britain, where figures showed an explosion in
consumption.
Professor Gilmore added: “Alcohol is pervasive, it has become
impossible to have a celebration in this country without drinking.
Alcohol has never been more available or cheaper.”
On alcohol taxes, Professor Gilmore said rates should be
linked to alcoholic strength because drinks such as strong cider were
too cheap and were being bought by children aiming to get drunk as
quickly as possible.
Responding to Professor Gilmore’s comments, a spokeswoman for
the Department of Culture, Media and Sport said: “Sponsorship by the
drinks industry is worth many millions to British sport - money which,
in many cases, is then used to support youth and grassroots development
programmes. There are currently no plans to impose greater restrictions
on alcohol sponsorship of sports events.”
For the Portman Group, David Poley, also speaking on the
‘Today’ programme, said: “It is right that irresponsible advertising
should be banned, but it already is banned under the strict code of
practice. If Professor Gilmore thinks there is any advertisement out
there that is in breach of these laws he can complain to the ASA.”
Put to him that advertising was designed to encourage
drinking, he said: “The main effect of advertising, as all studies will
show, is that it generally impacts on brand preference. I don’t see
there is anything wrong with advertising, provided that it complies with
these rules. If we acknowledge that advertising generally is complying
with these rules and yet there is still a problem with the alcoholic
culture in the UK, it suggests the problem is not caused by advertising
and we should start looking for other solutions.”
Education was a key component to changing the drinking culture in the UK, Mr Poley insisted.
Broadcaster Michael Grade attacked government restrictions on
advertising in general. He condemned restrictions as “nonsense” and
said:“We have a common cause in resisting this nanny state culture. The
restrictions are not going to stop the way that people live and behave.
It is a complete denial of what TV is about, which is reflecting real
life. It is nonsense. Either ban the products or just let us get on with
our lives.”
As reported in Marketing Week, Mr.Grade was speaking at
Thinkbox Experience, a conference organised by the commercial television
marketing body to show advertisers and agencies the future of
television. “There is a real common cause between us on the panel and
advertisers, in trying to wean Government off the idea that restrictions
on advertising are the answer to all society’s problems. It is too
easy, too simplistic.”
The call, which drew applause from the audience, came during
one of Mr Grade’s first public speeches since joining the commercial
broadcaster from the BBC at the start of this year.
It followed Ofcom’s announcement that food brands high in fat,
salt and sugar would be unable to advertise on television during
children’s programming or shows that were watched by a high proportion
of under 16-yearolds.
Fellow Thinkbox panelist Jane Lighting, Five chief executive,
added:“We have just seen kids and alcohol advertising restricted. What
comes after that? We genuinely need lighter touch regulation.”
Top of pageUK 'worst country for children' - and the most violent
The UK has the lowest level of child well-being among the
world’s richest countries, and it is also the most violent country in
the European Union according to two new international surveys, both of
which highlight the role of alcohol in the problems they identify.
The first survey, carried out for UNICEF and designed
primarily to measure child poverty, assessed 21 of the world’s richest
countries on the basis of six dimensions of child well-being including
material factors of wealth and poverty, health, family relationships and
risky behaviour. It found that overall the UK ranked lowest as the
worst country for children among those studied. The Netherlands was
assessed as having the highest levels of child well-being, with Nordic
countries claiming four of the top ten places.
The report concludes that there is no obvious relationship
between levels of child well-being and affluence.The Czech Republic, for
example, achieved a higher ranking for child well-being than several
much richer countries such as the UK and the USA.
The report identifies the UK’s particularly high levels of
family break-up and the growth in single parent families and
step-families as a main factor reducing child well-being. The report says
that children growing up in such families have been shown to be at
greater risk of dropping out of school, of leaving home early, of poorer
health, of low skills and of low pay.
On alcohol and other substance abuse problems, the report says
that these provide a clear indication of the problems and pressures
facing young people and of their ability or inability to cope with them.
It is on this dimension that the UK scored particularly badly in the
survey, having far higher levels of ‘risk behaviour’ than all the other
countries.
Violent Britain
The second report, an analysis of the European Crime and Safety
Survey, found that among 18 EU member states up to 2004, the UK had the
second highest victimisation rate for 10 common crimes, and ranked first
in relation to victimisation rates for assaults and threats.
A main finding of the survey, and one contrary to what many
believe,was that there was no apparent association between indicators of
wealth or economic inequality and levels of crime. It is often
suggested that poverty is a major cause of crime, but in this study,
both high crime countries and low crime countries included mixtures of
both the more affluent and the less affluent. This also applied to
specifically violent crime.
However, levels of violent crime did appear to be moderately
strongly related to alcohol consumption. Beer consumption per head was
taken to be indicative of alcohol consumption among young people, and
beer consumption was related to the prevalence of assaults and threats.
Generally, the countries with the highest levels of beer consumption
were also the countries with higher levels of violent crime.The report
says that although consumption of alcohol cannot be seen as a cause of
violent crime by itself, its excessive use is known to lessen controls
and to contribute to violent behaviour among young males in specific
cultural settings.
Rising Teenage Hospital Admissions for Alcohol
The publication of official reports into low child
well-being and high violence rates in the UK coincided with reports of
still higher levels of alcohol related harm even in young children.
Medical experts warned of problems extending into the future and of a
whole generation being scarred by alcohol.
Figures released by the Department of Health showed that among
16-19 year olds there has been a steep increase in alcohol-related
admissions to hospital following a visit to an accident and emergency
department. Between 1998/9 and 2005/6, such admissions rose by 72%.
Public health minister Caroline Flint explained that this increase was
almost entirely due to binge drinking.
Alcohol-related admissions for patients
aged 16-19, England, 1998-9 to 2005-6
2005-6 7596
2004-5 6004
2003-4 4727
2002-3 3916
2001-2 4079
2000-1 4232
1999-2000 4675
1998-9 4417
Other reports confirmed that the problems are evident some
years before the age of 16, with children as young as 12 or 13 also
being admitted.
Commenting on the figures, Professor Mark Bellis of the Centre
for Public Health at Liverpool John Moores University, said: “Hospital
statistics grossly under-estimate the number of young people drinking
alcohol in ways that will damage their health. It is only the tip of the
iceberg. Many more children are admitted for problems not recorded as
alcohol. The admissions include everything from being involved in
violence to teenage pregnancies.
For every one youth admitted due to alcohol consumption there
are many more whose health suffers through excessive alcohol
consumption.”
Prof Bellis, added:“We are in danger of creating a generation permanently scarred by alcohol.”
Professor Ian Gilmore of the Royal College of Physicians and a
liver specialist at the Royal Liverpool Hospital said he too was
dismayed by the scale of the problem. He said 24-hour licensing was a
key factor, in particular the round-the-clock availability of alcohol in
supermarkets and corner shops.
“Alcohol seems to be all around us,” he added. “I'm
particularly concerned about the cut-price offers in supermarkets which
are fuelling drinking among young people.”
Storing up problems for the future
Professor Gilmore said that binge drinking by teenagers was
likely to cause a major increase in liver disease in the future. He
said: “Cirrhosis of the liver has increased tenfold since the 1970s.
There is a big concern about the rise in deaths from cirrhosis among
young people. I think we are going to see big increases in people in
their 20s and 30s being diagnosed with liver cirrhosis.”
David Mayer, chair of the UK Transplant Liver Advisory Group,
also warned that young drinkers are storing up a problem for the future
and are likely to require his services in years to come. “People have
more money and more opportunity to drink from an earlier age and
therefore their livers are exposed to chronically high alcohol levels.We
are concerned that it's becoming an epidemic. It does take many years
to develop cirrhosis, but if you start drinking at an early age you are
going to see problems sooner rather than later.”
Alcohol Related Brain Damage ‘will become commonplace’
In Scotland specialists warned of an increase in alcohol related
brain damage being caused by teenage binge drinking. Dr Jonathan Chick,
a consultant psychiatrist in Edinburgh said: “For the first time, we
are seeing people in their thirties and early forties with conditions
such as Korsakoff's syndrome. This is at least ten years younger than
the patients with alcohol-related brain damage we used to deal with.
This definitely reflects the growing trend for heavy alcohol consumption
at an ever earlier age.”
Dr Chick said that the point about Korsakoff's syndrome was
that it was very disabling and very expensive to deal with because
sufferers were no longer able to live on their own and needed safe and
often secure accommodation.
He said the availability of cheap, clear cider - or what he
termed “oblivion in a bottle” - was at the root of the problem in
Scotland.
Shona Neil, the chief executive of Scottish Association for
Mental Health, agreed. She said: “The numbers of young people we are
recording with alcohol-related brain damage is just the tip of a
substantial and growing iceberg. The difficulty at the moment is that
there will be young people in the community with these syndromes, but
because of the current lack of information they do not know what is
wrong with them.”
Tom Wood, chairman of the Scottish Association of Alcohol and
Drug Action Teams, said: “Instead of alcohol related brain damage being
exceptional, it will soon become commonplace. That is why these early
drinking patterns… have such sinister implications for the future. My
very real fear is that we will start to pay the price for this behaviour
years down the line. It all adds to the growing body of evidence that
young Scots need to change their relationship with alcohol.”
Top of pageDoes TV encourage teenage drinking?
Television soap operas ‘normalise’ alcohol consumption,
de-sensitising viewers to its adverse effects and so may help to promote
teenage drinking.
These are the conclusions of a survey for The Food Magazine
investigating the portrayal of alcohol in television soap operas. The
survey discovered that alcohol, shown in background scenes or being
consumed by characters, accounts for considerable screen time in many
popular soaps. During the two week survey period, Hollyoaks was the
leader in total alcohol related references with these accounting for
around 18% of screen time. According to its website, Hollyoaks is the
UK’s most watched teenage drama serial; it goes out Monday to Friday at
6.30pm, right after the Simpsons.
All of the soaps surveyed go out before the 9pm watershed and
have millions of viewers for each programme segment, including many
children and young people. However, alcohol still plays a prominent role
in these dramas.
During the survey period, the alcohol scenes in Hollyoaks were
largely centred on the lives of three friends. One owned and managed a
bar-restaurant while the others assisted him. The three were young
twenty somethings, single, carefree and enjoying life to the full. Each
looked a picture of health, of average weight and physically fit.
The characters used alcohol to help them enjoy dates and to
celebrate special occasions. Even when characters were not explicitly
drinking, alcohol appeared in the background – on shelves at the bar, on
other tables in restaurants.
Similarly, other programmes showed characters that were
exemplars of health, yet storylines showed an obvious mismatch with
their unhealthy drinking habits. In Home and Away, the chief offender
was a gym instructor. As might be imagined, he was fit, healthy and
sporty, yet 50% of his scenes saw him drinking beer or wine. The survey
showed that alcohol was the most frequent food group in background
scenes, for example, 69% of all food occasions in Coronation Street
involved alcohol. The chart shows how alcohol dominates the food groups
appearing in background scenes of Hollyoaks.
The Food Magazine survey results are consistent with other
studies. One surveyed soap opera content over several weeks and found,
on average, seven drinking scenes per hour, with alcohol used primarily
for celebrations and as an aid to romance. The study found no explicit
portrayal of alcoholism and a tendency to portray potential problem
drinkers in a humourous, or lighthearted way.
Cally Matthews, a public health nutritionist and the author of
the Food Magazine report, says that the problem with over-saturation of
images, particularly alcohol, is that it dulls the senses to the point
in question – it becomes the ‘norm’. “Suddenly a daily lunchtime and
after work visit to the pub is normal.Two to three glasses of wine each
night is normal. We become desensitised to the shock of the image.”
Matthews says that evidence is accumulating about harm to
young people from this ‘naturalisation’. A recent study in the British
Medical Journal focused on young people in the Netherlands and found
that soaps were linked with alcohol abuse in young people.
The Food Magazine contacted the BBC, Channels Four and Five
and ITV and received official statements confirming that they follow the
Ofcom Broadcasting Code, with, for example, Channel 5 asserting,
“Representation of alcohol use and/or abuse in Five programming is
governed by the guidelines laid down by the Ofcom Broadcasting Code. In
accordance with these, alcohol is not featured in programmes made
primarily for children unless there is strong editorial justification.
In other programmes broadcast before the watershed which are likely to
be viewed widely by under eighteens, alcohol abuse is generally avoided,
and in any case not condoned, encouraged or glamourised unless there is
editorial justification.”
As the soaps surveyed all have bars or clubs or pubs as
significant settings, it is likely that ‘editorial justification’ is
going to allow many scenes with alcohol. The questions of glamourisation
and encouragement are perhaps more open to interpretation. The
regulator, Ofcom, is charged with enforcing its Code, but day to day
programme content is more likely to be monitored, and complained about,
by members of the public who object to certain scenes.
Cally Matthews argues that while the nation’s soaps continue
the process of normalisation of alcohol under the watchful gaze of the
regulator, campaigners have focused their attention on efforts to get a
pre-9pm watershed ban on alcohol advertising on television.
The drinks industry spends around £800 million a year
promoting its products, against a spend last year by the government of
not quite £4 million on safe drinking campaigns. Campaigners want to
make sure young people are protected as much as possible from the power
of that spend and believe a total pre-9pm ban is the best way to do
this.
A recent study, published in the Archives of Pediatrics and
Adolescent Medicine, found that young people aged 15-26 who watched more
alcohol adverts tended to drink more too. Nearly 2000 young people were
interviewed for the study, which took place in the United States.
Scheduling restrictions on TV advertisements are almost all
based on the Broadcasters Audience Research Board audience index.
Programmes attract alcohol advertising restrictions if the proportion of
under 18s in the audience is greater than the proportion of under 18s
in the population at large.
This still leaves some programmes with many young viewers but
not of a high enough percentage to enact a ban; it also means that
programmes with very high overall viewing figures need large child
audiences to enact a ban. For example, alcohol adverts are allowed
during Home and Away – a programme full of young characters that goes
out on weekdays at noon and 6pm and which has a viewing audience
comprised of around 8% under 16 year olds.
The complexities of the current system mean that it is not
that easy to find out if advertising is allowed during specific
programmes. The Advertising Standards Authority (ASA) was unable to tell
The Food Magazine whether alcohol adverts were allowed during
Emmerdale,Coronation Street, Hollyoaks and Home and Away, despite its
role as a so-called one-stop-shop for consumers concerned about
advertisements. They advised asking the Broadcast Advertising Clearance
Centre (BACC), a specialist body responsible for the pre-transmission
examination and clearance of television advertisements.
However, BACC said, “Our role is to advise broadcasters of the
character of the commercial, and in this case, we will inform the
broadcaster whether it is a commercial for alcohol. It is up to the
broadcaster to apply the scheduling restrictions which apply, and they
are therefore better placed to reply to your question, whether the four
programmes have a higher share of young among their viewership.”
The Food Magazine checked back with the ASA which responded
that they work on a complaints basis; if the Food Magazine had a
complaint about a specific alcohol advert they would then investigate
and the broadcasters would have to release audience information to them.
Cally Matthews argues that this type of system calls into
question the degree of regulation and is not particularly useful to a
parent who might not want to sit and watch a programme, but who would
prefer to find out if adverts for alcohol were likely to occur during
programmes their children would be watching. The Food Magazine tried to
get in touch with, for example, Channel 4 and were told that it could
take up to three weeks for an answer.
According to Jane Landon, Deputy Chief Executive of the
National Heart Forum, “A pre-9 pm watershed ban is logical, it is easy
for people to monitor at home, as all they need to do is look at their
watch to see if an advert is on when it shouldn’t be. A watershed also
offers a higher protection to all children and young people, as we know
many young people watch all kinds of programmes which attract a mixed
audience. At the moment the viewer at home is left to decide whether to
make a complaint,which is then investigated by the Advertising Standards
Authority. Even if at a later date the ASA rules against a broadcaster,
the consequence is usually the regulatory equivalent of a slap on the
wrist.”
Issue 76 of The Food Magazine
published Saturday 10th March 2007
Top of pageAlcohol as a problem for the South Asian community
In recent years there has been growing awareness of alcohol
problems in members of the South Asian community in the UK.While the
overall level of alcohol problems remains substantially lower in South
Asians than in the indigenous population, the problems are probably
increasing and there is evidence that South Asians may be particularly
vulnerable to some adverse effects of alcohol such as liver disease.
Some special treatment services for South Asians have been established.
Here, Narinder Gharial, Mental Health Project Manager
for the Confederation of Indian Organisations (UK) gives her personal
perspective on why alcohol matters to the South Asian community.
It needs to be said at the outset that it is not possible to
embrace the diversity of South Asian peoples in a single definition of
culture. The South Asian culture is not homogeneous. It encompasses a
large geographical area covered by India, Pakistan, Bangladesh and Sri
Lanka. In addition there are regional variations in these countries that
reflect clan, tribal and caste differences. There are many religions
practised in these regions and hundreds of languages spoken including
innumerable dialects. This picture is further complicated by the
migration history of South Asians to countries in Asia, Africa, South
America, Europe the Middle East and USA and islands such as Mauritius in
the Indian Ocean and Trinidad and Tobago in the West Indies.
Culture has been defined as the learned values, beliefs, norms
and way of life that influence an individual’s thinking, decisions and
actions in certain ways. It would also be useful to consider culture as a
process which is dynamic and evolving. This means that in the context
of South Asians living in the UK, the culture of first generation
immigrants has been subjected to knocks and jolts and the values that
they arrived with have needed to be revised in face of shifting
immigrant status, financial constraints, employment regulations and
housing deprivation. The second generation South Asians are struggling
to juggle two value systems – the domestic one and the external one. For
many young people the balancing of identities is proving stressful. It
is against this backdrop that this piece is pitched.
The Alcohol Research Forum in its report for Alcohol Concern
(2002) identified significant gaps in the knowledge base collated by
past research into alcohol misuse in the black and minority ethnic
groups. These groups had been pathologised and homogenised by poorly
conducted research and outdated material. This meant that the needs of
minority groups could not be effectively addressed. It is for this
reason the alcohol related services for ethnic minority groups are not
perceived as accessible or sensitive.There are also very low levels of
awareness of sources of advice relating to alcohol misuse.
Levels of alcohol misuse
The 2001 UK census was the first to ask a specific question of
ethnic origin and religion. When confined to England the proportion of
ethnic origin is 9.1% of which just over half are of South Asian
origins. This census also recorded religious differentials of ethnic
minority populations in England as 3.1% Muslim, 1.1% Hindu, 0.7% Sikh,
0.5% Jewish and 0.3% Buddhist. This spectrum of religious differential
in the South Asian communities does not necessarily reflect countries
and regions of origin of the ethnic population. It is important to be
aware of this difference when reviewing drinking patterns and support
services that are available.
Drinking in the South Asian communities has not been equated
with ‘being sociable’ as is the case in many Western societies.This
however, is changing and many young people are now drinking with the
same attitudes as their white counterparts.The difference is in the
experience of the South Asian young people.They feel that their culture
is not as permissive.When juggling the different value systems their
identity, beliefs and faith come into question. Crisis in identity can
lead to misuse of alcohol with associated feelings of anxiety, guilt and
conflict. It is for this reason that any difficulties associated to the
use of alcohol often remain largely hidden.
Bradby andWilliams (2006) reported on research into alcohol
use in 824 British born 14-15 year olds in 1992 and followed this in
1996 with further research of 492 18-20 year old South Asian young
people.These young people were found to be more abstinent from alcohol
use than non-South Asians in both age groups. Muslims were more
abstinent than Sikhs or Hindus. Asian girls were more abstinent than
Asian males. Abstinence was seen to be for cultural and religious
reasons.
Understanding the south Asian culture
In South Asian communities culture places strict parameters of
what is normal and what is not normal behaviour. There are huge
expectations from young people in terms of respectful behaviour towards
elders, safe guarding the ‘family name’ and generally behaving in an
acceptable and accepting manner. It is for this reason that individuals
who experience any difficulty in their life feel unable to talk about
it. Everyday experiences of South Asian individuals will help to reveal
why they are not able to acknowledge their difficulties. This hampers
any discussion or understanding of the difficulties. One of the
fundamental aspects of their being is that they do not exist as
individuals (although this is changing) but as part of the family and
other groups – not as separate entities but as extensions of each member
with the responsibility of carrying the name and preserving the entity
of the group. This means that ‘letting down’ the group is not an option.
For South Asians security is at the crux of their existence. The need
to be always secure has its origins in their family structure and
migration patterns. Traditionally families have existed as part of clans
which have struggled to survive along land and occupational divides. As
individuals have migrated they have tried to preserve the divides and
in many cases these divisions have shifted from the original rationale
to a less meaningful one. In the countries of their origin these divides
may be dissipating as a result and, changing social values and
legislation. In the UK however, the communities have continued to
function along the groups that they originally belonged to. This means
that the groups are insular and the families within the groups are
constantly monitored from within and from these on the outside. There is
a huge burden on individuals of ‘performance’ related behaviour. Each
member carries a responsibility to the person next on the hierarchy and
in this respect is answerable to that person.
The reasons for problematic drinking can be manifold.
Liability to develop alcohol problems can be both environmental and
individual. Research has shown that alcohol problems can be inherited.
They can also coexist with certain psychiatric conditions. In addition
stressful life styles prompted by family expectations and cultural
boundaries can lead to increased alcohol consumption.
Alcohol problems
In my very personal view many individuals in South Asian
families are seen as actors. They have to perform in terms of having a
sound education, serious career prospects, a respectable job, marital
status, have children, own a property and provide care for the elders.
When anything occurs to disrupt the expected transition of life then the
individual actor is seen as a failure. This failure can lead to
problems with alcohol. The problem with alcohol is then perceived as an
additional failure. Therefore, any debate or acknowledgement of the
problem is rife with issues of honour, shame and stigma.
He or she feels alone. This would be the experience of
most young people with similar difficulties. What is specific to young
South Asians is that they feel more isolated because they are answerable
to the family, the extended family and the community group that they
belong to. Speaking about the problem would expose them to all of these
units and shame would be brought onto the family.The difficulties
experienced by anyone who has a problem with alcohol are exacerbated. It
is not just the issue of health implications and personal and social
causalities resulting from alcohol use. Most importantly the individual
feels isolated and unable to speak to anyone.
What is the experience of a young South Asian who has difficulties with alcohol?
Reports on alcohol and ethnicity note that there are low
levels of uptake by minority ethnic groups in all preventative and
supportive services. Orford et al (2004) comment that despite growing
levels of alcohol use among second generation migrant populations there
remain low levels of awareness, perceived accessibility or sources of
advice relating to drinking. Most of the respondents appeared to believe
that the most accessible help was at health centres and GP surgeries.
Discussions with the family or close friends was not seen as an option.
This raises the very important issue of the appropriateness and
accessibility of services available for ethnic minority groups. Services
at all levels such as basic education and health promotion advice to
rehabilitation and recovery care need to be culturally sensitive. Many
community health and welfare professionals have limited knowledge of and
awareness of alcohol related issues. Clients may not be able to access
suitable support services through referrals even if there are services
that are culturally and linguistically appropriate. Few mainstream
service providers have much competence in dealing with the needs of
ethnic minority groups. Ethnic monitoring is also lacking which makes it
impossible to ascertain whether an adequate level of service is being
provided.
The study on Alcohol Use and the South Asian and African
Caribbean communities (2006) comments on what needs to be in place to
ensure greater sensitivity and availability of services. The
recommendations are based on interviews with agencies providing high
levels of service. Some of the key points made are:
- Training of staff
- Cultural matching of staff to client
- Cultural, political and social understanding of client
- Quarterly consultation of user
- Working with families
- Offering complementary therapies
Above all services need to be flexible and creative.
Traditional models of counselling are often not appropriate to meet the
needs of ethnic minorities.When working with South Asian clients the
counsellor or any other support worker needs to understand the family
structure, the community group and the issues of conflict experienced
when individuals try to fit in with main stream culture or other
minority cultures. The workers need to develop a way of thinking about
the clients whilst valuing and acknowledging their way of being.
It is paramount that young South Asian individuals
experiencing difficulties with alcohol find someone to speak to, someone
who will not judge them and someone who will hold them through
recovery.They should also feel secure about confidentiality issues and
have confidence in the professionalism of support workers.
It is important to acknowledge that every culture is changing
and evolving. Within every culture there are pockets of shifting value
systems. Sometimes one’s very own culture can facilitate recovery
through religion and spirituality and thus make it possible to come out
of alcohol without treatment.
References
Leininger MM (1991) Culture Care Diversity and
Universality – A Theory of Nursing. New York National League of Nursing,
New York.
Alcohol Concern (2002) Research for Action on Alcohol, London.
Bradby H.& William R. (2006) Is Religion or Culture the Key feature
in Changes in Substance Use after leaving School? Young Punjabis and a
Comparison Group in Glasgow. Ethinic health Capital 11(3), 307 - 24
Orford J, Johnson MRD, Purser R (2004) Drinking in Second
Generation Black and Asian Communities in the English Midlands.
Addiction Research and Theory 12(1), 11-30
Johnson MRD, Banton PM, Dhillon H, Subhra G & Hough J
(2006) Alcohol Issues and the South Asian & African Caribbean
Communities. The Alcohol Education and Research Council, London.
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