Coalition pioneers minimum unit alcohol pricing
The Prime Minister is
leading Government action on tackling drink-fuelled violence and the
binge-drinking culture that fuels it. A new Alcohol Strategy sets out a radical
approach to turn the tide against irresponsible drinking which costs the UK
£21billion a year.
It will help reverse a culture
that led to almost one million alcohol-related violent crimes and 1.2 million
alcohol-related hospital admissions last year alone. Strategy highlights include:
- a minimum unit price for alcohol
- banning the sale of multi-buy discount deals
- zero tolerance of drunken behaviour in A & E departments
- a late night levy to get pubs and clubs helping to pay for policing and improved powers to stop serving alcohol to drunks
The Prime Minister said:
“Binge drinking isn’t some fringe issue, it
accounts for half of all alcohol consumed in this country. The crime and
violence it causes drains resources in our hospitals, generates mayhem on our
streets and spreads fear in our communities.
“My message is simple. We can't go on
like this. We have to tackle the scourge of violence caused by binge drinking.
And we have to do it now.
“So we’re going to attack it from every
angle. More powers for pubs to stop serving alcohol to people who are already
drunk. More powers for hospitals not just to tackle the drunks turning up in
A&E – but also the problem clubs that send them there night after night.
And a real effort to get to grips with the root cause of the problem. And that
means coming down hard on cheap alcohol.
“When beer is cheaper than water, it’s just too easy
for people to get drunk on cheap alcohol at home before they even set foot in
the pub. So we are going to introduce a new minimum unit price - so for the
first time it will be illegal for shops to sell alcohol for less than this set
price per unit. We’re consulting on the actual price, but if it is 40p that
could mean 50,000 fewer crimes each year and 900 fewer alcohol related deaths
per year by the end of the decade.
“This isn’t about stopping responsible drinking,
adding burdens on business or some new kind of stealth tax - it's about fast
immediate action where universal change is needed.
“And let’s be clear. This will not hurt
pubs. A pint is two units. If the minimum price is 40p a unit, it won’t affect
the price of a pint. In fact, pubs may benefit by making the cheap alternatives
in supermarkets more expensive.
“Of course, I know this won’t be universally
popular. But the responsibility of being in government isn’t always about doing
the popular thing. It's about doing the right thing.
“Binge drinking is a serious problem.
And I make no excuses for clamping down on it.”
The Government Alcohol Strategy: Choice, Challenge and Responsibility
sets out a plan to reduce binge-drinking in a bid to drive down crime and
tackle health issues that for too long have gone hand-in-hand with drinking to
excess.
This is NOT about stopping
sensible, responsible drinking or penalising pubs. A minimum unit price will
not affect the price of a pint in the local. In fact, pubs may benefit from
making cheap alternatives in supermarkets more expensive.
A minimum unit price for alcohol will be introduced, meaning that, for
the first time, alcohol will not be allowed to be sold below a fixed price per
unit. This will put an end to cheap white ciders, spirits and super-strength
lagers.
The Government will consult on the level of the minimum unit price, but
expects it to be around 40p per unit. This will end the scandal of beer that is
cheaper than water, and will tackle ‘pre-loading’ - drinking cheap alcohol at
home before heading to the pub or nightclub. We will consult on this over the
summer with a view to introducing legislation as soon as possible.
We will also consult on stopping multi-buy promotions like buy one,
get one free promotions where consumers are encouraged to buy more than
they want, while keeping good value for customers like half-price deals.
The strategy is designed to
take fast action where immediate and universal change is needed and is not a
stealth tax, a regulatory burden on businesses, or a bid to end responsible
drinking.
Chief Constable Jon Stoddart,
Association of Chief Police Officers lead on alcohol, said:
“Week in
week out in town centres across the country the police have to deal with the
consequences of cheap alcohol and irresponsible drinking.
“The
growing trend for ‘pre-loading’ means that young people are often drunk before
they even enter a bar. By the time they hit the streets at closing they
are more likely to get involved in crime and disorder or injure themselves or
others.
“I
welcome the government’s new approach that will help reduce the availability of
cheap alcohol, give communities a greater say over licensing in their area and
reduce pressure on the police.”

Professor Sir Ian Gilmore, of
the Royal College of Physicians and the Alcohol Health Alliance, said:
"Health care workers who
struggle every day to cope with the impact of our nation’s unhealthy drinking
will welcome tough new policies in areas such as price and licensing that are
based on evidence and should bring about real benefits."
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Top of pagePromoting lower strength drinks
The initiative, announced by Health Secretary Andrew Lansley, is
designed to reduce sales of alcohol units and is being spearheaded by 34
leading companies behind brands like Echo Falls, First Cape and
Heineken. It will result in a greater choice of lower strength alcohol
products and smaller measures by 2015. Key commitments include new and
lighter products, innovating through existing brands and removing
products from sale. They include:
- Sainsbury's have pledged to double the sales of lighter alcohol wine and reduce the average alcohol content of own brand wine and beer by 2020
- 25 milliion units will be gradually removed from Accolade Wines including Echo Falls Rose and Echo Falls White Zinfandel
- Brand Phoenix have committed to taking 50 million units of alcohol out of their wines by reducing 0.8% ABV on all FirstCape full strength red wines
- Molson Coors, the UK's largest brewer, has committed to remove 50 million units by December 2015
- 100 million units will be removed by Heineken
- Own brand super-strength lager will be removed from sale by wholesaler Macro
- Tesco, the leading retailer for low alcohol drinks, will reduce the alcohol content of its own-label beer and cider and expand its range of lower alcohol wines and beers, already the biggest selling range in the UK
However, skepticism about NUP is not confined to sections of
the alcohol industry. The independent think tank the Institute of Fiscal
Studies also questioned the policy, arguing that a preferable approach
would be to introduce a floor price for alcohol through the duty system,
moving towards a more equal tax treatment of alcohol by type and
strength combined with a restriction on selling alcohol below the total
tax levied on it. Such a system could be designed to achieve an increase
in the price of low cost alcohol similar to that from a minimum price.
But it would have the advantage, the IFS says, of raising money for the
Exchequer, whereas a minimum price would transfer revenues to the
alcohol industry instead. If set at 40p, the IFS estimate that these
transfers could be as much as £850 million per year.
Health Secretary Andrew Lansley said:
“Cutting alcohol by a billion units will help more people
drink sensibly and within the guidelines. ….Estimates suggest that in a
decade, removing one billion units from sales would result in almost
1,000 fewer alcoholrelated deaths per year, thousands of fewer hospital
admissions and alcoholrelated crimes, as well as substantial savings to
health services and crime costs each year.”
Mark Bellis, Faculty of Public Health and co-Chair of the Responsibility Deal Alcohol Network said:
“The past thirty years have seen a steady increase in the
strength of beers and wines. Reversing this trend by switching sales to
lower strength drinks could help reduce the alcohol problems we’ve seen
grow over recent decades. Making this pledge work is not just about
increasing sales of lower alcohol drinks. For real public health benefi
ts, industry must also reduce sales of higher strength products.”
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Top of pageMP calls for more tax on super-strength cider
The former chairman of the All-Party Parliamentary Beer Group has
called on the Government to crack down on super strength cider because
producers are targeting the drinks at young people.
Alan Meale MP noted in the Early Day Motion (EDM) that super
strength ciders cause health problems including speeding up the rate of
liver cirrhosis.
He added that the drinks are taxed at “only half the amount
charged on lager”, and take home high-alcohol ciders sell for as little
as 16 pence per unit.
The MP for Mansfield also stated that cider sales in the UK
have again risen with 47% of drinkers now regularly having a glass,
compared to 42% less than a decade ago; and sales have increased from
1.7bn in 2006 to 2.4bn in 2011.
Fourteen MPs have signed the petition so far. Meale said:
“This is something I raise around this time every year because I have
always found the differences in tax between cider and beers. It is not
about the regional producers, this is about the big companies producing a
high range of high alcohol products. All the medical evidence shows
that it can be very harmful.“
Beers and lagers are being heavily taxed whereas the super
strength drinks that are being targeted at young people are available at
half the price.”
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Top of pageNHS Alcohol Statistics - the war of numbers
The launch of the Coalition Government’s new alcohol harm reduction
strategy coincides with another change to the way in which the
statistics of alcohol-related admissions to NHS hospitals are collected
and presented. On this occasion, the result is that the number of
admissions appears to have declined rather dramatically.
The number of admissions is, of course, an issue of
fundamental importance because these figures are one of the key
indicators used to measure the size and significance of the national
alcohol problem, and they are one of the determinants of the estimates
made of the size of the economic burden placed by alcohol on NHS budgets
and on the public purse. Clearly, the higher the number of
alcohol-related admissions to hospitals there are, the greater the
economic and social burden of alcohol appears to be. And, of course, the
greater the problem is perceived to be, then the greater the pressure
for policy measures to ameliorate it.
The Coalition’s New Improved Figures
The change in the Coalition Government’s approach to the
numbers issue became apparent when, in advance of the launch of the new
alcohol strategy, Prime Minister David Cameron made a highly publicised
speech in which he promised to tackle the scandal of the binge drinking
culture and the burden it places on society, and on the health service
in particular.
Mr Cameron said:
“In 2010/11 alone there were 200,000 hospital admissions with a
primary alcohol-related diagnosis, 40 per cent higher than in 2002/03.
The number of patients admitted with acute intoxication has more than
doubled to 18,500 since 2002/03.” Mr Cameron went on to say that the
figures show an ever-growing bill to the NHS, which currently stands at
£2.7bn a year, including £1bn on accident and emergency services. £2.7bn
equates to £90 for every taxpayer. This is part of a wider cost to
society from alcohol of between £17 billion and £22 billion per annum.”
Mr Cameron’s reference to the figures for 2010/2011 may have
been a mistake, because the figures he quoted are more probably for
2009/2010. But the significant point is that the figure of 200,000 is a
fraction of the figures that had previously received much media
attention, the headline claim being that alcohol-related hospital
admissions in England had passed the million mark.
What the figures mean
The difference between 200,000 and over a million is the
difference between admissions where there was a primary diagnosis of a
disease or a condition wholly attributable to alcohol, and the much
larger number of admissions in which alcohol was recorded as a secondary
or accompanying factor. (see graph below)
It appears that the Coalition Government is now minded to
revise the way the alcohol admissions statistics are presented to show
only those where alcohol entered into the primary diagnosis. Under the
new Public Health Outcomes Framework, the North West Public Health
Observatory will undertake a consultation on the methods used to measure
alcohol-related admissions, and the definition adopted will be informed
by the results of that consultation. However, the fact that Government
Ministers are already referring to the lower figures suggests that the
decision to change the system has already been taken.
What was wrong with the old figures?
Headlines about a million plus alcohol admissions to hospitals
are indisputably very bad publicity for the alcohol industry, and it is
understood that industry groups have been making representations to
Government to change the way the figures are presented.
However, the old method of presentation had also been
criticised by some more impartial commentators who argued that changes
in the way alcohol admissions were recorded made comparisons with
earlier years worthless and claims about a million plus admissions
extremely questionable.
The key argument is that the method of coding hospital
admissions has encouraged NHS hospitals artificially to inflate the
number of admissions related to alcohol.
The issue is that the million plus figure is based on taking
into account all the conditions recorded for each patient, not just the
one for which the patient is actually admitted. Nigel Hawkes, the
science journalist and founder of the Straight Statistics website,
points out that many seriously-ill patients are admitted with several
conditions: a lung cancer patient might, for example, additionally
suffer from high blood pressure. The high blood pressure is not the
condition for which the patient is being treated and it is not
responsible for the admission to hospital, but it will also be recorded
on his or her notes, and ‘coded’ by clerks. Lung cancer is not an
alcohol-related disease, but high blood pressure is, with alcohol being
implicated in around one third of cases. Hence, of every ten admissions
to hospital of this kind, around three will be recorded as
alcohol-related, even though alcohol was not the cause of the admission.
Hawkes writes:
“This might not matter much, beyond greatly exaggerating the
numbers harmed by alcohol, if it were not for the variation in coding
practice over time and between hospitals. The introduction of payment by
results by the NHS in England and the publication by health analysts ….
of death rates for individual hospitals have encouraged hospitals to
increase the number of codes attached to each patient.”
This is because, if a hospital can show that a patient who
died in its care suffered a whole range of conditions on admission, then
that death will count for less in the calculation of its Hospital
Standardised Mortality Ratio (HSMR) and its official performance rating
will improve commensurately. Health analysts have worked out that the
average number of codes per patient in the NHS in England rose from just
under 3 in April 2005 to almost 4.5 by December 2010, an increase of 50
per cent. If the number of codes increases, then so will the number of
‘alcohol-attributable’ codes. So, Hawkes argues, a rise of 50 per cent in
alcohol-attributable admissions over that period can be accounted for
simply by ‘coding creep’.
However, while there is clearly substance to Hawkes’ claim
that changes to the coding system have exaggerated the increase in
alcohol admissions over time, there is an even clearer danger that
counting only those in which alcohol forms part of the primary diagnosis
will result in a large underestimate. There is a range of conditions
which are not defined in terms of alcohol but which are partly
attributable to it, and which, therefore, contribute to a patient’s
admission to hospital. To exclude these would be to engage in the
opposite kind of misrepresentation.
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Top of pageHMRC's strategy for stopping alcohol duty fraud
- Better than before, but still not good enough...
Duty fraud costs Exchequer over £1billion each year, and rising
Her Majesty’s Revenue and Customs’ renewed strategy for
dealing with alcohol duty fraud, now covering wine and beer as well as
spirits, is a significant improvement on the previous strategy and the
Department has achieved some of its early objectives. However, a report
by the National Audit Office* has found that there has been no tangible
success achieved in working with industry to disrupt the illegal
diversion of duty-unpaid alcohol back into the UK market. There has also
been a low level of criminal sanctions against fraudsters.
Problem created by EU
Alcohol duty fraud is carried out primarily by organized
criminals who exploit weaknesses in the supply chains of alcohol
producers, wholesalers and distributors to divert goods onto the UK
market without paying the taxes that are due.
Opportunities for excise fraud emerged effectively with the
creation of the European Union (EU) single market on 1 January 1993.
Until that time, the Department and customs authorities in other Member
States had established tight control of excise goods to ensure duties
were paid on the goods produced. However, once the European single
market was established, businesses were legally free to move goods
around the EU, and alcohol could be held in warehouses on a duty
suspended basis until they were dispatched. The duty due on goods
dispatched for UK consumption becomes due once the goods are released
from the warehouses, and goods destined for export could travel without
any duty being paid. As excise duty rates on alcohol are far higher in
the UK than on mainland Europe, perpetrators of fraud have exploited
this new regime. The fraudsters move alcohol products to the EU with
excise duties unpaid, store the goods in warehouses on the near
continent, release the goods onto the EU market and then divert them
back into the UK. Products are then sold on to retailers, wholesalers or
other parties, without UK excise being paid.
The Department estimates that the amount lost, due to alcohol
duty evasion, could be as much as £1.2 billion in 2009-10, a significant
rise from £850 million in 2008-09.
According to the National Audit Office report, there has been
no success in reducing the volume of alcohol legally moved to other EU
countries with excise duties unpaid, but then diverted back into the UK
for illegal sale. The Department has recorded increased revenue from
agents participating in the new Registered Consignee scheme. However,
its scheme requiring traders to provide financial guarantees for the
duty on alcohol being moved has been less successful as the guarantees
required by the Department are far lower than the value of the duty on
goods being moved. HMRC has made minimal progress working with industry
to secure alcohol supply chains.
In each of the four years to 2009-10, there were convictions
in just six cases or fewer for suspected alcohol duties fraud. The
Department considers civil sanctions more effective in some cases.
During 2010-11, the quantity of alcohol seizures increased to almost 10
million litres – an increase of 61 per cent. Amyas Morse, head of the
National Audit Office, said:
“HMRC has estimated that the evasion of alcohol duty could
have cost the taxpayer over £1 billion in 2009-10 – and the level of
fraud is on the rise. While the renewed strategy to deal with this is
more comprehensive than what went before, and the Department has had
some early notable successes, it needs to do better in a number of
areas. This includes establishing reliable estimates of the tax gaps for
beer and wine and achieving tangible success in tackling the illicit
diversion of duty unpaid alcohol back into the UK market.”
*National Audit Office: HM Revenue and Customs’ Renewed Alcohol Strategy: A progress report 2012 is available for download at: http://www.nao.org. uk/publications/1012/ hmrc_alcohol_strategy_ progress.aspx
Back to contents page
Top of pageDisappointing results of Alcohol Arrest Referral Schemes
A Home Office evaluation of Alcohol Arrest Referral (AAR) schemes has
shown largely disappointing results. Pilot schemes were first
introduced by the Home Office in 2007, under the Labour Government, as a
means of tackling the link between alcohol and offending, in particular
in the nighttime economy. This was supported by the Labour Government’s
alcohol strategy ‘Safe. Sensible. Social’. AAR schemes aimed to test
whether the benefits of brief interventions to reduce alcohol
consumption in health settings could be extended to a criminal justice
setting, with the additional goal of reducing alcohol-related offending.
The schemes aimed to target those arrested for alcoholrelated offences
and used brief interventions to emphasise the role that alcohol might
have played in their offending, thus becoming a motivational lever to
reduce drinking.
However, overall, the evaluations do not suggest that AAR
schemes successfully reduced re-arrest. Average costs per intervention
across the pilot schemes varied from £62 to £826, but most schemes did
not break even as they did not reduce re-arrests overall. There was some
evidence of reduced alcohol consumption among those who received the
intervention, but for a number of reasons this finding should be treated
with caution.
Profile of arrestees
One of the key benefits from the evaluations was finding out
more about the population of people who are arrested in the night-time
economy. This information is usually difficult to ascertain as flagging
in custody for alcohol-related crimes is not consistently recorded.
Indeed the comparison groups for both evaluations had to be constructed
using proxy measures to approximate this.
The evaluations found that the profile of arrestees was
different from practitioners’ initial thoughts; most notably, there was a
higher proportion of dependent drinkers than anticipated. Furthermore,
an important finding was that individuals were not necessarily prolific
arrestees: over 50 per cent had just one arrest for the offence
triggering the intervention, meaning no previous or subsequent arrests
in the six months either side of the arrest. This was one of the factors
making it difficult for the intervention to have a substantial impact
on arrest rates. It also raises questions about whether an offender
centred approach is the most effective way of tackling night-time
economy-related crime and disorder if this is not a prolific group of
offenders.
Effectiveness of Alcohol Arrest Referral schemes
The evaluation found that, overall, there was no strong
evidence to suggest that delivering alcohol interventions following
arrest could impact on criminal justice outcomes, namely reducing
re-offending. The evaluation identified several possible reasons for the
relative lack of success:
- Brief interventions delivered in a custody suite are not an effective way to reduce alcohol-related offending
- The re-arrest rates for alcohol-related offending are low,
meaning that this is not a prolific group of offenders and therefore it
would be harder to make any impact on the re-arrest rate
- Insufficient screening was undertaken to target the clients most likely to respond positively to a brief intervention
- The intervention did not sufficiently address the criminogenic needs of those arrested
Home Office reports on evaluation of alcohol arrest referral pilot schemes are available at the following links:
http://tinyurl.com/73mvkdz
http://tinyurl.com/87kaafc
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Top of pageUK Alcohol-related deaths rise in 2010
In 2010 there were 8,790 alcohol-related deaths in the UK, 126 more
than in 2009 (8,664). The increase was accounted for by males, female
deaths falling slightly compared with the previous year. Since 2000,
alcohol-related death rates have tended to increase in both sexes and in
all regions. In England, death rates are highest in the North East and
the North West. However, the rates in England as a whole are lower than
in Wales, and they are still higher in Scotland.
The main findings from the Office of National Statistics are:
There are more alcohol-related deaths in males than in females,
with 67 per cent of all alcohol-related deaths in the UK in 2010 being
male
Alcohol-related death rates were highest for those aged 55-74 and lowest for those aged under 35 over the last ten years
UK males aged 55-74 years showed a sharp and statistically
significant increase in alcohol-related death rate from 41.8 per 100,000
in 2009 to 45.2 per 100,000 in 2010
Alcohol-related death rates varied between the regions of
England and tended to be highest in the North and lowest in the East of
England over the last ten years
Within England and Wales, alcohol-related death rates are
higher in Wales. In 2010 this difference was statistically significant.
Alcohol related death rates 2000-2010:
Alcohol related death rates by age group, males, 2000-2010:
Alcohol related death rates by age group, females, 2000-2010:
Source of graphs:
Office for national Statistics, National Records of Scotland, Northern Ireland Statistics and Research Agency
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Top of pageNew alcohol education campaigns launched in England and Scotland
New government alcohol health education campaigns have been launched
in both England and Scotland. While separate, the two campaigns share
the aim of warning drinkers of the dangers to health of regularly
exceeding the sensible drinking guidelines.
Don’t let drink sneak up on you
The new Department of Health Change 4 Life campaign in England
warns drinkers that there is an increased risk from serious illness,
including heart disease, stroke and cancer, if they drink just a little
bit more than they should. The campaign, including TV adverts, stresses
that drinking even slightly over the lower-risk alcohol guidelines can
seriously impact long-term health. The adverts highlight that regularly
drinking around two large glasses of wine or two strong pints of beer a
day triples the risk of developing mouth cancer and doubles the risk of
developing high blood pressure.
A new survey for the Department of Health revealed that most
people are unaware of the serious illnesses caused by drinking more than
the guidelines.
For example:
- 85% of people did not realise it increases the risk of developing breast cancer
- 66% did not realise it increases the risk of bowel cancer
- 63% did not realise it increases the chance of pancreatitis
- 59% did not realise it increases the risk of mouth, throat and neck cancer
- 30% did not realise it increases the risk of high blood pressure; and
- 37% did not realise it reduces fertility
A new online calculator is available on the Change4Life
website to help people check how much they are drinking and work out
whether they need to cut down. Two million leaflets are also available
for Change4Life supporters and health professionals around the country.
The campaign also offers handy hints and tips on how people
can cut down – such as having booze free days, not drinking at home
before people go out, swapping to low-alcohol or alcohol free drinks and
simply using smaller glasses.
Secretary of State, Andrew Lansley said:
“It’s crucial we support people to know about how drinking too
much poses risks to their health and how they can take control of their
drinking. It can be easy to slip into the habit of having a few extra
drinks each day, especially when drinking at home. But there can be
serious health risks. Don’t let drinking sneak up on you.
“Change4Life is a fantastic, well known campaign, that has
already helped a million families around the country. I want to expand
it beyond eating well and moving more, so people look after themselves
and really do live longer.”
Sarah Lyness, Executive Director of Policy and Information at Cancer Research UK, said:
“Alcohol can increase the risk of seven types of cancer,
including two of the commonest kinds - breast and bowel cancers. And a
recent study showed that nearly 12,500 cancers in the UK each year are
caused by alcohol.
“The risk of cancer starts to go up even at quite low levels
of drinking, but the more people cut back on alcohol, the more they can
reduce the risk. Small changes can really make a difference – so try
swapping a glass of wine or beer for a soft drink or having a few
alcohol-free days a week.”
Scottish Campaign
The new Scottish Government’s Alcohol Behaviour Change
campaign focuses on encouraging women to ‘Drop a Glass Size’ in 2012.
Figures in the Scottish Health Survey show that around 38% of women
regularly exceed daily and/or weekly sensible drinking guidelines. It is
possible for a woman to exceed the weekly guidelines for less than £3.
It is estimated that 1 in 30 female deaths in Scotland is
alcohol-related.
The campaign encourages people to make small changes to the
way they drink, such as alternating alcohol with soft drinks or water and
having two alcohol-free days a week. The initiative, which also
includes a national roadshow, aims to educate Scots about what they’re
drinking, how much is too much and how they can moderate their drinking.
As part of the campaign, a new ‘drinking time machine’ smart phone app
has been developed to show people the shocking effects of regularly
drinking too much. The app is available exclusively from the Scottish
Government free for one month and will show users how alcohol speeds up
the aging process. Cabinet Secretary for Health and Wellbeing Nicola
Sturgeon said:
“Evidence shows us that most people who drink alcohol,
particularly at home, have no idea of how much they are actually
consuming. This campaign aims to show people how small changes to their
drinking habits can have a significant impact on their health and
wellbeing.
“Scotland’s unhealthy relationship with alcohol is now widely
recognised and much has been done in the last five years to address
this. Our alcohol framework outlined a package of over 40 measures to
reduce alcohol-related harm. We have made considerable progress
including banning quantity discounts and restricting promotions on
off-sales. And we have invested a record £155 million over the last four
years to tackle alcohol misuse.
“However I have been clear that there is more that can and
must be done. Alongside educational efforts such as this campaign the
introduction of the Minimum Pricing Bill is a significant step forward.
There is a clear link between the price of alcohol and consumption
levels, which is why we have always made the case for the introduction
of a minimum price.
“The support in favour of minimum pricing is now overwhelming,
and I hope that, this time around, Scotland’s MSPs will do the right
thing and back this policy.”
Audrey Birt, Scotland Director at
Breakthrough Breast Cancer, comments:
“We’re happy to be supporting this new campaign from the
Scottish Government. We’ve known for some time that regularly drinking
alcohol can increase the risk of developing breast cancer as well as
causing other health problems. The good news is women can reduce their
risk of developing the disease in a number of ways, including decreasing
their alcohol intake, as well as maintaining a healthy weight and being
physically active.”
The nationwide campaign will feature three different sized
wine glasses to emphasise the central theme of the initiative. The three
different sized wine glasses highlight that by making a small change
such as dropping a glass size women can see and feel a big difference in
their health and well-being now and in the long term.
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Top of pageNew million pound fund to give local communities the tools to tackle binge and underage drinking
A new £1 million fund to give local communities the tools they need
to tackle binge and underage drinking has been announced by the
Government’s Champion for Active Safer Communities, Baroness Newlove. Baroness Newlove is a community campaigner
based in the North West of England and was made a peer in July 2010.
Since the death of her husband Garry at the hands of drunken teenagers
in 2007, she has worked to make communities safer. In October 2010 she
was appointed the Government Champion for Active Safer Communities and
spent six months at the Home Office where she wrote her first report
‘Our vision for safe and active communities’.
The announcement of the new fund came on the day Baroness
Newlove published her latest report ‘Building Safe, Active Communities:
Strong foundations by local people’, which is a collection of inspiring,
yet practical, lessons from those who are changing their neighbourhoods
for the better, providing good advice, and highlighting some of the
barriers that have stifled their growth. In her interim report to
Government published in July last year, Baroness Newlove identified
tackling problem drinking as her most urgent priority and she will
continue to focus sharply on this in the months ahead. This new fund
will give ten successful communities - based on models of grassroots
projects already delivering for their neighbourhoods - the resources to
tackle the alcohol issue locally.
Newquay
One claimed success is Newquay Safe Partnership. This brings
together local councils, police, health workers, the Local Safeguarding
Children’s Board, businesses, tourist chiefs, town planners and local
residents to share information and deliver action. In the past two years
the partnership has taken steps to curb the use of fake IDs, has
prosecuted proxy buyers and targeted campaigns aimed at young people,
urging them to be responsible and for parents not to supply alcohol to
children. Since 2009, the Cornish resort has seen an average fall of
almost 30 percentage points in recorded antisocial and ‘rowdy’
behaviour.
Baroness Newlove said:
“I am sick of the harm caused by those young people who put
themselves and others at risk from illegal drinking. The crime and
antisocial behaviour that comes in its wake is a terrible blight on this
country. It destroys the quality of life of innocent people and in the
process sucks up huge amounts of public funding to repair the damage
done to people and places.
“We need a new drinking culture in this country. I want to see
responsible drinking, so we can rid our streets of drunken violence and
intimidation. We need direct, effective action on the ground to make a
difference, and make ‘sociable drinking’ the acceptable norm. This will
not be achieved overnight, I realise. But we need to take action now and
I am very pleased that the Government will shortly publish a long-term
strategy on alcohol.
The report can be found at:
www.communities. gov.uk/publications/ communities/ buildingsafecommunities
Top of pageMore people dying from liver disease than ever before, with the disease being more common in the North and killing more men than women - Over one third of deaths alcohol-related
The number of people dying from liver disease in England is still
rising, according to the first ever national report on the statistics
published by the National End of Life Care Intelligence Network.
Deaths from liver disease: Implications for end of life care
in England describes how there has been a 25% increase in liver disease
deaths between 2001 (9,231 people) and 2009 (11,575 people). This is in
contrast to other major causes of death, which have been declining.
Although numbers of deaths due to cancer, vascular or
respiratory disease are still much greater, liver disease
disproportionately kills people at a much younger age - a striking 90%
of people who die from liver disease are under 70 years old. More than 1
in 10 of deaths of people in their 40s are from liver disease. When
measured as ‘years of life lost’, liver disease is, therefore, much more
prominent.
The report highlights that 60% of deaths from liver disease
occurred amongst men and 40% amongst women. The single most common cause
of liver deaths is alcohol-related liver disease, which accounts for
well over a third (37%) of all liver disease deaths. However, the
prevalence of deaths from alcohol-related liver disease varies greatly
between males (41% of liver disease deaths) and females (30% of liver
disease deaths). Alcohol-related liver disease is also more common in
the most deprived areas (44% of liver disease deaths) than the least
deprived areas (28% of liver disease deaths).
The complex needs of many patients who die from liver disease
mean that more than two thirds die in hospital, compared to 55% of all
deaths from any cause (2009).
Regional variation
Taking into account the diverse populations of each region,
for example the South East having the largest population and London
having a relatively younger population, the mortality rate due to liver
disease varies between the regions. The age standardised mortality rate
(2001-09) was highest in:
- North West (24.0 per 100,000, of which 11.4 were from alcohol-related liver disease)
- North East (21.9 per 100,000, of which 10.1 were from alcohol-related liver disease)
- London (20.2 per 100,000, of which 6.5 were from alcohol-related liver disease)
and lowest in:
- East of England (12.9 per 100,000, of which 4.9 were from alcohol-related liver disease)
- South West (14.3 per 100,000, of which 6.4 were from alcohol-related liver disease)
- South East (14.8 per 100,000, of which 5.8 were from alcohol-related liver disease)
Professor Martin Lombard, National Clinical Director for Liver
Disease, urged people to consider the challenging and complex needs of
those dying with this preventable disease. Professor Lombard said: “This
report makes for stark reading about the needs of people dying with
liver disease. Over 70% end up dying in hospital and this report is
timely in helping us understand the challenges in managing end of life
care for this group of people. The key drivers for increasing numbers of
deaths from liver disease are all preventable, such as alcohol,
obesity, hepatitis C and hepatitis B. We must focus our efforts and
tackle this problem sooner rather than later.”
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Top of page1 in 10 ambulance call outs down to alcohol in NE England
In a 1-year period, over 31,000 ambulance call outs were alcohol
related in North East England, around 10 per cent of the total, and at a
cost of millions to the public purse. These are the findings of a study
carried out by a research team in Newcastle and published in the
Journal Alcohol and Alcoholism*.
The researchers calculated that the cost of this ambulance
work and the associated A&E attendances was over £9 million. If
extrapolated to the whole country, the cost could be as much as £152
million per year.
It was found that, while alcohol related call-outs were most
frequent in the 20–29 age group, around half of the alcohol related
attendances occurred in individuals aged 30–59. The researchers suggest
that this shows that alcohol related acute harm is not merely a feature
of youth but is also relatively common in middle aged drinkers.
Unsurprisingly, street call outs were significantly more likely to happen on Fridays and Saturdays from 4 pm to midnight.
Violence
The data indicated that alcohol related ambulance call outs
were three times more likely to involve verbal or physical abuse of
staff compared with general ambulance work.
Other evidence shows that there are around 33 assaults per
1000 staff among ambulance staff nationally, compared with 14 per 1000
within Primary Care. Furthermore, A&E nurses are more than twice as
likely as other frontline NHS staff (including doctors, ward nurses and
receptionists) to experience verbal or physical abuse (78% compared with
the UK average of 7%), with the main reason for the abuse given as the
patient being under the influence of alcohol.
Underestimate
However striking their findings may be, the authors,
nonetheless, caution that their findings may underestimate the full
impact of alcohol related work in this area of emergency care. Firstly,
paramedics are likely to focus on patients’ presenting symptoms and may
not be able to assess less overt cases of alcohol related problems.
These could include situations where they are dealing with victims of
alcohol related physical or sexual violence, where the patient may not
have been drinking. Also, patients with a flare-up of a chronic problem
linked to drinking behaviour may not be detected. There is also the fact
that many patients present themselves directly to A&E or are
brought by family and friends rather than via ambulance.
*A Retrospective Analysis of the Nature, Extent and Cost of
Alcohol-Related Emergency Calls to the Ambulance Service in an English
Region : Martin, N; Newbury-Birch, D; Duckett, J; Mason, H; Shen, J;
Shevills, C; Kaner, E; 2012. Alcohol and Alcoholism, 2012, 47(2):
191-197
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Top of pageMany young people don't know what constitutes sensible alcohol consumption
Young people do not possess the knowledge or skills required to
adhere to government guidelines for responsible alcohol consumption.
This is the conclusion of a new British study published in the journal
Drug and Alcohol Review.
Led by Richard de Visser, PhD, of the University of Sussex,
researchers examined young people’s knowledge of, and use of, government
guidelines for safe alcohol consumption.
A total of 309 secondary school students and 125 university
students in England completed a survey regarding knowledge and beliefs.
The university students also reported their alcohol consumption and
completed tasks in which they poured their ‘usual’ drinks and what the
government guidelines recommend for maximum ‘unit’ consumption on a daily and
weekly basis.
Most respondents lacked the knowledge and skills required to drink in accordance with government guidelines.
Participants’ ‘usual’ drinks were substantially larger than
one unit, and participants tended to underestimate the unit content of
drinks.
For 5 of the 7 items examining knowledge and guidelines, fewer than half of the respondents gave correct responses.
Although university students gave a significantly greater
number of accurate estimates than did school students, only a quarter of
their estimates were within plus or minus 10% of actual content. The
majority of estimates were underestimates: 52% among school students,
65% among university students.
“Our results mean that people’s reports of drinking patterns
in research may lead to inaccurate estimates of the health effects of
different levels of alcohol use,” de Visser notes. “There may be a need
for more and/or different alcohol education in schools and the media.”
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Top of pageHeavy drinking on the decline
Contrary to the picture often presented of inexorable increases in
alcohol consumption and harm, heavy drinking is, in fact, on the decline
in Britain, according to the latest findings from the General Lifestyle
Survey (GLS)*
The GLS is a continuous survey carried out by the Office for
National Statistics to provide a picture of families and people living
in private households in Britain, and covering a range of subject areas
including drinking, smoking, education, employment and marriage,
cohabitation and fertility.
On the 2010 GLS, respondents were asked two sets of questions
about their drinking behaviour, resulting in measures of average weekly
consumption and maximum amount drunk on any one day in the previous
week.
Trends in Alcohol Consumption: Main findings
Between 2005 and 2010, average weekly alcohol consumption
decreased from 14.3 units to 11.5 units per adult. The decline was
evident in both men and women.
Since 2005, there has been a decline in percentages of both
men and women exceeding the old ‘sensible limits’ of 21 units per week
for men and 14 units per week for women.
There have also been declines in the proportions of men and women
classed as heavy drinkers, men drinking 50 or more units per week, women
drinking 35 or more units per week.
There is a downward trend in the maximum drunk on the heaviest
drinking day. The proportions of both men and women who have exceeded
twice the government’s recommended maximum consumption for a single
day - the official definition of ‘binge drinking’ - has declined,
the decline being most pronounced in the 16-24 age group.
Adults tend to drink more frequently as they get older. Over 1
in 5 men aged 65 and older drank almost every day, compared with just 3
per cent of men aged 16-24.
As is usually found, men and women in the managerial and
professional categories tended to drink more and drink more
frequently than those in routine and manual occupations. Normally,
also, those with higher incomes tended to drink more and more frequently.
Interestingly, average weekly consumption was higher in adults
living in rural areas than those in urban areas, the difference
being driven by women.
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Top of pageAlcohol and obesity
A new report from the NHS National Obesity Observatory examines the relationship between obesity and alcohol consumption. The report suggests that there is no clear causal relationship between alcohol consumption and obesity, and the complex associations between the two are heavily influenced by a number of factors. These include patterns and levels of drinking, types of alcoholic drinks consumed, gender, body weight, diet, genes, physical activity levels and other lifestyle factors. However, there is a lack of clear evidence of the roles and interactions of all these factors, and the issue remains poorly understood.
The report summarises what can be said about the subject:
- Many people are not aware of the calories contained in alcoholic drinks
- The effects of alcohol on body weight may be more pronounced in overweight and obese people
- Alcohol consumption can lead to an increase in food intake
- Heavy, but less frequent, drinkers seem to be at higher risk of obesity than moderate, frequent drinkers
- The relationships between obesity and alcohol consumption differ between men and women
- Excess body weight and alcohol consumption appear to act together to increase the risk of liver cirrhosis
- There is emerging evidence of a link between familial risk of alcohol dependency and obesity in women
Obesity and alcohol: an overview. National Obesity Observatory. February 2012
The report can be downloaded at:
http://www.noo. org.uk/NOO_pub/ briefing_papers
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Top of pageOne drink per day can increase breast cancer risk by 5%
A new review of research that looks at the relationship of alcohol
consumption and breast cancer has been published in the journal Alcohol
and Alcoholism. The analysis found that low level or moderate drinkers –
one drink per day – had a 5% increased risk of breast cancer. Heavy
alcohol consumption, defined as three or more drinks a day, was found
to have a 40-50% increased risk of breast cancer. Overall, alcohol
drinking accounts for roughly 5% of breast cancers in Northern Europe
and North America and up to 10% in countries such as Italy and France,
where drinking alcohol is common among women.
In Europe and the USA, breast cancer is the most common cancer
in women. Several population studies have also shown that women have a
high prevalence of light drinking. This represents a major health issue
in terms of breast cancers and the western world. Alcohol consumption
has been acknowledged as a risk factor for the development of cancer in
various organs of the body for quite some years and an association
between alcohol and breast cancer has been established since the 1980s.
The review of research conducted by Helmut K. Seitz and Carlo La Vecchia
et al, and published in Alcohol and Alcoholism, is entitled
‘Epidemiology and Pathophysiology of Alcohol and Breast Cancer: Update
2012’. The review analyses epidemiological data on the relationship of
alcohol and breast cancer, looking at the possible mechanisms of
alcohol-mediated breast cancer development.
Light alcohol consumption
When analysing the effects of light alcohol drinking, the
authors reviewed research published before November 2011 via a
literature search from MEDLINE, ISI Web of Science and EMBASE. In total,
3431 research papers were retrieved from the literature search. Of
these, 113 papers reporting breast cancer risk estimates for light
drinkers were included in the meta-analysis. The analysis included
44,552 cases in the reference category of nondrinkers and 77,539 cases
in the light drinking category. 51% of studies were from North America,
38% from Europe, 6% from Asia and 10% from other regions. The
meta-analysis of these studies reported a modest but significant
association between light drinking and breast cancer. The estimate was
based on the results of more than one hundred studies and found a small
increase in risk, in the order of 5%, with the association between light
drinking and breast cancer.
Dose-risk
The review carried out by Seitz and La Vecchia et al also
found that each increased alcohol consumption increases the risk of
breast cancer. This analysis showed a trend risk that was highly
significant and there is consistent evidence for a positive dose-risk
relation between alcohol and breast cancer.
Heavy Alcohol consumption
The largest collection of studies connecting the risk of
breast cancer to alcohol was based on high level consumption of alcohol
and cancer risk. The results indicated a 40-50% elevated risk of breast
cancer in women consuming three or more drinks a day.
Hormone related mechanisms
Cancer of the female breast is slightly different to other
body organ cancers as even small doses of alcohol can stimulate breast
cancer development. As alcohol consumption might affect the risk of
cancer through hormone-related mechanisms, the review published today in
Alcohol and Alcoholism particularly looked at the association between
alcohol consumption and the risk of breast cancer through
hormone-related mechanisms such as estrogen receptor (ER) and
progesterone receptor (PR) status. Seitz et al found that there was
significant research to suggest that alcohol consumption increased the
risk of all ER+ tumours by 27% and placed a 14% risk for all ER- breast
cancers for the highest vs lowest level of alcohol drinking. Subsequent
investigations by the team found further support for a stronger
association between heavy alcohol consumption and ER+ breast cancers.
Studies investigating the mechanisms of ethanol-mediated breast
cancer are rare and information is limited. However, a promotional
effect of estrogens on breast tissue has been observed and since alcohol
consumption causes elevated estrogen concentrations, it has been
speculated that the carcinogenic effect of alcohol is mediated, in part,
by estrogens. Seitz and La Vecchia et al discuss a number of study
examples that provide further evidence on the role of estrogens in
ethanol-mediated breast cancer and possible carcinogens for the breast.
The observation that several studies support the hypothesis that alcohol
is more strongly related to ER positive than ER negative breast tumours
underlines the pathogenic role of estrogens in alcohol-mediated breast
cancer.
“Epidemiology and Pathophysiology of Alcohol and Breast
Cancer: Update”, Seitz, La Vecchia, et al, Alcohol and Alcoholism, doi:
10.1093/alcalc/ags011
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Top of pageAlmost half of Londoners are worried about effects of alcohol on their health
Almost half of all Londoners are concerned about the long-term health
effects caused by the amount of alcohol they drink, according to a
survey of people living in the city.
The Regional Public Health Group, together with the Greater
London Authority, has published a report detailing the results of a
survey of 7,500 Londoners, which questioned them about alcohol
consumption and the consequences.
The survey found almost half of Londoners (48%) are concerned
about the long-term health issues linked to how much alcohol they drink.
The survey highlights how important GPs are in providing initial support
for people seeking help for alcohol problems. However, one fifth (19%)
of respondents did not know where to turn for help, a figure which was
significantly higher among people from lower socio-economic backgrounds
and the 18-24-year-olds.
Dr Simon Tanner, Director of Public Health at NHS London,
said: “We welcome this survey, which is the largest of its kind in
London. It provides invaluable intelligence for local authorities as to
how we can work together to tackle excessive drinking and its
consequences, at a time when public health responsibilities move from
PCTs to local government.”
Alcohol, with its links to violence, remains a public concern
with almost three quarters (72%) of Londoners questioned feeling either
quite or very concerned about alcohol-related crime and violence. The
survey also found that many people feel local communities should have a
larger role, with 51% of respondents believing that they could reduce
local problems if involved in making decisions around managing alcohol
issues.
Another finding of the survey was that more than half of the
people questioned (52%) believe that employers should play a bigger role
in providing access to advice on alcohol.
Will Tuckley, Chief Executive of London Borough of Bexley and
Chair of the Alcohol Project Board, a workstream of the London Health
Improvement Board, also welcomed the findings of the survey, saying:
“There is no denying the health and societal consequences of alcohol
misuse in local communities. However, what is missing from the debate is
an understanding from the perspective of local residents and that is
exactly what this survey has provided us with. As we move towards local
authorities delivering key public health services it is critical that we
understand the local issues and ensure that we use evidence to inform
our local alcohol policies.”
The results of the survey follow the reopening of the Soho
Alcohol Recovery Centre this weekend (February 24) which worked
successfully over Christmas to provide an alternative to A & E for
patients who have had too much to drink, while also freeing up A & E
departments to deal with the most urgent cases. In December, staff at
the centre treated around 180 patients who were taken there by response
vehicles or ‘booze buses’. All patients have their blood pressure and
sugar levels monitored while they sober up before they are discharged or
family and friends are called to collect them. People are also given
advice on drinking responsibly when they are discharged. The centre,
which is run by London Ambulance Service and funded by NHS London, operated for a further five weekends from February 24.
Dr Tanner added: “We know the opening of the alcohol support
centre will reduce pressure on A & E and beds within hospitals, but
we know this is not a solution to the consequences of excessive
drinking. We will be using these results to work with NHS services
across the capital to find ways to raise awareness about the dangers of
excessive drinking, as well as signpost patients to the correct place
to get the help and advice they need.”
The London Summary Report is supported by individual London borough analysis, and can be accessed at:
http://www.lho.org.uk/ LHO_Topics/Health_Topics/ Lifestyle_and_behaviour/ londondrinkdebate.aspx
This Report follows the publication of Closing time: counting
the cost of alcohol-attributable hospital admissions in London, published
by the London Health Observatory, which provides estimates of the NHS
inpatient resources used in treating patients whose alcohol use has
contributed to their condition. This provides a basis for both
pan-London comparison and local action. Both reports add to the evidence
base in support of the London Health Improvement Board‘s (LHIB)
priority to reduce the adverse impacts of alcohol on health.
The report can be accessed at:
http://www.lho.org.uk/ viewResource.aspx?id=17713
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Top of pageMayor welcomes new approach to alcohol-related crime in London
– but says more is needed
London will be the first city in England to trial a new scheme to
tackle alcohol-related crime. After campaigning for further measures to
be introduced, the Mayor of London, Boris Johnson, and his Deputy Mayor
for Policing, Kit Malthouse, have been offered a new pilot scheme by the
government for persistent alcohol offenders in the capital.
The ‘sobriety’ scheme will see criminals convicted of serious
drink-related offences like assault or criminal damage given electronic
tags that will be used to monitor alcohol in their blood. If the
offenders continue to consume alcohol they will be arrested and brought
before a judge who has the option of sending them back to prison.
This comes as a new Greater London Authority telephone survey
of over a thousand Londoners found that over two thirds (69%) would
welcome courts banning offenders from consuming alcohol if they were
guilty of committing an alcohol-related offence, whilst 60% backed the
right of courts to ban someone from consuming alcohol who has been given
bail.
Across the UK, one fifth of all violent incidents take place
in or around a pub or club. The majority (64%) of all violence occurs in
the evening or at night and just under half occurs at the weekend
(Friday 6pm until Sunday 6am).
The Mayor of London, Boris Johnson, said: “I am grateful to my
colleagues in Whitehall for recognising that tackling crime is a top
priority in this city and we must use every innovation at our disposal
to keep on making London safer. This proposal is welcome but we still
need the legislation passing to give the necessary powers in order to
have a major impact.”
The Mayor is keen to continue working with the government on
more comprehensive legislation to offer a wider scheme inspired by a
programme in South Dakota led by Keith Humphreys, where 99.3% of
offenders’ tests were negative and the prison population fell by 14%.
Kit Malthouse, the Deputy Mayor for Crime and Policing said: “This pilot
is great news for London and bad news for the persistent offenders who
cause misery and mayhem with alcohol-fuelled violence. We hope this will
now be the template for the wider reforms needed to fully implement the
wider sobriety scheme we’re lobbying for which can successfully tackle
wider issues like domestic violence and makes people pay for daily
testing. The success of South Dakota proves that removing alcohol really
reduces violent crime.
“In the meantime we hope this mini pilot will have a positive
impact on 300 people this summer. Our alcohol survey proves the public
want more done to tackle alcohol-related crime, so although criminals may
protest, this may be the short sharp shock they need. Offenders will
have to ask themselves if a drink is really worth a night in jail?”
In 2010/11 nearly half of all violent crime (almost 1 million
crimes) was fuelled by alcohol and the police are fighting a constant
and expensive battle against alcohol-related offences and antisocial
behaviour. The London Ambulance Service attended 51,718 incidents in
2010/11 where alcohol was mentioned as involved - a 9% increase on the
previous year.
The GLA survey also revealed that only 14 per cent of
Londoners think that the costs for testing for alcohol sobriety should
be met by the state – backing the lobbying of the Mayor’s Office for
offenders to pay a small amount of money (around £1) towards daily
breathalysing.
The total estimated cost of alcohol-related crime is £8bn to
£13bn per year (Home Office). This estimate takes into account the costs
in anticipation of crime, the direct physical and emotional costs to
victims, the value of lost output, and the costs to the health service
and Criminal Justice System.
Full topline results for the poll can be found at: http://www.london.gov.uk
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Top of pageNorthern Ireland - 1 in 10 regular drinkers may have drinking problem
The latest Northern Ireland Drinking Survey, conducted on behalf of
the Department of Health, Social Services and Public Safety, which
examines the amount people drink, when, where and what they drink and
who they drink with, finds that 1 in 10 of those who drink regularly may
show some signs of alcohol dependence.
The key findings of the survey include:
Alcohol Consumption:
-
More than 7 out of 10 (74%) adults drink alcohol
- A larger proportion of males (78%) than females (72%) drink alcohol
- Younger adults (18-29 years) are more likely to drink than older adults (60-75 years)
Frequency of Drinking:
- Around half (52%) of drinkers reported drinking alcohol at
least once a week or more frequently (6% of respondents reported
drinking on an almost daily basis)
- A greater proportion of male respondents (8%) compared to females (5%) reported drinking alcohol daily or on most days
Drinking Levels
Recommended daily drinking limits:
-
Around 8 in 10 respondents (78%) reported having reached or
exceeded the recommended daily limit for drinking on at least one
occasion in the week prior to the survey
- 18% of male drinkers reached or exceeded the recommended
daily limits on 3 or more days that week, compared to 16% of female
drinkers
- The recommended daily limits are exceeded most often on a Saturday (53% of drinkers) and on a Friday (31% of drinkers)
Weekly guidelines for sensible drinking:
- More females (80%) compared to males (74%) stayed within the weekly guidelines for sensible drinking limits
Binge Drinking:
-
3 in 10 (30%) of those who drank in the week before the survey had engaged in at least one binge drinking session
- Males (35%) are more likely than females (25%) to binge drink
- Half (50%) of respondents in the youngest age group (18-29)
who drank in the week prior to the survey had engaged in at least one
binge drinking session compared to 13% of respondents in the oldest age
group (60- 75)
Problem Drinking:
- CAGE question analysis (clinical interview questions)
indicated that 1 in 10 (9%) of those who drank in the week prior to the
survey are likely to have a problem with alcohol
- 6 in 10 (61%) of those who consumed alcohol in the week prior to the survey consider themselves to be light drinkers
- Just over one third (36%) consider themselves to be moderate drinkers and 3% consider themselves to be heavy drinkers
Adult drinking patterns in Northern Ireland 2011
The survey is available here: http://www.dhsspsni.gov.uk
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Top of pageSpecial Feature - Foetal Alcohol Syndrome
Damage to the unborn child is one of the main examples of the
way in which alcohol can cause harm to people other than the drinkers
themselves
Here, Stefan Lang, Medical Professionals Forum
Administrator with the FASD Trust, describes the challenges of
responding to the issue
There are two common misperceptions amongst a large proportion
of the British population: firstly, that the long-term effects of
drinking alcohol apply only to the individual in question. Secondly,
that alcoholic consumption in moderation during pregnancy is an
acceptable habit. These are not only sentiments held by the average
person, but also by a number of the country’s medical professionals. The
unfortunate result of this misinformation and laxity is an alarming
prevalence of foetal alcohol spectrum disorders
(FASD) in newborn babies across the country. FASD are caused
by pre-natal exposure to alcohol. What is important to note is that even
moderate amounts of alcohol ingestion by women during pregnancy are
enough to leave a baby with FASD symptoms. These symptoms are a broad
spectrum of structural anomalies and neurocognitive and behavioural
disabilities, constituting Foetal Alcohol Syndrome (FAS) in its severest
form. FAS is characterized by evidence of growth retardation,
neuro-developmental abnormalities, and a characteristic pattern of
facial anomalies. (See Fig. 1 below)

In a study at the University of California, San Diego, Haruna Sawada
Feldman found that “Higher prenatal alcohol exposure in every alcohol
consumption pattern was significantly linked to an increased risk of the
baby being born with reduced birth weight or length, having a smooth
philtrum, thin vermillion border or microcephaly”. Meanwhile, a study in
Denmark concluded that even minimal drinking during pregnancy doubles
the risk of a miscarriage or causing damage to an unborn child. Dr.
Anne-Marie Nybo Andersen said, “If our risk estimates are correct, it’s
best not to drink at all” during pregnancy.
That said some experts believe as many as one in three-hundred
newborn children in the UK could be suffering from FASD. Accurate
statistics are, however, difficult to come by. Although there was a 41%
increase in alcohol-related hospital admissions for women aged 15- 44
between 2003 and 2008, diagnosed cases of FASD did not rise. This,
according to Dr. Shirin Howell, “suggests that FASD is materially
under-reported in the UK.” In order to change this worrying state of
affairs, greater awareness for tackling FASD, from prevention to
diagnosis to management, is essential. To achieve this, a lot of lost
time needs to be made up.
Challenges of Tackling FASD in the UK
The idea that it is “bad to drink when you’re pregnant” is
commonly accepted in the UK. However, it is not ingrained in our culture
as it is in the US, for example. There, FASD was clinically diagnosed
in 1973, and from as early as 1980 women were actively encouraged by GPs
and paediatricians to refrain from drinking throughout the duration of
their pregnancies, from conception to birth. One need only look at the
abundant academic literature on FASD in America in relation to the UK to
see the seriousness with which it’s been taken across the Atlantic.
Because FASD have been so poorly publicised in the UK, there
is still a fairly relaxed attitude towards pregnant drinking. Indeed, in
2007 The National Institute for Health and Clinical Excellence
published guidelines stating that it was safe for pregnant women to
drink 1.5 units of alcohol a day without harming their unborn child.
Until recently, many women were even encouraged to drink the odd glass
of wine by doctors as a means of preventing early labour. Such archaic
methods and advice show how far the UK has to come. It could be argued
that this arrogance is a result of Britain’s more epidemic drinking
“culture”. For some people, it seems, drinking alcohol is such a stable
part of their lifestyle that giving-up during pregnancy is too much to
ask. That is where community, and national, support is necessary.
Prevention is achievable with the complicit help of schools, medical
clinics and public organisations. Otherwise, a child is burdened by an
incurable condition for life.
And that is not the end of the difficulties. By diagnosing
FASD at an early stage in a child’s life, management structures can be
put in place to aid their development. Unfortunately, many doctors in
the UK find it difficult to diagnose FASD. With such a wide array of
symptoms, FASD children are often defined as autistic or as suffering
from ADHD or dyspraxia. Whilst they may have some of the symptoms
associated with these conditions, their cases are often far more complex
and require more considered attention. If we fail to raise awareness
amongst the public and medical professionals then misdiagnoses will
persist, to the detriment of children and carers alike.
The FASD Trust
Raising awareness is the goal of the FASD Trust, an
Oxfordshire-based charity started by Julia and Simon Brown. By taking a
dual-approach, which involves targeting not only community leaders, but
medical professionals, the Trust seeks to end the casual approach to
pre-natal drinking in the UK. One of its key strategies in achieving
this lofty goal is through the creation of a Medical Professionals
Forum. The Forum’s membership consists of doctors in the fields of
paediatrics, CAMHS, psychiatry and psychology and aims to provide a
setting for sharing sensitive casework and research on FASD. By using
the existing networks of medical professionals, the Trust hopes to
spread its message further afield. The Forum provides an education for
medics so that they are better-able to diagnose FASD as early as
possible and simultaneously advise parents and carers on the management
of children with FASD. This is a far more effective method than simply
delivering leaflets to schools and community institutions, which alone
will not create the national awareness of FASD that is required.
Of course, the FASD Trust takes an active role in the
community as well. By running a network of regional support groups for
FASD sufferers and their carers, the Trust provides guidance for
hundreds of people in need of respite. Whilst early diagnosis is
crucial, the management of FASD is even more so, for it is a lifelong
responsibility. Medical help can only go so far; it is the carers that
shoulder the greatest burden in looking after people with FASD, from
childhood to adulthood. This can understandably be overwhelming for many
people and is where the Trust works to offer support, based on both
medical advice and personal experience. Furthermore, through
establishing partnerships with local schools the Trust serves another
double purpose. First, it encourages teachers to emphasise to their
students the importance of avoiding alcohol during pregnancy, thus
minimising the risk of ignorance amongst young parents. Second, it gives
teachers direction in dealing with pupils suffering from FASD so that
classes are not disrupted, and so that those with FASD receive the best
possible education within their limitations.
Preventable
Perhaps the most shocking fact about FASD is that it is
entirely preventable. It is only caused by the baby ingesting alcohol
when in the womb; a choice taken on its behalf by the mother. To think
that thousands of people in the UK, and their carers, are faced with
life-long repercussions because of a person’s selfishness or ignorance
is saddening. Encouragingly, the FASD Trust and its forum are proving
that medical attitudes towards FASD in the UK are changing. Only through
collaboration between the medical world and the community at large can
we hope to reverse the worrying trends of FASD case-prevalence in this
country.
In addition, by offering expert advice and dedicated support
groups, the Trust helps improve the lives of those affected by FASD.
Despite their disabilities, people with FASD are capable of great
empathy and affection, whilst having a positive attitude towards their
surrounding environment. It is essential to nurture this positivity.
We have created the FASD issue. Only through our concerted
effort and support can we alleviate the strains placed on the innocent
victims of our alcohol-fuelled society.
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