Health warnings on bottles and new advice on alcohol and pregnancy
‘Sensible drinking‘ messages on bottles by the end of 2008
and new advice to avoid alcohol when pregnant or seeking to become
pregnant are two key components of the new Alcohol Strategy. Both ideas
immediately ran into controversy, the Government being accused of either
going too far or not far enough. Interestingly, one accusation that
might have been made but was not was that the Government has in effect
now raised the ‘sensible drinking‘ limits. Despite this, and for
entirely different reasons, some drinks companies were reported as
threatening not to co-operate with the new labelling initiative.
There was also criticism of the new advice on pregnancy for
going beyond the scientific evidence. However, the British Medical
Association (BMA) supported the Government‘s new message. The BMA said
that while it was true that there is currently no conclusive evidence
that drinking one or two units of alcohol per week is harmful to the
developing child in the womb, evidence is continuing to emerge of
possible risks of prenatal alcohol exposure at low to moderate levels.
The BMA agreed, therefore, that “Given the current uncertainty regarding
the level of risk to the developing foetus, and the lack of clear
guidelines, the only safe sensible drinking message is not to drink any
alcohol during pregnancy."
Sensible drinking message on labels On ‘sensible drinking‘ the
Department of Health said that by the end of 2008 it expected all
alcoholic drinks labels to include alcohol unit information, following
what it described as a ground breaking agreement between Government and
the drinks industry.
It stated that labels will include:
- The drink‘s unit content and the recommended Government ‘safe drinking’ guidelines.
- UK Health Departments recommend men do not regularly exceed 3-4 units daily and women 2-3 units daily.
The label may also refer the consumer to the alcohol-industry funded charity ‘Drinkaware’ for further advice.
In addition, the Government is also encouraging the alcohol
industry to include ‘sensible drinking’ information for pregnant women
on labels.Avoid alcohol if pregnant or trying to conceive is the
shortened form of the Government advice announced on 25 May 2007.
Public Health Minister Caroline Flint said; “This landmark,
voluntary agreement will help people calculate, at a glance, how much
they are drinking and whether they are staying within sensible drinking
guidelines.We want to make it as simple as possible for people to keep
an eye on how much they are drinking and help them take the
responsibility for lessening the impact excess alcohol can have on their
health. Although most spirits and beer labels for sale in the UK market
and many supermarkets’ own brands of beers, wines and spirits, do carry
some information on unit content people can miscalculate and lose track
of how much they are drinking. Unit information combined with sensible
drinking guidelines on the new labels will make it simpler for people to
calculate how many units they are drinking and make it easier for them
to stick to the recommended limits.”
But have the limits been raised?
Until 1995, the recommended ‘sensible limits’ of regular
consumption were no more than 21 units of alcohol per week for men and
no more than 14 units per week for women. There was also guidance on
hazardous and definitely harmful levels of consumption.
In December 1995, following a Government review of the
‘sensible drinking’ message, the guidance was changed from weekly to
daily limits - no more than 3-4 units per day for men, and no more than
2-3 units per day for women, but with the qualification that
consistently drinking 4 units a day for men and 3 units for women was
not recommended on health grounds. There was also advice to have two
alcohol-free days following an ‘excessive drinking episode’.
While the advice to have two alcohol free days after a heavy
drinking episode is retained in the small print of the Government’s
revised Alcohol Strategy, it appears to be omitted from the new warning
to be placed on labels. And as the advice no longer warns against
drinking up to the maximum recommended amount every day, and there are
seven days a week, it seems that the weekly guidelines are now 21 and 28
units for women and men respectively, rather than the previously
recommended 14 and 21 units.
No new evidence to justify raising the limits has been
produced, and no official statement confirming the limits have been
raised has been made. However, on the face of it, the new advice cannot
be interpreted in any other way. As the new limits represent a 50%
increase in the recommended maximum consumption for women this might be
considered worthy of note, particularly at a time when there is
considerable medical and public concern about increased female
consumption and the consequences of the ‘binge drinking’ epidemic
Alcohol industry ambivalence
However, despite the apparent raising of the drinking limits,
the press reported considerable misgivings on the part of the alcohol
industry about the new initiatives. The Daily Telegraph reported that
“Plans to put detailed health warnings on bottles of alcohol have been
undermined by disagreements between drinks companies and the Department
of Health”. The newspaper went on to report that while most in the
industry supported the principle of better labeling,many had
reservations about what to put on their bottles and objected to being
forced to follow a Government template. Advising pregnant women to
avoid all alcohol was another cause of unhappiness in industry circles.
‘Alcohol can kill’
In contrast, the British Liver Trust criticized the Government’s
proposed messages for not going far enough. While the Trust welcomed
the move towards universal unit labelling on alcoholic drinks, it said
that the Department of Health, in suggesting that the industry puts a
sensible drinking message for pregnant women on labels, was missing the
key point - that almost every sector of the UK population drinks
excessively. Alison Rogers,Chief Executive of the British Liver Trust
said: “We have a rising rate of cirrhosis and alcohol-related deaths in
the UK. The government’s own figures show that 22,000 people die
prematurely each year as a result of alcohol.The Trust has previously
suggested to the Department of Health that unit labels should include
messages such as ‘Alcohol can kill’. This is a softer version of
cigarette packets’ message that ‘Smoking kills’, but nonetheless a fair
reflection of the harm that alcohol wreaks on the UK population.”
Ms Rogers said that this was backed up by the recent
scientific review which placed alcohol as fifth up the list of harmful
drugs - far above many that are classed as illegal substances such as
cannabis and ecstasy. “If we continue to adopt a very ‘softly softly’
approach to the whole issue of alcohol” she said, “it will be at a
horrendous health, social and economic cost to the UK. Cheap and
accessible booze coupled with the UK’s ‘anytime anywhere anyplace’
mentality is costing us all very dear, and far too many are literally
paying with their lives.”
Alcohol in pregnancy
The revised Department of Health advice says:
- Pregnant women or women trying to conceive should avoid drinking alcohol.
- If they do choose to drink, to minimise the risk to the
baby, they should not drink more than one to two units of alcohol once
or twice a week and should not get drunk.
The Department of Health explained that the new guidance had
been introduced to provide stronger, consistent advice for the whole of
the UK. It was not the result of new scientific evidence, but it was
consistent with the current evidence. The Government had revised the
advice to make it easier to understand and to provide consistent advice
across the UK.
Deputy Chief Medical Officer Dr Fiona Adshead said; “We have
strengthened our advice to women to help ensure that noone
underestimates the risk to the developing foetus of drinking above the
recommended safe levels. Our advice is simple: avoid alcohol if pregnant
or trying to conceive. This advice could also be included on alcohol
packaging or labels.
“The advice now reflects the fact the many women give up
drinking alcohol completely during pregnancy. It is now straightforward
and stresses that it is better to avoid drinking alcohol altogether.”
The National Organisation on Foetal Alcohol Syndrome estimates
for the UK as a whole that there are more than 6,000 children born each
year with Foetal Alcohol Spectrum Disorder.
Excessive alcohol can cause damage to the unborn baby at all
stages in pregnancy and of course many women don‘t confirm they are
pregnant until a number of weeks into the pregnancy. Therefore, for
women who are planning to conceive it makes sense to avoid alcohol or
limit their consumption to no more than 1-2 units once or twice a week.
Dr Sheila Shribman, the National Clinical Director for
Children,Young People and Maternity Services said: “Alcohol and
pregnancy advice is now consistent across the UK.
“Our last survey of pregnant women showed that nine per cent
were still drinking above the recommended levels. It is vital that we
alert pregnant women and women hoping to conceive about the potential
dangers of excessive alcohol consumption during pregnancy.
“Although there is still scientific uncertainty about the
precise impact of excess alcohol on unborn babies we believe the time is
right to introduce a strong consistent approach across the whole of the
UK. This revised advice has been agreed by the four Chief Medical
Officers across the UK.”
The previous advice in England was: pregnant women or women
trying to conceive should not drink more than one to two units of
alcohol once or twice a week and should avoid getting drunk.
Pregnancy and alcohol – a dangerous cocktail, says a new BMA report
Learning and physical disabilities and behavioural problems are
part of foetal alcohol spectrum disorders [FASD]. These lifelong
conditions can drastically impact on the lives of the individuals and
those around them. A new BMA report says the reality is that these
conditions are completely preventable by not drinking any alcohol during
pregnancy.
The report, ‘Fetal alcohol spectrum disorders’, highlights how
difficult it can be to detect FASD and how healthcare professionals
need more guidance to help them diagnose and treat children suffering
from the disorder.
The BMA report says the advice can be misinterpreted, as
individuals may not clearly understand how many units correspond to what
they are drinking. The alcoholic strengths of different beers and
wines, and the considerable variation of standard measures used in bars
and restaurants and in the home, can make it difficult for women to tell
how many units they are consuming.
The new advice from the English government was disputed by
some medical experts and the BMA is now calling for clear,
evidence-based guidelines on alcohol consumption during pregnancy and
for women who are planning a pregnancy.
Dr Vivienne Nathanson, Head of BMA Science and Ethics, said
today: “The UK has one of the highest levels of binge-drinking in Europe
and the highest rate of teenage pregnancies in Western Europe. Many
women will not know they are pregnant during the early part of
pregnancy, during which time they may continue to drink in their
pre-pregnancy fashion with no awareness of the risk to their unborn
child.”
There is proven risk that heavy drinking by pregnant women can
cause these disorders in their children, says the BMA. The report
states that evidence is continuing to emerge on the effects of low or
moderate prenatal alcohol exposure and until there is clarification the
only message is that it is not safe to drink any alcohol during
pregnancy or when planning a pregnancy.
Dr Nathanson, added: “What is clear is that this is a complex
concern and there is still so much that we do not know about this issue.
It‘s important that women who drank alcohol before realising they were
pregnant do not panic. But pregnant women should try to reduce their
alcohol intake, or better still give up completely. If they are anxious
they should talk to their doctor or midwife at their next antenatal
appointment.
“We need to raise awareness of the emerging evidence on FASD
among healthcare professionals. They need training and guidance on how
to identify these disorders so that children are diagnosed quickly and
get the help they need. Early intervention is crucial in decreasing the
risk of additional problems commonly found in individuals affected by
these disorders. These include mental health problems, disrupted school
experience, alcohol and drug addictions. The lack of awareness and
research in the UK on this subject, together with the complexity of the
syndrome itself is leading to delays in diagnosis and referral.
“Healthcare professionals also need to get the message across
to expectant mothers that consuming alcohol can cause irreversible harm
to their unborn child. It‘s about giving people the right information so
that they can act responsibly - and save children from completely
preventable life-long disabilities.”
Recommendations in the report include:
- There is an urgent need for further UK and international research on FASD.
- Research should be undertaken to examine the relationship
between different levels of prenatal exposure and the range of
conditions associated with FASD.
- The UK health departments should implement guidance and
training programmes for healthcare professionals on the prevention,
diagnosis and management of FASD.
- Women who are pregnant, or who are considering a pregnancy, should be advised not to consume any alcohol.
- Research should be undertaken to identify the most effective
ways to educate the public about FASD and to alter drinking behaviour.
This requires systematic studies that compare various universal
strategies and their impacts across the different social groups.
- All healthcare professionals should provide clear and
coherent advice for expectant mothers and anyone planning a pregnancy on
the risks of maternal alcohol consumption. This should be provided by
GPs as part of routine clinical care and targeted at women of
childbearing age. Members of the antenatal care team should provide
continued advice and support to expectant mothers throughout pregnancy.
- Any woman who is pregnant, or who is planning a pregnancy,
and who has a suspected or confirmed history of alcohol consumption at
low-to-moderate levels should be offered brief intervention counselling
to help them stop drinking. This should occur at the earliest possible
stage in a pregnancy and be considered as part of routine antenatal care
where required.
- Any woman who is identified as being at high-risk of
prenatal alcohol exposure should be offered referral to specialist
alcohol services for appropriate treatment. Any referral should be
followed up and assessed at regular intervals.
Top of page'Safe. Sensible. Social. - the next steps in the National Alcohol Strategy'
The new Alcohol Harm Reduction Strategy for England was
announced by the Government in June. It supersedes the Strategy launched
in 2004,which was heavily criticised by the public health lobby for
being too dependent on the voluntary co-operation of the alcohol
industry and too cosmetic in intent.
The new Strategy got a generally favourable reception from
alcohol problems and public health bodies apart from some complaints
concerning lack of consultation. However, there is a question of whether
the Government has surreptitiously raised the ‘sensible drinking’
limits.
The New Strategy
The Government says that the new Strategy builds on the
foundations laid and the lessons learnt since 2004 and that it will
ensure the laws and licensing powers introduced ‘to tackle
alcohol-fuelled crime and disorder’, protect young people and tackle
irresponsibly managed premises are being used widely and effectively. It
also sharpens the focus on ‘the minority of drinkers who cause the most
harm’.
The ultimate aim, the Government says, is to reduce the harm
to health, violence and anti-social behaviour associated with alcohol
while ensuring that people are able to enjoy alcohol safely and
responsibly.
Problem drinkers
The strategy highlights the country’s ‘problem drinkers’:
- 18-24 year old binge drinkers.
- Young people under 18 who drink alcohol.
- Harmful, adult drinkers who don’t necessarily realise their drinking is damaging their physical and mental health.
Focus on partnership and communications to promote sensible drinking
The Government says the strategy reflects its
commitment to work together with all those involved in reducing the harm
alcohol can cause, including the police, local authorities, prison and
probation staff, the NHS, voluntary organisations, the alcohol industry,
the business community, media and local communities, to shape an
environment which actively promotes sensible drinking.
Key actions in the strategy include:
- Sharpened criminal justice for drunken behaviour.
- A review of NHS alcohol spending.
- More help for people who want to drink less.
- Toughened enforcement of underage sales.
- Trusted guidance for parents and young people.
- Continued investment in communications campaigns to promote a new ‘sensible drinking’ culture.
- Public consultation on alcohol pricing and promotion.
- Compulsory local alcohol strategies.
Reactions
Speaking for the Royal College of Physicians, Professor Ian
Gilmore, RCP President and a liver specialist, welcomed the review of
the Government’s Alcohol Strategy: “We particularly welcome the review’s
focus not just on younger drinkers and binge drinkers, but on the
previously neglected issue of adults drinking harmfully at home, unaware
that they are damaging their health. It is clear that depending on
voluntary partnerships with the drinks industry has not worked, and it
is now time for much stronger cross-Governmental action on alcohol
issues.
“We need to review and increase the NHS alcohol budget to
address the gross deficiencies in both acute hospital services and
community treatment services. For example, the RCP in it’s 2001 report
‘Alcohol: Can the NHS Afford It?” called for every acute hospital to
have a specialist alcohol nurse as a cost-effective way of reducing
harm, yet most are yet to employ one.
“International evidence shows that increasing price and
reducing availability are the two main ways of reducing people’s
drinking, and while we welcome the review of retailing and promotions,
this should not be used to delay action in this area, as we already have
enough evidence to make the necessary decisions.”
British Liver Trust
The British Liver Trust also welcomed the Strategy, particularly
the government’s commitment to spend £10 million a year on alcohol
campaigning. However, the Trust said that the government’s warning must
be focused with an overwhelming priority on the health effects of
alcohol.
“People in Britain are storing up huge health problems for the
future if they continue to drink to excess.” said Alison Rogers, Chief
Executive of the Trust.
“Hopefully the Strategy will put forward a clear health
message. The habit of heavy drinking is leading to a frighteningly short
road to liver clinics and transplant units. With the total UK household
expenditure on alcohol running up £41.9 billion in 2005, making people
more aware of the health issues associated with alcohol is going to be a
long-term battle. Until people realise that a bottle of wine a night is
damaging to their liver and their general health there will not be a
change in behaviour.” added Ms Rogers.
Alcohol Concern welcomed the new Strategy as “a major step
forward in Government thinking on the issue of alcohol misuse.” However,
the charity added that there were some significant gaps in the
Strategy, particularly with regard to service provision for people with
alcohol problems.
For drug prevention charity Mentor UK, Eric Carlin, its chief
executive officer, said: “I am disappointed with the lack of
consultation on the next steps in the national alcohol strategy, not
only with drug prevention agencies such as ourselves, but with young
people who are key to minimising the problem of future alcohol misuse.
Although the need for early intervention is already recognised at
government level, with guidance issued from the DfES that education
should start in primary schools before drinking patterns become
established, there is no focus on prevention initiatives and the younger
age group in this alcohol strategy.”
Industry reactions
Reactions from the alcohol industry were also fairly restrained,
though there was obvious unhappiness at not being fully consulted. A
clear division began to appear between different sections of the
industry, with spokesmen for the on-trade welcoming the proposed review
of cut price alcohol promotions while those speaking for the off-trade
took the opportunity to deny any responsibility for promoting the binge
drinking culture.
John Grogan, MP for Selby and chairman of the All-Party
Parliamentary Beer Group and a well-known spokesman for the on-trade
said: “The announcement that the government is planning to hold a public
consultation on alcohol pricing and promotion is excellent news. This
is a major step forward for the campaign to get the supermarkets to end
irresponsible drinks promotions. It is the first sign that government
ministers are now taking this issue seriously.”
Tony Payne, chief executive of the Federation of Licensed
Victuallers’ Associations,welcomed news that supermarket pricing would
be targeted.He said: “Cheap prices are just encouraging people to buy
more and drink more. It’s good the government is to look at supermarkets
and venues that offer promotions such as ‘drink as much as you want’
for a fixed price.”
British Institute of Innkeeping chief executive John McNamara
commented: “A pub can be one of the most responsible places to drink
alcohol. While binge-drinking is an issue that needs to be continually
tackled, I am heartened that the government has recognised the impact of
drinking in the home.”
The British Beer & Pub Association also welcomed news that supermarkets’ loss-leading on alcohol will be investigated.
The Wine & Spirit Trade Association questioned why the Strategy had been drawn up without full consultation with the trade.
British Retailers Consortium
However, the British Retailers Consortium took a different view.
It joined with major retailers to meet with MPs to “debunk a series of
myths and spell out their commitment to public health and responsible
alcohol retailing”.
The BRC’s Parliamentary Briefing was held on the same day the
Government published the Alcohol Strategy. The BRC denied that
supermarkets caused excessive drinking and claimed that, in fact, they
were at the forefront of the drive to encourage responsible consumption
and prevent underage sales.
BRC ‘evidence’ showed supermarkets were rarely the outlet of
choice for people buying alcohol to drink immediately. Overwhelmingly,
alcohol was bought from supermarkets as part of a routine shop for a
full range of groceries with only one in a hundred transactions being of
alcohol alone.
BRC Director General Kevin Hawkins said: “Alcohol price
cutting by supermarkets does not create problem drinking. Very few
supermarket customers buy just alcohol and it isn’t aimed at immediate
consumption. Banning discounting, even if it was possible under
competition law, would simply penalise the vast majority of customers
who take it home to drink over a period or at family events.
“Retailers are leading the alcohol industry on efforts to
prevent underage sales and they are providing customers with clear
information to enable them to make sensible choices.
“On excessive drinking and its effects, retailers are an easy target but not the right one.”
For the Conservative Party, shadow Home Secretary David
Davis described the new Alcohol Strategy as an admission of failure on
the part of the Government. Mr Davis was particularly worried by the
Government’s proposal to introduce conditional cautions for drunken
behaviour.
Political reactions
Mr Davis said:“We will look at these proposals in detail but
it is important they do not become yet another stealth mechanism for the
Government to ditch their responsibility to tackle serious crime.
People should remember that half of all violent crime is fuelled by
alcohol.
“The public will not tolerate a situation where - as with
shoplifters – alcohol- fuelled crime becomes effectively decriminalised
with offenders getting a caution in exchange for undergoing a course
that may not work.
“In any event this is an admission that the Government has
failed on alcohol abuse. They are now acknowledging the serious harm
alcohol does both to public health and public safety. If this is the
case why did they simply unleash 24-hour drinking on our towns and
communities instead of listening to our calls to pilot the scheme so its
effects could be properly assessed?”
For the Liberal Democrats, Norman Lamb MP said: “A fresh look
at tackling the growing problem of excessive drinking is long overdue.
Too little has been done by this Government, which has allowed public
health budgets to be raided to cover deficits elsewhere. The
Government’s trumpeted 2004 Alcohol Strategy is now merely gathering
dust. The same must not be allowed to happen to these latest plans.
Urgent action is needed to stem the binge drinking culture which takes
root in so many people at a young age and leaves them with health
problems for life. Someone drinking as a young teenager is far more
likely to be dependent on alcohol in adult life.”
Top of pageAn end to the Carlsberg baby in sight?
Alcohol branding on children’s replica shirts is to be phased
out under new marketing rules agreed by the drinks industry. The move,
announced by the Portman Group, will be seen as a gesture by
the
multi-billion-pound drinks industry to head off more draconian
government action amid growing concern about levels of alcohol
consumption and harm among the young, including children.
The Portman Group announced the new initiative just ahead of
the publication of the Government’s revised alcohol strategy which will
require pubs, supermarkets and off-licences to display alcohol health
warnings at the bar or tills, as well as labels on drinks bottles and
cans.
The decision by the Portman Group follows a public
consultation on its Code of Practice on the Naming, Packaging and
Promotion of Alcoholic Drinks which applies to all alcohol marketing.
Industry insiders are reported as believing the ban could effectively
end the long history of drink companies sponsoring football teams.
Nine county cricket clubs, two Premiership football teams,
three Scottish Premier League clubs and a number of rugby clubs are
currently sponsored by drinks companies.
David Poley, Chief Executive of the Portman Group, the
industry’s ‘social responsibility’ organisation, said: “There is no
evidence to link this marketing with under-age drinking. Even so, drinks
companies are concerned about the negative perception caused by their
logos appearing on children's shirts.
“Despite producers having only ever been interested in
marketing their drinks to adults, some critics see children in replica
kit as walking billboards for alcohol. This side effect of sponsorship
is set to end. Drinks companies are taking the lead even though this
decision may lessen their commercial appeal as sponsors if clubs sell
fewer shirts.”
The alcohol industry insists it is not targeting children but
critics claim the firms are using sophisticated techniques – including
football sponsorship – to target the young. France has barred all
televised sports sponsorship by alcohol companies, and medical experts
are pushing for similar rules in Britain.
Professor Ian Gilmour, a liver specialist and president of the
Royal College of Physicians who led calls for the ban, said: “I welcome
the announcement and hope it’s a move towards the complete withdrawal
of the alcohol industry from sports events. Every statistic that comes
out shows an increasingly concerning situation surrounding alcohol use
by the young.”
However, the new restriction will only apply to sponsorship
contracts signed after 1 January 2008, which means that Carlsberg, which
sponsors Liverpool, and is thought to have agreed a new three year deal
just prior to the Portman Group announcement, will therefore evade the
restriction initially. The deal is said to be worth more than £20m. A
spokeswoman for the Danish brewer said it supported the new Portman
Group code but the firm was confident its new sponsorship deal would not
be affected.
Among the teams sponsored by alcohol producers are Derbyshire,
Essex, Glamorgan, Gloucestershire, Kent, Lancashire, Surrey,
Warwickshire, and Worcestershire cricket clubs, and Everton,Liverpool,
Celtic, Hibernian and Rangers Football Clubs. A children's size shirt is
defined by its VAT classification.
The rule change is included in the 4th Edition of the Portman
Group's Code of Practice on the Naming, Packaging and Promotion of
Alcoholic Drinks. The full version of the new Code was published in June
2007.
NUT attacks alcohol sports sponsorship
An example of the kind of pressure and negative publicity that
drinks companies have begun to suffer in relation to sports sponsorship
was provided by the demand of National Union of Teachers’ General
Secretary Steve Sinnott to end the practice. He was speaking at the
Union’s annual meeting in Harrogate.
Referring to the ‘massive assault of the drinks industry’ on
sport through advertising and sponsorship, Mr Siinnott warned beer firms
which sponsor football “are exposing impressionable children to highly
damaging messages.”Mr Sinnott said:
“This exposure to alcohol is damaging young people's lives and
their futures. We are failing our youngsters. The sponsorship of sport
by the drinks industry must end in advance of the Olympics in 2012.”
Mr Sinnott told delegates at the conference that 20 per cent
of pupils who are excluded from school are thrown out for drinking
alcohol, while 16 per cent drink alcohol every day. He also said
drink-related deaths among young people were up 60 per cent since 1991.
To illustrate his point he said if a young Everton fan went to
a Carling Cup match against Liverpool he would see the Carlsberg motif
on the opposing team's strip and “on the chest of his heroes” he would
see the logo of the Thai beer, Chang.
“He sees the scorer of Everton's winning goal presented with
the man of the match award – a bottle of champagne. The effects on the
young are stark,” he added
Top of pageTough action called for on youth drinking
The binge drinking epidemic has prompted calls for tougher
action to protect children and teenagers from being caught up in the
unhealthy drinking culture. An article in the journal of a leading think
tank with close links to the Labour Government argued that the minimum
age for buying alcohol should be raised to 21, while Alcohol Concern
proposed that supplying alcohol to adolescents aged under 15 be made a
criminal offence. Both proposals provoked considerable controversy and
appeared to divide opinion in the public health field, and both were
rejected by the Government.
Legal drinking age of 21?
Writing in the magazine of the left leaning Institute for Public
Policy Research, columnist Jasper Gerrard argued that “society has lost
its sense” when it comes to alcohol. He said that “society is
increasingly reluctant to tolerate passive smoking, so why passive
boozing - which is what innocent people experience when a drunken,
clunking fist attacks them on a Saturday night?”
Citing evidence that the UK has one of the highest rates of
teenage alcohol drinkers, and teenage drunkenness, anywhere in the
world, Gerrard argued that current regulations are failing to tackle the
growing trend of underage and binge drinking.
By raising the age threshold, he claimed: “It is at least
possible that those in their early and mid teens will not see drink as
something they will soon be allowed to do so therefore they might as
well start doing it surreptitiously now. Instead they might come to see
it as it should be: forbidden.”
Alternatively, all 18 year olds could be issued with smart
cards which would record how much they drank each night, and making it
an offence to serve more alcohol to anyone under-21 who had already
consumed more than three units (one and a half pints of beer, or a large
glass of wine).
Additionally, Gerrard argued that taxes on alcopops should be
increased, and that there should be harsher sentences for those who sell
alcohol to under 18's.
A government spokesman responded: “The majority of people
drink sensibly and responsibly and the government has no plans to raise
the minimum drinking age. Instead, we are using a combination of
effective education and tough enforcement to change the behaviour of the
minority that don't.”
‘Prosecute parents’
In responding to the Gerrard article, Alcohol Concern, the
national agency on alcohol misuse, agreed that further action was
needed, but did not think raising the legal drinking age would help.
Later, however, it made a proposal of its own which appeared to be even
less well received than Jasper Gerrard’s.This was to make it a criminal
offence to supply alcohol to under-15s.
Srabani Sen, director of Alcohol Concern, said that binge
drinking by children can have serious consequences for brain function,
significantly raises the risk of alcohol dependency in later life and
diminishes their life chances. She said that not enough was being done
to protect our children from alcohol and that what was needed was to
limit the access children and teenagers have to alcohol and and to
challenge more aggressively the drivers of underage consumption. Srabani
Sen listed a number of initiatives Alcohol Concern would like to see
implemented:
“Make it illegal to provide alcohol to anyone under the age of
15. Currently it is legal to provide children as young as five with
alcohol in a private home. Raising the age limit to fifteen would send a
stronger message to parents of the risks associated with letting very
young people consume alcohol.
“Enforce the law around underage purchase. Data from the most
recent Home Office AMEC (test purchasing) campaign showed that 29% of
underage participants were able to buy alcohol in pubs and bars, while
21% did so successfully in off-licenses. Local police forces and trading
standard units must devote more resources to identifying and
prosecuting those outlets in breach of the law.
“End advertising of alcohol on TV before the watershed and in
cinemas when films with ratings below 18 are shown. The European Court
of Justice has already refuted advertisers’ arguments and ruled, it is
in fact undeniable that advertising acts as an encouragement to
consumption. Reports show that supermarket alcohol promotions are shown
twice as often before 9pm (which is when children are more likely to be
watching TV) compared to after. Furthermore, 82% of films shown in
cinemas featuring alcohol adverts have ratings of 15 or below.”
“Make alcohol education part of the National Curriculum.
Inappropriate use of alcohol by young people has been shown to have an
impact on school performance. Alcohol is a factor in many school
exclusions and suspensions. Around 14% of pupils excluded from school
were suspended for drinking alcohol at school. The PSHE components of
the National Curriculum should provide an important opportunity for
conveying to young people the risks associated with bingeing.”
The Alcohol Concern proposals received extensive media
coverage but limited support, even from within the public health field.
Professor Martin Plant, director of the Alcohol and Health Research
Trust at the University of the West of England, described the proposals
as “very strange”. He said: “The bottom line is the number of alcohol
related deaths is connected to the affordability of alcohol. Alcohol
education is a complete waste of time as is drug education. These are
politically cowardly get-outs”.
Most of the media and political comment, however, focused on
the proposal to raise the legal drinking age to 15, an idea which most
seemed to see as undesirable or unworkable. The consequences of such a
move in relation to the prosecution of parents were generally regarded
as particularly unappealing.
Public Health Minister Caroline Flint said “I don’t think
passing a law to ban alcohol for those under 15 would be enforceable or
necessarily effective’’. Ms Flint added that there were signs the
problem of underage drinking was reducing: “Recent figures show there
has been a 5 per cent drop between 2001 and 2006 of young people aged
between 11 and 15 who had drunk alcohol in the previous week. We are
working closely with the alcohol industry to encourage the responsible
production and sale of alcohol…The new alcohol strategy to be published
this summer will continue to drive reductions in alcohol related
offending and harmful behaviour through a combination of education,
treatment and tough penalties.”
Ms Flint also defended the Government’s record by citing
restrictions on alcohol advertising that could appeal to under 18s
introduced in 2005. She added that alcohol education is already part of
the National Curriculum.
Police also call for no alcohol for under 21s
Merseyside Chief Constable Bernard Hogan-Howe has asked the
new Prime Minister Gordon Brown to increase the legal age for buying
alcohol to 21. Writing in the Liverpool Daily Post, Mr Hogan-Howe
outlined his case for tough action.
Last week, I asked the new Prime Minister to consider some
legislative changes. The ideas around alcohol sales were aimed at
helping the fight against anti-social behaviour.
Each year Merseyside Police deals with 2m calls for help:
250,000 of those are about antisocial behaviour. In the hot-spot areas,
where we get repeated calls about serious criminality, the main
aggravating factors tend to be similar time and time again.
There is either a street level drug market in the area or
there is a particular problem with the illegal sale of alcohol or the
consumption of alcohol by young people. My suggestions are to restrict
the sale of alcohol to young people through off-licences and to come
down hard on adults who go into off-licences to buy alcohol for
youngsters.
The relative cost of alcohol has come down, while the number
of off-licence points of sale has increased significantly. There is no
longer a test to see whether an area "needs" a new off-licence. The
control of the sale of alcohol is then left in the hands of young and
low-paid staff.
They have to challenge young people late at night, often alone
and when dealing with a crowd of potential customers. Would you
challenge that crowd? I have suggested reducing the points of sale,
increasing prices and allowing home deliveries only during the day. If
we reduce the sugar content in some drinks, then we may change the binge
drinking culture.
Alcoholic drinks should not be made to appeal to young people
by appearing more like everyday soft drinks. With the medical profession
alerting us to the high level of chronic liver disease in the young, we
need to do something. We can make a difference. Anti-social behaviour
is not new. Twenty-three years ago in his annual report, Sir Kenneth
Oxford said: “As everyone knows, the biggest problem today is young
people causing annoyance.”
What has changed is people now have easy access to
communications with mobile phones and are more able to report incidents
as they are happening. That gives us a clearer picture of the size of
the problem our communities are facing. Most importantly, the
availability of alcohol and drugs has significantly changed young
people's behaviour. In my view, we need to do something about it.
I believe my suggestions are considered and balanced.
Meanwhile Durham Police called on licencees to sign up to a
‘21 or over’ scheme which only allows those 21 and over to buy alcohol.
The move is an effort to reduce the problem of young adults buying
alcohol for under 18s. Speaking for the trade about the deal, John
Hudson condemned the idea as ‘draconian’. He said the licencees would be
unable to administer the scheme effectively and it would cost them a
lot of money.
Top of pageInsurance - solving some alcohol problems and causing others
Insurance cover is often taken out for risks that are related
to problem drinking. Examples include death, illness, criminal
behaviour, accidents (on the road and otherwise) and fire.
Insurance can sometimes pay for treatment for the effect of
alcohol misuse. It can help to meet the cost of alcohol-related harm.
Sometimes the insured may be encouraged to avoid alcohol problems by
risk management procedures required by the insurer or by the prospect of
paying higher premiums if those procedures are not adopted.
Often alcohol-related risks may be excluded from the scope of
the cover. Sometimes the non-payment of an insurance claim is an alcohol
problem in its own right. Non disclosure of (among other things)
problem drinking by the person applying for cover (‘the proposer’) may
invalidate the insurance. Insurance can also be problematic when it
contributes to dangerous behaviour by protecting people from the
consequences, as when an alcoholic makes a suicide attempt believing
that his family will be able to claim on his insurance.
Alcohol problems are studied within the scientific community.
Addiction professionals, including doctors and counsellors, help their
patients and clients to face up to their problems. In the insurance
industry, alcohol-related risk is an issue for medical staff and risk
management professionals. The insurance regulator, the Financial
Services Authority, has focused on the mis-selling of, for instance,
insurance against critical illness where customers are not given
appropriate advice about making full medical declarations. Problem
drinking is one of the main conditions which people do not disclose
adequately when taking out insurance.
A new paper published by the Institute of Alcohol Studies
considers the common ground between the scientific, medical and
insurance perspectives and the scope for co-operation in future research
and initiatives in addressing problem drinking.
Insurance: solving some alcohol problems and causing others Jonathan Goodliffe
IAS Occasional Paper 2007
Top of pageDate rape dangers
Drug facilitated sexual assault (DFSA), including rapes in
which drugs are mixed with alcohol, is a significant problem, the
Advisory Council on the Misuse of Drugs (ACMD) says in a new report,
‘Drug Facilitated Sexual Assault’. The Council makes several
recommendations to help tackle date rape. These include:
- the Association of Chief Police Officers (ACPO) should
enhance evidence gathering so that the Forensic Science Service can test
for date rape drugs;
- the Department of Health should ensure hospitals have early evidence kits to allow for similar tests;
- the Government should seek advice on whether the Sexual Offences Act should be strengthened;
- drug facilitated sexual assault should be part of the
British Crime Survey and be recorded by police; and schools and other
educational establishments should alert people to take common sense
measures, such as minding drinks, to avoid being a victim.
Two drugs - gammabuterolactone and 1,4-butanediol - are
reportedly used in date rape but are not currently illegal. The Council
will report on the potential for classification of these in the near
future. However, most drugs used in DFSA, including flunitrazepam, also
known as Rohypnol, gammahydroxybutyl rate (GHB), ketamine and cocaine
are already controlled under the Misuse of Drugs Act 1971 at an
appropriate level and the Council makes no recommendations to reclassify
any of them.
The report also highlights the very significant role played by
alcohol, either alone or in combination with other substances, in date
rape. It also provides an assessment of two reports : ‘Operation
Matisse: investigating drug facilitated sexual assault’, published by
ACPO; and ‘Toxicological findings in cases of alleged drug facilitated
sexual assault in the United Kingdom over a three year period’,
published by the Forensic Science Service.
Professor Sir Michael Rawlins, Chair of the ACMD, said: “Drug
facilitated sexual assault is a particularly disgusting offence that
wrecks people's lives. It is a significant but under reported problem.
“We need more information to help tackle drug facilitated sexual assault
and find out the true extent of the problem. That is why drug
facilitated sexual assault should be part of the British Crime Survey
and police recorded crime statistics.
“Most drugs used in drug facilitated sexual assault are
already controlled under the Misuse of Drugs Act, but we are concerned
that two drugs are not currently controlled and will further consider
whether they should be classified. We will advise the Home Office by the
end of the year.” To avoid being a date rape victim the ACMD is
encouraging people to:
- avoid going to a club, pub or party alone;
- not accept a drink from strangers;
- not share or exchange drinks;
- not leave your drink unattended even when going to the
toilet; and be a friend by watching out for others, and be aware of any
changes in their behaviour.
The Council will continue to keep drug facilitated sexual assault under review.
Top of pageOver one third of prisoners 'have a drink problem'
The inmates of Winchester Prison have 10 times as many
hazardous and dependent drinkers as are found in the general population,
and 35 per cent of prisoners believe they have a drinking problem.
Nearly half (46 per cent) of prisoners believe that alcohol was linked
to their offence, with violent crime accounting for half of these
offences.
These are among the conclusions of a new survey of
Winchester prisoners conducted by Mike Webb, Alcohol Strategy
Co-ordinator of the Hampshire Drug and Alcohol Action Team, and Steve
Neville, Winchester Drug Services Team.
Here, MikeWebb gives an account of the survey and its main findings.
Winchester Prison is a category B local prison with an all
male population of 697 prisoners who are either on remand, awaiting
sentence, serving a short sentence or waiting to be moved to another
prison. The majority of prisoners come from across Hampshire and are
roughly split from Hampshire, Portsmouth and Southampton.
Winchester Drug Services Team is a multidisciplinary service
consisting of prison staff, contracted in-service providers and clinical
specialists. Other than the detoxification wing, these services are not
funded to work with purely alcohol clients. An alcohol client can only
be seen if an illicit drug is also involved. Alcoholics Anonymous go
into the prison on a weekly basis.
The prison has a dedicated detoxification landing (34 beds),
for both drugs and alcohol. Between April 2005 and March 2006, a total
of 222 alcohol detoxifications were carried out, an average of 18.5 a
month. Anecdotal information suggested that the level of alcohol
consumption among prisoners at Winchester Prison was unusually high and
potentially linked to the crimes that they had committed. The survey
provided ample evidence to confirm that this picture is correct.
Prisoners were asked how much alcohol they consumed, and if
they felt this to be problematic, in two ways. The first was with a
closed question, “Do you have a drinking problem” with the responses
“Yes, No, Don’t know” available.The second was by listing different
measures of alcohol, such as a pint, and asking how many they consumed
within a week. This allowed the unit total to be calculated and compared
with the national guidelines for alcohol consumption. These suggest
that men should drink no more than 21 units in a week. Moderate to
heavy drinking is between 21–50 units a week, while those drinking over
50 units are in the serious/dependant category. The main findings are
summarised in graph 1.
Graph 1
The key comparison of this graph is with the hazardous/
dependant drinkers. Winchester Prison has 10 times as many hazardous
/dependant drinkers as would be expected to be found in the general
population.
The survey also compared the amount of alcohol consumed by
prisoners who said that they DID NOT have a drinking problem with those
who said that they did have a drinking problem.
The average consumption of the group that said they did not
have a drinking problem was 43 units per week, an average that is skewed
upwards by a few exceptionally heavy drinkers. 43% are drinking above
the recommended limit of 21 units per week. 20% of the respondents who
said that they did not have a drinking problem were actually consuming
over 50 units per week. This is the level of alcohol consumption that is
considered to be serious/dependant and highlights the lack of awareness
around safe
levels of alcohol consumption within the prison population.
The average alcohol consumption among those who say that they do have a drink problem was a 157 units per week.
Violent Crime
There was a particularly strong relationship between alcohol and
violent offences. 22% of all prisoners at HMP Winchester considered
that their violent crime offence was related to their alcohol
consumption and violent crime accounted for half of all offences from
prisoners who reported that alcohol was linked to their criminal
activity. Similarly, of those prisoners who believe that they have a
drinking problem, over half of the offences are for violent crime.
Nearly half of those who said that they would use an alcohol service
within the prison were violent offenders.
The question was also asked “How often have you carried out
criminal acts while under the influence of alcohol?” The breakdown of
responses for violent crime is shown in graph 2, with a comparison given with theft, burglary and other.
When asked if they believed they had a drinking problem, 143
(35%) of respondents believed that they did. Those who had been
imprisoned for violent crime are again disproportionately over
represented in this finding, as graph 3 illustrates.
Social problems
Respondents identified a range of social problems that they attributed to their drinking behaviour, as outlined in graph 4.
Prisoners whose category of arrest was violent and other (of which
nearly half are drugs related) are compared with the general prison
population.
The three social areas identified where alcohol causes the greatest difficulties for the whole population were:
- Violence to others (156/405)
- Relationship problems (144/405)
Within this, those whose category of arrest was violent crime
accounted for around half of the violence to other category, social
(e.g. housing), medical and injury (to you). The low awareness of
medical problems as an issue highlights that prisoners may be unaware of
the long term health implications of excessive alcohol consumption.
Domestic violence is the only category that produced an
unexpected outcome, with a % that is lower than expected. This may
indicate that acknowledging or recognising domestic violence as an issue
is difficult.
An interesting follow up exercise would be to carry out a
confidential questionnaire with the partners of prisoners to see what
they viewed the main social problems caused by alcohol to be.
Service provision
When asked if they would use an alcohol service located within
the prison, 198 (49%) of respondents said that they would.
However, from this group of people who have expressed an
interest in using a service, 67 (37%) had not used drugs in the previous
year and, therefore, might not be eligible to receive a service
designed to address their alcohol problem alone.
What the survey shows us
The findings of the survey strongly indicate that:
- Prisoners believe that alcohol is a causative factor in their offending behaviour
- Prisoners believe that alcohol consumption has caused them a
number of social problems, principally in relation to violence towards
others, relationship difficulties and financial concerns
- Prisoners are drinking at very high levels, with many unaware that they have an alcohol misuse problem
- A high proportion of respondents believe that they have a
drinking problem and would like to access an alcohol service if one were
available in the prison. However, because a significant proportion
(n=67) of these individuals have not taken illicit drugs in the previous
12 months, they may be ineligible for such a service from the Prison
Drug Team.
- Prisoners who have stated that their offence is violent
crime are proportionately more likely to have identified alcohol as
causing them social problems, to have identified alcohol as having been
linked with their offending and to be seeking a service to address their
drinking. However this over representation of violent offenders may
simply be reflective of the mix of prisoners within Winchester.
Where should we go from here?
This data strongly supports the view that there is indeed a
significant proportion of the prison population within HMP Winchester
who have serious social and offending problems that may be strongly
linked to their drinking behaviour; they recognise this problem and have
expressed a desire to access services to address it.
The Prison Service Alcohol Strategy for Prisoners and the
Treatment Interventions Good Practice Guide provides an alcohol
treatment framework but this has not yet been resourced while provision
nationally is extremely limited. Given the strong link between alcohol
and offending, the potential reduction in re-offending through
addressing problem drinking behaviour would indicate that this would be a
cost-effective intervention strategy.
Top of page'Binge drinking' linked to chlamydia in women
Alcohol has been shown to be a principal risk factor for
chlamydia in young women in the UK. A study by Valerie McMunn and Woody
Caan of Anglia Ruskin University of over 200 young women aged 16-25
found that three factors were associated with increased risk of
chlamydia: alcohol comprised two of them. The two alcohol factors were
the age of first drink and binge drinking. The non-alcohol factor was
the number of lifetime sexual partners.
Chlamydia trachomatis has become the most common sexually
transmitted infection in UK women aged 16-25. Concerns about the
long-term harm to women’s well being, fertility and pregnancy and also
about infant health have led the Department of Health to implement a
screening programme for chlamydia. At the same time, alcohol consumption
in adolescent girls has been rising and there has been, in particular, a
growth in episodic heavy consumption – binge drinking - which has led,
amongst other things, to a doubling in the number of intoxicated women
attending accident and emergency departments.
The study, of women attending a family planning clinic in the
East of England, was also designed to elucidate the relationship between
hazardous drinking and unsafe sex. The mean age of the women in the
sample was 19.4 years. Two particularly striking findings were the
number of sexual partners reported by a high proportion of the women,
and the amount of alcohol consumed per night.
The number of sexual partners ranged from 1 to 30, the average
being 6.8. 20.2% of the women reported more than one sexual partner at
the same time.Women being treated for chlamydia reported more lifetime
sexual partners than those who had never been treated.
The number of sexual partners correlated with all the alcohol
parameters, in particular the number of drinking days per week and the
total amount consumed. Three quarters of the women reported a pattern of
binge drinking, consuming 5 or more units on a ‘typical’ night out.
However, levels of consumption on ‘heavy’ nights out were far higher, up
to 50 units. Women being treated for chlamydia reportedly drank a
median of 15 units on a ‘heavy’ night, compared to 12 units for those
who had not been treated. Women being treated for chlamydia also
reported beginning to drink on average 1.2 years earlier than those not
being treated.
The authors suggest that the increased risk of chlamydia
associated with alcohol use may have been mediated by several factors
including reduced condom use, sex with strangers and exposure to
coercive sex.
The implication of the study for policymakers is that binge
drinking is not an isolated phenomenon but occurs in relation to many
other behaviours involving both individuals and social networks.
A challenge to the research community is to discover the links
in early adolescence (before age 16) between onset of drinking, early
sexual behaviour and exposure to sexually transmitted infections.
Top of pageWorkplace drinking culture influences alcohol intake elsewhere
A restrictive drinking culture at work curbs an individual's
overall alcohol intake, including outside of work, suggests new research
published in Occupational and Environmental Medicine.
The researchers base their findings on a detailed
analysis of workplace attitudes towards drinking and drinking behaviours
in over 5,000 employees in 16 different organisations, representing a
range of different sectors.
The employees were quizzed about how often they drank alcohol, and when and where they did so.
They were also asked to reveal their attitudes to social
drinking, including whether they thought alcohol boosted workplace
morale, was good for business, alleviated boredom, improved their
health, was harmful, or set a bad example.
Their responses were tied in with those of their supervisors
and managers who were also quizzed about the drinking culture in their
respective divisions.
Overall, women employees who often attended religious
services, and those who cohabited were less likely to drink. Younger
workers and smokers were more likely to do so.
Around one in five (19%) workers was classified as a heavy
drinker outside of work (four or more drinks in one day in men and more
than three in women).
A further 8% were classified as frequent drinkers (some
alcohol on five or more days of the week) outside of work, and 11% were
classified as drinking at work.
But rates of heavy, frequent, and workplace drinking were
significantly lower in organisations that discouraged social drinking
than in those that most tolerated it.
After taking account of other influential factors, workers in
organisations that most discouraged social drinking were 45% less likely
to be heavy drinkers than those in workplaces with the most relaxed
attitudes to drinking.
They were also 54% less likely to be frequent drinkers and 69% less likely to drink during the working day.
The authors conclude that the workplace drinking culture is
crucial for changing drinking patterns and preventing alcohol problems,
and should be included in public health initiatives.
Reference
[Drinking social norms and drinking behaviours:
a multilevel analysis of 137 workgroups in 16 worksites Online
First Occup Environ Med 2007; doi: 10.1136/oem.2006.031765]
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