Which direction for alcohol policy under the coalition?
The new Coalition Government has immediately courted controversy with
the public health community by basing its approach on education rather
than regulation, action to improve health being undertaken in close
cooperation with the alcohol and food industries as well as public
health practitioners and the Third Sector.
While Coalition policy is still being formulated, Government
Ministers have already made it clear that, from now on, alcohol policy
will be less dominated by the issue of crime and disorder, and less
focused on controls on availability. According to new Health Secretary
Andrew Lansley, alcohol policy will instead become a key responsibility
of a new Public Health Service, and the new Coalition Government’s
approach to creating a healthy nation will focus on behaviour change.
The idea is that the approach will go beyond constraining the supply of
illegal drugs, alcohol and tobacco, and begin to understand and
influence the drivers of demand.
Speaking at the UK Faculty of Public Health Conference in July
2010, Mr Lansley criticised the previous Labour Government for failing
to get to grips on demand.
Mr Lansley continued:
“Public health efforts which only try to control supply will
fail. We have to impact on demand. That people’s relationships with each
other and with drugs, alcohol, tobacco and food.
“And where behaviour change has been the aim of recent
initiatives, the outcomes have been with the alcohol issue or with other
public health problems, such as obesity, all of which had got worse
during its term of office. In regard to alcohol, Mr Lansley said that
the lack of national leadership under the previous Government could be
seen in the sharply rising effects of alcohol consumption, and the
pattern of alcohol consumption. Alcohol strategies had failed to go much
beyond the public order issue, and the approach had been confined to
supply, with little impact means we have to change behaviour, and change
patchy at best.
“It seems to me that awareness campaigns have too often sent
the wrong messages – when they’re screaming at you to drink less, many
people are just having their behaviour reinforced – the message doesn’t
come out as ‘drink less’ but as ‘everyone drinks, so don’t worry about
it’. It tells people that the norm in society is misuse of alcohol.”
The government’s coalition programme includes the following commitments:
- we will ban the sale of alcohol below cost price
- we will review alcohol taxation and pricing to ensure it
tackles binge drinking without unfairly penalising responsible drinkers,
pubs and important local industries
- we will overhaul the Licensing Act to give local authorities
and the police much stronger powers to remove licences from, or refuse
to grant licences to, any premises that are causing problems
- we will allow councils and the police to shut down permanently any shop or bar found persistently selling alcohol to children
- we will double the maximum fine for under-age alcohol sales
to £20,000 we will permit local councils to charge more for late-night
licences to pay for additional policing.
However, it is clear that this new emphasis on endeavouring to
empower the population to live more healthily, rather than seeking to
impose solutions from the top down, does not preclude action on
licensing controls or on the price of alcohol. Although the Coalition
does appear to have rejected the option of a nationwide minimum price
per unit of alcohol, the system for which the main alcohol and public
health bodies have been campaigning, Prime Minister, David Cameron, has
publicly supported local initiatives to establish a minimum price for
alcohol. The Coalition also intends to put an end to the 24 hour alcohol
licensing introduced by the Labour Government. Instead of minimum
pricing, the Coalition promises to ban the sale of alcohol below cost
price, and the Coalition has been quick to seek views on this proposal.
It has put forward four options to ban below-cost selling of alcohol and
is planning to take the proposals to a public consultation in the near
future. The issue is what is meant by ‘cost’.
The Grocer magazine reported that the Home Office told
industry lobbyists it was working on four possible options, the first of
which defined cost as simply duty and VAT. This is the definition used
by leading supermarket chains, including Morrisons, which last month
called on the Government to ban the sale of alcohol below this figure.
However, many in the industry objected to the definition on
the grounds that it would only affect the deepest discounts and
attributed no cost to the product itself. Two other options were to add
some form of cost for the production, distribution and marketing of the
product, or to ban sales below the cost of the invoice sent to
retailers.
The fourth option was to allow retailers to work together on
fair pricing without fear of prosecution under competition law. The four
options would be presented in a consultation document in early August
as part of the Police Reform and Social Responsibility Bill.
“End of 24 Hour Licensing in sight”
While the Coalition is still consulting on its plans to reform
the Licensing Act, it is clear that it intends to give local
authorities greater powers to limit opening hours in their own areas and
to control the excesses associated with late night opening. Coalition
Ministers have commented on the failure of the Labour Government’s new
Licensing Act to bring about the promised Mediterranean-style café
culture or to tackle effectively the binge drinking problem.
One unnamed Government source quoted in the Daily Telegraph commented:
“When (the Coalition’s licensing proposals) are implemented, this will be the death knell for 24-hour drinking.
“Labour unleashed 24- hour drinking on our communities, then
they said they had abandoned it but the truth was we were still saddled
with it.
“The whole point of this move is that unregulated 24-hour drinking is brought to an end.”
The toughening up of licensing controls coincides with
returning responsibility for licensing to the Home Office from the
Department of Culture, Media and Sport which was widely felt to have
mishandled the licensing issue.
Commenting on the transfer of responsibility, Minister for Crime Prevention, James Brokenshire said:
“We continue to be concerned about the number of
alcohol-related incidents and the drink fuelled violence and disorder
that blights many of our towns and cities.
“The government believes that the power to make licensing
decisions needs to be rebalanced in favour of local communities, so that
they can decide on the night-time economy they want.
“We have already committed to overhaul the Licensing Act to
give local authorities and the police much stronger powers to remove
licences from, or refuse to grant licences to, any premises that are
causing problems.
“We will toughen the sanctions for those premises found to be
persistently selling alcohol to children and will allow local councils
to charge more for late-night licences, which in turn will raise money
for extra policing. We will also ban the below cost sale of alcohol.
“This move will not only help reduce duplication of effort
but will mean just one department is responsible for enforcement and
licensing policy, allowing for a more consistent approach to tackling
this issue.”
Expert
opinion has generally sided with the Coalition on the licensing issue.
Professor Jonathan Shepherd, Director of the Cardiff University Violence
Research Group and a leading authority on combating alcohol-related
violence and disorder, welcomed the Coalition’s proposals which, he
said, could turn the tide in Cardiff’s fight against disorder.
Speaking to the Cardiff Echo Professor Shepherd said: “There
have been improvements in Cardiff city centre but the levels of
drunkenness out there late at night in St Mary Street are still almost
epidemic in proportion, so it’s still a really serious problem for the
city, the economic health of the city and for individuals. I think this
could turn the tide and stem the epidemic.”
He added: “I think a review of current licensing laws and the
laws that relate to dealing with and preventing alcohol-related
disorder and violence in our cities is welcome. And I would say that a
levy on late-night opening is very sensible and likely to be beneficial.
It’s clear that the powers that are currently available are not
sufficient.”
The new framework will include:
- A new responsibility deal between Government and business built on shared social responsibility and not state regulation
- A new ring-fenced public health budget
- A new ‘Health Premium’ to target public health resources towards the areas with the poorest health
- Clear outcomes and measures to judge progress alongside NHS and social care outcomes
- An enhanced role for Public Health Directors so they
have the resources and authority to improve the health of their
communities; and
- A new Cabinet Sub- Committee on Public Health, chaired by the Health Secretary, to tackle the drivers of demand on the NHS
- A White Paper, to be published later in the year, will set out in more detail how the Public Health Service will work.
Top of pageOverhaul of Licensing Act to give communities more power to tackle crime
Proposals for tough new measures to crack down on problem premises
and more powers for local communities to influence licensing decisions
have been unveiled by the government. Ahead of a major speech on
antisocial behaviour, Home Secretary, Theresa May, outlined a range of
options to overhaul the Licensing Act. Measures for consultation
include:
- making it easier for communities to have their say on local
licensing by allowing local authorities to consider the views of the
wider community, not just those living close to premises
- taking tough action against underage drinking by doubling
the fine to £20,000 for those found persistently selling alcohol to
children, extending orders that see premises closed on a voluntary basis
to a minimum of seven days and bringing in automatic license reviews
for these problem premises – which can see licenses revoked
- charging a fee for latenight licences to pay for the cost of
extra policing and scrapping ineffective, bureaucratic and unpopular
Alcohol Disorder Zones
- ensuring policing and health concerns are fully considered
so that the impact of licensing on crime and disorder or public health
can be fully taken into account when assessing license applications
- increasing license fees so that local councils can cover
costs linked to enforcement, leaving premises to pay, rather than the
local taxpayer tightening up rules for temporary licenses by limiting
the number of Temporary Event Notices that can be applied for in any one
year - these are often used to get around the restrictions of applying
for a permanent license
- introducing a ban on the sale of below cost alcohol and consulting on how this can be achieved.
Home Secretary, Theresa May, said: “The benefits promised by
the 24 hour drinking ‘café culture’ have failed to materialise and in
its place we have seen an increase in the number of alcohol related
incidents and drink-fuelled crime and disorder.
“We know that the majority of pubs and bars are well run
businesses but the Government believes that the system needs to be
rebalanced in favour of the local communities they serve with tougher
action taken to crack down on the small number of premises who cause
problems.”
Last year there were almost one million violent crimes that
were alcohol related, with a fifth of all violent incidents taking place
in or around a pub or club, and almost two-thirds of these happen at
night. As well as this, the total cost of alcohol-related crime and
disorder to the taxpayer is estimated to be between £8bn and £13bn.
The government’s public consultation will run for six weeks and seeks
views on a range of proposals to tackle alcohol related crime and
disorder.
The consultation paper, Rebalancing the Licensing Act – a
consultation on empowering individuals, families and local communities
to shape and determine local licensing, is available at:
http://www.homeoffice.gov.uk/publications/consultations/cons-2010-licensing-act/
Labour elder statesman criticizes “Labour’s ghastly mistake”
Some Labour politicians also appear to support the
Coalition’s policy of being tougher on alcohol licensing. Writing in the
Daily Mail, Lord Hattersley, former Deputy Leader of the Labour Party,
described the introduction of 24-hour drinking as New Labour at its
silliest. Lord Hattersley added:
“Looking back to 2003, when the new and undeniably
disastrous licensing law was passed, it is almost impossible to
understand why New Labour ministers expected anything except a rise in
alcohol-related crime and nights of misery for honest citizens who lived
near pubs, clubs and wine bars. The only answer to the conundrum is
that this ghastly error represented New Labour at its silliest, as
personified by Tessa Jowell, then the Secretary of State for Culture
Media and Sport, who pioneered the legislation and took responsibility
for its implementation.”
Police chiefs as well as politicians have also criticised the Labour
Government’s licensing reforms. Sir Hugh Orde, President of the
Association of Chief Police Officers, agreed with the Coalition
government’s view that the new licensing act was a mistake. And Sir Hugh
told the BBC that those who benefited from longer licensing hours
should help pay for the extra policing required.
Sir Hugh told the Andrew Marr Show: “I think 24-hour
drinking frankly was probably a mistake. The culture in the UK is
different from other parts of Europe, where it is far less threatening
and far more successful. We need to take that legislation away and
indeed I would welcome the notion that if we have longer licensing hours
the people making the money pay for some of the policing that has to be
put in place to keep those people safe when they’re out under the
influence of alcohol.”
KENT police agreed. Ian Pointon, Chairman of the Kent
Police Federation, said late-night drinking had created more problems
than it had solved and had resulted in fewer officers being available to
fight crime during the day.
Speaking to local media, Mr Pointon said: “I think the
introduction of 24-hour drinking without the requisite change in culture
was a mistake.
“The idea was that we would somehow develop a Continental café culture but that hasn’t happened, especially in town centres.
“The feedback from officers is that they’ve had more problems since the 24-hour laws came in.
“They’re also working into the early hours, which means
they’re not available at other times of the day when the public would
like to see them.
“It’s time to have a long, hard look at the licensing hours coupled with the drinking culture in this country.”
Mr Pointon’s criticism of 24-hour drinking is shared by
Kent’s former Chief Constable Mike Fuller, who had warned against its
introduction in an interview with local Kent in January, 2005.
Top of pageWill the Coalition Government lower the drink drive limit?
The Coalition government has chosen to delay making a decision on
whether or not to accept the recommendations of the Review of Drink and
Drug Driving Law undertaken by Sir Peter North. The Review, commissioned
by the previous Labour Government, recommends lowering the present
drink drive blood alcohol limit from 80mg% to 50mg% and, in regard to
enforcement, amending the law to give police an unrestricted power to
require anyone driving a vehicle on the public highway to give a
preliminary breath test. At present, while police can stop any driver at
random, they can only require the driver to take a breath test if he or
she has committed a moving traffic offence, or been involved in an
accident or if there is a specific reason that he or she has been
drinking.
The North Review considered but rejected the option of
lowering the blood alcohol limit to 20mg%. While the Review accepted the
evidence that a driver who has a blood alcohol level of between 20mg%
and 50mg% is at least three times more likely to die in a road traffic
accident than a driver who is completely sober, it concluded that a
sudden reduction in the limit from 80mg% to 20mg% could have a
detrimental effect on the currently high level of public support for and
compliance with drink drive legislation in the UK. Lowering the limit
to 20mg% would necessitate drastically reducing the severity of the
penalty for the offence of drink driving, and this could dilute the
effectiveness of the current approach for little gain in terms of
tackling the drink drive problem.
However, the Review concluded that these objections do not
apply to the introduction of a 50mg% limit which, the Review estimates,
could save tens or even hundreds of lives each year.
The Review also rejected the option of a lower legal alcohol
limit for specific groups of drivers such as drivers of Heavy Goods
Vehicles (HGV) and novice or young drivers. The main reason for
rejecting the idea of a lower limit for HGV, taxi and private hire
drivers was the relative lack of propensity of these drivers to drink
and drive, compared with the general population, and the fact that such
drivers already face higher penalties from the courts and also from
their employers. A lower limit for young drivers could appear
discriminatory, and in any case, roadside enforcement would be
difficult, given that, as there is no statutory requirement for drivers
to carry their driving licence with them, police could find it difficult
to tell to which age group they belonged.
Industry opposition to a lower limit
It is clear from submissions made to the North Review that the
hospitality, entertainment and leisure industries are still opposing
any reduction of the present legal blood alcohol limit for drivers on
the basis that it would have a detrimental impact, particularly on
country pubs. The North Review, however, decided that reducing the limit
to 50mg% would, of itself, have a widespread detrimental impact on the
sector, and that, indeed, providing further encouragement for people to
drink at home could have beneficial consequences for much of the
industry. The Review states that a 50mg% limit is not a zero tolerance
approach, and that its introduction would not, therefore, deter those
customers the trade is most concerned about, those who consume modest
amounts of alcohol to accompany a meal in a pub or restaurant.
Government Response
It may well be, however, that commercial and economic, as
distinct from road safety, considerations will weigh heavily with the
Government. Responding to the Review, The Secretary of State for
Transport (Mr Philip Hammond) said:
“This report covers a wide range of issues and makes 51
detailed recommendations, which we need to consider carefully with other
Government departments. In doing so, it is important that we fully
investigate the economic and public service resource impact of any
suggested changes to the law, taking account of the current financial
and economic situation.”
Drop in drink drive casualties
The Department for Transport has published provisional
statistics on road accidents reported to police involving drinking and
driving in Great Britain in 2009, which show a reduction in the numbers
of killed and injured as a result of drink driving compared with the
previous year. The figures show that:
Fatalities resulting from drink and drive accidents fell by 5%
from 400 in 2008 to 380 in 2009, whilst seriously injured casualties
fell by 9% from 1, 620 to 1,480. Slight casualties resulting from drink
drive accidents fell by 8% from 10,960 to 10,130. Total casualties fell
by 8% from 12,990 to 11,990
Fatal accidents remained unchanged from 2008, remaining at 350
for the second year in a row. Overall drink and drive accidents fell by
7% from 8,620 to 8,050
Rise in number of petrol stations selling alcohol
The reduction in drink drive casualties was achieved despite a
growth in the number of petrol stations licensed to sell alcohol in
England and Wales. Sales of alcohol from petrol stations have been a
recurrent issue in the alcohol policy debate for some time. Alcohol
control advocates have always argued that such sales are inappropriate
given the obvious incompatibility of drinking with driving. While
English and Welsh licensing law normally prohibits the granting of
alcohol licences to garages and petrol stations, there is a get-out
clause in the legislation which permits such premises to sell alcohol so
long as their ‘primary purpose’ is not the selling of petrol. The
practice of setting up convenience stores at petrol stations has
permitted the proprietors to claim that it is the store which is the
primary activity, with petrol sales being of secondary importance.
A survey undertaken by Alcohol Concern Wales found that a
third of petrol stations in the principality were licensed to sell
alcohol, with two of the premises licensed to sell alcohol 24 hours per
day.
Alcohol Concern Cymru makes the following recommendations:
- It should be a mandatory requirement that drink-drive
warnings be displayed at the point of sale at all petrol stations where
alcohol is also available for purchase. Such warnings would serve to
support ongoing awareness-raising campaigns concerning the dangers of
drinking and driving
- It should be a condition that any petrol station applying
for an alcohol license must be able to demonstrate that it will either
buy-in, or provide themselves, thorough training for staff on
responsible alcohol sales practices
- A review of the effectiveness of bans on alcohol sales from
petrol stations, and alternative measures undertaken in other countries,
should be undertaken to inform discussions about the appropriateness of
equivalent measures being implemented in England and Wales
- In recognition of the growth of alcohol as a public health
issue, and in order to enable licensing authorities to properly address
this, the protection and improvement of public health must be
established as a fifth criterion within the Licensing Act 2003 for
assessing license applications, including those from petrol stations
- The drink-driving blood alcohol limit in England and Wales
should be reduced from 80mg/100ml to 50mg/100ml, in line with the North
Review, on the grounds that drivers are more likely to be involved in an
accident the higher their blood alcohol level. This should be
accompanied by greater publicity on penalties and highly visible
enforcement.
Top of pageMajority of Britons support better alcohol labelling and higher age limit
A new opinion poll* has found strong support for the improved
labelling of alcohol products, with 82% of the public believing that
alcohol manufacturers should be required to provide detailed information
about the number of alcohol units and calories contained in all
alcoholic drinks. This high level of support was closely matched across
the UK, across all age groups and across supporters of all political
parties, with 85% of Conservative and 82% of Labour and 84% of LibDem
voters supporting the measure. Those aged 18-34 and those over 55 years
both gave a strong thumbs up to clearer labelling on alcohol.
A smaller majority (57%) of those questioned also favoured raising the legal age at which people can buy alcohol from 18 to 21.
However, there is much less public support for setting a
minimum price for each unit of alcohol, opinion being divided 45% in
favour, 44% opposed, with 11% undecided.
There was a clear majority against banning supermarket offers
on alcohol such as ‘buy one get one free’ and ‘three for the price of
two’. The figures were 41% in favour, 51% opposed with 8% undecided.
The opinion poll was carried out by YouGov for the Faculty of
Public Health. Other public health policies with strong public support
included making two hours of games or sport each week compulsory in all
schools, a ‘traffic light’ system of food labelling, banning anyone from
smoking in a car carrying children, and banning TV advertisements
before 9pm for ‘junk foods’.
The Faculty of Public Health commissioned the survey to help
inform the Coalition Government’s new public health strategy, and, in
particular, the White Paper on public health expected later in the year.
*Healthy Nudges: when the public wants change and politicians don't know it
Faculty of Public Health, 2010
Top of pagePeople dependent on drugs or alcohol who refuse treatment could lose their welfare benefits
The Home Office is considering withdrawing benefits from people who
are dependent on alcohol or other drugs who refuse the offer of
treatment, while exempting them from the requirement to seek work if
they do undergo a treatment programme.
The idea is one of a range put forward in a consultation paper
on the Coalition Government’s Drug Strategy for England, Wales and
Scotland.
The same idea was put forward by the previous Labour
Government as part of the Welfare Reform Bill, introduced into the House
of Commons by the then Work and Pensions Secretary, James Purnell. The
rationale of the measure is also essentially the same for both
Governments – using the benefits system to provide incentives for people
dependent on drugs, including alcohol, to overcome their problems and
to re-engage with the labour market.
A strong prompt for such an initiative is provided by the high
number of people who receive incapacity benefit, a weekly payment for
people who become incapable of work through illness or disability while
under State Pension age. Figures from the Department of Work and
Pensions show that in 2008, there were over 2.6 million people claiming
incapacity benefits, of whom nearly 54,000 were claiming because of
alcohol dependence and 51,000 because of drug dependence.
The new consultation document asks people for their views in
regard to whether more use should be made of the potential to use the
benefit system to offer claimants a choice between:
a) some form of financial benefit sanction, if they do not take action to address their drug or alcohol dependency; or
b) additional support to take such steps, by tailoring the
requirements placed upon them as a condition of benefit receipt to
assist their recovery (for example temporarily removing the need to seek
employment whilst undergoing treatment).
The proposal to withdraw benefits was immediately attacked by
Martin Barnes, Chief Executive of DrugScope, who said he “seriously
questioned” whether linking benefit sanctions to a requirement to
undergo medical treatment was either fair or effective.
He told BBC Radio 4’s Today programme there was no evidence
that such an approach would for work for a “particularly vulnerable and
marginalised group”.
“Also, we have to bear in mind that under the principles that
are enshrined in the NHS Constitution, medical intervention should be
therapeutic, consensual, confidential - and I just don’t see that’s
compatible with using the benefits system to require people to undergo a
complex form of drug treatment intervention,” he added.
Simon Antrobus, Chief Executive of Addaction, was also
critical. He said that while getting more people into drug treatment was
always a good thing, attempting to force them into that process by
taking away their benefits would be a mistake as it could increase their
chances of turning to crime to find an alternative income.
The previous Labour Government’s similar proposals were
attacked on the same basis. Then, the Royal College of Psychiatrists and
the civil rights lobby group ‘Liberty’ protested that the proposals
amounted to a gross intrusion into privacy and jeopardised patient
confidentiality, as well as being based on a “fundamentally flawed”
understanding of the nature of drug dependence.
In a briefing on the Welfare Reform Bill to the House of
Lords, the Royal College and Liberty stated that the proposals would
“discourage many problem drug users from applying for benefits and may
mean a number of people will withdraw from the system to ensure that
their dependency does not become public. Many people dependent on drugs
hide the problem from their friends and family and, indeed, do not even
admit their addiction to themselves. Imposing what, in effect, amounts
to forced treatment also shows a failure to understand the fundamental
nature of addiction and the method by which it is treated. These
provisions are likely to act as a further barrier to employment; may
increase the risk of social exclusion; and risk increasing crime rates
and entrenching the cycle of dependency.”
However, these views were themselves regarded as questionable
by others in the field. This journal commented that arguments about
patient confidentiality and alcohol and drug dependents being in denial
were strange ones, given that the question arose in relation to people
claiming benefi ts precisely on the basis of a medical diagnosis of
alcohol or drug dependence. And forcing people to confront their
dependence on alcohol and other drugs and to do something constructive
to overcome the problem was normally accepted as a legitimate, indeed
indispensable, element of the social response to alcohol and drug
dependence.
In the criminal justice system, for example, the return of the
driving licence to drink drive offenders with a serious alcohol problem
was conditional upon their providing convincing evidence to the
authorities that they had overcome their problem and were fit to drive.
The same principle of conditionality applied in workplace
alcohol and drug programmes, which normally offered alcohol or drug
dependent employees a hobson’s choice between agreeing to overcome their
dependence by, for example, undergoing a treatment programme, or
accepting normal discipline, which would often mean being fired. Far
from being attacked as counterproductive intrusions into privacy, likely
to entrench dependence and bring about relapse, workplace programmes
were actively promoted as highly desirable responses to alcohol and drug
problems. Indeed, in one of its major reports on alcohol, the Royal
College of Psychiatrists itself claimed that “in companies where such
policies exist and are genuinely operated, the extra motivation provided
by the opportunity to remain employed greatly enhanced treatment
outcome.”
On the face of it, it was difficult to see why the proper
approach to treatment for dependence should take not just different, but
exactly opposite forms in the employed compared with the unemployed.
Top of pageAlcohol: No Ordinary Commodity New edition
Seven years after the original publication of the book that has come
to be regarded by many in the public health community as the standard
manual for alcohol policy interventions at the local, national and
international levels, an international group of alcohol experts has just
published a revised and expanded edition of Alcohol: No Ordinary
Commodity - Research and Public Policy.
The 15 alcohol scientists who compiled the book’s findings
represent the world’s leading authorities on how evidence informed
alcohol policy can better serve the public good by reducing the burden
of disease and disability caused by the misuse of beverage alcohol.
The second edition of the book was officially launched in July
at a meeting at the Royal College of Physicians, sponsored by the
Society for the Study of Addiction.
According to lead author Professor Thomas Babor from the
United States, alcohol is one of the most prominent causes of health
problems in the European Union, accounting for more death and disability
than tobacco, obesity, high blood pressure, illicit drugs and a variety
of other health risk factors. In England, it is estimated that 10
million adults drink above safe limits. Alcohol-related admissions in the
UK between 2004 and 2009 increased from 644,000 to 945,000, and liver
disease deaths have increased by 12% in the last three years.
Babor argues that two things need to happen to reduce
alcohol’s adverse impact, both locally and globally. “First, we need to
recognize that alcohol is no ordinary commodity. Second, we need to look
at effective alcohol policies supported by scientific evidence. Our
book reviews the scientific literature on 42 strategies and
interventions used around the world to prevent alcohol problems,” he
said.
“Interventions with the most empirical support include alcohol
taxes, drunk driving laws, age restrictions on alcohol purchases, and
limits on the physical availability of alcohol.”
In
the revised version of the book, the global alcohol industry is singled
out for its role in promoting alcohol availability in developing
countries and its aggressive marketing tactics targeting young adults
throughout the world. According to co-author Professor Sally Casswell
from New Zealand, “The major players in the alcohol industry
consistently oppose effective policies, and then take credit for
supporting ineffective policies like voluntary self-regulation of
advertising and alcohol education programs.”
Alcohol No Ordinary Commodity
research and public policy, second edition
Babor, T et al 2010
Oxford University Press ISBN - 978-0-19-955114-9
Top of pageGovernment 'health watchdog' calls for minimum price of alcohol
A minimum price for a unit of alcohol should be introduced to help
tackle the rise in problem drinking in Britain. This is one of the main
recommendations of the Guidance issued by the National Institute for
Health and Clinical Excellence (NICE) on preventing hazardous and
harmful drinking. The guidance is intended for the NHS but also for
government as a whole, industry and commerce and all those whose actions
influence the population’s attitude to, and use of, alcohol.
The Guidance was welcomed by the Alcohol Health Alliance, the
British Medical Association and other public health practitioners and
advocates, but criticised by representatives of the alcohol industry.
Simon Litherland of Diageo GB said: “Yet again it is disappointing to
see continued support for minimum pricing despite no credible empirical
evidence that it would be an effective measure in reducing
alcohol-related harm.”
Andrew Opie, Food Policy Director at the British Retail
Consortium, said: “It’s too simplistic to say the UK’s alcohol problems
are down to price. Irresponsible alcohol consumption is primarily a
cultural issue that needs to be addressed through education and
information.”
However, the month before the publication of the NICE
Guidance, Sir Terry Leahy, the boss of Tesco, came out in favour of
minimum pricing.
Health Secretary Andrew Lansley also distanced the Government
from the NICE recommendation, saying that ministers instead favoured
banning supermarkets and off-licences from selling alcohol “below cost
price”. Mr Lansley said: “It is not clear that [Nice’s] research
examines specifically the regressive effect on low income families [of a
minimum price], or proves conclusively that it is the best way to impact
price in order to impact demand.”
The NICE Guidance is based on the findings that one in 4 men
and women are currently drinking dangerous amounts of alcohol that are
causing, or have the potential to cause, physical and mental damage, and
that the number of alcohol-related deaths has more than doubled in the
past 16 years, with over 8,000 people dying of conditions such as
alcohol poisoning and liver cirrhosis every year.
NICE argues that introducing a minimum price for alcohol
alongside other measures that make it harder to buy alcohol, like
reducing the number of outlets selling alcohol in a given area or the
days and hours that it can be purchased, will help to save thousands of
lives each year.
Professor Anne Ludbrook, a health economist from the
University of Aberdeen who helped develop the NICE guidance on
alcohol-use disorders, said: “Alcohol is much more affordable now than
it ever has been, and the price people pay does not reflect the cost of
the health and social harms that arise.
“When it is sold at a very low price, people often buy and
then consume more than they otherwise would have done. It is a dangerous
pattern which many people have unknowingly fallen into.”
Professor Ludbrook, who was speaking at the guidance launch in
London, added that there are over 100 studies showing that increasing
the price of alcohol will reduce levels of drinking and the harms
associated with drinking.
“Increasing the price is likely to be the most cost-effective way of reducing drinking,” she said.
Economic modelling work for the guidance was carried out at
the University of Sheffield, where researchers found that introducing a
minimum price of 50p per unit reduced levels of alcohol consumption by
10.3 % among harmful drinkers and 3.8 % among moderate drinkers.
But
Professor Mike Kelly, Director of Public Health at NICE, stressed that
it was not down to the Institute to set a price for a unit of alcohol.
“What we do is review the evidence not specify a minimum
price. The decision is one for Parliament and for ministers to take,” he
said.
Professor Kelly added: “Alcohol misuse is a major public
health concern which kills thousands of people every year and causes a
multitude of physical, behavioural and mental health problems.
“What’s more, it costs the NHS over £2 billion annually to
treat the chronic and acute effects of alcohol - this is money that
could be spent elsewhere to treat conditions that are not so easily
preventable.
“This
is a big-ticket issue and the recommendations on minimum pricing chime
very well with those made by the Conservatives in their working paper.
The Chief Medical Officer and the Scottish Government have all been
moving in this direction, and the signals from the Department of Health
look quite promising.” Professor Sir Ian Gilmore, President of the Royal
College of Physicians and Chair of the Alcohol Health Alliance UK, has
long been an advocate of minimum pricing and welcomed NICE’s careful and
systematic review of the evidence for minimum pricing.
‘It is reassuring to hear these recommendations from NICE.
Week in, week out I see the burden of alcohol misuse in my clinics.
There is not a family out there that has not been affected by it. “
Elsewhere, the guidance addresses the problem of
alcohol-misuse from an individual level with recommendations to screen
young people aged 16 and 17 and adults for alcohol problems.
Professor Eileen Kaner, Chair of the Development Group and a
public health researcher at the University of Newcastle, said: “The
guidance calls for GPs and other public service workers to ask some
simple questions about people’s drinking habits as early as possible if
they ever suspect that there may be a problem.
“Just 5-10 minutes of brief structured lifestyle advice is
sufficient to make changes in drinking behaviour. This can help make
people aware of the potential risks they are taking or harm they may be
doing at an early stage.”
Top of pageAlcohol and obesity mix to create deadly liver disease cocktail
Drinkers who are overweight are much more likely to develop deadly
liver disease, according to scientists from the University of Glasgow.
In a study conducted by Dr Carole Hart of the Section of Public Health
and Health Policy, scientists examined whether a raised Body Mass Index
(BMI) and alcohol consumption acted together to increase the risk of
liver disease. They found that the combination of drinking and being
overweight or obese led to a much greater risk of liver disease than
either alcohol consumption or overweight/ obesity alone.
Meanwhile, another Glasgow University research team found that
virtually the entire adult population of Scotland are dangerously at
risk of illness or premature death as a result of unhealthy lifestyles.
Obesity and alcohol
Overweight (BMI of 25 to <30) men had higher death rates
than normal weight men while obese men (BMI of 30 or more) had a
five-fold increase in the risk of dying of liver disease.
Drinkers of 15 or more units a week of alcohol in any BMI
category, and obese drinkers had higher risks of liver disease mortality
than normal weight non-drinkers. Risks increased as BMI and alcohol
levels increased. Obese men drinking 15 or more units a week had almost
19 times higher risk of dying of liver disease.
Dr Hart added: “We may need to consider recommending lower ‘safe’ limits of alcohol consumption for people who are overweight.”
The study was published in the British Medical Journal.
Hart, C et al - Effect of body mass index and alcohol
consumption on liver disease: analysis of data from two prospective
cohort studies. BMJ, 2010, doi - 10.1136/bmj. c1240
Scots living dangerously
In the second study, researchers examined the Scottish Health
Survey and found that nearly the whole adult population (97.5%) reported
to have at least one of five main behavioural risk factors for
ill-health - tobacco use, alcohol consumption, poor diet, physical
inactivity, overweight and obesity. 55% of the sample reported having
three or more risk factors, and nearly 20% reported having four or all
five risk factors. The most important determinants for having four or
five multiple risk factors were low educational attainment which
conferred over a 3-fold increased risk compared to high education, and
residence in the most deprived communities (relative to least deprived)
which had greater than 3-fold increased risk.
The study was led by Dr David Conway, who commented that the
true picture could be even worse, due to respondents putting a positive
spin on their behaviour.
The Scottish results are similar to those in a recent survey
of English behaviour, and suggest both nations are more unhealthy than
many European countries, and North America.
Scotland has earned a reputation as the ‘sick man’ of Europe
in recent years. The country has higher death rates from cancer, heart
disease and stroke than anywhere else in the UK, and among men, Scotland
has more than twice as many alcohol-related deaths than England.
Scots Drink 24% more than English and Welsh
The reason alcohol features so large in the unusually high
mortality rate in Scotland is that the Scots drink almost a quarter as
much again as the English and Welsh. Figures based on alcohol sales data
and analysed by NHS Scotland show that the drinking Scots population
aged over 16 consume 13.5 litres of pure alcohol per annum, compared
with 11.1 litres in England and Wales. Expressed in terms of alcohol
units, Scots aged 16 and over purchased 1190 units in 2009, equivalent
to 22.9 units per person per week. When the proportion of Scots who do
not drink alcohol are taken into account, consumption per drinker
increases to 25.9 units per week, almost five units per week more than
the recommended weekly maximum for men. The equivalent English figures
are 18.4 and 21.4 units.
Other highlights from the report are that:
- More than twice as much alcohol was purchased in Scotland
from the off trade as from the on trade, with off sales continuing to
increase and on sales to decline
- The price per unit of alcohol was between two and three times as high in the on-trade as in the off trade
- The average price per unit of alcohol in 2009 was 72 pence in Scotland, compared with 71 pence in England and Wales
However, in Scotland 77% of all drink was sold from shops and
supermarkets at less than 50p a unit, 51% at 40p or less and 16% at 30p
or less
- A quarter of cider was sold for less than 20p per unit, 48%
at less than 30p per unit and three-quarters at less than 40p per unit
- More than half (5%) of beer was sold at 40p per unit and 59% of vodka was sold for less than 35p per unit.
The study was published in the online journal BMC Public Health
Conway, D et al – Is the Scottish population living dangerously?
Prevalence of multiple risk factors: the Scottish Health Survey 2003;
BMC Public Health 2010, doi: 10.1186/1471- 2458-10-330
Top of pageFree NHS treatment to be pared back by 2020, says new report
The continued unhealthy lifestyles of the British population,
including the over -consumption of alcohol, mean that the NHS may have
no choice other than to pare back some of the free treatment that we
currently receive and penalise unhealthy behaviours, according to a new
report commissioned by the Friends Provident, a company originally
founded in 1832 to alleviate the hardship of Quaker families facing
misfortune.
The report, Visions of Britain 2020, conducted with the Future Foundation, condemns Government health campaigns as failing to persuade individuals
to live healthier lifestyles. However, in contrast, legislation to curb
smoking has been hugely successful. As a result, Visions of Britain
argues that penalties are a likely solution to help relieve the current
strain that unhealthy behaviours place on the NHS. The report predicts
that it is only a matter of time before similar legislation to the
smoking ban will be imposed to curb obesity. It also suggests that
minimum pricing of alcohol is also on the way. The main conclusion of
the report is that the rising cost of the NHS will necessitate a focus
on preventative treatment. Given the failure of persuasion the
government is more likely to legislate – curbing a range of behaviours
to force healthier outcomes and reduce demand on the NHS. A voluble ‘New
Puritan’ group will support these measures, something that will
encourage legislators. Secondly, private companies will become more
involved in the NHS than they are now. Their role may be in creating
greater competition to reduce costs (for example through out-sourcing
treatments). Thirdly, citizens will have to take greater responsibility
for their own health as less treatment is provided. This may take the
form of paying for treatments that are currently offered for free, or
greater take-up of private medical insurance. It may also mean the
provision of individualised preventative measures.
That the NHS will be reduced in terms of scope is almost
inevitable. One of the experts consulted for the report, Dr Sarah Brewer
said:
“Something has to give. One scenario is that people may well
end up being charged for certain treatments or denied certain
non-essential treatment, particularly if their unhealthy lifestyle was a
contributory factor. The other scenario is the withdrawal of many free
treatments.”
The report says that experts and consumers agree that
unhealthy lifestyles should be penalised when it comes to treatment,
with almost half (44%) supporting the introduction of a ‘fat tax’ and
over a third (38%) agreeing that the NHS should not prioritise people
who fail to look after their health. But, despite this apparent support
for penalties, we still readily admit that we aren’t leading healthy
lifestyles. Less than one in five claim to adhere to Government
guidelines on calorie intake (18%) and exercise (19%). Just one in three
(34%) follow official guidelines on alcohol consumption. Experts claim
this apparent ambivalence to today’s guidelines will force Government to
take a new, prescriptive approach.
Trevor Matthews, Chief Executive Officer of Friends Provident, said:
“Our report reveals that there will be a fundamental and
permanent change in the provision of free healthcare in the next decade.
The study identifies a disconnect between our aspirations for
healthcare, and our behaviour.
We all need to adopt healthier lifestyles or else risk being faced with penalties in the years ahead.”
“We all know that we should follow a healthy low fat diet, eat
at least 5-a day etc. But how many actually do anything about it?
Unless an unhealthy diet and lifestyle is penalised in some way no-one
will change.”
As well as penalties, experts consulted for the report predict
that a range of treatments will no longer be free in 2020, including:
- IVF and fertility treatment
- Subsidised dental treatment
- Obesity surgery and drugs
- Dementia treatment
- Complementary therapies
Dr Patricia Macnair, a medical practitioner consulted for the report said:
“There will be less and less money coming from the state to
help people maintain their health, so something needs to give, and
increasingly it will be up to us to take responsibility for our own
health. In addition there will be endless paring away in subtle degrees
at the funding for all sorts of different treatments - although this may
be subtle the changes will be profound.”
Top of pageScottish doctors say 'Minimum pricing for alcohol only credible option available'
Commenting in advance of a cross party meeting of Scottish
politicians to discuss areas of consensus on alcohol policy, Dr Brian
Keighley, Chairman of the BMA in Scotland, said:
“I am pleased that the political parties are coming together
to discuss alcohol policy but it will not be possible to reach consensus
until public health is put before party politics.
“So far, none of the major opposition parties have brought
forward credible alternatives to minimum pricing, which modelling has
shown could save hundreds of lives, reduce alcohol related illness and
harm and cut alcohol consumption by around 5%.
“The NHS is buckling under the pressure of having to pick up
the pieces of Scotland’s drinking culture which has largely been driven
by cheap, strong alcohol.
“Consensus must be based on evidence-based policies and the
BMA calls on the political parties to support minimum pricing or present
an equally effective policy.”
Source: BMA Scotland Public Affairs Office
Top of pageMore than 100 children a week contact Childline with worries about their parents' drinking or drug use
Worries about parental alcohol or drug use account for just under one
third of all calls from children to Childline, the helpline provided by
the NSPCC, concerning parental behaviour. Some of the calls are from
children as young as five years old.
The figures are derived from an analysis of the calls made to
the helpline in the year between April 2008 and March 2009. In the year,
4,028 children (21% of all callers [18,983] with a concern about a
significant other) were counselled by ChildLine with concerns about
their parents’ alcohol misuse. This number consisted of 2,867 girls and
1,161 boys. Alcohol problems were the largest concern mentioned
regarding parents.
In addition, 2,284 children (12% of all callers about a
parental drug misuse concern) were counselled by ChildLine with concerns
about their parents’ drug misuse. This number consisted of 1,639 girls
and 645 boys.
Calls to ChildLine from children who talked about parental
alcohol and drug misuse represent 4 per cent of all (156,729) children
counselled by ChildLine. Alcohol and drug concerns make up 33% of the
total concerns given by children for their parents.
Altogether, the NSPCC helpline received more than 150,000
calls during the year. Although concerns about parental drug and alcohol
use made up only a small percentage of them, the head of ChildLine, Sue
Minto, said: “The fall-out from parental drug and alcohol abuse is a
ticking timebomb in many children’s lives. It is vital these children
are helped before lasting damage occurs.”
Ms Minto said that some children told ChildLine about their
parents’ severe mood swings, episodes of violence and emotional
instability.
Some said their parents were regularly sick and that caring
for them had affected their schooling, or prevented them forming
friendships with other children.
Ms Minto added that children affected by parental alcohol and
drug problems were at more risk of harm than other children and ways
needed to be found of helping them sooner.
“But we must also remember they can be fiercely protective of their parents,” she added.
“One young girl’s first comment to the ChildLine counsellor was: ‘I don’t want anything to happen to my mother’.”
Key findings
Children who were counselled by ChildLine about their parents’
alcohol and drug misuse often also talked about their experiences of
physical abuse, family relationship problems, neglect and sexual abuse.
Children talked about being worried, frightened and confused by their parents’ alcohol and drug misuse.
Children often took on a caring role and saw it as their
responsibility to solve their parents’ alcohol and drug misuse problems.
Throughout this report we use the terms “parents” and
“parental” interchangeably to mean either/both parent(s), carers and
others with parental responsibility. This person is usually the child’s
mother or father.
Almost twice the number of children were counselled by ChildLine about their parents’ alcohol misuse than about drug misuse.
Children who were cared for by habitual alcohol or drug users
could be inducted to rely on alcohol and drugs in order to cope with
life’s challenges.
Children talking to ChildLine about parental alcohol and drug misuse.
How children describe the problems:
“My mum drinks all the time and leaves me alone lots of
times. I feel scared and lonely. I look after my mum when she drinks. I
put her to bed. Mum shouts and hits me; she is worse on a Friday. I
don’t want to feel pain. I want to die.” (Angel, aged 10)
“My mum and dad don’t feed me. I have to steal money from
people so I can get food. When I cry, Mum and Dad hit me. They are
drinking all the time. I can’t tell anyone because I am scared my mum
and dad might do something and hit me.” (Jonathan, aged 10)
“I live with my mum and her boyfriend. They both take drugs. I
am worried they might die. My mum makes tea and then smokes drugs. She
shouts at me. I feed my baby sister. I see my dad every two months and
he takes drugs.” (Sarah, age unknown)
“I want to run away from home. Both my parents use drugs and
alcohol and they fight. My mum brings men home all the time. I really
hate their way of living and would like to get away. I did try to get
away with my sister but my sister is partly disabled so she couldn’t
keep up and we came back home. I am really unhappy to be left alone in
the house all night.” (Sanjay, aged 14)
Top of pageThe alcoholic beverage industry's use of new media 'a cause for concern'
The alcohol industry’s use of new media channels to market alcohol is
a clear cause of concern due to their youth appeal, relative lack of
regulation and the sheer volume of promotional messages.
This is the main conclusion of an investigation into the use
of new digital media undertaken by the Institute for Social Marketing at
Glasgow University for Scottish Health Action on Alcohol Problems
(SHAAP), the body established by the Scottish Medical Royal Colleges and
Faculties to raise awareness about the high levels of alcohol harm in
Scotland and to advocate for evidence based solutions to reduce this
harm.
New media are digital forms of communication such as the
internet, mobile devices, electronic games, blogs and podcasting. These
media are fast-growing and rapidly evolving channels for marketing
communications, which represent a departure from traditional forms of
media (e.g. print, radio and television). New media offer advertisers a
range of innovative and powerful channels to interact with consumers.
These channels (e.g. text messages, social networking or
blogging sites) are recognised as having particular appeal to young
people. These channels also include e-mail newsletters and promotions,
online competitions and downloadable features such as branded MSN icons,
wallpapers, cocktail recipes, barfinders and nightlife guides. The
report examines the ways in which alcohol producers can use these
diverse and increasingly sophisticated new media channels as a powerful
means to interact and engage with consumers.
However, the report comments that a key point to note is that
new media marketing is not simply replacing traditional alcohol
marketing channels; rather it is an extension of alcohol marketing
activities. Alcohol brand websites, for example, allow alcohol producers
to extend the reach of expensive television advertising campaigns by
providing a facility for these adverts to be viewed online. These
television adverts can then also be found on video sharing sites such as
YouTube, even if they have been banned by the ASA from television
broadcast. While alcohol producers may not upload these video clips to
YouTube, there is no need for them to do so since users do this for
them. It is a matter of concern that television adverts streamed on
YouTube for alcohol brands are frequently cited as being most popular
with those who are underage (ie. 13-17 years).
Viral marketing campaigns are used by alcohol producers to
facilitate the adoption of brand values by consumers who will, in turn,
distribute these messages within their social networks. Consumers are
encouraged to upload their own photographs, stories and comments to
alcohol brand websites and social networking sites. There is
considerable evidence of consumers developing their own alcohol
brand-related pages and groups on social networking sites, using branded
images, and doing so in a way which celebrates irresponsible, excessive
and underage consumption.
Further, much of the material contained within alcohol brand
websites and social networking sites contravenes the spirit of the CAP
Codes on alcohol advertising by appealing to youth, social success,
masculinity and femininity. Indeed, viral marketing campaigns are
inherently linked to social success and social acceptance since they
thrive upon the existence and development of social networks. The 2008
Alcoholic Drinks Advertisements Compliance Survey by the ASA reported
that alcohol advertising was 100% compliant with the regulations.
However, this may say more about the regulations than alcohol
advertising using new media channels; brand websites and pages on social
networking sites are not currently covered by CAP Codes.
The extensive use of new media to market alcohol represents a
proliferation of alcohol branded messages directed towards consumers.
The cumulative impact of such an extensive range of marketing
communications has the potential to contribute to the normalisation of
alcohol consumption, while responsible drinking messages are lost in
amongst the volume of exposure to other messages. Thus, both the volume
and content of alcohol advertising must be addressed. The current system
of regulation continues to rely upon self-regulatory codes, which focus
primarily on content rather than volume and exposure to alcohol
advertising.
Recommendations
- Based on the ISM report, SHAAP calls on the four governments of the UK to:
- Subject alcohol brand websites to CAP Codes and all online
alcohol adverts to a pre-vetting process in keeping with broadcast
adverts with immediate effect.
- Move towards ending self-regulation - regulation should be independent of the alcohol and advertising industries.
- Move towards a complete ban on alcohol promotion on social networking sites.
- Involve young people in the process of regulation given the rapidly evolving nature of new media.
Brooks, O, 2010: ‘“Routes to Magic” – The Alcoholic Beverage
Industry’s use of new media in alcohol Marketing’; Institute for Social
Marketing, University of Stirling and The Open University
Top of pageRowntree reviews ethnicity and alcohol
Individuals from certain minority ethnic groups have historically
reported lower rates of drinking and fewer people from minority ethnic
groups present to alcohol services for problems related to alcohol
misuse.
However, some research has shown that patterns of drinking in
second generation minority ethnic groups may alter, becoming similar to
the drinking habits of the general population, whilst the drinking
patterns of the first generation minority ethnic groups continue to
resemble those from their country of origin. A new report from the
Joseph Rowntree Foundation, ‘Ethnicity and alcohol: a review of the UK
literature’, looks at whether rates of alcohol use are actually changing
among ethnic groups, and examines the possible impact of changes in
drinking behaviour on the nature and level of support services required.
Key points arising from the report are:
- Most minority ethnic groups have higher rates of abstinence
and lower levels of drinking compared to people from white backgrounds.
- Abstinence is high amongst South Asians, particularly those
from Pakistani, Bangladeshi and Muslim backgrounds. But Pakistani and
Muslim men who do drink do so more heavily than other non-white minority
ethnic and religious groups.
- People from mixed ethnic backgrounds are less likely to
abstain and more likely to drink heavily compared to other non-white
minority ethnic groups.
- People from Indian, Chinese, Irish and Pakistani backgrounds on higher incomes tend to drink above recommended limits.
Over time generational differences may emerge:
- Frequent and heavy drinking has increased for Indian women and Chinese men.
- Drinking among Sikh girls has increased whilst second generation Sikh men drink less than first generations.
- People from some ethnic groups are more at risk of alcohol-related harm:
- Irish, Scottish, and Indian men, and Irish and Scottish
women have higher than national average alcohol-related deaths in
England and Wales.
- Sikh men are over-represented for liver cirrhosis.
- People from minority ethnic groups have similar levels of
alcohol dependence compared to the general population, despite drinking
less.
- Services are reportedly not responsive enough:
- Minority ethnic groups are under-represented in seeking treatment and advice for drinking problems.
- Problem drinking may be hidden among women and young people from South Asian ethnic groups in which drinking is proscribed.
- Greater understanding of cultural issues is needed in developing mainstream and specialist alcohol services.
A copy of the report can be downloaded from: http://alcoholreports.blogspot.com/
Top of pageSt Mary's Alcohol Health Work Project named HubCAPP project of the year
The Alcohol Health Work Project at St Mary’s Hospital, Paddington,
has been named as the winner of the inaugural ‘HubCAPP Project of the
Year’ 2009, an award which ‘recognised the project that has had an
impact on the health and wellbeing of the community’.
The HubCAPP (Hub of Commissioned Alcohol Projects and
Policies) awards, launched in 2009, were shortlisted and voted on by
members of the public and professionals working in the field. The Hub
focuses on identifying and sharing local and regional practice regarding
alcohol harm reduction and also collects information on needs analysis
and strategic planning.
Alcohol Health work at St Mary’s hospital began in 1988 and
has developed through extensive research and practice, leading to the
appointment of a full-time Alcohol Nurse Specialist (ANS) at St Mary’s
Hospital Trust in 2005.
The team developed the Paddington Alcohol Test (PAT) (available to view here – www.sips.iop.kcl.ac.uk/download.php?id=132),
a clinical tool used to screen patients who present with the top 10
reasons associated with alcohol misuse (including areas such as falls,
collapse, head injury and other medical the relationship between
attendance at A & E and drinking. They refer to this conditions) and
which asks questions about their levels of alcohol consumption.
The Paddington Alcohol Test (PAT) is at the heart of the
Alcohol Health Work Project. Doctors and nurses use PAT to highlight to
the patient as the ‘teachable moment’ (Patton et al, 2004) and aim to
use it advantageously to combat hazardous and binge drinking.
Patients who screen as positive on the PAT are referred on to
an A & E Alcohol Health Work session run by the Alcohol Nurse
Specialist, who sees patients from across the wards as well as A & E
and who has developed alcohol withdrawal management protocols for the
hospital. At this session, the ANS provides a patientcentred assessment
of alcohol issues, discusses the impact of alcohol use with the patient
and provides further information or referral in order to encourage the
patient to reduce their consumption, where appropriate. The ANS can also
give brief advice about drinking and provide alcohol information
leaflets. For every two patients who accept such an appointment, it has
been found that there is one fewer re-attendance at A & E over the
next year.
The Alcohol Nurse Specialist also accepts direct referrals
from other wards in the hospital and provides several key services,
including:
- Alcohol withdrawal management
- A review of St Mary’s alcohol guidelines and protocols
- Advice and support for ward staff
- Psychiatric liaison where dual diagnosis is an issue
- Brief assessment of substance misuse
- Referral to community alcohol services
The St Mary’s team have published their findings extensively
and have also helped to replicate the system in other hospitals across
England
‘The St Mary’s team demonstrate leadership in the field and provide high quality patient care’
‘St Mary’s was the first hospital to do this work and it
has been used as a model for the development of similar services in
other areas’
Professor Robin Touquet, Consultant in A & E Medicine, St Mary’s Hospital
‘We are delighted that St Mary’s work has been recognised.
This highlights the investment happening countrywide with the roll out
of Alcohol Nurse Specialists, many duplicating the St Mary’s model, and
incorporating the Paddington Alcohol Test.’
Don Shenker, Alcohol Concern
‘This project has shown how a moment of crisis can be turned
into an opportunity to help people change their lives for the better.
Every day the work of St Mary’s is making a difference to the lives of
people up and down the country’
HubCAPP, an online resource of local alcohol initiatives
throughout England was commissioned by the Department of Health and is
managed by Alcohol Concern. HubCAPP is also part of the Department of
Health’s Alcohol Improvement Programme and is a sister site of the
Alcohol Learning Centre.
Top of pageBook Review - Tackling Addiction, Pathways to recovery - edited by Rowdy Yates and Margaret S Malloch
Reveiwed by By Dr Amul Patel, Specialty Registrar (ST5) in Addictions Psychiatry, Royal Edinburgh Hospital
‘Recovery’ is currently a topical and debated subject in the
field of addiction. The Scottish Government has embraced recovery in its
latest drug strategy: The Road to Recovery: A New Approach to Tackling
Scotland’s Drug Problem. We may also see a similar move in the UK’s drug
policy following recent change of government. This book’s stated aim is
to contribute to the ongoing debate on recovery with an intention to
inform the way forward for policy and practice in this area.
This is an edited book authored by experienced academics,
researchers, professionals, clinicians, and service users with a broad
range of expertise in addiction, criminal justice, psychology,
psychiatry, service development and management, and sociology. It is a
compilation of themes which emerged from a seminar series at the
University of Stirling which brought together experts to examine various
approaches to recovery and consider the relationship of these
approaches to the broader policy context. Although the content of the
book has a Scottish flavour, the themes discussed are relevant to the
UK. The book is relevant for practitioners, researchers, policy makers
and students in the fields of addiction, social care, psychology, and
criminal justice.
The concept of recovery may have different connotations for
the public, professionals and policy makers. The book begins with a
discussion of various definitions of recovery and emphasises the
importance of individual meaning and the holistic process. It moves on
to describe a brief history of recovery, the new recovery movement and
the emerging evidence base for the approach. It describes a recovery
model by William White in the United States who has suggested three
critical elements: sobriety, improvement in global health, and
citizenship. The model acknowledges the place of treatment in the early
phase of the recovery journey but emphasises much more the social
location of the process. It underscores the need for a paradigm shift
from an acute care model to the long-term approach.
The middle section of the book explores themes on recovery
within projects, women and recovery, and the therapeutic community as a
recovery-oriented treatment pathway. The chapters on recovery-oriented
integrated systems in North West England and the Ley community, an
addiction therapeutic community in Oxfordshire, give a useful insight in
to how such systems can be commissioned and provided. The later
chapters highlight implications for practitioners and also discuss the
concept of recovery in the context of UK drug policies and criminal
justice system. The book argues that in recent years, evidence has been
used selectively to explain drug use as a crime problem rather than
public health problem. It also examines the extent to which drug
treatment and testing orders contribute towards promoting recovery. The
longest chapter of the book explores the experiences of individuals ‘in
recovery’, which I found fascinating. It instils optimism that
individuals do recover from chronic and relapsing nature of addiction.
This, along with its inclusion of hard-to-come-by information on women
in recovery, makes the book unique.
Though the book covers disparate themes, its repeated emphasis
on the definition of recovery is evident throughout. It is concise and
does not intend to be comprehensive. It provides a starting point on the
subject of recovery in addiction. It is easy to read but the style and
content of chapters vary according to the theme and the background of
the author. The discussion on the limitations of the recovery approach
is sketchy and it does not appear to adequately acknowledge the process
of recovery in non-abstinence based models.
The book does appear to succeed in its critique of current UK
drug policies and criminal justice system which are described as
somewhat less than favourable to the recovery oriented approach. It
contrasts policies based on the public health (harm reduction)
perspective with the person-centred approach of the recovery model and
succeeds in stimulating thoughts on that subject. It is useful in
understanding the recovery standpoint but the reader would have been
benefitted by case examples from professionals’ perspectives depicting
how the process of recovery could be facilitated at grassroot level and
how service users could be helped to be ‘on top’ of the process.
The book aspires researchers to be creative in finding
academically credible ways of studying pathways and models of recovery,
as described by one of its authors: ‘We are riding on a wave of
enthusiasm and optimism at present – it is essential that this is
translated into meaningful change and evidence’.
Tackling Addiction: Pathways to Recovery - Edited by Rowdy
Yates & Margaret S. Malloch, Jessica Kingsley Publishers, 2010.
£22.99 (pb). 192pp. ISBN: 9781849050173
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