Responsibility deal under renewed pressure
Alcohol and health bodies criticise Diageo for funding
programme warning of dangers of alcohol in pregnancy as part of the
Deal, while Health Secretary suggests supermarkets might do more to help
Health Secretary, Andrew Lansley, has written to the leading
supermarket companies, suggesting that they could do more to reduce
aggressive alcohol marketing in their stores. The clear implication is
that they are failing to take the Government’s Responsibility Deal
seriously enough. At the same time, the alcohol and health organisations
that decided to boycott the Responsibility Deal because of alcohol
industry involvement, criticised Diageo for agreeing to fund an
educational programme for midwives on the dangers of alcohol during
pregnancy.
The Responsibility Deal is the name given to the Coalition
government’s attempt to bring together the various industries whose
products are relevant to health issues such as alcohol, obesity and
physical fitness, with the health organisations. The idea is to persuade
the commercial operators to sign up to the process of improving public
health by doing useful things such as improved labelling of food and
drink products. In pursuing this policy, the present government is, in
fact, continuing an initiative begun under the previous Labour
government, when it was known as the ‘Coalition for Better Health’.
However, a number of alcohol and health bodies, including the Institute
of Alcohol Studies and the BMA, decided to boycott the Responsibility
Deal because they thought it gave the alcohol industry too much
influence and was a diversion from ‘evidence-based’ alcohol policy (See Alcohol Alert Issue 1 Spring 2011)
Row over Diageo funding of alcohol and pregnancy programme
Controversy was caused by the announcement that Diageo had
agreed to extend the funding of an education and training programme for
midwives on the dangers of drinking alcohol during pregnancy. The
training programme is being run by the National Organisation for Foetal
Alcohol Syndrome UK (Nofas-UK), the leading health charity in the UK
that focuses on the issue. Susan Fleisher, the Chief Executive of the
charity, said the programme would have huge benefits.
“The thing that’s so fantastic is that they’re helping us with
prevention, we can actually prevent children being born with foetal
alcohol brain damage”, she said. “But it costs money, and thanks to
Diageo we expect we will be educating, in the next three years, 10,000
midwives. Ultimately, if it all goes well, we will reach at least a
million women.”
Anne Milton, the Public Health Minister, supported the
initiative. She said: “Midwives are one of the most trusted sources of
information and advice for pregnant women. This pledge is a great
example of how business can work with NHS staff to provide women with
valuable information.”
However, Vivienne Nathanson from the British Medical
Association said that there were concerns over the scheme and its
funding by Diageo. She said:
“They certainly have a conflict of interest because it’s in
the interest of the drinks industry for people to continue to drink and
it’s in the interest of health for people to drink much less, and
certainly not to drink during pregnancy, or to drink really minimally. I
think the issue for us would be if money is given by the industry, it
must be given to an honest broker, a third party.”
Other alcohol and health bodies joined Labour Party health
spokesmen in opposing the plan, labeling it a ‘smokescreen’ and accusing
the Conservatives of allowing corporations “further influence on public
health policy.”
However, speaking to Alcohol Alert, Susan Fleisher explained
that Diageo began funding the pilot training programme two years ago,
which means it began under the Labour government. The pilot was regarded
as a success, and all that has now happened is that Diageo has agreed
to fund the programme for a further three years. The programme promotes
Nofas-UK’s standard advice on alcohol and pregnancy, which is based on
the official guidance from the Department of Health. This is that,
ideally, women who are pregnant or contemplating becoming pregnant
should not drink alcohol at all, but if they do they should restrict
consumption to a minimum. The programme was reviewed by the Royal
College of Midwives, and the International FASD Medical Advisory Panel.
Ms Fleisher also confirmed that Diageo have no influence over
the content of the training programme, and that Diageo’s logo does not
appear on the published material.
Criticism by the alcohol and health organisations
Commenting on the Nofas- UK programme, Don Shenker, Chief
Executive of Alcohol Concern, one of the organisations boycotting the
Responsibility Deal, said: “It is deeply worrying that alcohol education
is being paid for by the drinks industry, as it is then unaccountable
and not necessarily based on evidence or public health guidance.”
Labour’s health spokesperson John Healey said: “Industry
sponsored initiatives should not be an excuse for stealth cuts to
funding for public health campaigns.”
Professor Ian Gilmore, Chairman of the Alcohol Health Alliance
UK, of which Nofas-UK was one of the founder organisations, none the
less branded the initiative a ‘diversion’ and said, “To really make a
difference, education and information must be backed-up by tougher
action on the price, availability and marketing of alcohol.”
For the IAS, Katherine Brown said:
“It is unnerving to see money being accepted from the drinks
industry to fund alcohol education programmes when there is a direct
conflict of interest between its profits and public health objectives.
“In funding this initiative, Diageo may be seen as a
‘responsible’ producer but we must also be reminded that the
organisation is an influential and active opponent of effective alcohol
policies such as minimum pricing, licensing restrictions and raising the
drink drive limit.
“Foetal Alcohol Syndrome Disorder is an emotive subject, but
so is domestic violence, sexual assault, homicide, homelessness, people
dying from liver disease… all of which are exacerbated by the increased
affordability and availability of alcohol.
“Evidence shows that this type of targeted activity is not an
effective means of reducing levels of alcohol harm unless it is backed
up by population-wide measures that tackle price, availability and
promotion of alcohol.
“This PR initiative can be seen as a cynical distraction from
the huge drink problem this country faces at present, and a worrying
sign that government is hand in glove with industry.”
Supermarkets failing the Responsibility test?
It now seems that Health Secretary, Andrew Lansley, may
himself have started to become impatient with the progress of the Deal
in regard to sections of the alcohol retail sector. Mr Lansley has
written to Tesco, Sainsbury’s, M&S, Morrisons, The Co-operative
Group, Waitrose and Aldi, calling on them to do more to back the Deal,
which was launched in March. The one exception was Asda, which, shortly
after the strategy was announced, revealed it was removing front of
store alcohol displays in its stores.
Interestingly, the letter was reported in the trade press as
being a stiff rebuke to the recipients for not doing more. While the
actual text of the letter reads more like friendly encouragement, (see full text)
the implication between the lines is that the supermarkets are failing
to do enough, quickly enough. This impression was confirmed by the
briefings given to the media. The Department of Health told The Grocer
magazine there was “increasing frustration from ministers” that major
retailers had failed to take sufficient voluntary action on the back of
its strategy to tackle obesity and alcohol abuse. Speaking to The
Grocer, a spokeswoman at the Department of Health said that there was
“increasing frustration from ministers that other supermarkets aren’t
getting on board with similar pledges. I’d imagine Asda is not all that
happy about being the lone commercial ranger either”.
She said Mr Lansley would also be writing to Asda “thanking them for their efforts”.
A spokesman for Asda said: “In April we made a decision that
we would take the lead because we thought it was the right thing to do.
For us it was the next step in a package of measures we began a couple
of years ago when we began looking at one or two issues around the way
alcohol was sold and displayed. We will stay close to the Government on
this issue”.
The British Retail Consortium said it was perplexed by the Government’s attack.
A spokesman said: “This is a surprise. All the major retailers
are actively pursuing the pledges they agreed with the Government in
the Public Health Responsibility Deal. They deserve credit for providing
customers with unit labelling, preventing underage sales of alcohol and
funding the Drinkaware campaign exactly as they said they would”.
For the IAS, Katherine Brown took a different view. She said:
“This latest stage of the Responsibility Deal debacle comes as no
surprise and is exactly why we refused to sign up in the fi rst place.
Relying on industry to adhere to voluntary pledges that could threaten
their bottom line is never going to work. The Government knows this; it
has commissioned reports that show the failings of self-regulation and
seen evidence from the Health Select Committee.
“Tackling cheap booze in supermarkets should be a key priority
for this Government if it is serious about reducing alcohol harm. This
can only be achieved through increased regulation that demands industry
compliance; voluntary agreements are not the answer to the nation’s
alcohol problem.
“We don’t have time to waste saying ‘I told you so’, we need
the Government to act now and produce a robust national alcohol strategy
based on evidence of what works.”
Top of pageConservative MP introduces Bill to restrict alcohol marketing
Conservative MP, Dr Sarah Wollaston, has introduced a Ten
Minute Rule Bill in the House of Commons to toughen regulations on
alcohol advertising, along the lines of the French Loi Evin. Here, she
explains the Bill.
Since arriving in Parliament, I have been campaigning for an
end to our binge drinking culture and I introduced a Private Member’s
Bill at the end of March to prevent alcohol being marketed to children.
About 13 young people will die this week as a result of
alcohol, and about 650 this year. Nearly a quarter of all deaths of
young people aged between 15 and 24 are caused by alcohol. That is two
every day - far more than are killed by knife crime or cancer - yet this
tragic loss from alcohol attracts far less by way of a response. These
totally avoidable deaths are just the tip of the iceberg and do not
begin to represent the full scale of the harm caused by alcohol to
children.
Alcohol blights lives, with criminal records as a result of
violent and antisocial behaviour, and it results in educational failure.
Regretted and unprotected sex raises the risk of unwanted pregnancies
and sexually transmitted infections. Around 7,500 children are admitted
every year to English hospitals alone as a result of acute intoxication,
and that figure does not include the carnage in our accident and
emergency departments. There are many contributing factors and no simple
solutions. Ultra-cheap alcohol and saturation availability still need
to be tackled, but we also need a change in our drinking culture. The
Bill aims to tackle one of the root causes of that culture, and there is
a clear evidence base to support it. Youth culture is heavily
influenced by marketing and our children are saturated by alcohol
advertising. Despite the clear evidence of harm - only Denmark and the
Isle of Man have higher levels of binge drinking and drunkenness in
their schoolchildren - the European school survey demonstrated that our
children have the most positive expectations of alcohol of any children
in Europe and were the least likely to feel that it might cause them
harm.
The problem of advertising
Where do those positive expectations come from? Let us just
look at the scale of marketing in the UK. The estimated spend on alcohol
marketing is around £800 million, compared with the Drinkaware Trust’s
funding by the industry of just £2.6 million. When £307 is spent
encouraging drinking for every pound spent promoting sensible behaviour,
the results are predictable. The World Health Organisation hit the nail
on the head when it said:
“In such a profoundly pro-drinking environment, health education becomes futile.”
The Portman Group, one of the main regulators of the industry,
would have us believe that it runs a very tight ship and is effective
in protecting children. That simply is not true.
Our confusing and inadequate combination of legislation and
industry self-regulation is not working. The report on alcohol by the
last Health Committee highlighted the fact that 96% of 13-year-olds from
a sample of 920 were aware of alcohol advertising in at least five
different media, and between 91% and 95% were able to identify masked
brands. Nearly half owned alcohol-branded products, such as clothing.
Does that matter?
A systematic review of multiple studies looking at the impact
of alcohol advertising and media exposure on adolescents - a study that
reviewed many studies - concluded that increasing exposure to alcohol
marketing encourages children to start drinking younger and to drink
more when they do. The Academy of Medical Sciences’ report “Calling
Time” showed a consistent correlation between consumption levels by 11
to 15-year-olds and the amount spent on marketing. We can be sure that,
if alcohol advertising did not work, the industry would not pay for it.
So many of the possible solutions to our binge drinking epidemic are
incompatible with European law, so it is rather refreshing to hear that
France has found a way forward. In 1991, in response to saturation
inappropriate marketing, the French introduced a measure called the Loi
Evin. This law has been repeatedly challenged in the European courts and
has been upheld as “proportionate, effective and consistent with the
Treaty of Rome”, which all Members of Parliament would agree makes a
pleasant change.
The French Model
Alcohol was a serious problem in France. In 1960 the French
were consuming over 30 litres of pure alcohol per capita per year.
Consumption is well under half that figure now. I accept that French
levels of alcohol consumption were falling before the Loi Evin was
introduced, but the French have managed to sustain that decline and the
long-term trend continues to be downwards. That is partly because their
young people are no longer exposed to a continuous barrage of
insinuating and pervasive messages about alcohol.
I am not suggesting a retreat to the nanny state or a ban, but
we should aim to protect children, especially as there is clear
evidence of their exposure to marketing and the consequent harm. We
currently have an absurd situation where advertisers are not supposed to
link drinking with social or sexual success or portray drinkers as
youthful or vigorous, but they can regularly sponsor major sporting and
youth events, such as T in the Park. The Bill aims to reduce the
exposure of children to the harmful effects of alcohol marketing by
setting out what advertisers are allowed to say and where they can say
it. Rather than the current confused cocktail of legislation and
self-regulatory codes, let us switch to something that works.
The Bill would permit the promotion of alcohol in media that
adults use. That would include the print media, where at least 90% of
readers are adults rather than children, radio after 9 pm and films with
an 18 certificate. It would allow advertising at the point of sale in
licensed premises and at traditional producer events, so it would not
penalise, for example, west country cider makers or small Scottish
distilleries. In these media, advertisers would be permitted only to
make factual and verifiable statements about their products, such as
alcoholic strength, composition and place of origin. Every advert would
also carry an advisory message about responsible drinking or health.
Any other marketing or promotion not specifically permitted
would therefore be banned, and this would include television, social
media and youth-certified films. The Bill would specifically prevent the
growing threat from viral phone marketing and ploys such as
“advergames” on the internet, where so-called games are a cover for
alcohol marketing. I think we would all agree that those are designed
specifically to appeal to young people. Ofcom, in its own research, has
demonstrated that for every five 24-year-olds who see an alcohol advert
on television, there are four 10-year-olds who see the same advert. The
industry will claim that these measures will kill off sport and culture,
and that advertising is designed only to persuade people to switch
brands. The same claim was made before the tobacco advertising ban. I
point out that France has managed a World cup and a European cup without
any help from alcohol sponsorship.
Across the channel, the Loi Evin is backed up by heavy
penalties which have been imposed by the courts and now act as a
significant deterrent. May I ask that we stop putting the fox in charge
of the chickens and have a clear statutory code to protect our children?
The Government could adopt this measure very quickly.
The Coalition has staked a great deal on talking about
outcomes. If we are serious about outcomes such as reducing health
inequality, reducing violent crime and domestic violence, improving the
life chances of our children and reducing teenage pregnancy, we must
stop talking to the drinks industry, with its vested interest in
increasing drinking, and start listening to those with real expertise in
preventing alcohol-related deaths. Not so much big society, perhaps, as
big sobriety.
Top of pageLiverpool launches major bid to tackle alcohol harm
Liverpool has unveiled a three-year approach to preventing and
reducing alcohol misuse. The city has the highest rates of
alcohol-related hospital admissions in England, and its residents are
twice as likely to die from an alcohol specific condition, such as liver
disease, as the national average. 
‘Reducing Harm, Improving Care’ has been produced by the
Liverpool Alcohol Strategy Group, which is jointly chaired by Liverpool
Primary Care Trust (PCT) and Liverpool City Council and includes other
key agencies in the city.
The strategy sets out plans to double the number of
individuals able to access alcohol treatment services, allowing an extra
2,000 people a year to receive help for their drinking. This will
involve creating a new Community Alcohol Service, which will provide
drop-in clinics between Monday and Friday in each of Liverpool’s five
neighbourhood areas. Other initiatives include equipping the city’s
frontline NHS workers - such as GPs, nurses and pharmacists - with the
skills to identify harmful drinking in patients who may report to them
with other symptoms. More than 350 staff have already been trained to
identify those individuals who regularly consume alcohol above
recommended levels, and offer them practical advice about cutting down.
This is part of a wider approach to reach people who often don’t see
their drinking as a problem, but who are unknowingly putting themselves
at risk of diseases such as cancer, cirrhosis and high blood pressure.
It is now estimated that by drinking over the daily recommended limits
more than 42% of adult drinkers in Liverpool could fall into this
category.
Dr Paula Grey, Director of Public Health for Liverpool, said:
“Alcohol contributes to some serious health and social problems in
Liverpool - as it does in many other cities - and tackling these issues
presents a major challenge. It’s really important that key local
agencies, such as the NHS, the local authority and the police, continue
to work in partnership to address both the causes and impacts of alcohol
misuse. We also need to ensure that the wider population understands
what it means to drink at harmful levels. Many of those who exceed
recommended daily guidelines associate alcohol misuse with teenage binge
drinkers, and do not realise that their own behaviour is putting their
health at risk. Part of our challenge is to make sure that people
realise what they are consuming and what the effects could be, so that
they can make informed decisions.”
In 2010, Liverpool PCT launched a campaign called ‘What’s
Yours?’ to raise awareness about recommended daily guidelines for
alcohol. It was particularly targeted at drinkers aged between 35 and
55, who might underestimate how many units they are drinking.
Future plans for the What’s Yours? brand include a dedicated website.
Professor Sir Ian Gilmore, liver specialist at the Royal
Liverpool Hospital and former President of the Royal College of
Physicians, said: “It’s welcoming to see local partnerships taking the
initiative by introducing credible interventions to tackle
alcohol-related harms and to continue to lobby for more strident
national measures to protect the public, like a minimum unit price for
alcohol and better control over its availability.”
Top of pageAlcohol-related hospital admissions top 1 million, new report shows
The number of admissions to hospital in England related to alcohol
has topped 1 million, according to the NHS Information Centre’s annual
report, Statistics on Alcohol: England 2011.
Statistics show there were 1,057,000 such admissions in
2009/10. This is up 12% on the 2008/09 figure (945,500) and more than
twice as many as in 2002/03 (510,800).
Of these admissions, nearly two thirds (63%) were for men.
Among all adults there were more admissions in the older age groups than
in the younger age groups.
New prescriptions data shows that alcohol dependency cost the
NHS £2.41million in prescription items in 2010. This is up 1.4% on the
2009 figure (£2.38 million) and up 40% since 2003 (£1.72 million).
There were 160,181 prescription items prescribed for drugs to
treat alcohol dependency in primary care settings or NHS hospitals and
dispensed in the community in 2010. This is an increase of 6% on 2009
(150,445) and an increase of 56% since 2003 (102,741).
The report also shows that in 2010 in England:
There were 290 prescription items issued for alcohol dependency per 100,000 of the population
Regionally, the figures for prescription items per 100,000 of
the population were highest in the North West (515 items) and North East
(410 items) and lowest in London (130 items)
The NHS Information Centre Chief Executive, Tim Straughan,
said: “Today’s report shows the number of admissions to hospital each
year for alcohol-related problems has topped 1 million for the first
time. The report also highlights the increasing cost of alcohol
dependency to the NHS as the number of prescription items dispensed
continues to rise. 
“This report provides health professionals and policy makers
with a useful picture of the health issues relating to alcohol use and
misuse. It also highlights the importance of policy makers and health
professionals in recognising and tackling alcohol misuse, which, in
turn, could lead to Alcohol affordability index: 1980 (=100%) to 2010
savings for the NHS.” Responding to the publication of the report,
Public Health Minister, Anne Milton, said:
“These statistics show that the old ways of tackling public
health problems have not always yielded the necessary improvements. We
are already taking action to tackle problem drinking, including plans to
stop supermarkets selling below-cost alcohol and working to introduce a
tougher licensing regime.
“We are taking a bold new approach to public health. Our
recent white paper set out our plan to ring-fence public health spending
and give power to local communities to improve the health of local
people. We will also be publishing a new alcohol strategy later this
year to follow on from the Public Health White Paper.”
However, some commentators noted the strangeness of
alcohol-related hospital admissions appearing to increase sharply at a
time when alcohol consumption is falling. According to the data
presented in the report, the proportion of men drinking more than 21
units a week fell by two percentage points, from 28 to 26%, and the
number of women drinking more than 14 units by one percentage point,
from 19 to 18%, between 2008 and 2009. The commentators suggested that,
in reality, the apparent increase in admissions is probably due to the
change in the method of counting alcohol-related hospital admissions
that took place in 2009.
Alcohol Affordability
It is now generally accepted that alcohol affordability - how
cheap or expensive alcohol is relative to disposable income - is one of
the main factors explaining fluctuations in the level of alcohol
consumption.
As a result of representations by the Institute of Alcohol
Studies, National Statistics has now altered its method of calculating
alcohol affordability. Previously, the affordability index was
calculated partly on the basis of changes in the total disposable income
of all households. Dr Rachel Seabrook of IAS pointed out that this was
an unsatisfactory measure because changes in total household income
reflected, in part, changes in the size of the population, and the
measure was not, therefore, an accurate method of calculating the
disposable income of individual consumers.
The new measure of alcohol affordability adjusts for this
failing and thus provides a more accurate picture of the relationship
between affordability and consumption. As can be seen from the graph
(below), the old measure had the effect of exaggerating how affordable
alcohol has become in recent years. However, even with the new, more
accurate measure, alcohol in 2010 was still 44% cheaper than it was in
1980, highlighting the overall trend of increased affordability over the
period.
Key Findings
In England, in 2009:
- 69% of men and 55% of women (aged 16 and over) reported
drinking an alcoholic drink on at least one day in the week prior to
interview. 10% of men and 6% of women reported drinking on every day in
the previous week.
- 37% of men drank over 4 units on at least one day in the
week prior to interview and 29% of women drank more than 3 units on at
least one day in the week prior to interview. 20% of men reported
drinking over 8 units and 13% of women reported drinking over 6 units on
at least one day in the week prior to interview.
- The average weekly alcohol consumption was 16.4 units for men and 8.0 units for women.
- 26% of men reported drinking more than 21 units in an
average week. For women, 18% reported drinking more than 14 units in an
average week.
- In 2007, 33% of men and 16% of women (24% of adults) were classified as hazardous drinkers
- Among adults aged 16 to 74, 9% of men and 4% of women showed some signs of alcohol dependence
- 18% of secondary school pupils aged 11 to 15 reported
drinking alcohol in the week prior to interview, compared with 26% in
2001
- Around half of pupils had ever had an alcoholic drink (51%), compared with 61% in 2003
- The overall volume of alcoholic drinks purchased for
consumption outside the home has decreased by 39% from 733 millilitres
(ml) of alcohol per person per week in 2001/02 to 446 ml per person per
week in 2009. This reduction is mainly due to a 45% decrease in the
volume of beer purchases from 623 ml to 342 ml per person per week over
the same period.
- There has been an increase from 54% in 1997 to 75% in 2009 in the percentage of people who had heard of daily drinking limits
- In 2009, there were 6,584 deaths directly related to
alcohol, a 3% decrease on the 2008 figure. Of these alcohol-related
deaths, the majority (4,154) died from alcoholic liver disease.
- It is estimated that the cost of alcohol-related harm to the NHS in England is £2.7 billion in 2006/07 prices
The full report can be viewed at www.ic.nhs.uk/pubs/alcohol11
Top of page5500 GP alcohol consultations per day in Scotland
According to a survey conducted by the BMA in Scotland, on one day in
April, alcohol was a factor in more than 5,500 consultations in general
practice. This equates to around 1.4 million consultations per year,
costing the NHS in excess of £28 million, and accounts for six per cent
of all GP consultations.
The results of the BMA study are based on a sample of 31
practices (3% of the total number of practices) from across Scotland.
These practices reported that, on the 21st of April 2011, 169
consultations with a GP or practice nurse had alcohol as a factor.
However, critics attacked the survey as unreliable, given
especially the extremely small percentage of GP practices who responded
and the absence of any attempt to ensure that they were properly
representative of Scotland as a whole. One critic, Nigel Hawkes of the
Straight Statistics website, accused the BMA of being a serial offender
in publishing ‘dodgy surveys’.
Election Call
The survey results were released prior to the Scottish
Parliament General Election, and BMA Scotland called on candidates in
all the political parties to acknowledge the damaging influence of
alcohol misuse on individuals and in communities every day in Scotland
and to spend one of the last few days of the election campaign outlining
how they will tackle alcohol misuse in the next Scottish Parliament.
The BMA summed up the position:
In one day:
- alcohol will cost Scotland £97.5 million in terms of health, violence and crime
- alcohol will kill five people
- 98 people will be admitted to hospital with an alcohol-related condition
- 23 people will commit a drink driving offence
- 450 victims of violent crime will perceive their assailant to be under the influence of alcohol
Dr Alan McDevitt, Deputy Chairman of the BMA’s Scottish General Practitioners’ Committee, said:
“We wanted to conduct this survey to demonstrate very clearly
how much of an impact alcohol has on the everyday work of general
practice. Those who suffer from alcohol-related health problems are not
just alcoholics or heavy binge drinkers. By regularly drinking over and
above recommended limits, a significant proportion of the adult
population is at risk of experiencing health problems that are linked to
the alcohol they consume, whether it is high blood pressure, breast
cancer or even domestic abuse.
“In just one day, nurses and doctors working in general
practices across Scotland saw more than 5,500 patients where alcohol had
contributed to their ill health. But the patients seen in general
practice are just the tip of the iceberg. The impact of alcohol misuse
across the rest of the NHS, in hospitals and in our communities is far
greater.
“That is why we are asking the parliamentary candidates to
spend one day talking about how they are going to address this serious
issue in the next Scottish Parliament. I think this is the very least
that they can do for their constituencies.”
Theresa Fyffe, Chief Executive of the Royal College of Nursing (RCN) Scotland, said:
“We now need to hear from politicians of all parties about
what they are going to do to reduce the harmful effects of alcohol. For
instance, they could consider investing in more alcohol liaison nurses
who provide a whole range of support that ultimately saves the NHS money
by reducing re-attendance at A & E and hospital admissions. It is
time for the political parties to set out exactly what they intend to do
to help stem the tide of harm caused by alcohol across Scotland.”
Evelyn Gillan, Chief Executive of Alcohol Focus Scotland, said:
“We must face up to the fact that the increase in alcohol
consumption is being fuelled by the fact that alcohol is more
affordable, more available and more heavily marketed than at any time
over the last thirty years. The cheaper it is the more we consume. For
the health and well-being of everyone in Scotland robust action must be
taken to increase price. As we approach the Scottish elections on 5 May,
we would urge politicians from all parties to reflect on the worrying
levels of alcohol-related harm which individuals, families and
communities are experiencing and to consider again the urgent need for a
minimum unit price for alcohol to reduce the devastating effects of
excessive drinking fuelled by cheap booze.”
Dr Bruce Ritson, Chairman of Scottish Health Action on Alcohol Problems (SHAAP) said:
“The level of harm caused by alcohol in Scotland concerns not
only health workers, but other professions, individuals, families and
communities across the country. All will be looking to the next Scottish
Parliament for effective action to reduce problem alcohol use.
Enforcement of existing legislation is one approach, but politicians
will need to recognise that most people seen in general practice with an
alcohol-related condition have not broken any law. The simple fact is
that individually and collectively we are drinking at levels that
compromise our health and well-being and, as a society, we need to drink
less.”
However, Nigel Hawkes and Straight Statistics remained
unconvinced. They complained that, as well as the failure to ensure the
representativeness of the respondents to the survey, the BMA had also
neglected to standardise the criteria for defining a consultation as
‘alcohol related’, making it difficult or impossible to interpret the
results of the survey.
Top of pageAlcohol death rate greater for women and men in routine jobs
Men whose jobs are classified as ‘routine’, such as van drivers and
labourers, face 3.5 times the risk of dying from an alcohol-related
disease than those in higher managerial and professional jobs.
Women in ‘routine’ jobs, such as cleaners and sewing
machinists, face 5.7 times the chance of dying from an alcohol-related
disease than women in higher professional jobs such as doctors and
lawyers.
These are two of the conclusions contained in a new report
published by the Office for National Statistics (ONS). It is the first
analysis of the social inequalities in adult alcohol-related mortality
in England and Wales at the start of the 21st century as measured by the
National Statistics Socio-economic Classification (NS-SEC).
The analysis highlighted the fact that the number of
alcohol-related deaths in England and Wales doubled between 1991 and
2008, rising from 3,415 (6.4 per 100,000 population) in 1991 to 7,344
(12.4 per 100,000) in 2008. However, the most recent data in 2009
indicated a drop in alcohol-related deaths of 3.3%, to 7,099.
The focus of the current analysis was social inequality in
alcohol-related mortality. Mortality rates from alcohol-related causes
were consistently higher for men than women across all the NS-SEC
analysis classes in England and Wales.
The highest mortality rate of all classes occurred in routine
workers, for men at age 50-54, 52.2 per 100,000, and for women at age
45-49, 42.0 per 100,000.
For the less advantaged groups, alcohol-related mortality
peaked in middle age and then declined, whereas for managers and
professionals, the risk of mortality increased steadily with age. This
means that alcohol-related deaths in the less advantaged groups tend to
occur younger as well as being more common.
Region
The highest mortality rate for men in all occupied classes
combined was found in the North West of England (26.9 per 100,000)
followed by the North East (23.7), the West Midlands (23.6) and London
(21.3). These regions all had significantly higher mortality rates for
all occupied classes combined than England and Wales as a whole, where
the figure was 19.0 per 100,000. The lowest mortality rate for all
occupied classes combined occurred in the East of England (12.4 per
100,000), half of that seen in the North West. The second lowest was the
South West (15.2) followed by the East Midlands and the South East,
both 15.5 per 100,000. Similar regional patterns were observed for
women, but with lower overall death rates.
Previous survey results have suggested that less advantaged
social groups drink less in total than the more advantaged groups.
Therefore the explanation for these inequalities is not a simple one,
and may be associated with differences in the detailed patterns of
drinking among different groups or with the influence of underlying
factors other than alcohol consumption.
Alcohol-related deaths include only those causes defined as
being most directly due to alcohol consumption, including alcoholic
liver disease (accounting for approximately two-thirds of all
alcohol-related deaths), fibrosis and cirrhosis of the liver,
(accounting for about 18% of deaths), mental disorders due to the use of
alcohol (about 9% of deaths) and accidental alcohol poisoning (about
3%). It does not include other diseases where alcohol has been shown to
contribute to the risk of death, such as cancers of the mouth,
oesophagus and liver. It also excludes deaths from accidents and
violence where alcohol may have played a part.
Social inequalities in alcohol-related adult mortality
by National Statistics Socio-economic Classification, England and
Wales, 2001-03 - Statistical Bulletin
The article, which can be found in ‘Health Statistics Quarterly 50’ at http:// www.statistics.gov.uk/hsq,
gives the first detailed breakdown of alcohol-related deaths by NS-SEC,
age, gender and region and underlines the fact that people from less
advantaged sections of society in England and Wales are
disproportionately dying from alcohol-related causes at earlier ages.
Top of pagePsychiatrists call for action to tackle substance misuse in older people - lower 'sensible drinking limit' recommended for pensioners
The NHS must wise up to the ‘growing problem’ of drug and alcohol
misuse among older people, according to a new report published by the
Royal College of Psychiatrists. The report, written by the Older
People’s Substance Misuse Working Group of the Royal College of
Psychiatrists, warns that not enough is being done to tackle substance
misuse in our aging population - making them society’s ‘invisible
addicts’. The report pulls together evidence to highlight the extent of
the problem:
The number of older people in the UK population is increasing
rapidly - between 2001 and 2031 there is predicted to be a 50% increase
A third of older people with alcohol use problems develop them
in later life - often as a result of life changes such as retirement or
bereavement, or feelings of boredom, loneliness and depression
Older people often show complex patterns and combinations of
substance misuse e.g. excessive alcohol consumption as well as
inappropriate use of prescribed and over the counter medications
Although illegal drug use is uncommon among over-65s at the moment,
there has been a significant increase in the over-40s in recent years.
The problem is likely to get worse as these people get older.
Professor Ilana Crome, Professor of Addiction Psychiatry and
Chair of the Working Group, said: “The traditional view is that alcohol
misuse is uncommon in older people, and that the misuse of drugs is very
rare. However, this is simply not true. A lack of awareness means that
GPs and other healthcare professionals often overlook or discount the
signs when someone has a problem. We hope this report highlights the
scale of the problem, and that the multiple medical and social needs of
this group of people are not ignored any longer.” The Working Group
makes a series of key recommendations including:
- GPs screen every person over the age of 65 for substance misuse as part of a routine health check
- The government issues separate guidance on alcohol
consumption for older people. Current recommended ‘safe limits’ are
based on work in younger adults. Since there are physiological and
metabolic changes associated with aging, these limits are too high for
older people. Evidence suggests the upper ‘safe limit’ for older men is
1.5 units per day or 11 units per week, and for women 1 unit per day or 7
units per week.
- Public health campaigns around alcohol and drug misuse are developed specifically to target older people
- All doctors, nurses, psychologists, social care workers and
allied health professionals are given suitable training in substance use
disorders in older people
There is accumulating evidence that the treatment for alcohol
and drug misuse in older people is effective and that older people often
stay in treatment for longer than younger people. Dr Tony Rao, a
consultant in old age psychiatry and member of the Working Group, said:
“We are witnessing the birth of a burgeoning public health problem in a
‘baby boomer’ generation of older people for whom alcohol and drug
misuse is growing. There is a pressing need to meet this need with
primary, secondary and tertiary care services that can offer timely and
effective detection, treatment and follow up for a large but hidden
population.” Dr Owen Bowden-Jones, Chair of the Royal College of
Psychiatrists’ Faculty of Addictions Psychiatry, said: “Because of the
preconception that alcohol and drug use are problems of the young, there
is a generation of older people for whom these problems have gone
undetected. This timely report is a wake-up call for healthcare
professionals and a reminder that older people have particular risks for
substance misuse. Our challenge is to improve the detection of these
invisible addicts and offer the treatments which we know can transform
people’s lives.” Don Shenker, Chief Executive of Alcohol Concern, said:
“While younger excessive drinkers often make the headlines, we should
remember that older people often turn to alcohol in later life as a
coping mechanism and this can remain stubbornly hidden from view. This
report calls for much greater recognition that excessive drinking in
older age is both widespread and preventable, particularly if public
health professionals are supported and trained to spot the signs and
take appropriate action.”
Top of pageAlcohol blamed for high suicide rates in Northern Ireland
Alcohol and drugs are fuelling homicide and suicide rates in Northern
Ireland, a new independent report by University of Manchester
researchers has found, with alcohol appearing to be a key factor for the
country’s higher suicide rates, including among mental health patients,
compared to England and Wales.
The ‘Suicide and Homicide in Northern Ireland’ report by the
National Confidential Inquiry into Suicide and Homicide by People with
Mental Illness (NCI), which is based in the University’s Centre for
Suicide Prevention, also shows that the higher Northern Ireland suicide
rate is greatest among young people; 332 suicides occurred in people
under 25 during the study period (2000 to 2008), with mental illness,
drugs and alcohol, previous self-harm and deprivation being contributing
factors in the majority of cases.
The NCI report – commissioned by the Health and Social Care
Division of the Public Health Agency (PHA) on behalf of the Department
of Health, Social Services and Public Safety (DHSSPS) in Northern
Ireland – also reports: A total of 1,865 suicides occurred in the
general population in Northern Ireland between 2000 and 2008, equivalent
to 207 per year, or 13.9 per 100,000 people per annum. This rate is
higher than the UK average but lower than the rate in Scotland.
During the same period, there were 533 suicides in current
mental health patients – defined as individuals who had had contact with
mental health services in the previous 12 months. This amounted to 29%
of all suicides and corresponds to 59 patient deaths per year.
Young people who died by suicide were more likely than other
age groups to be living in the poorest areas and they had the lowest
rate of contact with mental health services (15%). Young mental health
patients who died by suicide tended to have high rates of drug misuse
(65%), alcohol misuse (70%) and previous self-harm (73%).
There were 142 homicide convictions between 2000 and 2008.
This figure, while likely to be an underestimate, equates to 16
homicides per year, or 10.6 per million people per annum, similar to the
rate in England and Wales but lower than the rate in Scotland.
“High rates of substance misuse and dependence run through
this report and, as we rely on information known to clinicians, our
figures are likely to underestimate the problem,” said Louis Appleby,
Professor of Psychiatry at The University of Manchester and NCI
Director.
“Alcohol misuse was a factor in 60% of patient suicides and
this appears to have become more common during the course of the study
period. Alcohol dependence was also the most common clinical diagnosis
in patients convicted of homicide, with more than half known to have a
problem prior to conviction.
“In homicide and suicide generally, alcohol misuse was a more
common feature in Northern Ireland than in the other UK countries and a
broad public health approach, including better dual diagnosis of mental
illness and alcohol or drug misuse, health education and alcohol
pricing, should be seen as key steps towards reducing the risk of both
homicide and suicide. In particular, there needs to be a focus on
developing new services for young people with substance misuse
problems.”
The NCI report, which was launched at Mossley Hill,
Newtownabbey, Northern Ireland, on Wednesday, June 29, also revealed
that there was not a single ‘stranger homicide’ by a patient with mental
illness throughout the eight-year study period.
“Stranger homicides are important in mental health because
they are assumed to reinforce public prejudice against mentally ill
people, the popular assumption being that the killing of a stranger is
likely to be associated with mental illness,” said Professor Appleby,
who is also National Director for Health and Criminal Justice. “
In this report, almost a third of homicides involved the
killing of a stranger and the frequency of these cases appeared to have
increased in the decade up to 2008. However, these were not associated
with mental disorder and we recommend initiatives to combat the stigma
of mental illness should emphasise the low risk to the general public
from mentally ill patients living in the community.”
Top of pageControversy over welfare benefits for problem drinkers and drug addicts
Welfare benefits for people with alcohol or drug problems hit the
headlines again when the Department of Work and Pensions released
figures showing that, in 2010, 80,000 people dependent on either alcohol
or other drugs were receiving incapacity benefit or what, since October
2008, has been known as Employment Support Allowance.
The figures showed that over 48,000 of the total had been in
receipt of benefits in excess of 5 years, over 22,000 for ten years or
more. Further doubt on the effectiveness and fairness of the present
arrangements for paying welfare benefits was prompted by separate
figures showing that three-quarters of people who apply for sickness
benefit are found fit to work or drop their claims before they are
completed. The figures show 887,300 of 1,175,700 people applying for
employment and support allowance (ESA) between October 2008 and August
2010 failed to qualify. Only 6% of claims - 73,500 people - were
considered to be entitled to full ESA support.
Employment Minister, Chris Grayling, said the figures showed
how important it was to reassess people who were still on the old
incapacity benefit.
“We now know very clearly that the vast majority of new
claimants for sickness benefits are in fact able to return to work.
That’s why we are turning our attention to existing claimants, who were
simply abandoned on benefits. That’s why we are reassessing all of those
claimants, and launching the work programme to provide specialist back
to work support,” he said.
Alcohol and Drug Claimants
Prime Minister, David Cameron, promised tough action to reduce
the numbers of people on ESA. Speaking to the BBC, he said that the
public believed welfare recipients should be “people who are
incapacitated through no fault of their own”. He continued: “Of course
someone who has an alcohol or drug problem has a problem, but is it OK
to leave these people on incapacity benefit, year after year, not
examining their circumstances, not seeing if we can help them? It traps
people in long-term poverty and it is not good enough.”
Mr Cameron said the government was showing courage to
re-examine all existing incapacity benefit claims, suggesting recipients
had been “left for dead” by the last government, and those not entitled
to the payments would have them removed.
The Coalition Government is, in fact, continuing a process
begun by the previous Labour Government of attempting to get people off
incapacity benefit and back into work. Altogether, over 2 million people
receive incapacity benefits, with over 900,000 being in receipt of
benefits for 10 years or more. In relation to people with alcohol or
drug problems, the position is the same as with other claimants in that
their medical condition, in their case, dependence, does not, of itself,
provide an entitlement to welfare benefits. Decisions on entitlement to
benefits are based on claimants’ ability to carry out a range of tasks
or on the effects of any associated mental health problems.
Alcohol awareness campaigners welcomed the aim of helping
people to give up drink and get back to work but warned removing
benefits from vulnerable people risked making their situation worse.
Don Shenker, Chief Executive of Alcohol Concern, said he was
concerned the government was not prepared to commit enough funds to
tackle a shortage of treatment facilities for those with addictions. He
told the BBC:
“I would imagine that the vast majority would find it quite
difficult to go back into the workplace because, first of all, how many
employers would take on someone who’s been out of work for two or three
years because they’ve been drinking?
“Secondly, the very stressful nature of being in the workplace
environment means that for people who are heavily dependent on alcohol
it would be difficult for some people to hold down a job.”
Martin Barnes, Chief Executive of DrugScope, said:
“Most people with a drug or alcohol dependency also have
physical or mental health problems which can affect their ability to
work. While a drug or alcohol dependency can be extremely debilitating,
it does not, of itself, give an entitlement or ‘passport’ to benefit,
which may be suggested by the publication of today’s figures. People
with drug or alcohol problems must satisfy all the conditions for
benefit entitlement, including proof of incapacity, and may be required
to undergo a medical examination to determine eligibility.
“For many people with drug problems, employment can help
support and sustain recovery from dependency. DrugScope supports the
government’s commitment to help drug users into employment, as part of a
broader recovery agenda. However, while people in drug treatment and
recovery want to access training and employment, they can face
formidable barriers, not least the stigma associated with drug or
alcohol dependency. Research and experience shows that a majority of
employers will not knowingly take on someone with a history of drug
problems even if they are otherwise able to do the job.
“Despite the clear challenges of supporting people who have
had drug or alcohol problems off benefit and into employment, it is
unclear what specific, tailored support the government is providing,
despite the clear ambition and commitment set out in the drug strategy.
It has recently been confirmed that two support programmes for people
with drug and alcohol problems are being discontinued, with no new
referrals to the Progress to Work scheme after 1 June 2011 and no
further funding for dedicated Job Centre drug coordinators. Both
initiatives provided welcome and necessary tailored support for people
with often multiple and complex problems associated with drug
dependency. It is still unclear what specific support for this client
group will be provided by the new Work Programme.
Employment Minister, Chris Grayling, said private and
voluntary organisations had agreed to invest £580m in treating addicts
and preparing them for employment, adding that all of the conditions
were treatable if people received the right support.
Top of pageIssue of legal liability raised by the case of the Irish barmen
The question of the legal liability of the owners of bars and the
servers of alcohol in cases where harm arises from the consumption of
the alcohol provided to customers, came into sharp focus in Ireland when
two barmen were charged with manslaughter following the death of a
customer from acute alcoholic poisoning.
In the context of the alcohol trade, issues of civil liability
can arise in terms of a duty of care but there is also the possibility
of criminal responsibility when a licensee or member of their staff
could be regarded as aiding or abetting the commission of a criminal
offence such as drink driving.
Inspired by the success of tobacco litigation, many alcohol
policy advocates have favoured making licensees or their servants
legally liable for the harmful consequences to themselves or others of
their customers’ alcohol consumption, in circumstances where the
licensees can be shown to have acted neglectfully or irresponsibly. In
2004, one of Scotland’s leading licensing specialists called for ‘server
(or third-party) liability’ to be introduced to produce more
responsible behaviour on the part of the country’s pubs and clubs.
Jack Cummins, one of Scotland’s foremost licensing experts,
said: “It has yet to be established whether, under Scots law, a licensee
owes a ‘duty of care’ to members of the public who may be affected by
the acts of their intoxicated patrons. The day could well come when a
court decides that allowing a customer to consume an excessive amount of
alcohol, or worse still, encouraging excessive consumption, creates a
foreseeable risk to third parties, rendering the licensee answerable in
damages to victims of violence.” Others, however, have opposed the idea
as leading to great injustice, promoting a harmful ‘compensation
culture’ and as undermining the personal responsibility of the drinkers
themselves.
The Irish Case
In the Irish case, the two barmen were put on trial following
the death of a British customer, Graham Parrish, who died of acute
alcoholic poisoning after celebrating his 26th birthday at a hotel in
Thurles, Ireland in 2008. Among the drinks he had consumed was one
containing multiple ‘shots’ in one glass which he downed in one go. The
two defendants told the trial jury that they would have declined to
serve this particular drink had they understood it was not going to be
shared between Mr Parrish and his friends. The charge came under the
common law heading of ‘involuntary manslaughter’, where the accused does
not intend to harm the victim, but acted in such a negligent way it was
foreseeable that harm would ensue.
The Irish Times reported that evidence was presented at the
trial that Mr Parish had begun drinking at about 7pm with some friends
and had drunk eight pints by 10pm when he and his friends began ‘to race
their pints’. When he went to the toilet, his friends twice ordered
vodkas to put in his pint.
Mr Parish drank both pints unaware they contained shots.
Around 10.30pm, some of his friends ordered 10 shots in a pint glass and
Mr Dalton, the barman on duty at the time, asked Mr Wright, his
manager, if it was all right to put so much spirits in one glass. Wright
told the Irish police that he agreed to serve the drink on the
understanding that it would be shared and not downed in one go as it
ultimately was, Mr Parrish being spurred on by his friends who bet on
him to drink it.
Mr Parrish later fell off his stool and was left in an
upstairs function room by his friends where he was checked on at about
midnight and found to be snoring. But he was later discovered
unconscious by a night porter at about 6am and pronounced dead at
7.15am. A post mortem revealed he had a blood alcohol level of 375mgs
per 100mls, which proved fatal.
Legal liability and alcohol policy
The authors of the text book of alcohol policy, ‘Alcohol: No
Ordinary Commodity’, state that holding servers legally liable for the
consequences of providing more alcohol to persons who are already
intoxicated, or those underage, has shown consistent benefits as a
policy measure in the US. In particular, States that hold bar owners and
staff legally liable for damage attributable to intoxication have lower
rates of traffic fatalities and homicide.
However, in Europe, there appear to be greater legal obstacles
in the way of bringing successful prosecutions against licensees. While
there do not seem to have been many cases brought before the courts,
most of those that have been brought seem to have been lost, including
that of the Irish barmen.
For example, in 2003 in Scotland, twelve problem drinkers made
an attempt to sue drink manufacturers for failing to warn them of the
dangers of alcohol. The group, aged between 18 and 60, claimed that
drinking had led to ill health, loss of jobs and the breakdown of
relationships, damaging their quality of life. They argued that the
drink manufacturers owed them a duty of care to warn of the dangers of
addiction. However, the case was not successful.
Irish Acquittal
In the Irish case, the judge directed the jury to acquit the
defendants. He found that, while there was enough evidence of ‘gross
negligence’ by the men to be brought to the jury, the fact that Parish
had taken the decision to consume the alcohol broke the ‘chain of
causation’ linking the barmen’s actions to his death.
The Irish Times, in an analysis of the case, commented that
the barmen’s case followed another Irish High Court judgment which also
emphasised the personal responsibility of the consumer, rather than that
of the providers of the alcohol, for any injury that followed. In that
High Court civil case which involved drink driving, Mr Justice Feeney
reviewed the law in several common law jurisdictions about the
responsibility of bar staff for the actions of those who consume alcohol
on their premises. He said there was a wide divergence between
Australia and the UK on the one hand, and Canada and the US on the
other, in their attitudes towards the responsibilities of alcohol
providers. He pointed out that this reflected the different historical
and cultural contexts. Both the US and Canada had had years of
prohibition, and this was reflected in their continuing approach to
alcohol.
The Canadian courts had found that providers owed a broad duty
of care to those consuming their alcohol, and US laws in most states
held retail establishments accountable for harm, death or other damages
caused by an intoxicated customer.
However, in Australia, the courts declined to impose
alcohol-provider liability, and in the UK, while each case was
fact-dependent, there was a clear reluctance to impose liability except
in exceptional circumstances. He agreed with this approach, and found
the bar staff in this instance did not owe a duty of care to the
drink driver.
The Irish Times concluded that this judgment, combined with
the acquittal of the barmen, means that, except in exceptional
circumstances, criminal responsibility for death or injury arising from
consuming large amounts of alcohol rests with the consumer, not the
provider.
Top of pageNew guidance for treating alcohol dependence
The majority of people who are dependent on alcohol are not currently
being treated, partly because health and social care professionals are
failing to identify those in need and assisted withdrawal treatments are
inadequate. In response, the National Institute for Health and Clinical
Excellence (NICE) has published new guidance outlining how the NHS
should diagnose, assess and treat the condition.
Although over one million people in England are dependent on
alcohol, only around 6% of these currently receive treatment. This means
that every year there are over 940,000 people who are either not
seeking help, do not have access to the relevant services, or whose
symptoms are not being appropriately identified by healthcare
professionals.
This is the first time that NICE has published guidance for
the NHS to help address these serious variations in clinical practice.
The guideline calls for all relevant health and social care
professionals to be able to identify patients who could be misusing
alcohol through clinical interviews and internationally recognised
assessment tools, such as the AUDIT and SADQ. These will help healthcare
professionals to make accurate diagnoses and measure the severity of
their patients’ dependence, on which their subsequent treatment options
will be based. 
Dr Fergus Macbeth, Director of the Centre for Clinical
Practice at NICE said: “People who suffer from alcohol dependence often
face much stigma and discrimination in their day to day lives which can
act as a barrier to them seeking help. Our guideline calls for all
healthcare professionals who come into contact with these people to be
appropriately trained to identify those in need and be able to offer
them help in a trusting, supportive and non-judgemental environment.
“Improvements must be made across the NHS so that more people can be
correctly diagnosed, assessed and treated for their dependence and
harmful drinking patterns. Our clinical guideline outlines the most
effective ways that the NHS can do this, based on the available evidence
and expert feedback.”
Alcohol dependence is characterised by a craving for,
tolerance of, and preoccupation with alcohol and continued drinking,
despite the physical and mental harm that it can cause.
Harmful drinking is defined as drinking over the recommended
weekly amount and experiencing health problems directly related to
alcohol. This could include psychological problems such as depression
and anxiety, or physical illness such as high blood pressure, acute
pancreatitis, liver cirrhosis, heart disease and several cancers.
Other key recommendations from NICE include:
- Harmful drinkers and people who are mildly dependent (e.g.
those who score 15 or less on the SADQ) should be offered psychological
interventions, such as cognitive behavioural therapy, behavioural
couples therapy or social network and environment-based therapies.
- People who drink more than 15 units a day or who score 20 or
more on the AUDIT should be offered a structured assisted withdrawal
programme. This can be offered in a community-based setting, unless
there are safety concerns; e.g. if the person drinks more than 30 units a
day, scores more than 30 on the SADQ, has a history of epilepsy,
withdrawal-related seizures, delirium tremens or previous withdrawal
attempts, is homeless, or needs concurrent assisted withdrawal from
benzodiazepines.
In these circumstances, people should be offered an inpatient
or residential assisted withdrawal programme. People who drink 15-20
units of alcohol a day and have significant mental or physical problems
(e.g. depression or psychosis) or a significant learning disability or
cognitive impairment, should also be offered inpatient or residential
assisted withdrawal.
After completing a successful alcohol withdrawal programme,
healthcare professionals should consider offering people who were
moderately or severely dependent, acamprosate or oral naltrexone. This
should be offered alongside an individual psychological intervention
which specifically focuses on alcohol misuse.
Health and social care professionals should seek to treat a
person’s alcohol misuse before treating any coexisting mental health
conditions, e.g. depression or anxiety. This is because symptoms can
often improve once alcohol misuse has been effectively treated. However,
if a person with a mental health condition hasn’t experienced
significant improvements after abstaining from alcohol for around 3-4
weeks, then the health and social care professionals should consider
referring them for specific treatment for this.
Professor Colin Drummond, Professor of Addiction Psychiatry
and Chair of the Guideline Development Group said: “The clinical
guideline from NICE has been developed following a detailed systematic
review of research on the full range of alcohol treatments to date. The
evidence shows that alcohol treatment can be both effective and cost
effective. However the effectiveness of these are crucially dependent
upon people who misuse alcohol having better access to evidence-based
interventions, which are delivered by appropriately trained and skilled
staff.
“With problems relating to alcohol consumption increasing
steeply in the UK, I hope that this guideline provides a much needed
impetus to making effective treatments more available to those who need
them.”
Alcohol use disorders:
diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE 2011
Top of pageNational Treatment Agency issues guide to safeguarding children affected by substance misuse
A third of drug addicts or problem drinkers in treatment have
childcare responsibilities and the lives of these children are much
improved when providers and children’s services get together early on to
ensure the whole family gets the support it may need.
A new practical guide issued by the National Treatment Agency
for Substance Misuse (NTA) says those responsible for drink and drug
treatment must take a wider, more preventative approach, identifying
early on when families need help as well as protecting children from
neglect and harm.
The guide also calls on children and family services to view
treatment for parents as a way of improving life for the whole family
and to get involved when problems are first identified, ensuring these
are dealt with before a crisis point is reached.
Rosanna O’Connor, Director of Delivery for the NTA, said:
“In many ways, having a parent in drug or alcohol treatment
protects the child because their mother or father is more motivated to
get better, stabilise their lives and seek support.
“The danger is, as the Munro Review pointed out, that children
are too often ‘invisible’ to adult front line services, including those
dealing with substance misuse, which tend to focus on the person in
front of them.”
The guide draws on existing guidelines and makes new
recommendations on how those seeking treatment are assessed and when and
how children and families services should be involved. It offers clear
advice to managers and commissioners on partnership working to identify,
assess, refer, support and treat adults with the aim of protecting any
children involved and improving their outcomes.
Supporting Information for the Development of Joint Local
Protocols between Drug and Alcohol Partnerships, Children and Family
Services was supported by the Department for Education and is available
on the NTA website at www.nta.nhs.uk
Top of pageNew research 'makes the case' for investment in young people's drug and alcohol treatment
A government commissioned evaluation has found that alcohol and drug
treatment services for young people are highly cost effective, with long
term savings of between £5 and £8 for every pound invested.
Published by the Department for Education, the report,
‘Specialist drug and alcohol services for young people - a cost benefit
analysis’, finds that drug and alcohol treatment for young people
reduces otherwise significant economic, social and health costs.
Immediate savings are achieved in reduced crime and improved health. In
the longer term, there are reductions in costs associated with
problematic drug use in adulthood, including unemployment, crime and
drug and alcohol dependency.
Approximately 24,000 young people received specialist drug and
alcohol treatment in the UK in 2008/09. Most were treated primarily for
alcohol (37%) or cannabis (53%); one in ten were treated for problems
associated with Class A drugs, including heroin and crack.
Despite evidence of the cost effectiveness of spending on
substance misuse treatment, many young people’s services have contacted
agencies such as DrugScope to report significant cuts in local funding. 
Commenting on the report, Martin Barnes, Chief Executive of
DrugScope said: “At a time when many drug and alcohol services for young
people are facing funding cuts, this research makes a timely,
compelling and robust case for continued investment. Even on quite
cautious and conservative estimates, the evidence shows that there are
immediate net gains in return for spending on drug and alcohol
treatment. Not only will cuts in services have a negative impact on
vulnerable young people, the research confirms that greater costs are
likely to be incurred in terms of crime, unemployment and poor health.
“The concern is that, with a record number of young people not
in education, employment or training, there will be a greater demand on
prevention and treatment services. It is far easier to prevent young
people from developing problems at an early stage than it is to treat
adults with addiction issues. A considered assessment of the benefits to
local communities of investment in drug and alcohol treatment services
needs to be made to inform decisions on funding.”
Dowload the full report (pdf 454kb)
Top of pageMajor survey shows family and friends are key influences on teenage drinking
A major survey of early teen drinking patterns in England finds that
drinking escalates to a worrying extent during these years. The
research, conducted by Ipsos MORI for the Joseph Rowntree Foundation,
also finds that family and friends have a strong influence on teenagers’
drinking patterns, and are stronger influences than some other factors –
such as individual well-being, celebrity figures and the media.
The detailed survey of 5,700 teenagers looked at the drinking
habits of students in years 9 (aged 13–14) and 11 (aged 15–16). The
study found that around seven in ten students in year 9, and nine out of
ten students in year 11, had drunk alcohol, the majority claiming to
have had their first drink by the time they were 13. Around one in five
students had been drunk multiple times by the time they reached 14; this
number leapt to around half of students by age 16.
Pamela Bremner from Ipsos MORI, lead author of the report,
said: “For the first time in the UK, this study ranks what most
influences young people’s drinking behaviour. It found that the
behaviour of friends and family is a strong influential factor in
determining a young person’s relationship with alcohol.”
Teenagers’ friends have a significant impact on drinking
behaviour. The odds of a teenager drinking to excess more than double if
they spend more than two evenings a week with friends. Spending every
evening with friends multiplies the odds of excessive drinking more than
four times. Parents have a particularly strong impact on their
children’s behaviour with alcohol. Levels of parental supervision
influence behaviour: for example, the odds of a teenager having ever had
an alcoholic drink are greater if their parents do not know where they
are on a Saturday evening or if they allow their child to watch 18-rated
films unsupervised.
Parents’ own drinking habits also have an impact. The odds of a
teenager getting drunk multiple times is twice as great if they have
seen their parents drunk, even if only a few times, as those teenagers
who have never seen their parents drunk. Ease of access to alcohol was
also an important influencing factor on current drinking and
drunkenness.
However, researchers found mixed messages about the ideal age
and method of introducing teenagers to alcohol. In general terms, those
introduced to alcohol when very young had greater odds of having had a
drink recently and of having been drunk multiple times, but there were
differences in the pattern for young people of different ages.
Claire Turner, Programme Manager for the Joseph Rowntree Foundation, said:
“This research shows that parents can have more influence on
their teenagers’ behaviour than perhaps many assumed. Both what parents
say, and how they behave, have a strong impact on their teenagers
drinking, drinking regularly, and drinking to excess.”
Bremner, P; Burnett, J; Nunney, F; Ravat, M; Mistral, W:
Young people, alcohol and influences - A study of young people and their relationship with alcohol.
Joseph Rowntree Foundation, 2011
Top of pageSchool alcohol education programmes can work, review finds
School prevention programmes aimed at curbing alcohol misuse in
children can be effective, according to a large, international
systematic review. The findings undermine the frequently made claim that
school based alcohol education programmes are wholly ineffective.
The review found that the most significant programme effects
were reductions in episodes of drunkenness and binge drinking.
School-based prevention programmes that take a social skills-oriented
approach or that focus on classroom behavior management can work to
reduce alcohol problems in young people,” said David Foxcroft, lead
review author. “However, there is good evidence that these sorts of
approaches are not always effective.”
David Foxcroft, a psychologist at Oxford Brookes University,
in England, and co-author Alexander Tsertsvadze, at the University of
Ottawa Evidence-Based Practice Center, in Canada, analyzed 53 randomized
controlled trials done in a wide range of countries with youth aged 5
to 18 when studies began. Forty-one studies took place in North America,
six in Europe and six in Australia. One was conducted in India and one
in Swaziland. Two studies took place in multiple locations.
The studies were divided into two major groups based on the nature of the prevention program:
- programs specifically targeting prevention or reduction of alcohol misuse
- generic programs with wider focus for prevention, for example other drug use/abuse, antisocial behavior
The review found studies that showed no effects of the
preventive programme, as well as studies that demonstrated statistically
significant effects. There was no easily discernible pattern in
programme characteristics that would distinguish studies with positive
results from those with no effects. Most commonly observed positive
effects across programmes were for drunkenness and binge drinking. The
authors conclude that current evidence suggests that certain generic
psychosocial and developmental prevention programmes can be effective
and could be considered as policy and practice options. These include
the Life Skills Training Program, the Unplugged program, and the Good
Behaviour Game.
The review appears in the May 2011 issue of The Cochrane
Library, a publication of The Cochrane Collaboration, an international
organisation that evaluates medical research. Systematic reviews draw
evidence-based conclusions about medical practice after considering both
the content and quality of existing medical trials on a topic.
Foxcroft, D; Tsertsvadze, A:
Universal school-based prevention programs for alcohol misuse in young people.
Cochrane Database of Systematic Reviews 2011, Issue 5
Top of pageNine year old boy arrested for drink driving
Police records have shown a boy aged nine was arrested for drink driving.
The boy, from Cumbria, was breathalysed and taken into police
custody. However, when officers discovered his age, they were forced to
release him without charge as he was too young to be held accountable
for his actions.
No further information is available about the circumstances of
the case, such as how much alcohol the boy had consumed or how he had
obtained it.
Safety campaigners have since demanded action to curb juvenile car crime.
The child, who has not been named, was just one of thousands
of under 18s arrested in the north of England over the past two years.
These included four 11-year-olds and a 10-year-old arrested in the
Northumbria force area for car theft, and seven 12-year-olds arrested in
Cleveland for the same crime. During the same time period, Durham
Police arrested one 12-year-old for aggravated vehicle taking and North
Yorkshire Police arrested one 10-year-old for car theft. These were
among 2,467 juveniles arrested for crimes including car theft,
aggravated vehicle taking, drink driving and underage driving.
Kath Hartley, of the charity Brake, which campaigns for lower
speed limits, demanded road safety education be taught in school. She
told The Sunday Sun in Newcastle: “It is incredibly concerning that
young people are risking their own and other people’s lives on the road.
This must be addressed as a matter of urgency.”
Source: Press Association
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