Government alcohol and drugs policy in disarray
The Government’s approach to tackling the problems of drugs, legal
and illegal, was brought into severe question when the Home Secretary
sacked its Chief Scientific Advisor on Drug Policy, Professor David
Nutt, from his position as Chairman of the Advisory Council on the
Misuse of Drugs (ACMD). The sacking followed publication of a briefing
on drug policy written by Professor Nutt for the Centre for Crime and
Justice Studies at Kings College, London.
In the briefing, which was written in his capacity as an
academic rather than as Chairman of ACMD, he criticises the existing
drug classification system for artificially separating legal and illegal
drugs, and argues that cannabis and ecstasy are less dangerous than
alcohol and tobacco. Professor Nutt criticises, in particular, the
former Home Secretary, Jacqui Smith for ‘distorting and devaluing’
scientific research when she re-classified cannabis from Class B to
Class A. Later, he also criticised Gordon Brown for being the first
Prime Minister to go against the advice of his scientific advisors on
drug policy.
Alan Johnson, the present Home Secretary, promptly demanded
Professor Nutt’s resignation, stating that he had lost confidence in him
as an impartial adviser to the Government. He said that Professor Nutt
had been sacked not for his views but because he could not be an advisor
to the government while simultaneously campaigning against government
policy.
The sacking resulted in a major public row in which the
Government was roundly condemned for attempting to gag scientists and
accused of preferring to pander to popular prejudice than base drug
policy on scientific evidence. Other members of the ACMD also resigned
in protest, and there were widespread demands in the media and from the
scientific community that new rules should be brought in to safeguard
the independence of scientists who agree to participate in governmental
scientific advisory committees.
While most of the coverage and comment regarding the row
appeared to be framed in terms of ‘politicians versus scientists’, and
to take Professor Nutt’s side in the dispute, there was a minority view
which was less sympathetic. Some commentators took the view that it was
perfectly reasonable for the Home Secretary to say that scientists
advise but it is the government which decides policy, and agreed with Mr
Johnson that Professor Nutt and the ACMD had crossed the line into
territory which properly belonged to Government. Others accused the ACMD
of diminishing its own scientific credibility by itself ignoring or
downplaying the evidence on the harmfulness of cannabis and Ecstasy.
In a letter to The Guardian, Professor Robin Murray took
Professor Nutt and the ACMD to task for having ‘an unfortunate history’
in relation to cannabis. Professor Murray wrote:
“In 2002, it boobed by advising David Blunkett, then Home
Secretary, that there were no serious mental health consequences of
cannabis use; the council had done a sloppy job of reviewing the
evidence. Since that time, they have been trying to regain credibility,
and now accept that heavy use of cannabis is a risk factor for psychotic
illnesses including schizophrenia. However, Professor Nutt’s comments
demonstrate how difficult it has been for some members of the committee
to accept their error.”
Another critic was Professor Neil McKeganey, Director of the
Centre for Drug Misuse Research at the University of Glasgow. Writing in
the Scottish newspaper, The Herald, Professor McKeganey said that
abolishing the distinction between legal and illegal drugs would open
the possibility of much wider drug use and undermine efforts at drug
prevention. He criticised, in particular, a claim previously made by
Professor Nutt in which he had stated that Ecstasy was no more dangerous
than horseriding. This claim, Professor McKeganey said, served only ‘to
trivialise, normalise and ultimately encourage’ drug use, and
represented ‘a very dangerous position for a government adviser on
illegal drugs to take.’
Alcohol most dangerous drug
In a later interview to The Times, Professor Nutt amplified
his views on the dangers of alcohol. It was alcohol, he said, that was
the ‘gateway drug’ and it remained the greatest threat to society. The
Government’s failure to address the problem epitomised its disregard for
scientific evidence. Professor Nutt said that the comparison he made
between the harm caused by alcohol and Ecstasy, which led to his
dismissal as Head of the Advisory Council on the Misuse of Drugs, ‘was
incontrovertible’.
“When I say alcohol is more dangerous than Ecstasy, cannabis
and LSD, I mean it, and the council means it,” Professor Nutt said. “The
Government has to wake up to this time bomb and the health risks of
alcohol. Across the political spectrum everyone knows that alcohol is
the biggest killer.” He added: “If alcohol was discovered tomorrow it
would definitely be illegal. It’s a dangerous drug — there’s no doubt
about that. There is an issue about understanding that it’s alcohol that
will kill people’s kids, not Ecstasy.”
Professor Nutt advocated the tripling of alcohol prices, with taxation the most obvious way of achieving this.
Top of pageThe Centre for Crime and Justice Studies briefing
Professor Nutt’s briefing on drug policy makes clear that, in his
view, alcohol poses the biggest drugs harm challenge. In ‘Estimating
drug harms: a risky business’, Professor Nutt argues that the relative
harms of legal drugs such as alcohol and tobacco are greater than those
of a number of illegal drugs, including cannabis, LSD and ecstasy.
Professor Nutt proposes a ‘drug harm ranking’, which compares the harms
caused by legal as well as illegal drugs. Alcohol ranks as the fifth
most harmful drug after heroin, cocaine, barbiturates and methadone.
Tobacco is ranked ninth. Cannabis, LSD and ecstasy, while harmful, are
ranked lower at 11, 14 and 18 respectively. Professor Nutt argues that
simply focusing on the harms caused by illegal drugs, without assessing
them against those of drugs such as alcohol and tobacco, results in an
‘isolated and arbitrary’ debate about relative drug harms.
Professor Nutt argues strongly in favour of an evidence-based
approach to drugs classification policy and criticises the
‘precautionary principle’, used by the former Home Secretary Jackie
Smith to justify her decision to reclassify cannabis from a class C to a
class B drug. By erring on the side of caution, Professor Nutt argues,
politicians ‘distort’ and ‘devalue’ research evidence. “This leads us to
a position where people really don’t know what the evidence is”, he
writes.
On cannabis, Professor Nutt makes clear that it is ‘a harmful
drug’ and argues for a ‘concerted public health response... to
drastically reduce its use’. However, he points out that cannabis usage
fell when it was reclassified from class B to class C. And he points out
that there is ‘a relatively small risk’ of psychotic illness following
cannabis use. To prevent one episode of schizophrenia, he argues, it
would be necessary ‘to stop 5,000 men aged 20 to 25 from ever using’
cannabis. On recent debates about the classification of ecstasy, in
which the Advisory Council on the Misuse of Drugs (ACMD) recommended it
be classified as a class B drug, Professor Nutt writes that the ACMD
‘won the intellectual argument, but we obviously didn’t win the decision
in terms of classification’.
Professor Nutt also criticises the quality of some research
evidence on drug harms. There are, he writes, “some horrific examples
where some of the so-called ‘top’ scientific journals have published
poor quality research about the harms of drugs such as cannabis and
ecstasy, sometimes having to retract the articles”.
Among Professor Nutt’s recommendations are:
Stopping the ‘artificial separation of alcohol and tobacco as
non-drugs’. It will only be possible to assess the real harms of illicit
drugs when set alongside the harms of other drugs ‘that people know and
use’, he writes.
Improving the public’s general understanding of relative
harms. He had previously compared the risks of taking ecstasy over the
risks of horse-riding, he writes, because media reporting ‘gives the
impression that ecstasy is a much more dangerous drug than it is’.
The provision of ‘more accurate and credible’ information on
drugs and the harms they cause. Drug classification based on the best
research evidence would ‘be a powerful educational tool’. Basing
classification on the desire ‘to give messages other than those relating
to relative harms... does great damage to the educational message’, he
argues.
Professor Nutt said:
“No one is suggesting that drugs are not harmful. The critical
question is one of scale and degree. We need a full and open discussion
of the evidence and a mature debate about what the drug laws are for -
and whether they are doing their job.”
Top of pageSupporting delivery - England's Fourth National Alcohol Conference, Aintree, 24-25 November 2009
England’s 4th National Alcohol Conference, `Safe Sensible Social:
Supporting Delivery’, took place at Aintree, Liverpool in November 2009.
Hosted by the Home Office, the Department of Health and the Department
for Children, Schools and Families, it was designed to give further
momentum to the alcohol harm reduction strategy, particularly in
relation to local developments. Aneurin Owen, who represented IAS at the
conference, sums up what he thought it accomplished.
Five years into the Alcohol Harm Reduction Strategy, it is
still early days – some gains have been made – but there is a long way
to go. The Conference was a showcase for local and national initiatives
but fell short of addressing the key policy areas that would
significantly reduce alcohol-related harm in the UK.
References to population-level measures were conspicuous by
their absence in several keynote addresses and it was left to ‘critical
friends’ – Don Shenker, Mark Bellis and others – to challenge progress
made on protecting young people, marketing, price, availability and
access.
Call for minimum pricing
Dr Arif Rajpura, Director of Public Health, NHS Blackpool,
made a strong case for government action on minimum pricing and for the
alcohol field in all its diversity to advocate actively for this to be
introduced. He was not a lone voice as was clear from the participants’
reaction. It was confirmed by ministers and senior officials from the
Department of Health and the Home Office that minimum pricing is a live
issue and further research has been commissioned.
Responding to a challenge as to why further research is required, following publication of the Sheffield reports:
It was said that the Government requires greater understanding
of the economics of the drinks industry – how pricing policies work
through the commercial chain which is currently shrouded in lack of
transparency
The Home Office requires further detail on the impact of
minimum pricing on the criminal justice service – there is good analysis
on the impact on health.
The Government wishes to consolidate public support for any
measures taken and that more time is required to consult, convince and
carry public opinion on this issue
Alcohol or Drunkenness
Harm Reduction Strategy?
Several presentations and workshops focussed on the success of
partnership approaches and problem solving approaches to managing
night-time economy, antisocial behaviour and youth crime. This is a key
theme in the strategy and the delivery of local and regional actions has
readymade support. Increasingly, however, the impression given is that
the strategy is addressing the management of intoxication and that there
should be more incisive action from government to introduce effective
population-based approaches to create the right environment for local
actions to achieve sustainable outcomes on reducing all alcohol-related
harm. As Mark Bellis commented, “England has become an international
expert on creating safe environments for intoxication”.
Government action
The government will roll out an information and awareness
campaign in the new year based on the CMO’s guidance to parents and
children. This programme will be preceded by a brief PR exercise before
Christmas. David Chater from DCSF confirmed that this campaign has been
developed in partnership with parents and will be based on the weight of
medical opinion that delaying the onset of drinking is best for
children and the need to build resilience and aspiration.
Changing cultural attitudes in this way will be supported by
new measures introduced in the Policing and Crime Act – persistent
possession, dispersal powers to include those over 10 years old
(previously 16 years) and the mandatory code of practice.
From the examples presented at the Conference, significant
progress has been achieved within and across government departments and
at regional and local levels. However, the lasting impression left by
the conference was a call to government: “Support our efforts and
delivery by acting on price”.
Top of page24 hour licensing under threat
Both major political parties have now signalled that the new
licensing regime in England and Wales will be tightened up, and with the
Scottish National Party continuing with its plan to introduce minimum
prices for a unit of alcohol it looks as if the price and availability
of alcohol will remain high up the political agenda.
Speaking at the Labour Party conference in Brighton, Prime
Minister Gordon Brown appeared to repudiate a key part of the licensing
reforms introduced by his predecessor, Tony Blair. A week later at the
Conservative Party conference, Shadow Home Secretary, Chris Grayling,
also promised tough action from a future Conservative government.
Labour to restrict opening hours
In his last party conference speech before the general
election, in the part of the speech concerned with crime and anti-social
behaviour, Mr Brown said:
“We will never allow teenage tearaways or anybody else to turn
our town centres into no go areas at night times. No one has yet
cracked the whole problem of a youth drinking culture. We thought that
extended hours would make our city centres easier to police and in many
areas it has. But it’s not working in some places and so we will give
local authorities the power to ban 24 hour drinking the interests of
local people.”
Later, the Department for Culture, Media and Sport appeared to
confirm that changes to the Licensing Act 2003 are being planned.
Speaking to The Publican newspaper, a spokesman confirmed that the
government is seeking to alter the Licensing Act to give councils the
powers to restrict the opening hours of every licensed venue, including
off-licences and supermarkets, in a problem area.
Council officers will also be given the right to review the
trading hours of a premises, regardless of whether the police or
residents have complained.
The changes will require primary legislation and will see a full consultation before the proposals go through Parliament.
The spokesman said:
“We will give councils the powers to impose a complete blanket
ban on 24-hour licenses in a particular area – such as a street, city
centre, or the whole of the local authority area.
“Councils will still make the majority of licensing decisions
on opening hours on a case-by-case basis, but we accept that there are
times where disorder cannot be attributed to individual premises.
“We will also introduce a new power to make it easier and
faster for councils to restrict or remove individual pub and club
licenses where there are problems.
“We accept the arguments put to us by local government that
councillors should be able to call for reviews without having to wait
for a resident or the police to make a complaint.
“This change will make it easier for licensing authorities to bring problem premises to review.”
According to the DCMS just 10 per cent of 24-hour licenses –
640 in total – are pubs, bars and nightclubs. In his conference speech,
Mr Brown also made another pledge:
“And let me say this bluntly; when someone is found guilty of a
serious crime caused by drinking, the drink banning order which is
available to the courts should be imposed. And where there is persistent
trouble from binge drinking, we will give local people the right to
make pubs and clubs pay for cleaning up their neighbourhood and making
it safe.”
The idea of making licensees pay a special levy to cover the
cost of policing and cleaning up the night-time economy is not, of
course, new. Indeed, Mr Brown appeared to be promising to introduce a
measure which already exists, it having formed part of the legislation
on Alcohol Disorder Zones which came into force on 5 June 2008. These
are designed to help local authorities and the police tackle high levels
of alcohol related nuisance, crime and disorder that cannot be directly
attributable to individual licensed premises. However, as, so far as is
known, not a single local authority has made use of the legislation to
designate an alcohol disorder zone, no licensees have ever been made to
pay the levy.
The fact that one of Mr Brown’s proposed measures to tackle
binge drinking already exists in theory, albeit not in practice, and
that, if the opinion polls are accurate, Mr Brown will not be around
after the next general election to rescind 24 hour licensing, should
not, however, provide much comfort for the licensed trade. For spokesmen
for the main opposition party have also threatened to reform the
Licensing Act 2003, and, in particular, the extended hours granted by
the Act.
Conservatives “will tackle alcohol-fuelled antisocial behaviour”
Speaking at the Conservative Party conference, Shadow Home
Secretary, Chris Grayling, promised a future Conservative
Government would introduce a much tougher licensing regime, with local
councils and the police being given new powers to restrict the large
number of late licenses awarded to shops, takeaways and other venues.
Other promised measures include:
Significant tax increases, including on alcopops, strong beer
and strong cider, “that contribute to violence and disorder on our
streets.” As a result, a 4-pack of super-strength beer will be £1.30
more expensive, a 2-litre bottle of super-strength cider will be 84p more
expensive and a large bottle of alcopops will be up to £1.50 more
expensive.
Supermarkets and other retailers will be banned from selling
alcohol below cost price. This, Mr Grayling said, would help tackle the
‘pre-loading’ trend – young people and binge drinkers consuming cheap
alcohol at home before going to town centres.
Police - 24 –hour drinking Act ‘should be reversed’
The Licensing Act 2003, which introduced 24 hour drinking, has
failed and should be reversed, according to Garry Shewan, Assistant
Chief Constable of Greater Manchester Police.
Addressing a police conference devoted to the theme of
alcohol-related crime and disorder, Mr Shewan warned that the new
Licensing Act ‘leaves police dangerously stretched.’ He said that the
Government’s claim that the extension of drinking hours would stop the
11pm or 2am rush had not been borne out by events. He continued:
“The reality is it’s not stopped the rush and sometimes it has
pushed the rush back. What used to be a late-night problem is sometimes
in major cities extended to 16-18 hours and that clearly is a real
risk. Bars and clubs are staying open much later and that puts a real
strain on police resources. It would be far safer if the period of time
people drink irresponsibly was reduced.”
Top of pageDoctors call time on alcohol promotion
In a bid to tackle the soaring cost of alcohol-related harm,
particularly in young people, the BMA has called for a total ban on
alcohol advertising, including sports events and music festival
sponsorship. In addition, the BMA also called for an end to all
promotional deals like happy hours, two for-one purchases and ladies’
free entry nights. A new BMA report, ‘Under the Influence’, also renews
the call for other tough measures such as a minimum price per unit on
alcoholic drinks and for them to be taxed higher than the rate of inflation.
Launching the report, Dr Vivienne Nathanson, Head of BMA
Science and Ethics, said: “Over the centuries alcohol has become
established as the country’s favourite drug. The reality is that young
people are drinking more because the whole population is drinking more
and our society is awash with pro-alcohol messaging and marketing. In
treating this we need to look beyond young people and at society as a
whole.”
According to the World Health Organisation (WHO), alcohol is
the leading risk factor for premature death and disability in developed
countries after tobacco and blood pressure problems. It is related to
over 60 medical conditions, costs the NHS millions of pounds every year
and is linked to crime and domestic abuse.
Alcohol consumption in the UK has increased rapidly in recent
years; for example, household expenditure on all alcoholic drinks
increased by 81 per cent between 1992 and 2006. And at the same time,
says the author of the report, Professor Gerard Hastings, never before
has alcohol been so heavily promoted.
Professor Hastings said:
“Given the alcohol industry spends £800 million a year in
promoting alcohol in the UK, it is no surprise that children and young
people see it everywhere – on TV, in magazines, on billboards, as part
of music festivals or football sponsorship deals, on internet pop-ups
and on social networking sites. Given adolescents often dislike the
taste of alcohol, new products like alcopops and toffee vodka are
developed and promoted as they have greater appeal to young people.”
“All these promotional activities serve to normalise alcohol
as an essential part of everyday life. It is no surprise that young
people are drawn to alcohol.”
The report claims that brand development and stakeholder
marketing by the alcohol industry, including partnership working and
industry-funded health education, have served the needs of the alcohol
industry, not public health.
Dr Nathanson added:
“We have a perverse situation where the alcohol industry is
advising our governments about alcohol reduction policies. As with
tobacco, putting the fox in charge of the chicken coop – or at least
putting him on a par with the farmer – is a dangerous idea. Politicians
showed courage before by not bowing to the tobacco industry, they need
to do the same now and make tough decisions that will not please alcohol
companies.”
Key recommendations from the report include:
- A ban on all alcohol marketing and promotion
- Minimum price levels for the sale of alcoholic products
- Tax increases on alcohol set above the rate of inflation and linked to alcoholic content
- A reduction in licensing hours for on- and off-licensed premises.
The full title of the report is:
“Under the Influence – the damaging effect of alcohol marketing on young people”.
Top of pageAlcohol sponsors should have to prove they do no harm
Researchers from Australia and the UK have called for a new approach
to the debate over whether alcohol industry sponsorship of sports
increases drinking among sports participants. They want to shift the
burden of proof to the alcohol industry.
The debate over sports sponsorship saw renewed activity in
2008 when the findings of a New Zealand study among sports participants
showed that those who received alcohol industry sponsorship – especially
in the form of free or discounted alcohol – drank more heavily than
those not in receipt of such sponsorship. The study received extensive
media coverage, but the Portman Group (a public relations body set up by
the alcohol industry) and the European Sponsorship Association (whose
members include leading alcohol producers) dismissed the results, citing
no causal relationship between sponsorships and alcohol misuse.
In an editorial in the journal Addiction, researchers say that
the alcohol industry should be required to prove that industry
sponsorship of sports does not cause unhealthy alcohol use among adults
or encourage children to drink. They argue that “it should not be left
to the public to demonstrate that alcohol industry sponsorship is
harmful but rather, it should be up to the proponents of the activity,
i.e., the alcohol industry, to show that the practice is harmless.” Lead
author Dr Kypros Kypri said that the position taken by the drinks
industry is reminiscent of that taken by the tobacco companies, which
until the 1990s doggedly denied that there was proof of a causal
association between smoking and lung cancer. Until the industry has
proved lack of harm, governments should prohibit alcohol industry
sponsorship of sports.
Dr Kypri suggested that “The latest moves by the major
sporting codes in Australia, to lobby against the regulation of alcohol
sponsorship of sport, are indicative that these bodies remain in denial
of alcohol-related problems in their sports. In addition, it is clear
that these organisations have enormous vested interests in continuing to
receive alcohol money and government should be careful to act in the
public interest rather than cave in to the sports and Big Booze.”
Co-author Dr Kerry O’Brien of the University of Manchester added that
“Sport administrators are sending mixed messages to sportspeople and
fans when on the one hand they embrace and peddle alcohol via sport, yet
on the other punish individual sport stars and fans when they display
loutish behaviour while under its influences.”
In place of industry sponsorship, the researchers suggest that
governments use the proceeds from alcohol taxation to sponsor sports
via an independent body. Such an approach is already in place in
Australia and New Zealand, where tax revenues from tobacco sales are
used to sponsor sports and other activities through publicly accountable
agencies. The authors point out that this has the added advantage of
providing a more equitable and accountable basis for allocating
sponsorship of elite and community sport than leaving it up to the
alcohol industry to decide who gets funded.
Kypri K., O’Brien K., Miller P.
Time for precautionary action on alcohol industry funding of sporting bodies. Addiction 2009; 104: 1949-1950
Top of page100,000 people could die as a result of their drinking over next ten years
Almost 100,000 people could die over the next ten years as a direct
result of their drinking, according to Alcohol Concern, on the basis of a
report they commissioned from the Alcohol & Health Research Unit at
the University of the West of England, released to coincide with the
start of Alcohol Awareness Week in England in October 2009. The report,
‘Future Proof’, suggests that in the UK 90,800 people could die
avoidable deaths from alcohol-related causes by 2019 if the population
continue to drink at the average rate of the past 15 years.

The report also highlights ONS statistics which show that
deaths from alcohol are highest among older people, supporting Alcohol
Concern’s view that the focus on encouraging ‘sensible drinking’ among
young people should be widened to target the whole population.
Commenting on ‘Future Proof’, Professor Ian Gilmore, President of the
Royal College of Physicians and Chair of the Alcohol Health Alliance UK
said:
“Over the next decade alcohol misuse is set to kill more
people than the population of a city the size of Bath. Much of this
tragic loss of life, often in young and otherwise productive people,
could be prevented if our policymakers followed the evidence for what
works. Confronting the culture of low prices and saturation advertising,
along with investment in accessible, effective treatments for harmful
and dependent drinkers could make a big impact on what is becoming a
public health emergency.
” Professor Martin Plant, lead author of the work said:
“The UK has been experiencing an epidemic of alcohol-related
health and social problems that is remarkable by international
standards. It is strongly recommended that reducing mortality should be
the top priority for alcohol control policy. This could be done by
introducing a minimum unit price of 50p which would cut alcohol-related
hospital admissions, crimes and absence days from work.
Only 100,000?
Launching the report, Alcohol Concern made the astonishing
claim that it broke new ground in calculating the relationship between
alcohol consumption and mortality for the first time in the UK, a claim
repeated in the published summary of the report itself. In reality, the
relationship has been studied extensively over many years, with numerous
researchers concluding that alcohol is the cause of rather more deaths
than the 9,000 or so per annum suggested in ‘Future Proof’. An Oxford
University research team estimated that in 2005 there were 31,000 deaths
attributable to alcohol in the UK. The discrepancy derives from the
different methodologies employed, with the Alcohol Concern report
including only diseases directly caused by alcohol and alcohol
poisoning, but excluding deaths caused indirectly by alcohol, such as
those from drink-driving or cancers which have been caused in part by
drinking.
Key Findings from ‘Future Proof’
The report states that alcohol consumption in the UK has
increased rapidly in recent years so that the UK is now among the
heaviest alcohol consuming countries in Europe. In England, over a third
of men report drinking over 21 units in an average week and among women
a fifth report an average weekly consumption of over 14 units. In
Wales, nearly 40% of adults admit to consuming more than the recommended
limits. In Scotland, 1 in 3 men and 1 in 4 women exceed recommended
daily limits. Across Britain, 1.1 million adults are alcohol dependent.
It is estimated that the annual cost of alcohol misuse to the NHS is
£2.7 billion in 2006-07 prices. In 2008 the government estimated that
the total cost of harm from alcohol was between £17.7 and £25.1 billion
per year.
Link between consumption and harm
The research presents a clear correlation between increase in
alcohol consumption per capita and the number of additional deaths that
would occur as a consequence. Findings suggest that an increase of one
litre in per capita consumption would be associated with approximately
928 extra alcohol-related deaths in the UK per year. Given the average
increase in per capita consumption of 0.0875 litres over the past 15
years, an extra 810 deaths would occur across the UK over the next 10
years if the country continues to drink at the rate of the past 15
years. In Northern Ireland, Scotland and Wales, these levels of
association between consumption and mortality were the strongest, the
effect of consumption levels being evident immediately in mortality
rates. In England, there was a one-year time lag between consumption
changes and mortality.
Future Proof – Can We Afford the Cost of Drinking Too Much? - How to stem the tide of alcohol harms
The report says that because of the link between consumption
and harm, the government’s strategy should be to lower overall alcohol
consumption levels for the whole population, targeting a reduction in
heavy drinking amongst all age groups. Price is the most effective, efficient and evidence-based lever to achieve this. Therefore, policies
should include the introduction of a minimum price per unit of alcohol
to stamp out loss-leading and the sale of high volumes of alcohol at
very low prices, especially in off-licenses and supermarkets. Government
should also consider a revision of alcohol duty, linking it to product
strength in order to encourage both the production and consumption of
lower alcohol beverages.
Other recommendations are that all alcohol products should
show mandatory unit and health information, including the sensible
drinking guidelines, and brief intervention and advice should routinely
take place in all primary health and social care settings to help
identify those that are drinking at unsafe levels. International
evidence and practice shows there is a reduction in the health care
needs and associated costs if front line services are able to identify
at an early stage those who are drinking too much and help them reduce
their consumption, directly or through referral to specialist services.
Top of pageMandatory code still on the agenda
The power to impose statutory regulations on the selling of alcohol,
designed to outlaw irresponsible drinks promotions, was, after all,
included in the Policing and crime Act which received Royal Assent in
November 2009.
There had been considerable doubt as to whether the
controversial mandatory code on the retailing of alcohol, announced to a
fanfare of publicity earlier in the year, would ever actually be
introduced, particularly after Lord Mandelson, the Business Secretary,
and normally reckoned to be the Deputy Prime Minister in all but name,
pleased the alcohol industry and disappointed many in the public health
sector by calling for a delay in introducing the code until after the
next general election.
However, the Home Office, which still favoured the early
introduction of the Mandatory Code, appears to have won the day. The
Policing and Crime Act introduces an ‘enabling power’ whereby the Home
Secretary can draw up a code of practice for the alcohol industry which
will permit the imposition of some mandatory licensing conditions and
allow licensing authorities to ‘block apply’ conditions to a number of
premises at a time. At the time of writing, however, the content of the
code appears not to have been decided, and it is not entirely clear what
the next steps will be or what timescale will apply.
Prime Ministerial initiative
Prior to the passage of the Policing and Crime Act, a draft
code was put out to extensive consultation with stakeholders including
the trade, police, local authorities and alcohol NGOs. The code was
originally announced by Prime Minister Gordon Brown as the latest
Government initiative to combat binge drinking. It was presented as a
means of outlawing promotions aimed at encouraging customers to drink
more than they would otherwise have done, such as drinking games, the
provision of free drink for certain groups, and offers to ‘drink as much
as you like’ for a fixed fee. These promotions, Mr Brown said, could
turn some town centres into no-go areas.
Predictably, Mandelson’s attempt to delay was attacked by some
in the alcohol harm prevention lobby. In a letter to the Times
newspaper, Don Shenker of Alcohol Concern and Professor Ian Gilmour of
the Royal College of Physicians accused the Government of favouring
profit over health. The letter was also signed by Alison Rogers of the
British Liver Trust and Mike Craik, Chief Constable of Northumbria
Police. The letter said:
“When the mandatory code for alcohol sales was announced six
months ago it was already a long overdue measure, designed to tackle
patently irresponsible promotion of alcohol, such as the ‘drink all you
can’ offers and giveaway prices in supermarkets.
“Delaying the measure until 2011 - effectively shelving it
indefinitely - would be a costly error and appears to pander to big
business concerns over profit at the expense of safer streets and public
health.”
However, the disappointment at Lord Mandelson’s attempt to delay the Code was not shared by all non-business stakeholders.
Some local authorities had attacked the Code for being little
more than another gimmick. The City of Westminster, normally regarded as
one of the toughest licensing authorities in the country, questioned
whether the new powers in the Code would have any effect as powers
already existed in the Licensing Act to deal with problem alcohol
retailers. Westminster also pointed out the lack of coherence in policy,
with the Mandatory Code seeming to impose the very list of mandatory
conditions on licensed premises that the Ministerial Guidance to the new
Licensing Act disallowed. The London Borough of Lambeth criticised the
Code for focusing on pubs when the real problem was very cheap alcohol
being sold from off licenses, especially the supermarkets.
Top of pageOldham tackles supermarket alcohol sales
The Mandatory Code may still not be a reality, and the legality of
minimum pricing may be in dispute, but at least one local licensing
authority has decided to take its own initiative on supermarket sales of
alcohol. The Trading Standards and Civil Resilience department of
Oldham Council has sent out a letter to all supermarkets in the borough
setting out new proposals to review their drinks licenses and require
them to adopt additional measures if alcohol is to be sold at less than
fifty pence per unit of alcoholic strength.
The letter explains the concerns of the Council regarding
irresponsible drinks promotions. These, the Council says, encourage
alcohol misuse and/ or antisocial behaviour. The cumulative effect of
irresponsible drinks promotions is to cause greater drunkenness, which,
in turn, causes a rise in crime and disorder. The letter also refers
specifically to the problem of ‘pre-loading’, and to the attractiveness
of irresponsible drinks promotions particularly to young people, and
the problems that causes. For example, the effect of drinking excessive
amounts of alcohol can be that people vomit or urinate in the streets,
which is a public nuisance.
The letter explains the Council’s objectives in setting out new
licensing conditions for supermarket sales of alcohol. These are:
- To reduce the available space for irresponsible drinks promotions in off licensed premises
- To increase the protective services available, both
through promotion of responsible drinks messages and through adequate
security supervision of drinks promotion
Accordingly, the letter sets out proposed conditions and
invites licensees to comment. A key point is that the conditions are
intended to apply only to premises which sell alcohol at less than 50p
per unit of alcoholic strength. This is the same benchmark that the
Council used for the on trade in Oldham Town Centre.
The proposals include:
- A license requirement that ‘designated alcohol sales
zones’ be identified on the operating schedule of the premises. The
specific location and size would vary according to the premises size,
but would typically be two aisles in your premises
- That alcohol on sale below 50p per unit of alcoholic
strength would not be permitted to be displayed outside of the
designated zone
- That the designated zone be delineated by a barrier with
entrance gates, the entrance gates clearly showing that no unaccompanied
under-18s are permitted in the zone
- That each designated zone be patrolled during opening hours by an SIA registered security officer
- That the promotional material for alcohol on sale below
50p per unit of alcoholic strength be limited to a size less than 20cm
by 10cm
- That one of a choice of five social responsibility
messages be displayed within a circle of 1 metre diameter (field of
vision) for each location where alcohol is on sale below 50p per unit of
alcoholic strength
Top of pagePrice of alcohol influences drinking habits of heaviest drinkers
A new study suggests that minimum pricing of alcohol will reduce
consumption amongst Scotland’s heaviest drinkers. The study which
explored the drinking habits of patients referred to alcohol problems
services in Edinburgh in 2008/09 found that:
- The lower the price a patient paid per unit of alcohol, the more units they consumed
- Most of the alcohol consumed was bought from off-licenced
premises where the cheapest alcohol is sold. The average price paid per
unit of alcohol was 34p which is much lower than the average paid per
unit in Scotland as a whole
- Off-licensed purchases were made in roughly equal proportions from supermarkets and local/ independent shops
- 75% of patients reported never purchasing alcohol from on-licensed settings
- Vodka was reportedly the most popular drink, but it was noted that white cider provided a particularly cheap access to alcohol
- Patients in the study consumed on average 198 units of
alcohol in a typical drinking week. The recommended weekly limit for men
is 21 and 14 for women
Dr Jonathan Chick, coauthor of the study said:
“Information on drinking patterns usually comes from big
population surveys. However, the heaviest drinkers in a population tend
not to respond to surveys so this study provides important information
on how price changes might affect those most affected by alcohol.
Because the average unit price paid by these chronically ill patients
was considerably lower than the rest of the Scottish population, it is
likely that eliminating the cheapest alcohol sales by minimum pricing
will result in reduced overall consumption by this group of drinkers
with a fairly immediate reduction in serious alcohol-related illnesses
in our community.”
A minimum price for a unit of alcohol of around 40 pence is
mid-range of price levels suggested for discussion in the new Scottish
strategy to tackle the substantial burden of harm due to alcohol use in
Scotland. Alternative options to minimum pricing, such as a ban on the
sale of alcohol below the cost of duty plus VAT payable on a product,
have also been suggested.
Dr Bruce Ritson, Chair of Scottish Health Action on Alcohol Problems said:
“This emerging research makes an important contribution to
the debate and adds to the evidence base on the likely health benefits
of minimum pricing. Other alternatives that have been suggested are
unlikely to deliver the same health benefits. If we had a ban on the
sale of alcohol below the cost of duty and VAT instead of minimum
pricing the price of white cider would remain unchanged and vodka could
still be purchased for 26 pence per unit of alcohol. With six people
dying an alcohol-related death every day in Scotland, we need to adopt
the policy that is going to be most effective in reducing harm and
saving lives.”
Dr Jonathan Chick is a Scientific Advisor to the IAS
Top of pageMinimum alcohol price legal?
Further uncertainty overtook the Scottish Government’s plan to set a
minimum price for alcohol when the European Court of Justice opposed a
similar policy on tobacco. The Court’s advocate-general ruled against
proposals by Ireland, France and Austria to set a minimum price on
cigarettes, saying it would break competition laws by benefiting
manufacturers. The drinks industry in Scotland immediately claimed that
the ruling would apply to alcohol as well, and said that the plan for
minimum alcohol prices should therefore be abandoned.
However, Health Secretary Nicola Sturgeon dismissed the
industry’s claim, insisting that the court’s ruling on tobacco was
“irrelevant”. The leader of SHAAP, (Scottish Health Action on Alcohol
Problems) also defended the policy of minimum pricing.
Ms Sturgeon said:
“It is entirely inappropriate and irrelevant to translate an
opinion on tobacco to the totally different issue of minimum pricing of
alcoholic products per unit of alcohol for public health reasons. We are
well aware of these cases, and the relevant Directive - 95/59/ EC - is
specifically about the excise duty on manufactured tobacco and has
nothing to do with alcohol products.
“In fact, the European Commission has already said that
Community legislation does not prohibit minimum pricing for alcohol on
public health grounds. Obviously, we rely on our own legal advice to
progress this policy which is fair, proportionate and necessary to
protect public health in Scotland.
“The issue here is ending a situation where three-litre
bottles of chemical cider are sold for £3, or 700ml bottles of
industrial vodka for less than £7. These are the products favoured by
problem drinkers and are exactly the ones that will be targeted by
minimum pricing - not quality products sold at responsible prices.
“Minimum pricing of alcohol has broad support base among
medical experts, the police and the pub trade. Just last week, the
National Institute for Clinical Excellence (NICE) in England, the UK
Government’s expert advisory body on medical treatment, strongly backed
minimum pricing as a way of reducing consumption among harmful and
hazardous drinkers.”
Top of pageNorth West Directors of Public Health call for minimum price of alcohol
Legislation to introduce a minimum price for alcohol of 50p per unit,
has been called for by a group of nineteen Directors of Public Health
in the North West of England. Writing in a letter to The Times
newspaper, the public health doctors urge the government to add a ban on
selling alcohol below 50p per unit to the other measures it is
proposing, to tackle the irresponsible sale of cut-price alcohol by the
off-trade. The doctors continue:
“None of us comes to this policy solution easily. However,
despite considerable investment in the NHS and public health messages, a
new Licensing Act and efforts by the industry itself, HMRC figures show
that the overall consumption of alcohol continues to rise, as measured
by volume of alcohol sold. Hospital admissions due to alcohol harm have
risen by 64% in the North West in the past five years. Apart from the
implications for public health of this situation, we believe that the
cost to the NHS in the North West of £400 million per year is simply
unsustainable.
“Of course, personal responsibility must continue to be part
of our collective focus in tackling alcohol consumption, but it is naive
for any of us to think it can be the sole focus. Alcohol is
sufficiently price elastic for the aggressive price-cutting we have seen
in recent years to affect individual consumption. It follows, as
Sheffield University has shown, that raising the price of the cheapest
alcohol sold would affect overall consumption and would target
effectively the consumption of those that drink above moderate levels.
“We know that the Government has argued that it does not wish
to penalise moderate drinkers. Neither do we. A unit price of 50p means
£1.50 for a pint in the pub or £4.50 for a bottle of wine in the
supermarket. Is this really too much to pay to save 3,393 lives per
year, to cut crimes by 45,800 and save the country £1 billion every year
in alcohol-related costs?
“We urge the Government to act quickly and decisively. The
political leadership that was shown on smoking in public places needs to
be shown on alcohol too. As with smoking, the politicians that take a
lead in combating alcohol harm may find that they command the public’s
respect and support as a result.”
Top of pageDepartment of Health under fire
The Department of Health’s approach to reducing alcohol-related harm
has been heavily criticized by the House of Commons Public Accounts
Committee (PAC) in its report ‘Reducing Alcohol Harm: health services in
England for alcohol misuse’. The report examines how the Department
responds to alcohol-related harm through Primary Care Trusts,
responsible for determining local priorities and spending. It states:
“Many PCTs …. do not know what they spend on [alcohol]
services and across England there is little correlation between need and
expenditure. Where services Launching the report, the PAC’s Chairman,
Edward Leigh MP, said:
“Too many people are drinking too much. In England, nearly a
third of all men and a fifth of all women are regularly drinking more
than the official guidelines say they should. In doing so, many are on
course to damaging their health and general well-being.
“The burden on local health services is of course huge, with
the rate of alcohol-related hospital admissions climbing sharply and A
& E departments flooded on weekend nights with drink-associated
injury cases.
“The responsibility for are commissioned there is frequently a
lack of performance monitoring and examination of whether what is
provided represents value for money.” addressing alcohol harm has been
handed to the Primary Care Trusts. But many have neither drawn up
strategies to tackle alcohol harm in their areas nor even have much idea
what they are spending on the relevant local services. These services
are often ill-coordinated, increasing the risk that dependent drinkers,
after immediate medical care, will simply relapse into their former
drinking habits. Each PCT should have to demonstrate what progress it
has made towards reducing the number of alcohol-related hospital
admissions in its area.
“None of this is helped by poor coordination between Whitehall
departments on such relevant matters as licensing, taxation and glass
sizes. The Department of Health should look across all departments,
identify all the initiatives and policy areas bearing on alcohol misuse
and determine the extent to which each is helping or hindering the
Department’s objectives. Where the latter are being stymied, the
Department should communicate its concerns to senior officials in the
relevant departments.”
Mr Leigh was speaking as the Committee published its 47th
Report of this Session which, on the basis of evidence from the
Department of Health (the Department), examined the current performance
of the National Health Service in addressing alcohol harm, the
Department’s influence on local commissioners, and the Department’s work
to encourage sensible drinking.
Background
In 2004, alcohol harm became subject to a national government
strategy, which was updated by the Department and the Home Office in
2007. Since April 2008, the Department has also been responsible for
delivering against a Public Service Agreement (PSA) indicator on the
rate of increase of alcohol-related hospital admissions.
Primary Care Trusts (PCTs) are responsible for determining
local health priorities and have control over the majority of NHS
spending. PCTs are free to decide for themselves how much to spend on
services to address alcohol harm. Many PCTs, however, do not know what
they spend on such services and across England there is little
correlation between need and expenditure. Where services are
commissioned, there is frequently a lack of performance monitoring and
examination of whether what is provided represents value for money.
In 2008, the Department introduced a number of new measures
designed to help address alcohol harm: providing extra funding for GPs
to screen new patients, increasing alcohol specific training for
doctors, and creating 20 pilot sites designed to improve specialist
treatment services. The Department has, however, yet to demonstrate its
ability effectively to influence local commissioners, the drinks
industry, and people’s drinking behaviour. The Department also needs to
work more closely with the other government departments which are
responsible for policies affecting alcohol consumption, such as taxation
and licensing.
Achieving this will be necessary if the Department is to
reduce levels of alcohol harm and succeed against the PSA indicator. The
PAC report makes 10 key conclusions and recommendations:
Alcohol misuse places a large and growing burden on local health services; in particular, accident and emergency departments.
Some preventive services, such as ‘brief advice’... can be
delivered effectively by...other officials outside the health service,
but this requires effective partnership working at the local level.
There is little evidence that this is happening.
General Practitioners (GPs) have an important role to play...
but are not doing so consistently. A new scheme [the DES] to encourage
such work is likely to have only limited effects.
Only around 1 in 18 people who are dependent on alcohol
receive treatment and the availability of specialist services differs
widely across England.
...there is frequently a lack of monitoring of whether what is
provided by the public, private and voluntary sectors represents value
for money.
[Treatment] services are often not joined up, increasing the
risk that people will simply relapse into their former drinking habits.
The Department’s sensible drinking guidelines were changed
from weekly to daily limits in 1995, but 11 years later almost
two-fifths of people did not know the current recommended guidance.
By July 2008, only 3% of alcoholic products had fully complied with the drinks industry voluntary labelling scheme.
There is little evidence that Whitehall-wide action on other
policies and regulations which affect alcohol consumption - such as
licensing, taxation and glass sizes - is effectively coordinated.
Alcohol has become steadily cheaper in relation to income; meanwhile, consumption and health damage have increased.
Responding to the publication of the Public Accounts Committee’s report
‘Reducing Alcohol Harm: Health services in England for alcohol misuse’,
Professor Ian Gilmore, President of the Royal College of Physicians and
Chairman of the Alcohol Health Alliance said:
“It clearly demonstrates that the delivery of alcohol
policy locally has been uncoordinated and muddled, and the effect on
those particular interventions left unevaluated. The Government must now
focus on better policy coordination and a clear mandatory framework
rather than voluntary partnerships with industry. Above all it must
prevent harm and drive down overall consumption through introducing a
minimum unit price for alcohol.”
Top of pageDepartment of Health to develop National Liver Strategy
The Department of Health has announced that it is to implement a
National Strategy for Liver Disease, of which alcohol is the largest
single cause. A first step is the appointment of a new National Clinical
Director to lead the development.
Liver disease is the fifth most common cause of death in
England and, the Department says, if action is not taken to combat the
disease, it could overtake stroke and coronary heart disease as a cause
of death within the next 10-20 years. The growth in liver disease is
largely fuelled by lifestyle factors such as excessive drinking and
obesity and could easily be prevented. The Department is to recruit a
National Clinical Director in the next few months to develop and oversee
the implementation of a strategy to combat Liver Disease effectively.
Health Minister Ann Keen said:
“Liver disease is the only one of the top five causes of death
which is continuing to affect more people every year at an increasingly
young age. We know that by identifying people earlier, encouraging
people to change their behaviour and making sure the right services are
in the right place, we can improve the quality of care and stop the rise
in this disease. By appointing a National Clinical Director to oversee
the development of a strategy we will ensure that clinical evidence and
outcomes for patients are at the heart of our work to improve the
quality of services to tackle liver disease. We will continue to work
closely with the NHS and patient groups to make a real difference for
patients and for the healthcare staff working in this area.”
Liver disease facts:
- The average age of death from liver disease is 59, compared to 82 for heart disease and 84 for stroke
- Liver disease is largely preventable and can be treated if diagnosed sufficiently early
- Obesity is a rising cause of liver disease, with
Non-Alcoholic Fatty Liver Disease (NAFLD) a growing concern amongst
liver specialists
- While lifestyle factors such as drinking and obesity are
the biggest causes, liver disease can also be caused by viral hepatitis,
excessive iron and rare disorders
- Liver disease currently costs the NHS £460m a year
Top of pageScotland tops UK alchol league
Figures on alcohol consumption and harm show that Scotland not only
remains top of the alcohol league in the UK, they also suggest Scotland
has the eighth highest alcohol consumption level in the world. According
to industry sales figures, Scotland drank nearly 50 million litres of
pure alcohol in 2007 - equivalent to 11.8 litres per capita for every
person aged over 16. This was considerably higher than England and
Wales, which had an average consumption figure of 9.9 litres per capita.
For Scottish adults aged over 18, moreover, the figure was
even higher at 12.2 litres of pure alcohol per person, while the figure
for England and Wales was 10.3 litres.
Scotland’s pure alcohol per capita figure of 11.8 litres is
equivalent to 570 pints of 4 per cent beer, nearly 500 pints of strong 5
per cent lager, 42 bottles of vodka or 125 bottles of wine - enough for
every single adult to exceed the sensible drinking guidelines for men
of 21 units every week of the year. And the difference between
Scotland’s consumption and that of England and Wales, of 189 units per
person, equates to 80-90 pints of beer or 21 bottles of wine more per
head.
The figures are derived from market data analysed by the
Nielsen Company for the Scottish Government, which also showed that
two-thirds of alcohol in Scotland was bought in off-sales locations such
as supermarkets.
Compared with the latest figures compiled by the World Health
Organisation, this would place Scotland as having the eighth highest
pure alcohol consumption level, behind only Luxembourg (15.6 litres per
capita), Ireland (13.7 litres), Hungary (13.6 litres), Moldova (13.2
litres), Czech Republic (13.0 litres), Croatia (12.3 litres) and Germany
(12.0 litres). England and Wales’ figure of 9.9 litres per capita would
place it at fifteenth - equal with Lithuania.
Scotland’s figure is higher than nearly every other country in
Western Europe, including Spain (11.7 litres), France (11.4 litres) and
Italy (8.0 litres). It is more than double the consumption level in
Scandinavian countries like Sweden (6.0 litres) and Norway (5.5 litres)
where the relative price of alcohol is considerably higher and the sale
of alcohol is more restricted.
Commenting on the figures, Shona Robison, Minister for Public Health, said:
“When it comes to alcohol consumption, Scotland is worryingly
close to the top of the international league table. Sales data from the
alcohol industry itself indicates that we’re buying and drinking much
more than people in the other UK countries and most of the rest of the
world.
“There can be little doubt that this is largely a consequence
of the big fall in alcohol’s relative price, which has dropped 70 per
cent since 1980. Significantly, we now buy two-thirds of our alcohol
from supermarkets and shops, rather than in pubs and clubs. In these
contexts, alcohol is frequently sold as a ‘loss leader’, with heavily
discounted deals and pocket-money prices the norm. The sad knock-on of
all this has been a huge rise in all types of alcohol-related illnesses
and deaths, with Scotland’s liver cirrhosis rate one of the
fastest-growing worldwide and double that of England and Wales. Health
experts are now agreed that alcohol misuse is the most pressing public
health issue facing Scotland and we have to get to grips with it.
Deluding ourselves that over-consumption of alcohol across our society
is consequence free, or someone else’s problem, is no longer an option.”
Scottish alcohol death rates up to six times UK average
Not surprisingly, Scotland’s high level of alcohol consumption is accompanied by a high death toll from alcohol.
Death rates in one constituency - Glasgow Shettleston - are nearly 6 times the UK level or 574% of the UK average.
In the view of Alcohol Focus, Scotland, the figures, revealed
in a Parliamentary Answer by Health Secretary Nicola Sturgeon, add to
the case for the Scottish Parliament to introduce serious measures to
address Scotland’s relationship with alcohol and support the proposals
put forward by the Scottish National Party to crack down on cheap
alcohol. “The Scottish Government is proposing radical action to tackle
Scotland’s problems with alcohol, but it is also for each and every one
of us to think about what we’re drinking and the effect that has on
ourselves and public services. “Alcohol misuse costs Scottish society
£2.25 billion a year. Recent reports estimating that 30% of ambulance
journeys are alcohol-related put the cost to the ambulance service at
£30 million – today’s figures show it could be much more than that. “At
the start of Alcohol Awareness Week I would urge everyone to look at
their relationship with alcohol, how much they drink, and the impact it
is having on their lives and on their communities.” The ten
constituencies with the highest number of deaths as a percentage of the
UK death rate (approx 13 deaths per 100,000) are shown in the
accompanying box. Of the 73 Scottish Parliament constituencies, 64 of
them have alcohol-related death rates above the UK average and all but
one health board has an alcohol-related death rate above the UK average.
Amongst health boards, Greater Glasgow and Clyde recorded the highest
number of alcohol-related deaths at 267% or nearly three times the UK
average.
Jack Law, Chief Executive of Alcohol Focus Scotland said:
“These shocking figures highlight the links between alcohol misuse and
poverty. Although people from across the social spectrum are affected by
personal alcohol problems, people in areas of deprivation suffer
greater health and social inequalities as a result of problem drinking.
“Too many communities in Scotland are blighted by alcohol
problems. We want to see action on the price of alcohol and its
availability - the lure of deeply discounted alcohol comes at a huge
cost to families, communities, and services.
“Introducing minimum pricing will make a real difference to alcohol-related harm in Scotland.”
Most night-time Scottish Ambulance call-outs due to alcohol
Figures from the Scottish Ambulance Service, reported on the
BBC on the first day of Scotland’s Alcohol Awareness Week in October
2009, show that 68% of calls between Friday night and Sunday morning are
alcohol-related. Glasgow SNP MSP Anne McLaughlin who recently joined an
ambulance crew in Glasgow on a Saturday night said the figures matched
what she had seen:
“Spending the night working with Glasgow’s paramedics showed
me how much of their time is spent dealing with the impact of alcohol.
“Whether it is people hurting themselves in drink-related
accidents, ending up so drunk they need hospitalization, or the end
result of alcohol-induced violence, all the cases we saw on a Saturday
night shift involved alcohol.
“I want our emergency services to be dealing with people who
really need them, not having to spend all their time mopping up the
damage caused by alcohol.
“The Scottish Government is proposing radical action to tackle
Scotland’s problems with alcohol, but it is also for each and every one
of us to think about what we’re drinking and the effect that has on
ourselves and public services.
“Alcohol misuse costs Scottish society £2.25 billion a year.
Recent reports estimating that 30% of ambulance journeys are
alcohol-related put the cost to the ambulance service at £30 million –
today’s figures show it could be much more than that.
“At the start of Alcohol Awareness Week I would urge everyone
to look at their relationship with alcohol, how much they drink, and
the impact it is having on their lives and on their communities.”
Top of pageYet another sensible drinking campaign launched
October 2009 saw the launch of the ‘Campaign for Smarter Drinking’,
the latest attempt to persuade young adults not to binge drink.
The campaign, billed as being funded to the tune of £100
million over five years, is being implemented in England in conjunction
with the Drinkaware Trust and with the support of the Department of
Health. Forty-five drinks producers and retailers are involved in the
campaign, which will “offer practical tips to make sure good times don’t
go bad, such as reminders to drink water or soft drinks, eat food and
plan to get home safely.” The campaign claims it will take a social
marketing approach to “use outdoor advertising, signs, drink mats in
pubs and bars, on-drink and point of sale displays in retailers to
deliver its message.”
Critics claim that on the face of it, the campaign appears to
add little to previous efforts. There has been an assortment of
responsible drinking campaigns over recent years, funded by a range of
government departments as well as industry-funded organisations. Drinks
industry giant Diageo launched its own responsible drinking website, and
there have been a number of Home Office campaigns alongside the £10
million NHS Know Your Limits campaign.
Interestingly, Sainsburys have refused to participate in the
latest effort precisely on the grounds that it merely duplicates other
educational initiatives that are already taking place.
However, some public health bodies have made even harsher
criticisms, claiming not only that such campaigns are a waste of money
but also that the campaign for smarter drinking is little more than a
ploy by the drinks industry to head off the threat of mandatory controls
on the retailing of alcohol.
Professor Ian Gilmore, Chair of the UK Alcohol Health Alliance and President of the Royal college of Physicians, commented:
“There is very little evidence that health messages work to
prevent binge or harmful drinking. Instead, all the international
evidence shows that increasing the price and reducing the availability
of alcohol, together with bans on advertising, are the main methods of
reducing alcohol-related harm. We need strong government action in these
areas right now.” Was the Mandatory Code doomed anyway?
Alcohol Concern’s Don Shenker went further, describing the
campaign as “yet another example of the drinks industry trying
desperately to avoid mandatory legislation. ‘We’ve seen this before from
the industry,” he said. “There was a big fanfare when Drinkaware was
launched but the money never materialised.”
He added that the campaign’s budget had been calculated at
ratecard and through in-kind payments, and as a result the funding was
not nearly as great as it sounded. Shenker’s view appeared to be given
support by an unnamed drinks industry informant who was reported in a
trade journal as agreeing that the purpose of the campaign was to avoid a
mandatory code of practice. “The industry has been told by government
that if you cough up, we won’t introduce it,’ said the source.
This may have been a reference to a letter from Health
Secretary Andy Burnham to the Campaign for Smarter Drinking’s Director,
Richard Evans. In the letter, Burnham states that the new campaign plans
to make extensive use of point-of sale, advertising and on pack
communication and therefore any new mandatory messaging requirements for
these media….could potentially conflict with the (new campaign’s)
messages and therefore potentially confuse consumers, as well as
competing for space in media where space is physically limited.” Burnham
goes on to say that the Government therefore wishes to give the new
campaign the opportunity to prove its effectiveness before bringing in
any mandatory messaging requirements. As the new campaign is scheduled
to run for 5 years, that appears to rule out any mandatory code for at
least that period of time.
Top of pageDangers of unsupervised youth drinking
More evidence of the importance of parental awareness and supervision
of their children’s alcohol consumption, and of the dangers of
unsupervised youth drinking, has been provided by a major new study by a
research team led by Professor Mark Bellis at the Centre for Public
Health in Liverpool.
The study of just under 10,000 15- and 16-year olds in the
north west of England, a region with particularly high levels of alcohol
consumption and harm, found that likelihood of binge drinking and also
of harm from drinking was substantially higher in children who drank
outside the family environment in parks, streets or other public places
compared with those whose access to alcohol was through their parents.
The findings were widely misreported in the media, notably the
BBC, as showing that parents should provide their teenage children with
a weekly allowance of alcohol. However, lead author Mark Bellis refuted
this, pointing out that the report contained no such recommendation. He
said that one of the most striking findings of the study was that
adverse effects of drinking were common even in children who drank
relatively small amounts in the family home. Bellis said:
“Regretted sex after drinking, having been involved in
violence when drunk, consuming alcohol in public places and forgetting
things after drinking had all been experienced by relatively large
proportions of teen drinkers. For children who drink alcohol we did not
find any typical drinking patterns where children were at no risk of
harms. Accessing alcohol through parents did not remove the risks of
alcohol related harms but was associated with lower levels of risk”.
While 19.9% of teen drinkers whose parents provide alcohol and who drink
once a week had been involved in violence when drunk, this rose to
35.9% in those who only access alcohol through other means.
Another notable finding of the study was that problems from
youth drinking are strongly associated with the types of alcohol
consumed. Those who consumed multi-litre value cider bottles, spirits
and other cheap forms of alcohol reported higher frequency of violence
when drunk, and alcohol-related sexual encounters that they later
regretted compared with those who had consumed other products.
Interestingly, alcopops were not associated with higher levels of
adverse effects. Bellis concluded: “The negative impacts of alcohol on
children’s health are substantial. Those parents who choose to allow
children aged 15-16 years to drink may limit harms by restricting
consumption to lower frequencies (e.g. no more than once a week) and
under no circumstances permitting binge drinking. However, parental
efforts should be matched by genuine legislative and enforcement
activity to reduce independent access to alcohol by children and to
increase the price of cheap alcohol products”.
Top of pageScottish children besiege Childline over parental drinking
New research reveals that a high number of calls to ChildLine from
young people concerned about their parents harmful drinking come from
children in Scotland compared to the rest of the UK.
The study carried out by ChildLine and SHAAP highlights
children’s accounts of the severe negative impacts of harmful parental
drinking on their lives including emotional stress, physical abuse and
neglect.
Dr Evelyn Gillan, Director of Scottish Health Action on
Alcohol Problems and co-author of the study added: “We know that
increased alcohol consumption in Scotland is driving an increase in
health and social harm but what is often not acknowledged is the harm
this causes to people other than the drinker.
“It’s likely that people drinking harmfully will negatively
affect the lives of two other close family members. What this study
shows is that many of those negatively affected by someone else’s
drinking are children and the direct impact on their lives includes an
increased risk of physical violence and abuse, severe emotional distress
and neglect. What is particularly sad, is that many children experience
a loss of childhood because they often take on caring responsibilities
such as looking after brothers or sisters and this can prevent children
doing normal childhood activities.”
Untold Damage - children’s accounts of living with harmful parental drinking - Wales, A; Gillan, E; 2009
Top of pageNumbers of children of substance abusing parents
Almost 1 in 3 children live with a binge drinking parent. Widespread
patterns of binge drinking and recreational drug use have resulted in
higher numbers of children in the UK than previously thought being
exposed to sub-optimal care and substance-using role models.
This is the conclusion of a new study to estimate the numbers
of children aged under 16 exposed to parental substance abuse.* Deriving
estimates from UK national household surveys of alcohol and drug use
and the prevalence of psychological disorders, the researchers calculate
that around 700,000 children live with a parent who is dependent on
alcohol, and up to 3.6 million with at least one parent who is a binge
drinker. Just under 1 million children live with a parent who has used
an illegal drug during the last 12 months.
The detailed estimates are shown in the box below. However,
the researchers say that the situation is not universally bleak, despite
these figures. Research findings also indicate that the most high-risk
drug-taking behaviours tend to exist among parental substance misusers
physically separated from their children, thus eliminating direct
negative effects. Moreover, while parental substance misuse can impair
parenting capacity, harm is not inevitable and indeed, the authors say,
rarely exists in isolation from other factors such as poverty, social
exclusion, poor housing and family tension.
Alcohol:
- 3.3 - 3.5 million (30% of total) in the UK live with at least one binge drinking parent
- 8% (978000) with two binge drinkers
- 4% (500000) with one binge drinking parent
- 2.6 million live with a ‘hazardous’ drinker
- 6% (705000) with an alcohol dependent drinker
Drugs:
- 978000 (8%) lived with at least one adult who had used illegal drugs during that year
- 2% (256000) with class A drug user
- 7% (873000) live with a Class C drug user
- 335000 live with a drug dependent parent
- 72000 live with an injecting drug user
- 72000 live with a drug user in treatment
- 108000 live with an adult who had overdosed
Alcohol and Drugs:
- 3.6% (430000) lived with a problem drinker who also took drugs
- 4% (500000) lived with a parent who had alcohol problems coexisting with other mental health problems
*Manning, V et al 09; New estimates of the number of children living
with substance misusing parents: results from UK national household
surveys: BMC Public Health 2009, 9:377
Top of pageMoves to provide greater protection for children living with alcohol and drug dependent parents
The children of parents dependent on alcohol or other drugs will get
special help if they are at risk when their parents are receiving
treatment, under a new agreement between the National Treatment Agency
for Substance Misuse (NTA) and the Department for Children, Schools and
Families (DCSF). New guidance issued to local social services makes
clear that drug and alcohol treatment workers can help children’s
services identify vulnerable children and families.
For the first time, local protocols will spell out the
important role that drug workers can play in delivering a child
protection plan:
Information about the risk of harm
Specialist advice on how the parents’ addictive behavior may affect the child’s safety
Securing improvements in the health and social functioning of parents
The guidance entitled Joint Guidance on Development of Local
Protocols between Drug and Alcohol Treatment Services and Local
Safeguarding and Family Services, published jointly by the NTA and DCSF,
makes explicit to all staff working with families that referrals should
be made to children’s services when a child is suspected of suffering
significant harm.
This builds on the statutory duty of section 11 of the
Children’s Act 2004 which ensures that protecting a child from harm has
to be the paramount concern of all agencies.
Paul Hayes, NTA Chief Executive, launched the initiative at a
‘Think Families’ conference. He said: “Drug workers are not child
protection or safeguarding experts, but their role in providing
effective treatment to drug dependent individuals means identifying the
influences on an adult’s drug use and what motivates them to stop.
Questioning what’s happening within the families of drug users in
treatment is critical for successful treatment outcomes, both for the
individual as well as any family involved, and the new guidance for
local protocols clarifi es when and how to involve children’s social
care. Entering drug treatment is protective: it protects the individual,
their children and wider society.”
Alongside the guidance, the NTA is releasing figures from the
National Drug Treatment Monitoring System (NDTMS) which have been
collected from the 83,000 adults newly presenting to treatment in
2008/09.
These show:
- 39,156 adults newly entering drug treatment in England in
2008/09 are parents who may not be living with children but may have
access to them periodically
- 27,670 adults newly entering drug treatment in England in 2008/09 are living in a household with children
- 48,703 children are living in the same home as someone newly entering drug treatment in England in 2008/09
On this basis the NTA estimates that at least 120,000 children
are living with the 207,000 adult drug users in England’s total
treatment population.
Access to treatment will enable many drug-misusing parents to
care for their children well. These protocols are designed to maximize
the proportion of drug-using parents who can look after their children,
while minimizing the risk of harm to the children of those who cannot,
through early identification and prompt intervention.
The Think Families agenda is led by the DCSF and supported by
the NTA in delivering safeguarding guidance to the drug treatment sector
in England.
Top of pageCot death alcohol link
More than half of sudden unexplained infant deaths occur while the
infant is sharing a bed or a sofa with a parent (co-sleeping) and may be
related to parents drinking alcohol or taking drugs, suggests a study
published in the on-line version of the British Medical Journal.
Although the rate of cot death in the UK has fallen dramatically since
the early 1990s, specific advice to avoid dangerous co-sleeping
arrangements is needed to help reduce these deaths even further, say the
researchers.
The term sudden infant death syndrome (SIDS) was introduced in
1969 as a recognised category of natural death that carried no
implication of blame for bereaved parents. Since then, a lot has been
learnt about risk factors, and parents are now advised to reduce the
risk of death by placing infants on their back to sleep, in the “feet to
foot” position at the bottom of the cot, and keeping infants in a
smoke-free environment. But it is not clear which risk messages have
been taken on board in different social or cultural groups, and little
is known about the emergence of new or previously unrecognised risk
factors.
A four-year study* by a team of researchers from Bristol and
Warwick Universities, (funded by The Foundation for the Study of Infant
Deaths (FSID)) looked at all unexpected infant deaths, from birth to two
years, in southwest England from January 2003 to December 2006. To
investigate a possible link between SIDS and socioeconomic deprivation,
they compared these deaths with a control group at ‘high risk’ for SIDS
(young, socially deprived mothers who smoked) as well as a randomly
selected control group.
Parents were interviewed shortly after the death and
information was collected on alcohol and drug use. A detailed
investigation of the scene and circumstances of death was also conducted
by trained professionals.
Of the 80 SIDS deaths analysed, more than half (54%) occurred
whilst co-sleeping compared to 20% co-sleeping rate amongst both control
groups. Much of this risk may be explained by the combination of
parental alcohol or drug use prior to co-sleeping (31% compared with 3%
random controls), and the high proportion of co-sleeping deaths on a
sofa (17% compared with 1% random controls), say the authors. A fifth
of SIDS infants were found with a pillow for the last sleep and a
quarter were swaddled, suggesting potentially new risk factors emerging.
The risk factors were similar whichever group the SIDS cases
were compared with, suggesting that these risk factors for SIDS apply to
all sections of the community and are not just a consequence of social
deprivation.
Some of the risk reduction messages seem to be getting across
and may have contributed to the continued fall in the SIDS rate, say the
authors. However, the majority of the co-sleeping SIDS deaths occurred
in a hazardous sleeping environment. The safest place for an infant to
sleep is in a cot beside the parental bed in the first six months of
life, they write.
Parents need to be advised never to put themselves in a
situation where they might fall asleep with a young infant on a sofa.
They also need to be reminded that they should never co-sleep with an
infant in any environment if they have been drinking or taking drugs.
We have learnt that SIDS is largely preventable, says Edwin
Mitchell, Professor of Child Health Research at the University of
Auckland, in an accompanying editorial. It is important to monitor
parents’ knowledge and infant care practices to inform health education
and promotion. Implementing what we already know has the potential to
eliminate SIDS, the challenge now is how to change behaviour, he
concludes.
*Hazardous co-sleeping environments and risk factors
amenable to change: case-control study of SIDS in South West England -
Sidebotham et al 09
Top of pageA promising start for the Family Drug and Alcohol Court
By Jonathan Goodliffe, Solicitor (info@jgoodliffe.co.uk)
Alcohol and drug misuse is at the heart of many family
problems, including those on which lawyers advise. 2 to 3% of all
children in England and Wales under 16 are thought to have one or both
parents who misuse illegal drugs. Up to 1 in 11 children may be living
with parents with alcohol problems.
In serious cases parents may become unfit to look after their
children. Their problems may be aggravated by factors such as
psychiatric comorbidity, domestic violence, poverty and homelessness.
Action taken by local authorities may result in the children going into
care.
At a later stage children may be placed for adoption. The
longer this is deferred the more difficult it may become to find a
placement. Adoption may sometimes be the best ultimate outcome. Children
of parents misusing alcohol or drugs are at risk of harm. Children
brought up within the care system often have poor educational
performance and prospects. A cycle may arise when the child develops
their own addiction or when the mother repeatedly compensates for the
loss of her child by getting pregnant again and again losing the child
into the care system.
The court procedure may also be a problem. Cases may take
years to reach a conclusion. Different judges, some of whom may not have
appropriate experience, can be involved at different stages. The
adversarial court procedure usually involves the examination and
cross examination of a variety of different expert witnesses instructed
by the parties rather than the court. By the time the case is decided
the children’s problems may have got worse rather than better.
Operation of FDAC
The London Family Drug and Alcohol Court (FDAC) was founded to
address these problems. It started operating in January 2008 to help
families in the boroughs of Camden, Islington and Westminster. It is
running for an initial trial period of 3 years. It is funded partly by
those boroughs and partly by Central Government. It follows in most
respects the example of similar “problem solving courts” in the USA.
I asked Caroline Little of Hanne & Co for her impressions
of FDAC. She sits on the Safeguarding and Voice of the Child
subcommittees of the Family Justice Council. She told me that she had a
number of cases in FDAC and added: start for the Family Drug and Alcohol
Court
“The mother in a nearly concluded case recognises that she
would not have succeeded in the normal court. In another case the
parents had been addicts for over 20 years and on paper looked hopeless.
They are doing very well - but of course have to be, and are,
completely motivated.
“I believe that FDAC provides children in care proceedings with the best opportunity to be brought up in their natural family.
“The key component is the quality of the personnel in the
FDAC team and the judges. They give parents early access to coordinated
resources, and a really supportive, rather than punitive environment.
Children’s solicitors and guardians ensure that the focus remains on the
child and that children’s interests are not lost. A parent who is
committed to caring for their child should be able to do so in the FDAC
scheme. He or she will leave, not only with care of their children, but a
real respect for professionals and the court.”
FDAC’s key features
The advantages of FDAC are as follows:
It is supported by a multidisciplinary team (the “FDAC team”)
based at the Coram Foundation in Central London. The team includes a
general manager and a service manager, a child psychiatrist and adult
psychiatrist, a clinical nurse, a parental substance misuse specialist, 3
social workers and a parent mentor co-ordinator.
The FDAC team is also supported by a team of 12 guardians, one
of which is usually appointed for the child[ren] in each case. The
guardian will then appoint a solicitor to represent the child’s
interests.
There are also 5 “parent mentors” who have themselves personal
experience of addiction problems. In the first phase, the mentor
provides initial support to the parent from the time of the first
hearing through the assessment and planning stage. If parents decide to
accept the FDAC service, a mentor may be matched to the parent, to
undertake a specific type of support that will have been set out in the
parent’s individual intervention plan.
The Court itself is based at the Inner London Family
Proceedings Court in Wells Street. So far as possible all hearings take
place on Mondays before two specialised district judges, Judge Nicholas
Crichton and Judge Kenneth Grant. They are backed up where necessary by
two other judges.
Parents facing court action relating to their children are
given the choice whether to take part in the FDAC proceedings or to be
dealt with under normal procedures. If they do take part, they sign an
agreement to that effect. They are then given the intensive support of
the FDAC team with a view to controlling their substance misuse,
addressing their other problems and otherwise becoming fit to care for
their children. If they succeed this is recognised at a “graduation
ceremony”. If not their cases are transferred out of FDAC into the
ordinary list. Non-graduation does not, however, necessarily equate with
total failure. Parents may sometimes get significantly better but not
necessarily to the extent of being able to retain care of their
children.
Progress is usually reviewed every two weeks at short hearings
typically attended by the parents, a member of the FDAC team, the
guardian and/or mentor if available and a representative from the local
authority. These hearings enable the judge to engage directly with the
parents, to show a personal interest in the children, to motivate the
parent to continue with the good work and to give full recognition to
any progress. Judge Crichton described this to me as sometimes
endeavouring to “turn every negative into a positive”.
The purpose of the procedure is to lead to an outcome within a
much shorter time frame than is usually possible. Even if the outcome
is that the parents cannot keep their children it is better that this
should be decided sooner rather than later.
Parents are not usually represented by lawyers at these
hearings unless a special need arises. If a contentious issue arises
which requires a longer hearing this will usually take place outside the
FDAC process. It is, nonetheless, essential that parents and children
should receive legal advice.
Impressions of FDAC
I spent a Monday in court with Judge Grant and a shorter
period with Judge Crichton. Several of the cases seemed to be going very
well, others less so. This is not surprising. It is generally
recognised that a common outcome of even the best form of addiction
treatment is relapse or a series of relapses before long term recovery
is achieved. Nonetheless the general impression was very encouraging.
I saw two cases where the mother was approaching “graduation”.
In each case she came across as happy and healthy. The judge was shown a
photograph of the children. He congratulated the mother on her progress
and the improvement in her general health and appearance. There was no
sign of any negative body language between the mother and the FDAC team
or local authority representative. In other cases there was less room
for optimism. These included one where the mother had recently been
discharged from hospital and did not appear.
In one case the father addressed the court at some length. He
expressed his apprehension that, despite all his efforts, he feared that
he would not be able to progress his recovery from drug use within a
short enough time scale to avoid losing his child. Everyone listened
attentively and showed an appreciation of the father’s anguish. This
may, perhaps, have been quite a fortifying experience for him.
Another notable feature of FDAC cases which I saw was the
participation and support provided by members of the extended family,
often a grandparent. Typically the extended family can feel powerless to
help where parents are addicted. Knowledge of the support provided by
FDAC must be a strong motivating factor. In one of the cases the
extended family member was appointed special guardian to the child.
Interim report on the FDAC project
It was Judge Crichton who originated the FDAC project. It was
launched, however, on the advice of, and is to be evaluated by, a
research team led by Judith Harwin, professor of social work at Brunel
University. The research team’s interim report was published in
September 2009. It contains a full description of the court’s procedures
and how lawyers have adapted to them. It also describes:
- how the specialist FDAC team works
- the demographics of parents and children in all cases entering FDAC in its first year
- the research team’s approach in costing and evaluating FDAC in the final report due in July 2010
- court observations by the research team, and
- perspectives on FDAC from parents, judges, the FDAC team, and children’s guardians.
In presenting the report Professor Harwin commented:
“The speed with which FDAC has become a fully operational
service and the strong partnerships being developed between agencies
show this new multi-disciplinary approach has the potential to succeed
in breaking the cycle of harm caused to families by substance misuse.”
The report expresses concerns about the lower-than expected number of
families taking part in the pilot. Since the report was completed,
however, this has ceased to be an issue.
Not enough mentors
There has been some difficulty in recruiting mentors, so the
qualifications for applicants have been relaxed. Aspiring mentors need
to demonstrate first hand experience of substance misuse, either through
their own experience or that of a close family member.
They do not necessarily now need to be a parent or have
experienced care proceedings. They will need to demonstrate an
understanding of the issues arising in FDAC. They will receive their own
training and become full members of the team.
The future
It remains to be seen whether funding continues after the
three year pilot despite constraints imposed by the recession. Judge
Crichton is confident that the new approach will gain ground. He points
out that there is scope for some of the FDAC methods to be extended
into ordinary child residence and contact proceedings. He is hopeful
that it may ultimately be possible for FDAC to extend its operations,
possibly starting in South East London, in the neighbourhood of the
Maudsley Hospital.
There are now a wide range of materials on the internet relating to FDAC’s activities. I have created a page http:// www.jgoodliffe.co.uk/fdac/ containing a full set of links.
Top of pageNew publication: Understanding the high functioning alcoholic by Dr Sarah Allen Benton
With increasing numbers of people returning from work and reaching
for a glass of wine, either as a reward or to relieve the stress of
working life, the condition of high-functioning alcoholism; that is,
having an addiction to alcohol which appears from the outside to have no
adverse effects on a person’s day-to-day professional life, may be an
increasing but under-reported problem.
In ’Understanding the high-functioning alcoholic –
Professional views and personal insights’, Sarah Allen Benton (who
describes herself as a high-functioning alcoholic in recovery) ‘takes us
into the worlds and minds of so-called “high-functioning alcoholics” to
help us understand how people so intelligent and achievement oriented
get drawn into states in which they cannot control their liquor
consumption, but still manage to excel in their careers.’ The book takes
the form of detailed accounts of the various stages in the development
of high-functioning alcoholism and the journey to recovery, each stage
accompanied with reflections from the author on her own experiences.
She describes the signs of high-functioning alcoholism as:
- Denial that a person has an alcohol problem – HFAs don’t
think that they fit the stereotypical image of an alcoholic because they
feel they are managing their lives
- Trouble controlling alcohol intake even after deciding to drink no more than a certain amount
- Obsessive thinking about drinking
- Behaviour when drinking is uncharacteristic of sober self
- Experiencing blackouts and being unable to remember what happened during a drinking bout
She describes a highfunctioning alcoholic (HFA) as someone who
is able to maintain their ‘outside life’ including career and family
commitments, home life and friendships, whilst, at the same time,
drinking alcoholically. Society, she says, does not see HFAs as being
alcoholics because they have been successful in their careers and
personal lives – indeed she argues that such success, and often
over-achievement, lead many HFAs and those close to them to remain in
denial of the problem, with the result that their alcoholism remains
undiagnosed. Benton explains that many HFAs would not consider
themselves alcoholic because they may not drink on a daily basis or be
physically addicted to alcohol, so their particular problem does not
match the accepted diagnostic criteria for alcohol dependence. HFAs, she
says, use the facts that they are well respected for career or academic
performance and that they can maintain a social life and intimate
relationships as evidence that their drinking is not a problem, but she
also explains that they are skilled at compartmentalising their lives
and that they surround themselves with people who drink heavily, thus
‘normalising’ their drinking habit.
The content of the book is heavily geared towards the American
market but the problems discussed are also relevant to the UK and the
author’s personal perspective aims to demonstrate why she feels that
high-functioning alcoholism is so difficult to admit, to cope with and
to recover from.
Further information on the book and on the author’s work can be found at
http://www.highfunctioningalcoholic.com
The author can be contacted at : sarah@highfunctioningalcoholic.com
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