Policies that lead to increased alcohol consumption in the population as a whole may lead to an increase in the amount of problem drinking and alcohol related problems and are therefore not in the interest of the public's health.
The truth of this statement may be obvious to some, such as most of those involved in alcohol research and in the prevention of alcohol problems, but it appears to be far from obvious to others, such as executives of the alcohol industry and the former British Government. In 1995, the Conservative Government raised the 'sensible drinking' limits following a review of alcohol policy, key elements of which were the rejection of the whole population theory, and the wish to promote `moderate' drinking because of its supposed protective effect in regard to coronary heart disease. Both elements had been (and remain) constant themes of the alcohol industry.
The whole population theory was discounted as scientifically uncertain and difficult to apply, 'especially in the UK'. A particular objection was that while the whole population theory might apply to comparisons of one country with another (countries with higher average consumption would probably be found to have more heavy drinkers), it did not necessarily follow that the theory applied within a single country, such as the UK.
Prompted by this challenge, a team of researchers at University College, London analysed information on drinking habits in fourteen regions of England.* Even in a country as geographically small as England there are marked regional variations in alcohol consumption, especially in men, and what became evident was that, exactly as the whole population theory would predict, the regions with the lowest average consumption had the fewest heavy drinkers and vice versa - the regions with the highest average per capita consumption also had the highest proportions of heavy drinkers (defined as those drinking above both the old and the new 'sensible limits') and the highest prevalence of people reporting symptoms of alcohol dependence. This was found for both men and women.
These observations confirm that heavy drinking or 'alcohol abuse' are not purely the result of individual attributes scattered randomly through the population, but are also, and mainly, a reflection of the prevailing drinking culture and the average level of consumption. They also imply that factors encouraging increased average consumption in light to moderate drinkers, - such as longer drinking hours, alcohol becoming cheaper, or, perhaps, governments raising the 'sensible drinking limits' and sending messages about the 'heath benefits' of moderate consumption - are likely also to result in an increase in heavy drinking and alcohol-related problems.
The authors comment that the Government's raising of the drinking limits assumed firstly, that higher levels of consumption than previously recommended are `safe' and, secondly, that heavy drinkers are indifferent to the acceptability of drinking in their culture. These assumptions lead to the view that an upward shift in consumption that might result from raising the limits would, therefore, be harmless.
The University College researchers believe that this is not the case. "Our analysis suggests that this is not the case and that higher average consumption among moderate drinkers is associated with higher rates of heavy drinking and problem drinking."
It remains to be seen whether or not the new Government will revise the 'sensible drinking' guidelines in the light of this evidence.
*H. Colhoun et al: Ecological analysis of collectivity of alcohol consumption in England: importance of average drinker.
The study, of middle aged to elderly men and women, found evidence of alcohol reducing the risk of heart attack by around 60 per cent but only in those whose pattern of consumption was little and often - one to four drinks per day in men, less in women, taken on five or six days a week. Other patterns of consumption did not provide the same benefits and, in particular, a binge drinking pattern had an adverse effect. Men who consumed nine or more drinks a day one or two days a week actually had an increased risk of heart attack compared with non-drinkers. This could explain why evidence of a protective effect has been apparent in wine consuming countries and populations where there is an established pattern of alcohol being consumed regularly but not to the point of drunkenness. In contrast, there appears to be less evidence for any protective effect in northern European countries, especially the `vodka belt', traditionally characterised by explosive, binge drinking patterns.
However, the authors of the new study emphasise that the health benefits of `little but often' should not be got out of perspective and caution:
"Despite the results of this and other studies caution is needed in promoting alcohol consumption because the adverse effects of abuse may outweigh any potentially beneficial effect in reducing heart disease."
P. McElduff & A. Dobson: How much alcohol and how often? Population based case-control study of alcohol consumption and risk of a major coronary event.
Alcohol control advocates have been known to express the view that journalists, and the newspapers for which they write, are not necessarily sympathetic to their cause. This could be mere paranoia, or it could be that journalists and newspapers actually are hostile to any views they define as `anti-alcohol'. For one thing, in many countries newspapers are keen to attract revenue from alcohol advertising, and pursuing an `anti-alcohol' policy in the editorial sections is unlikely to help in this regard.
There is also the matter of the drinking habits of the journalists themselves. Private Eye's fictional reporter `Lunchtime O' Booze' exemplifies the stereotype of the drunken hack all of whose news stories are found in the local bar. Now, a new academic study shows that while the stereotype is an exaggeration, it may not be a complete invention.*
The study, of 154 relatively senior British journalists, found that as a group they do indeed drink more than the general population. A third of the male journalists reported drinking between 22-35 drinks per week, compared with only 15 per cent of men in the general population. The contrast with the rest of the population was even more pronounced in the women journalists. For example, while only 4 per cent of women report drinking at `high risk' levels, over 18 per cent of the women journalists reported doing so. These reported drinking levels are of course consistent with the figures for deaths from cirrhosis and other alcohol-related causes, male workers in literary and artistic occupations, including journalism, being at around twice the risk of men in general.
But do journalists' drinking habits affect their opinions? The answer seems to be that they do. This is not surprising, as previous investigations have found that one of if not the best, predictors of people's attitudes to alcohol control policy is their own drinking habits: broadly, the more people drink themselves, the more liberal their attitudes to alcohol issues are likely to be. And so it was with the journalists: as a group they were generally hostile to measures restricting the availability of alcohol. Seventy to ninety per cent of them were positively opposed to increasing the tax on alcohol, restricting opening hours and banning media alcohol advertising. Some measures did meet the approval of the majority - tighter laws on drinking and driving, warning labels on alcoholic drink and making the proof of age scheme compulsory. A possible interpretation of these findings is that the journalists were only prepared to support measures that did not directly impinge on themselves.
Source: R. Baillie: Drinking Patterns among a Sample of British Newspaper Journalists. Paper presented at the meeting of the Kettil Bruun Society, Iceland, June 1997.
Mortality from alcohol related liver disease has increased substantially in Scotland, more than doubling between 1983 and 1995. However, the increase is puzzling as alcohol consumption appears not to have changed greatly over this period.
The pattern is the same in England, with deaths from alcoholic liver disease increasing by two-thirds between 1984 and 1994. The increase was especially steep in young adults aged 15-44, in whom the death rate doubled during this period. Deaths from other alcohol-specific causes - alcohol dependence syndrome, non-dependent abuse of alcohol and alcoholic cardiomyopathy also increased, despite national alcohol consumption being largely unchanged.
No clear explanation for these trends has been found, but Scottish researchers suggest that changes in society such as greater income disparities and greater social isolation may be involved.
The need for further measures against drugs was emphasised by five coroners, all from Lancashire, who warned of an alarming rise in the number of young people dying from drug addiction and overdoses, particularly of heroin and methadone.
The coroners said that there was "tremendous naivety" among the public about the scale of the drugs problem and young people's casual acceptance of the dangers. They said that the number of inquests into drug-related deaths had risen markedly in their courts in the past few years, to about 130 a year.
Andre Rebello, Coroner for Blackburn, said that he was haunted by the stunned and bewildered look on the faces of parents whose children had died. "There are no social strata that have not been touched by this problem. It affects everyone; every race and every culture. People should not be complacent that the drugs problems will never affect them. It happens to the best of homes and to people with the greatest advantages in life."
It is unusual for coroners to speak out publicly on a particular issue, but the scale of the drug problem prompted the action by Mr Rebello, Howard McCann, Coroner for Preston, George Howson (Lancaster), and David Smith (Burnley), and Anne Hind, Deputy Coroner for Blackpool.
Mrs Hind said that she tried to impress upon people the sheer waste of a drug death by emphasising the sordidness and the fact that victims often choked on their own vomit. But frequently she was speaking to habitual drugtakers: "You look around the court and you see a row of dilated pupils."
She was especially shocked by the death of a boy aged 17 who, with a friend, decided to stay in one night with a four-pack of beer and £10-worth of heroin. "That was how they chose to spend the evening.
He injected first and then his friend. It is the casual acceptance of drugs as a way of life that is so shocking." Mr Howson said:
"The death of an addict does not appear to serve as a warning to their friends. They listen to the evidence, they listen to how the person came to die, and I repeatedly come to the conclusion that you are speaking with no effect whatsoever. There is simply a casual acceptance of that way of life and the dangers that it presents. They appear to have no concern for their own lives. Quite simply, they are playing Russian roulette."
According to Home Office figures, between 1984 and 1994 the number of deaths caused by drug dependence and non-dependent abuse of drugs, excluding solvents and alcohol, more than trippled, up from 133 deaths in 1984 to 489 in 1994, the latest year for which official statistics are available. When deaths from poisoning involving a controlled drug, both accidental or suicide, are included the figures rise substantially. There were 442 accidental deaths in this category in 1994 and 334 drug-related suicides.
Drug victims are predominantly male, between 18 and 35, unemployed, and often from a broken family.
British doctors have called for drugs derived from cannabis to be legalised for the treatment of seriously ill and dying patients.
Debating the issue at the at the annual meeting of the British Medical Association a large majority backed a motion that the time had come to decriminalise a range of cannabinoids – drugs derived from cannabis - that research proves can ease suffering. The Association's board of science and education is preparing a report supporting the medical use of cannabinoids which is to be published in September.
Speaking in the debate, Dr. U. Pati said: "There are many conditions like multiple sclerosis and cancer where symptoms could be controlled by drugs we are not allowed to use".
Dr. Steven Hajioff agreed. He said that increasing evidence showed that cannabis-based drugs helped people who were suffering from such things as anorexia or nausea caused by chemotherapy. People were buying it illegally because they knew it helped them. "This is ridiculous," he said. "The sick and dying should be able to turn to their doctor for help and not their drug dealer."
There were dissenting voices. Dr. E. Tierney said that cannabis might ease pain but it impaired the ability to drive, fly, or work machinery, and caused agitation, anxiety and apathy. It also took 28 days to work its way out of the bodily tissues.
About a third of delegates at the conference voted against the legalisation of cannabinoids, but they were unanimous in condemning tobacco and alcohol manufacturers.
Dr Michael Crowe said that, if society could have one legal substance from alcohol, tobacco, opium or cannabis, it should choose cannabis.
Professor Jack Howell, chairman of the board of science, said he would have liked the report to be published before the motion was carried. The drugs concerned were extracted from the 400 chemicals, including 60 cannabinoids. The drugs would be pure and prescribed in measured doses, as pills, aerosol sprays or injections.
Professor Howell said: "I would be astonished if we decided that it could be administered by smoking"
The doctors were criticised for being too hasty by the Multiple Sclerosis Society. Peter Cardy, the society's chief executive said: "We are very surprised that doctors should be advocating a wider use of substances derived from cannabis before convincing scientific trials have taken place. There is plenty of evidence from individuals that cannabis can help to control spasm, pain and incontinence for some people with MS, others have reported negative effects. The society believes properly controlled trials are essential."
Those with moderate to heavy alcohol consumption over a long period of time do not necessarily reduce their brain power, according to a study conducted by researchers from the Australian National University, Canberra, and the Center for Education and Ageing in Sydney and published in the British Medical Journal.*
Over 200 men, all veterans of the Second World War, and with an average age of 73 were examined for the study. Compared with Australian men of the same age, the veterans as a group had sustained a high level of consumption into old age. Researchers say the average veteran drank about two and a half pints.
The group of men were given 18 different tests to measure their intellectual functioning. No relationship could be found between drinking habits and intellectual performance. According to the researchers, the heavier drinkers scored just as well on psychological and intellectual tests as those who consumed alcohol in moderation and nondrinkers. They also noted that there was no difference in the proportion with brain shrinkage between those who drank alcohol and those who did not.
* O.F.Dent et al: Alcohol consumption and cognitive performance in a random sample of Australian soldiers who served in the second world war. BMJ 7 June 1997.
Although the more scientifically - minded have wondered whether it is merely an old wives tale, it is sometimes suggested that eating sweets or chocolate can help recovering problem drinkers to keep off alcohol. Now, studies of animals are providing evidence that there may be real link between a liking for sugar or saccharine and a liking for alcohol.
Dr. Alexey Kampov-Polevoy, a research fellow at the University of North Carolina, started examining the issue because he noticed that many recovering problem drinkers have a sweet tooth, putting a lot of sugar in their coffee, and starting their day with a bar of chocolate.
What he found was a number of studies of rats and mice showing connections between preferences for sweet things and preferences for alcohol. For example, rats and mice bred to prefer alcohol to water drank significantly more saccharine solution than rats and mice that did not prefer alcohol. Also, the alcohol preferring rats preferred the sweetest saccharine solution available, whereas the water-preferers would not drink the saccharine beyond a certain concentration. Moreover, although all rats preferred the saccharine solution to water, when offered the saccharine, some rats experienced a form of 'loss of control' and almost doubled their daily consumption of fluid.
Perhaps most significantly of all, when the alcohol-preferring rats had their daily alcohol replaced for four days with saccharine solution, when the alcohol was returned the rats reduced their alcohol consumption by 60 per cent, an effect that lasted for a week.
But what of human beings? Research in this area is only just beginning, but Kampov-Polevoy has already conducted one study which suggests that people may show the same patterns as the rats. In the study, the problem drinkers revealed much sweeter tooths than the non-problem drinking control group. For example, only 16 per cent of the control group preferred the sweetest drink available, compared with 65 per cent of the problem drinkers. Indeed, a quarter of the drinkers asked for an even sweeter drink.
It is early days, but Kampov-Polevoy is convinced that further investigations could be very useful. One possibility is that people with a sweet tooth might be at raised risk of alcohol problems. Another is that sweet drinks or foods could be useful in the treatment of problem drinkers, being an alternative to drugs.
Kampov-Polevoy is discussing the possibility of a large- scale research project with the Finnish National Public Health Institute.
ARF Journal. July/August 1997
The Government has launched a new website providing independent drugs information and research for drugs professionals and local Drug Action Teams. The web site was set up by the Institute for the Study of Drug Dependence (ISDD).
Announcing the project, Ann Taylor, the President of the Council and Chair of the cabinet sub-committee on drug misuse, said:
"Independent, up to date and reliable information is vital for those working in the drugs field. This new site means that local Drug Action Teams, policy makers and practitioners - as well as members of the public - can access a comprehensive library of drug information through the Internet.
"This immediate form of communication can be particularly effective in an area where trends in drug misuse can change quickly and the focus of our efforts need to shift accordingly.
The ISDD website address is http://www.isdd.co.uk
Addiction to full-cream milk was identified as the cause of death of a 26-year-old van driver who drank up to five pints a day for 12 years. A post-mortem examination revealed that Richard Goymer, who became a "milkoholic" at 14, died of a heart attack when his arteries became clogged with fatty deposits. The pathologist said that Mr. Goymer had had the heart of a man who was much older.
Mr. Goymer's mother said: "He ate normal food like any other young man. The only exceptional thing about his diet was his love of milk. From the age of 14 he just could not get enough. I would have four pints a day delivered for the four of us and Richard would often make me angry by drinking most of it so I would have to buy more. He carried on drinking a huge amount of it as he got older – but I never imagined it was doing him any harm.
"I was brought up to think that milk was extremely healthy. I never used to worry if he was just having cereal for lunch because I thought the milk was doing him good."
However, Mrs. Goymer's mother said that the pathologist had suggested that other factors, including alcohol, could have been involved. She said. "He said the heart attack could have been caused by a combination of too much fatty food, lack of exercise, smoking and drinking. But Richard drank alcohol only moderately and smoked only about ten hand-rolled cigarettes a day."
Brian Wharton, of the British Nutrition Foundation, said the five pints of milk would not only provide a very large amount of saturated fat but would displace other foods such as fresh fruit and vegetables needed for a healthy diet. He said: "Milk should be part of a good mixed diet but never in this quantity. We think a daily pinta is probably a bit too much these days."
The Government should review the drug education needs of 5 to 7 year olds and make a long-term commitment to equipping children with the skills needed to resist the pressures to experiment with and misuse illegal drugs, alcohol and tobacco.
This was the message of Hope UK when it delivered a new report on a drugs survey to 10 Downing Street. The survey enquired into the knowledge and attitudes to drugs of children aged five and eleven.
In a covering letter to the Prime Minister, Hope UK's director George Ruston emphasised that some even very young children are not only aware of illegal drugs, they also regard them as `normal'.
He said: 'Some of the comments that we have highlighted from the survey show how far drugs have penetrated into everyday life. Children as young as five already identify with the use of drugs as normal behaviour'. Nationally we need standards which will help us to guide and educate our children. As one of the 11-year-old children in the research said, "I know how bad drugs can be as my cousin died of them." A 5-year-old child wrote. "Daddy keeps his drugs under my bed."
The report `Daddy keeps his drugs under my bed' is available from Hope UK, 25(f) Copperfield St. London SE1 0EN.
Both men and women can reduce the risk of suffering from osteoporosis by avoiding smoking or excessive drinking, taking regular exercise and ensuring that their balanced diet includes calcium.
This was the message of Tessa Jowell, Minister for Public Health, speaking on World Osteoporosis Day in June. She said: "Osteoporosis is a condition which affects one in three women and one in 12 men. It often runs in families but there are specific ways in which potential sufferers can reduce their chances of getting osteoporosis."
The Department of Health set up the Advisory Group on Osteoporosis in 1993, chaired by Professor David Barlow, of the Nuffield Department of Obstetrics and Gynaecology at Oxford University. The Group's report was published in January 1995 and its recommendations accepted. In particular, the group asked that the Committee on the Medical Aspects of Food Policy (COMA) should consider the role of diet in the prevention of osteoporosis. COMA has set up an expert group to look at bone health, to which the National Osteoporosis Society has submitted evidence. The group's work is likely to continue for the next 18 months.Clinical guidelines, as recommended by the report, are now being drawn up by a group led by the Royal College of Physicians.
A number of research reports have identified alcohol as a risk factor for osteoporosis. In one, alcohol intakes of greater than 4 units/day appeared to be a significant predictor of bone loss in postmenopausal women. In men, alcohol also featured predominantly as a risk factor for osteoporosis.(1)
It is suggested that "High alcohol consumption may have a direct suppressive effect on bone formation and may also lead to hypogonadism. Weekly alcohol consumption of more than 14 units for women or 21 units for men may be toxic to the bone". (2)
(1) C Moniz: Alcohol and Bone in British Medical Bulletin (1994), vol 50, No1, pp 67-75
(2) Peel, N; Eastell, R "Osteoporosis" in ABC of Rheumatology; BMJ; 15 April 1995
Some jurisdictions have introduced a differential lower, or zero, drink drive limit for newly qualified drivers. The idea has been opposed by some, on the basis that a lower limit, and especially, a zero limit may be interpreted by youngsters as giving the message that it is acceptable to drink (more) and drive later on in their driving career. However, the evidence suggests that this objection may be misplaced.
An evaluation of the `graduated' licensing system introduced in Ontario, Canada in 1994, suggests that it has cut the proportion of young male drink drivers by over 20%. The new system imposes a zero alcohol limit on new drivers for the first two years after qualification; avoiding major motorways, drive only during the day and be accompanied by a fully qualified and experienced driver.
Before the system was introduced, 23.2% of young male drivers reported driving after drinking: two years after the new system came into operation, the figure was down to 17.9%. There was no significant drop in relation to young women drivers.
Addiction Research Foundation researcher Bob Mann believes the figures show the graduated licensing system is having a general deterrent effect, and that many young men are changing their behaviour to conform to the new requirements. It appears it is not just drinking behaviour which has changed. Following the introduction of the new system there seems to be fewer new drivers. The implication being that some youngsters have delayed obtaining a driving licence
In New Zealand, the first country to introduce graduated licensing, deaths among 15-17 year old drivers and their passengers fell by around 25% during the first two years of the programme. The Canadians are hoping for a similar impact.
Police have called for an end to the practice of company sponsorship in return for adverts on police cars. Leaders of the junior ranks of the Police Federation will raise the matter with the Home Secretary, Jack Straw at their annual conference.
Chairman of the constables' branch, David French said, "I don't want PC McBurger on my shoulder or my helmet or my back. Policing is a public service and it must operate independetly of, and above, all private interests. Anything else is tantamount to corruption". Mr. French said all policing should be paid for out of taxation. "Our badge is not for sale".
Chief constables are presently allowed to raise 1 per cent of their annual budget from sponsorship after the Home office relaxed rules several years ago. This has amounted to £70 million across the country. Avon and Somerset police are being sponsored by a chain of off-licences and Mr French pointed out the difficulty of officers policing against drink driving whilst advertising alcohol on their cars. The City of London force was already considering putting advertising on uniforms, and Merseyside police putting a logo on the backs of officers patrolling a football ground.
Nigel Griffiths, Consumer Affairs Minister, added his full support for Dennis Turner's Private Members Bill which will mean that beer drinkers will get a full liquid measure, even for beers that are customarily served with a significant "head" comprising a mixture of gas and liquid.
Mr Griffiths said: "I have been calling for a change in the law for a very long time and am delighted to give my full support to the Bill. Down the years I have received many complaints from consumers and Trading Standards Officers who have frequently reported short measures, in contravention even of the industry's own Guidance Notes. A recent survey by CAMRA showed that 8 out of 10 pints weren't pints at all and that 1 in 4 pints fell below even the 95% liquid target recommended in the industry's guidelines. When the consumer asks for a pint and is charged for a pint, that is the quantity that he should be served. I wish Mr Turner every success with his Bill and offer him my full support."
The Bill is the Weights and Measures (Beer and Cider) Bill. It will provide that, when measuring the quantity of beer or cider, the gas comprised in any foam shall be disregarded. This will mean that full liquid pints of draught beer and cider must be provided in addition to the gas in any froth on the head.
A new set of guidelines for service managers and providers in higher education was launched at the Association of Managers of Student Services in Higher Education (AMOSSHE) annual conference in York 30th June -3rd July.
The guidelines summarise the issues facing students and staff in higher education in the 1990s and outline the findings of a number of studies on the incidence of substance misuse. Guidance is given on how people both inside and outside educational institutions can contribute to the identification of key issues and subsequent development of policy and practice.
Copies of the guidelines are priced at £5 and are available from: CVCP Publications, Woburn House, 20 Tavistock Square, London WC1H 9EZ. Tel: 0171 419 4111 Fax: 0171 388 8649
A gallon of tea a day, about 25 cups, for 20 years was the reason an army officer got into trouble, it was explained to the court martial.
Major David Senior, 45, a teetotaller, was alleged to have mishandled ration funds. At the court martial, his defence argued that the major was suffering the classic symptoms of caffeinism, an addiction to tea or coffee. The symptoms of caffeinism can include confusion, restlessness, nervousness, insomnia, sweating, palpitations and, in extreme cases, panic attacks. In one instance a soldier in the Indian Army was believed to have been blinded by drinking too much tea. It has been suggested that caffeinism is similar to alcoholism in that sufferers are the last to realise they have a problem.
One expert on caffeine has defined a `high' level of consumption as ten cups of tea or coffee a day. A breakfast cup of tea contains about 25mg of caffeine.
The major's condition emerged when he was sent home from a posting to Belize, Central America, and referred to a psychiatrist.
Charles Gabb, for the defence, explained that Major Senior– decorated for his undercover work in Northern Ireland – had consumed enormous quantities of tea all his adult life. The defence argued that the major was not dishonest, but may have made a genuine mistake with the paperwork because of the effects of his addiction to caffeine.