Alcohol affects us all:
Scotland's Developing Approach
Jack Law

It is an exciting time to be working in the alcohol field in Scotland. The Scottish Executive has begun a consultation process, seeking the views of the broad community to inform its Plan for Action on Alcohol Misuse. By the end of the year we will have a national strategic framework for tackling alcohol misuse in the form of a Plan for Action. Indeed, even the media have revived their interest in alcohol misuse and licensing law.

Why is this happening now?

It may be that the creation of a Scottish Parliament is something to do with this revitalisation in interest. The Parliament has responsibility for health and social issues which has perhaps allowed greater attention to be paid to matters relating to alcohol misuse than in the past. It appears that that we are becoming increasingly aware that the cost of alcohol misuse to society significantly outstrips the costs associated with the use of illegal drugs. In the recent debate on alcohol issues in the Scottish Parliament, it was quoted that "a conservative estimate of alcohol related deaths in Scotland is 3000, ten times the number of illegal drugs related deaths in Scotland". Whatever the reasons, the Scottish Executive is to be commended on its decision to produce a Plan for Action.

It is clearly the case that alcohol misuse is a major social and public health issue for Scotland. For example, figures released by Greater Glasgow Health Board indicate that 30,000 males and 3,000 females weekly drink more than twice the recommended limits. We still tend to binge drink, and remain wedded to the idea that intoxication and having a good time are synonymous. One of the main problems arising from binge drinking is the strain it places on emergency services such as accident and emergency services and the police. We know that alcohol is a factor in 65%-75 per cent of violent crime (source Measures for Measures: A Framework for Alcohol Policy, Alcohol Concern, London, 1997) and that 1 in 5 of all violent crimes takes place in or around licensed premises (source Scottish Crime Survey, 1996).

Underage drinking is a cause for concern. Figures indicate that 75 per cent of fifth year pupils and 15 per cent of primary six pupils drink alcohol at least once a week (source Providing Drug Education to Meet Young People's Needs, Scottish Council for Research in Education, 1999). Undoubtedly young people are influenced by adults' drinking patterns, whether it is their family, friends, or by prominent rôle models (pop stars, sportsmen, DJs, etc), who can reinforce the association of drunkenness with having a good time. Indeed Scotland is similar to the rest of the UK in that young people's consumption appears to be on the increase, and that the pattern of binge drinking is being continued by the younger generation.

In 1995 the Scottish Health Survey found that 13 per cent of women had exceeded the sensible limit, and by 1998 this had increased to 15 per cent. Alcohol consumption amongst young women appears to be on the increase. 24 per cent of Scottish women aged between 16 and 24 years exceed the weekly safe limit of 14 units (source: The Scottish Health Survey, 1998). There is an upward trend of women seeking help for alcohol related problems, inquiries to Local Councils on Alcohol by women have increased by 17 per cent over the last two years. It would appear that women in employment are now consuming more alcohol than they have in the past, and this is giving some cause for concern, particularly for the longer term.

So, what is happening in Scotland?

On 7th December 2000, in the debate on alcohol misuse in the Scottish Parliament, the Scottish Deputy Minister for Health, Malcolm Chisholm announced plans for a major inclusive consultation process, which would take place between February and the end of June. This will lead to the development of an alcohol misuse strategy, taking the form of a National Plan for Action by the end of 2001.

He also announced that there would be a comprehensive review of licensing law, undertaken by an independent committee, with a broad remit. The licensing system is one of the elements of the whole approach to alcohol misuse. The licensing review is expected to meet for about 18 months, and will draw on the overall framework set by the Plan for Action.

As progress is made towards the development of the Action Plan, we should not forget that much is already being done to address alcohol misuse in Scotland. Work on prevention and education for young people, services for those who misuse alcohol and their families and carers is ongoing. The Scottish Executive also supports the work of the Alcohol Misuse Coordinating Committees that were set up locally to ensure measures and services are in place to tackle alcohol misuse. These local partnerships involve representatives from all key interests including health, local authorities, police, licensing, etc.

At national level the Scottish Advisory Committee on Alcohol Misuse (SACAM), which brings together representatives from all key sectors, including health, local authority, police, the drinks industry, the licensed trade and the voluntary sector (including Alcohol Focus Scotland) meets under the chairmanship of Malcolm Chisholm. The committee is probably unique in the UK in that it brings together all the major players in the alcohol arena, and through its deliberations is able to draw together their common interests and concerns. SACAM was specifically set up to advise the Scottish Executive on an alcohol misuse strategy and is closely involved in advising Ministers on the development of the Plan for Action. SACAM is also involved in the development of some building blocks for the Plan, including in the area of, services provision, prevention and communication, and information collection and dissemination.

Alcohol Focus Scotland (formerly The Scottish Council on Alcohol) is actively involved in SACAM, in reviewing policy, and in addressing the breadth of alcohol related issues in Scotland. In this connection we have organised key events to bring together the accumulated knowledge and experience of those with an interest and expertise in alcohol to contribute to the consultation process for the national Plan for Action. We are also involved in services through the 28 Local Councils on Alcohol affiliated to us, which means that we cover the majority of Scotland. As well as providing high profile information on alcohol issues, we target a number of key areas such as information for people affected by alcohol misuse, training for those addressing alcohol related problems, and prevention.

We manage two national projects aimed at reducing alcohol misuse through prevention; Drinkwise and ServeWise.

The national Drinkwise campaign, which involves the Scottish Executive, the Health Education Board for Scotland and Alcohol Focus Scotland working in partnership, has developed considerably since its inception some five years ago. The campaign, which places at its core the concept of personal responsibility, focuses on sensible drinking and the exercise of personal choice through a process of cognitive reappraisal. In other words through the presentation of challenging and thought provoking images and text, the campaign aims to raise questions for individuals about their drinking, which are intended to influence their drinking behaviour. The campaign has a national dimension and a local focus through the twenty local Drinkwise organisations which run community based campaigns. Between 1996 and 2001, Drinkwise has been involved in over eighty local projects, with themes such as personal responsibility, safety, relationships, public behaviour and leisure.

ServeWise is a training programme aimed at licensees and those who sell alcohol, which has the support of the Scottish Executive. It has grown from a local project based in Aberdeen into a national initiative, aimed at training those who serve alcohol to understand their legal and social responsibilities. The training has been developed and tested with the assistance of the police, the licensed trade, licensing boards and colleges of further education. By developing such a training programme, Alcohol Focus Scotland hopes to contribute to a reduction in the number of accidents and crimes resulting from the misuse of alcohol on and in the environs of licensed premises, and to a reduction in the social and economic costs of alcohol misuse. A further benefit of the programme as it unfolds across Scotland is that it will set minimum standards for the sale of alcohol and contribute in a positive way to any changes in Licensing Law which may arise from the review. Overall the programme is aimed at making licensed premises, and the general drinking environment a safer and more pleasant experience for the community.

The programme is developing throughout Scotland, and enjoys the support of the trade, industry, retail trade, licensing lawyers, and other significant agencies.

Given that 1 in 5 people in Scotland are concerned about their own or someone else's drinking, the role played by properly trained and accredited alcohol counsellors is a crucial one. Training volunteer counsellors for the Local Councils on Alcohol is an important aspect of Alcohol Focus Scotland's work. We train between fifty and eighty volunteer counsellors, trained to university validated standards over two years, and just under twenty supervisors each year, who deliver counselling and supervision through the Local Councils. Furthermore we run an extensive programme of workshops on topics such as homelessness, young people, and brief interventions for those in the field with a concern about alcohol related issues.

While not being a direct service provider, Alcohol Focus Scotland received over 6,000 inquiries last year. Many of these are passed on to the Local Councils on Alcohol, but some may be dealt with directly. Our Information Section designs and delivers information materials for individuals, and organisations, as well as assembling information materials for research and other matters.

Alcohol Focus Scotland has the support of a network of twenty eight Local Councils on Alcohol across Scotland, from Orkney to the Borders. Each Local Council provides a variety of services including brief intervention, counselling, befriending, information and advice, and educational services. In addition the Local Councils are each involved in their local strategic planning processes for alcohol services in partnership with other local agencies. The importance of the services provided by Councils is considerable; for example, they provided over 42,000 counselling sessions last years, saw over 5,000 new clients in 2000, and currently have just over 300 trained alcohol counsellors.

It is an exciting time for us to be both influencing and developing the policy agenda, as well as working on the future for alcohol services in Scotland. The developing agenda provides us with the opportunity to make a difference to Scotland's drinking traditions and behaviour.

Jack Law is the Director of Alcohol Focus