Alcohol and illicit drugs - What the people think

Attitudes in society seem to be changing and it is apparent that public opinion on illicit drugs is not always in tune with expert medical opinion and practice. For example, while we seem to have a more relaxed view of cannabis these days, there are warnings that its use may lead to psychosis. But when it comes to alcohol, the public and doctors are at one on the need for health warnings.

On the one hand

Attitudes to cannabis

The British people are becoming more tolerant towards the use of cannabis, but there are still clear limits to what is acceptable in the area of illegal drug-taking. This is the conclusion of new research funded by the Economic & Social Research Council (ESRC).

Opinions on cannabis have changed considerably during the past twenty years, with 41 per cent of Britons now supporting its legalisation – a rise from just 12 per cent in 1983. However, only a small minority (eight per cent) support the view that adults should be free to take any drugs they please, says the report of the team of researchers led by Nina Stratford of the National Centre for Social Research.

The views of a thousand people in England and Wales and one thousand six hundred in Scotland were surveyed. In contrast to attitudes towards cannabis, those towards heroin remain very negative with ninety per cent believing it should stay illegal – the same proportion as in 1993.

Ecstasy is regarded in much the same way, again with nine people out of ten believing that it should remain illegal. Only seven per cent agree that ecstasy is not as damaging as some people think, and seventy-five per cent believe that the liberalization of the law would lead to an increase in addiction. The view that ecstasy is a 'soft' drug similar to cannabis has little public support.

A considerable majority of people (86 per cent) support the belief that doctors should be permitted to prescribe cannabis for medical purposes. As was shown in research carried out in 1995, certain groups - the young, the more highly educated, professionals, and people living in London – have a more liberal attitude towards the drug.

Nina Stratford points out, however, that the increase in these liberal attitudes is not confined to those categories. She said: "It is a society-wide phenomenon affecting all ages and social backgrounds."

Fewer people now think that cannabis is harmful or addictive or that it causes crime and violence. When those surveyed were asked which drugs were the most harmful to regular users, heroin, cocaine, tobacco and alcohol came at the top of the list.

In contrast, perceptions as to the damage inflicted by heroin have not change. In fact, today more people link it with crime and violence than ten years ago.

The research, published by ESRC as The Measurement of Changing Public Attitudes Towards Illegal Drugs in Britain, supports the notion that the use of cannabis is becoming as acceptable as drinking alcohol or smoking cigarettes, especially among young people, indifferently as to whether they use the drug or not Two-thirds of 18-34 year-olds admit to having a friend or family member who has used illegal drugs, half have tried cannabis themselves, and only a third think that cannabis should remain illegal. More than half (55 per cent) accept that the illegal use of drugs is a normal part of some people's lives – an increase from 41 per cent in 1995 – and even those young people who have never used cannabis have more liberal views as to its legalisation.

The research may have shown that attitudes to cannabis have become more tolerant, but it also uncovered clear limits to peoples' tolerance. Whilst Nina Stafford and her team found that the idea of giving users clean needles was backed by nearly two-thirds of adults and that giving harm-reduction information to young people was also accepted by 55 per cent in Great Britain as a whole and 47 per cent in Scotland, when it comes to prescribing drugs, people's attitudes were very restrictive. Ms Stratford said: "We found that very few people support allowing doctors to prescribe drugs for addicts – something which has been an established part of medical practice for almost a century."

and on the other

Cannabis-induced psychosis

As has long been suspected, heavy use of cannabis may well be a cause of psychosis, according to Robin Murray, professor of psychiatry at the Institute of Psychiatry and consultant psychiatrist at the Maudsley hospital in London. He believes that society should think carefully about the potential consequences of its increasing use.

He says that in the last year and a half, an increasing body of evidence has grown up that cannabis causes serious mental illness. Most particularly, research carried out in the Netherlands, involving a study of four thousand people from the general population, discovered that those taking large amounts of cannabis were almost seven times more likely to display psychotic symptoms three years later.

Speaking in Edinburgh at the annual general meeting of the Royal College of Psychiatrists, Professor Murray said, "This research must not be ignored." He was already on record in the national press as saying that he had been surprised that the discussion around cannabis had avoided the issue of psychosis. Psychiatrists had known for 150 years that very heavy consumption of cannabis could cause hallucinations and delusions. "This was thought to be very rare and transient until the 1980s when, as cannabis consumption rose across Europe and the USA, it became apparent that people with chronic psychotic illnesses were more likely to be regular daily consumers of cannabis than the general population."

He further added that, in the United Kingdom, people with schizophrenia were about twice as likely to smoke cannabis. The reason for this appeared to be the effect that the drug has on chemicals in the brain. "In schizophrenia, the hallucinations and delusions result from an excess of a brain chemical called dopamine. All the drugs which are known to cause psychosis - amphetamine, cocaine and cannabis - increase the release of dopamine in the brain."

Drawing attention to the effect cannabis has had on many of the most talented young people, Professor Murray said, "Like any practising psychiatrist, I have often listened to the distraught parents of a young man diagnosed with schizophrenia tell me that as a child their son was very bright and had no obvious psychological problems. Then in his mid-teens his grades began falling. He started complaining that his friends were against him and that people were talking about him behind his back.

"After several years of increasingly bizarre behaviour, he dropped out of school, job or university; he was admitted to a psychiatric unit overwhelmed by paranoid fears and persecution by voices. The parents tell me that, at some point their son was heavily dependent on cannabis."

The previously held view was that the high numbers of psychotic patients taking cannabis could be explained because they used it to alleviate their symptoms. The recent research, however, has studied large populations free of mental illness and looked at the numbers of cannabis takers within them who have developed psychosis.
Call for health warnings on alcohol

The country's leading liver specialists want official health warnings on all alcoholic drinks. Their call to the Government comes as a result of a dramatic rise in alcohol-related illness among young people.

A petition signed by five hundred senior doctors has been delivered to the Prime Minister. They want to see the number of units of alcohol and the agreed "sensible drinking limits" printed on all containers.

Figures from the Department of Health show a four-fold increase in deaths in men aged 45 to 54 and three-fold increases in deaths in women from cirrhosis during the past 30 years. In the younger age group, 35 to 44, the increase in deaths rose eight times for men and seven times for women. These astonishing increases were highlighted by the Government's Chief Medical Officer, Sir Liam Donaldson, in his 2002 Report and the doctors are now demanding action. They are acutely concerned about the effects of the increase in binge drinking in young people which is contributing to the 4,000 deaths every year from liver disease.

The doctors want the labels on all drinks containers to say: "HM Government Health Warning. This product contains x units of alcohol. Consumption of more than 21 units/week for men and 14 units/week for women can damage your health."

The Registrar of the Royal College of Physicians, Professor Ian Gilmore, said: "Fifty per cent of our patients with cirrhosis are not alcoholics. They are not dependent on alcohol, but they have advanced liver disease.

"People grossly underestimate the amount that they drink. We need better labelling so you know just what you are doing."

Dr Christopher Record, a consultant physician from Newcastle, added: "We intend to win this battle, it is in the best interests of our patients and we will not let go until it is done."

The industry's Portman Group has consistently opposed health warnings. Its Chief Executive, Jean Coussins, said, "We don't know of any evidence that putting health warnings on alcoholic drinks has significant effect on behaviour. However we would encourage all drinks producers to ensure where possible the number of units of alcohol contained is clear on all labelling."

A spokesman for the Department of Health said: "The Cabinet Office is developing a National Alcohol Harm Reduction Strategy which should be published in the autumn. It is considering a range of issues including placing information on labels."

The opinion of the public on the subject of health warnings was recently reflected in a poll conducted by OMD Snapshots. Fifty per cent believes that the responsibility should be on the alcohol industry to run advertising campaigns preaching responsible drinking, whilst 38 per cent say the government should do so.

Just over one thousand people took part in the survey in which three-quarters agreed that alcohol brands should carry health warnings similar to those on tobacco packets. However, almost half said they would take no notice of a television campaign such as the one recently launched by Smirnoff which reminds drinkers that "it's good to know when to stop".

Costing Smirnoff's parent company Diageo Great Britain £500,000, the campaign is called 'Congratulations', and thirty second spots on ITV, Channel 4, Channel 5, and satellite TV mean that over half the core audience of 18-34 year olds will see the advertisement at least once.

"The new advertising was developed to help consumers understand their limits and to drink in moderation," says Diageo. The "Knowing when to stop" metaphor was in the United States last year and, according to the company "performed exceptionally well. Research in that market shows that respondents enjoyed watching it very much (20 per cent higher than average) and a high proportion found it involving (40 per cent higher than average)."

The television commercial opens on an attractive couple, Hank and Cindy, enjoying a romantic meal at a restaurant. They are approached by a man who is an old friend of Hank's. He hears they have just got engaged, congratulates them and then starts reliving the good old days back at college, when Hank was allegedly a bit of a ladies man. As the conversation progresses, the woman looks more shocked. The advertisement finishes with the end line: "Knowing when to stop is a good thing".

Tony Mair, Diageo GB Corporate Affairs Director says: "We believe that the launch of the new Smirnoff responsible drinking campaign marks a major step forward for the industry, and that we have a role to play in educating consumers about how to drink responsibly.

"As market leader and founder member of The Portman Group - set up by leading drinks companies to promote sensible drinking - we have always encouraged drinking in moderation. We are now taking the step of introducing this new advertising initiative in our own name and would always welcome the continued support of others in the industry to encourage responsible drinking amongst consumers.

"We feel really positive about the Smirnoff ad' launch. Learnings from US research show us that consumers understand the message behind the ad' and we know the Smirnoff brand has strong appeal for our core audience of 18-34 British consumers."

Many may be sceptical about the motives of Diageo and see the move as an attempt to head off increasing demands for a curb on alcohol advertising, especially that aimed at young people. They may also feel that the campaign does little to counteract the overwhelming emphasis on the link between drinking alcohol and a glamorous lifestyle.

It may also prove difficult to achieve the same success in the United Kingdom for the campaign which Diageo claims for the USA.

Asked whether they would take more notice of such a campaign if it were run by alcohol brands or by the government, 42 per cent said "neither".

The OMD Snapshots survey asked: