New Welsh Substance Misuse Strategy puts new emphasis on dealing with alcohol misuse

In January 2008 the Welsh Assembly Government launched its substance misuse Strategy for Wales 2008 - 2018. Here it is reviewed by Aneurin Owen.

Brian Gibbons AM, Minister for Social Justice and Local Government, in his foreword to the Strategy states: “I believe that we must redouble our efforts to tackle alcohol misuse. Most of us drink sensibly (though we also drink more than we think we do), but a substantial minority drink too much, too often, and blight the streets of our towns and cities through alcohol related crime and disorder and damage their own long term health in the process.” This is a familiar mantra, and not surprising since the implementation of the Strategy will be through partnership working at Community Safety Partnership level. Alcohol policy, health and social issues will need to continue to compete for agenda time and a fair share of resources at the commissioning tables of the CSPs. But there is at least recognition at Strategic and Ministerial level of the need to intensify responses to alcohol misuse.

Since the introduction of a joint substance misuse strategy in the mid-1980s alcohol issues have not always commanded centre stage in Wales and the overall emphasis has been on reducing crime and increasing harm reduction services in the drugs field. This new ten year Strategy “Working Together to Reduce Harm” now places alcohol firmly in the arena of harm reduction with all its incumbent benefits and pitfalls.

The Strategy is written in the belief that “there are distinctive issues to be considered in relation to alcohol misuse and a clear consensus exists for our Strategy to focus on tackling the problems caused by inappropriate or risky consumption of alcohol”. A specific alcohol plan (again a new feature within the Strategy) will focus effort on those who cause damage or problems for the wider community “but who may not need specialist treatment for addiction.” (Executive Summary p.1) For those who do require support and treatment, the Strategy outlines proposals for the expansion of services in an attempt to “do more to engage and help priority groups.” (p 3) There is a welcomed emphasis here on more investment in youth and other outreach services, on whole system approaches to the provision of services to children and on wraparound services – housing, education, training and employment.

Action Area 3 focuses on the need to support families by reducing the risk of harm to children and adults that is a consequence of a parent’s, a partner’s or a child’s substance misuse. An estimated 17,500 children and young people in Wales are living in families affected by drug misuse and “64,000 Welsh children may be adversely affected by parental alcohol problems.” (p 35)

The Welsh Assembly Government is to consult on a Strategy for Vulnerable Children in 2008 with the proposed Legislative Competency Order for Vulnerable Children and Child Poverty enabling the introduction of legislation in relation to the welfare of children and young people. Based on the experience of several imaginative and coordinated interventions, and on agrowing evidence base, there is a stated objective to “develop an integrated family support tool to assist local authorities and their partners” and to increase support for young carers, parents and adult carers. There is also a commitment to producing a “module of the Substance Misuse Treatment Framework which sets out good practice in joint working where there is domestic abuse and coexisting substance misuse.” (p 39)

On the broader issue of tackling availability and protecting individuals and communities via enforcement activity, the Strategy recognises that “access to” the supply of alcohol has been increased through changes to the licensing legislation and a fall in the relative price of alcohol.” (p 41)

Under the heading ‘Tackling Alcohol Related Crime and Disorder’ (pages 42 – 44) the Strategy outlines actions to be taken to control the supply, sale and consumption of alcohol. This section recognizes the limitation of working within legislation (Licensing Act 2003) that is not devolved to the Welsh Assembly Government and concern is raised that “partners are not yet making best use of the Licensing Act and Violent Crime Reduction Act to reduce harms to individuals and communities from excessive drinking.” (p 42) Greater collaboration between CSPs and NHS Trusts should ensure that “traders who persistently sell or supply alcohol to children” and individuals “who drink irresponsibly and become involved in crime and anti-social behaviour” are tackled using the full force of current powers and legislation. Holistic approaches to the management of towns and cities, including the management of the evening and night-time economy, requires partnerships to work on the wider use of Proof of Age card schemes and on tackling rogue retailers, licensing, underage drinking, transport, CCTV and other environmental issues. “Reducing alcohol related injuries and the resultant pressure on the health service should be a key objective.” (p 44)

In another new departure from previous Strategies, the new Strategy contains specific references to the areas in which the Welsh Assembly Government will seek working co-operation with the UK Government, retailers and the alcohol industry in order to “tackle the inappropriate availability of alcohol.”(p 45)

The Welsh Assembly Government will “press the case for:

Stricter rules on the promotion of alcohol

Consideration of reducing demand by increasing the price by greater taxation

An increase in taxation on cider

A reduction of the drink drive limit and better enforcement of the limit through random testing for both alcohol and drugs

Inclusion of “safeguarding public health” as a statutory objective of theLicensing Act

Strengthening the Code of Conduct for the alcohol industry

Ensuring the availability and better promotion of low strength alcoholic drinks and low priced soft drinks

We will also consider whether there is support for exploring opportunities under the Government of Wales Act 2006 to strengthen the hand of licensing authorities in Wales in tackling these and related issues and for establishing a working group involving the licensed trade in Wales.” (p 43) Increases in direct resources to deliver this strategy are planned - a further £9.6 m to the Substance Misuse Action Revenue Fund, and £3 m over the period 2008/9 to 2010/11 specifically for the delivery of the alcohol action plan. The ringfenced allocation to LHBs will be increased to £10.9 million for 2008-9. Other funding streams such as those from the Home Office and Ministry of Justice, the European Union Convergence Fund, Rural Development Programme and Lottery Funding will support the delivery of the Strategy.

The delivery of the Substance Misuse Strategy for Wales 2008 - 2018 with its four priority action areas (prevention, support for substance misusers, support for families, tackling availability and protecting individuals and communities) will require the involvement of a range of policy areas within the Welsh Assembly Government and a variety of devolved and nondevolved agencies and service sectors. A commitment is made to the establishment of a National Substance Misuse Strategy Implementation Board made up of key stakeholders and representatives to oversee set indicators. (Annex 3) This is an important and new development that will provide stability over the medium to long term as local delivery mechanisms change.

The Substance Misuse Strategy for Wales 2008 - 2018 sets out a clear harm reduction course for Wales for the next ten years with firm commitments, new delivery structures and a new focus on alcohol. It is sufficiently broad to allow for the possibility of greater co-ordination across policy areas and service sectors. It specifies actions to be taken to tackle the inappropriate availability of alcohol and to provide support for at risk groups, families and communities. As the Strategy evolves it will be interesting to note the impact or otherwise of these ambitious plans and calls for action within Wales and on the UK Government. Harm reduction approaches need also to be supported by actions that take into account the evidence base for total population approaches and the sensitization of professionals, decisionmakers and to alcohol policy issues would also keep Wales in tandem with other national and European policies.