Issue 3 2010

Scottish Parliament approves Alcohol Bill, but without minimum pricing

Members of the Scottish Parliament approved the Alcohol Bill presented by the Scottish National Party government but minimum pricing of alcohol was rejected. Other key measures that failed to win approval were – banning combination alcohol promotions (eg alcohol with a meal), banning the awarding of loyalty card points for alcohol, a minimum age of 21 for off-sale purchases, and the banning of caffeinated alcoholic beverages.

The measures that were approved were:

• A ban on quantity discounts such as ‘three for two’ or ‘25 per cent off when you buy six’
• Alcohol promotions permitted only in the designated alcohol sales area of off-sales outlets
• The introduction of a Challenge 25 age verification scheme for all licensed premises
• Paving the way for the introduction of a social responsibility levy in areas where alcohol causes significant police, health and social care costs.

Removal of minimum pricing from Alcohol Bill a ‘missed opportunity’ say health campaigners

The BMA, Alcohol Focus Scotland and Scottish Health Action on Alcohol Problems (SHAAP) joined together to express ‘deep disappointment’ over the Health Committee’s decision to remove minimum pricing from the Alcohol Bill.

Dr Brian Keighley, Chairman of the BMA in Scotland said:

“This is a missed opportunity for our parliamentarians who had a real opportunity to drive forward public health policy, not just in Scotland but in the rest of the world. I am frustrated and disappointed that the debate on such a serious health issue has been polarised and that many opposition MSPs had made their minds up before even considering the evidence presented to the Committee. The inclusion of a ‘sunset clause’ offered an opportunity to test the effectiveness of minimum pricing and provide doubters with the reassurances they had initially sought. Sadly, now we will never know.

“I hope that this is not the end of the debate on how we tackle the increasing affordability of alcohol, but signals the beginning of a mature, non-partisan approach to address Scotland’s relationship with alcohol.”

Dr Evelyn Gillan, Chief Executive of Alcohol Focus Scotland, said:

“The removal of minimum pricing will render the other measures in the Bill much less effective. Cheap alcohol is driving consumption and harm and politicians in Scotland have wasted an opportunity to do something about it. To reject minimum pricing without offering a credible alternative is to abdicate responsibility for the health and wellbeing of the people of Scotland.”

Tom Roberts, Project Director of SHAAP, said:

“During their deliberations on the Alcohol Bill, Health Committee members have all voiced the opinion that price is a significant factor in levels of alcohol consumption. It is therefore deeply disappointing that they have voted to remove action on price from the Bill without putting in place any alternative. This vote has weakened the Bill and therefore weakened our response to Scotland’s alcohol problems.”

Tax increases ‘superior to minimum prices’

The attempt by the Scottish Government to introduce a minimum price for a unit of alcohol has attracted international attention. Most public health advocates in the UK have adopted the cause of minimum alcohol pricing, seeing it as a key element in an effective policy to reduce alcohol harm, and many of their counterparts in the European Union and elsewhere in the world have also expressed support for the idea.

Now, however, the cause of minimum alcohol pricing has suffered a possibly major setback, the abandonment of minimum pricing in the Scottish Alcohol Bill.

During the debate on the Bill, Scottish Health Secretary Nicola Sturgeon accused opposition MSPs of opposing minimum pricing for party political reasons, adding:

“This is a sad day for the parliament. If this parliament refuses to take action to deal with a monumental problem, I think, in the fullness of time, Scotland will judge those who vote against this policy very harshly indeed.”

However, Labour health spokeswoman Jackie Baillie replied that her party was opposing minimum pricing, not on political grounds, but because “we do not believe it works – and that is a view that is shared by the main opposition parties in this chamber”.

Ms Baillie continued: “There are three main concerns. It is untried and untested, it is possibly illegal and it will put £140m per year into the pockets of supermarkets.”

IFS Report

It is possible that some opposition Members were influenced by a report from the prestigious and influential Institute of Fiscal Studies (IFS), which concluded that minimum pricing is not such a good idea after all, and that increasing alcohol taxes is to be preferred as a measure to prevent alcohol harm.

In the report, IFS researchers estimate that, if minimum pricing of 45 pence per unit were rolled out across Britain, it could transfer £700 million from alcohol consumers to retailers and manufacturers. This contrasts with increases in alcohol taxes, which largely result in transfers to government in the form of much needed tax revenue. In the long term, it would be desirable to restructure alcohol taxes so that they were based on alcohol strength, thus allowing the tax system to mimic the impact of a minimum price but ensuring the additional revenues went to the government rather than firms.

The figure opposite shows the estimate of the total transfer to different retailers, though some of the gains would likely be shared with alcohol manufacturers. The largest beneficiaries are those stores which sell the most alcohol: the supermarket chains Tesco, Asda and Sainsbury’s. In relative terms, the biggest beneficiaries are stores that sell alcohol most cheaply: the discount retailers Lidl, Aldi and Netto. Those stores which do not sell much cheap alcohol – Waitrose and Marks and Spencer – gain relatively little.

Percentage figures show the relative change in alcohol spending by store following a 45p per unit minimum price.

The other main findings of the research are:

Almost 85% of off-licensed alcohol units sold for less than 45p in 2007, including 91% of lager units, 90% of cider units and 87% of spirits units. Only 9% of alcopop units sold below this price.

The average unit of cider sold for only 25p, compared to 33p for lager and 69p for alcopops.

80% of those with incomes under £10,000 per year bought alcohol during 2007, compared with 95% of those with incomes above £70,000. However, low income households bought cheaper alcohol: those on under £10,000 paid 33p per unit on average compared to 41p for those on more than £70,000.

Assuming that all households reduce their alcohol demand by 5% when prices rise by 10%, the off-licensed alcohol consumption of those on less than £10,000 would fall by 25% following the introduction of a 45p per unit minimum price. The fall would be 12% for those on more than £60,000.

Households that purchase a lot of alcohol not only buy more units but also buy cheaper units. Those buying less than 2 units per adult per week on average pay more than 40p per unit, compared with 32p per unit for those buying more than 35 units per adult per week.

The structure of alcohol taxes is governed by European Directives that mean it is not possible at present to tax the number of units directly for wine or cider, but it is possible for beer and spirits.

Current implied taxes per unit are 17.3p for beer and 23.8p for spirits. However, a 75cl bottle of 9% strength wine is effectively taxed at 25.0p per unit whereas a bottle of 14% strength wine is taxed at only 16.1p per unit. It would be desirable to change this so that all alcohols could be taxed according to the number of units.

The response to minimum pricing would probably be complex. Different consumers would respond to different extents, including substituting alcohol purchases towards pubs and bars which would be less affected by a minimum price. Retailers could change the price of alcohol currently sold above 45p per unit and change non-alcohol prices. Manufacturers could switch production into more expensive, higher quality products. Estimating the impact of these wider responses would require a more detailed model of behaviour.

“The impact of introducing a minimum price on alcohol in Britain” by Andrew Leicester and Rachel Griffith is available on the IFS website: www.ifs.org.uk

Minimum pricing – Greater Manchester to go it alone?

Greater Manchester could become the first city to introduce minimum pricing of alcohol after 10 councils agreed it should not sell for less than 50p a unit. Officials hope the move will become nationwide. Cheshire, Merseyside, Sussex, Devon, Wales and Jersey are reported to be considering following suit.

At its November 2009 meeting the ASSOCIATION OF GREATER MANCHESTER AUTHORITIES Executive recognised the damage that excessive consumption of alcohol does to local communities and agreed to work with the Health Commission and other agencies to reduce excessive alcohol consumption including through lobbying for a minimum unit price for alcohol.

At its February 2010 meeting the AGMA Executive agreed to advocate strongly nationally and locally for a minimum unit price for alcohol of 50p. Prime Minister David Cameron was reported as saying he would look sympathetically on such an initiative.

However, there are some concerns as to whether a system of minimum pricing could be made to work effectively in a single locality, given the obvious possibility of residents crossing the border into the neighbouring local authority to buy cheaper alcohol, and the risk of a black market.

Stop press

HM Treasury has now published the review of alcohol taxation that was agreed as part of the Coalition Agreement. The Government states that it is committed to reviewing alcohol taxation to tackle problem drinking without unfairly penalising responsible drinkers, pubs and important local industries. However, the harms associated with problem consumption of alcohol remain a concern: alcohol-related hospital admissions have been increasing year on year and almost half of all violent crimes are alcohol-related.

The review states that there are a number of measures that can be considered to help address the harms associated with problem drinking, and the Government recognises that in some areas taxation can play a role. A change to the definition of cider has already been made to increase the duty on cheap, strong ciders strongly associated with public health concerns. To complement this change, the Government intends to introduce a new additional duty on beers over 7.5% abv in strength. This will help to address the consumption of cheap, “super strength” lagers that are also associated with high, and dangerous, levels of alcohol consumption.

Changes will also be made to introduce a reduced rate of duty on beers produced at an alcohol strength of 2.8% abv or below. This measure will help encourage the production and consumption of lower strength beers and give responsible drinkers additional choice. These measures will continue to be developed with a final announcement made at Budget 2011. Draft Finance Bill clauses will be published alongside other Finance Bill measures on 9 December 2011 as announced by the Exchequer Secretary. The Treasury will continue to engage with industry and other interested groups ahead of Budget. There are no further changes to the structure of duty on alcohol as a result of this review. Decisions about duty rates remain a matter for the Chancellor at the Budget. The Government will continue to work with all interested groups to monitor and assess the available evidence about alcohol consumption.

The Coalition’s plans for alcohol taxation will be covered more fully in the next issue of Alcohol Alert.

Open all Hours? calls for stronger alcohol licensing controls to control ‘passive drinking’

Towns and cities will continue to be blighted by the effects of irresponsible drinking without a stronger say on alcohol licenses being put in the hands of local communities. This was the call from the Open All Hours? network of civic societies and residents groups working with Civic Voice and the Institute of Alcohol Studies to strengthen the Coalition Government’s proposals for licensing reform.

The Coalition Government undertook a consultation on reform of the 2003 Licensing Act introduced by the previous Labour administration and has suggested that it is planning a substantial rebalancing of the Act in favour of local communities. Alcohol industry lobby groups have joined together to oppose the Coalition’s plans. Commenting on the Government’s proposed licensing reforms, Matthew Bennett, Chairman of the Open All Hours? network said, “The Coalition Government will only achieve its ambition of putting ‘local communities in the lead’ on alcohol licensing if it addresses growing public concern about the impacts of stress and disturbance from irresponsible drinking on public health. Too many of our streets and town and city centres are plagued by shouting, vomiting, fights, urination and other rowdy behaviour.”

The campaign is urging the Government to:

• Address these wider impacts of “passive drinking” on public health in the same way as attitudes to passive smoking have been transformed in recent years
• Simplify licensing regulations and improve publicity for licensing applications
• Allow anyone with an interest in the quality of life of an area to influence licensing decisions, not just local residents
• Strengthen local councils’ hands in requiring all applicants to show how their alcohol license will contribute to and not damage the local area
• Support local communities concerned about the multiple impact of different licensed premises on an area
• Tackle the loophole of temporary notices which gives freedom from all licensing conditions for up to 96 hours for commercial premises

A study in Richmond upon Thames, reported by the Richmond Society and Friends of Richmond Green, found around 1,000 incidents of anti-social behaviour in four evenings in April 2009. The Societies estimate that 95% of such incidents are not recordable crimes. Matthew Bennett concluded, “We all deserve vibrant, well managed and successful town and city centres which everyone can enjoy. The Coalition Government needs to ditch lax licensing controls which marginalise the community voice and support businesses that promote a responsible drinking culture.”

In its response to the Government’s consultation on licensing reform, Open All Hours? made a number of specific recommendations:

• Remove the presumption in favour of granting licenses – we welcome the proposals for licensing authorities to be given direct powers to take action to refuse, review or remove licenses which conflict with the licensing objectives agreed for the area and to require applicants to demonstrate how their applications fit in
• Take action to involve and engage the community – the current licensing arrangements are discouraging for local communities and residents and the Coalition Government’s proposals need to go further if the ambition to put ‘local communities in the lead’ is to be met.

We urge that:

• Any person or organisation with an interest in the quality of life of the area should be able to make representations, not just those who live ‘in the vicinity’ or who are included in a list of ‘interested parties’
• The guidance and regulations should be overhauled to remove jargon and qualify for a plain English crystal mark
• Noise, litter and other forms of public nuisance can blight an area as much as crime and disorder and licensing authorities should place greater emphasis on license holders to prevent such nuisance
• Publicity and consultation should be improved, including clarifying that the period when objections can be made is 28 days from when an application is accepted by the council as valid and it appearing on the council’s website
• Communications by email should be accepted without the need for additional paper copies
• Incomplete licensing applications which do not set out the steps that will be taken to reduce or avoid adverse impacts should be considered invalid and returned to the applicant
• A new licensing objective of preventing health harm should be added which embraces the impact of what might be termed ‘passive drinking’ – the effect on the local community in terms of stress and disturbance on public health
• A clear appeals process to the magistrates should remain so that local communities can question council licensing decisions
• Control cumulative impacts – local councils should be allowed to introduce policies controlling the cumulative impact of licensed premises in response to public representations, not just those of official bodies, to prevent a build up of problems before they occur
• Close the four day loophole for temporary events – we can see no reason why commercial licensed premises should be able to obtain ‘temporary event notices’ that give them freedom from all licensing conditions for up to 96 hours. Temporary event notices should be limited to charitable and community events
• Support for better management of the night-time economy – the welcome review of licensing laws should be accompanied by support for other measures which promote good management of town and city centres at night, such as Purple Flag.

Restrictions on pub closing times

Towns and cities will continue to be blighted by the effects of irresponsible drinking without a stronger say on alcohol licenses being put in the hands of local communities. This was the call from the Open All Hours? network of civic societies and residents groups working with Civic Voice and the Institute of Alcohol Studies to strengthen the Coalition Government’s proposals for licensing reform.

The Coalition Government undertook a consultation on reform of the 2003 Licensing Act introduced by the previous Labour administration and has suggested that it is planning a substantial rebalancing of the Act in favour of local communities. Alcohol industry lobby groups have joined together to oppose the Coalition’s plans. Commenting on the Government’s proposed licensing reforms, Matthew Bennett, Chairman of the Open All Hours? network said, “The Coalition Government will only achieve its ambition of putting ‘local communities in the lead’ on alcohol licensing if it addresses growing public concern about the impacts of stress and disturbance from irresponsible drinking on public health. Too many of our streets and town and city centres are plagued by shouting, vomiting, fights, urination and other rowdy behaviour.”

The campaign is urging the Government to:

• Address these wider impacts of “passive drinking” on public health in the same way as attitudes to passive smoking have been transformed in recent years
• Simplify licensing regulations and improve publicity for licensing applications
• Allow anyone with an interest in the quality of life of an area to influence licensing decisions, not just local residents
• Strengthen local councils’ hands in requiring all applicants to show how their alcohol license will contribute to and not damage the local area
• Support local communities concerned about the multiple impact of different licensed premises on an area
• Tackle the loophole of temporary notices which gives freedom from all licensing conditions for up to 96 hours for commercial premises

A study in Richmond upon Thames, reported by the Richmond Society and Friends of Richmond Green, found around 1,000 incidents of anti-social behaviour in four evenings in April 2009. The Societies estimate that 95% of such incidents are not recordable crimes. Matthew Bennett concluded, “We all deserve vibrant, well managed and successful town and city centres which everyone can enjoy. The Coalition Government needs to ditch lax licensing controls which marginalise the community voice and support businesses that promote a responsible drinking culture.”

In its response to the Government’s consultation on licensing reform, Open All Hours? made a number of specific recommendations:

• Remove the presumption in favour of granting licenses – we welcome the proposals for licensing authorities to be given direct powers to take action to refuse, review or remove licenses which conflict with the licensing objectives agreed for the area and to require applicants to demonstrate how their applications fit in
• Take action to involve and engage the community – the current licensing arrangements are discouraging for local communities and residents and the Coalition Government’s proposals need to go further if the ambition to put ‘local communities in the lead’ is to be met.

Restrictions on pub closing times imposed in 2008 within the Australian city of Newcastle have reduced the assault rate by 37 per cent, according to a study published in the international scientific journal Addiction. This is, of course, the opposite approach of the previous Labour Government’s Licensing Act which extended trading hours, supposedly in a bid to tackle binge drinking. The study, conducted at the University of Newcastle, shows the number of assaults in the Central Business District (CBD) fell from 33 per month before the restrictions were put in place, to 22 afterwards. The team of researchers, led by Associate Professor Kypros Kypri, compared the Newcastle CBD assault rates with those in the nearby suburb of Hamilton, where late trading venues were not subject to the restriction.

The study took into account long term trends in assault rates as well as certain reporting biases. “It is a common belief that restricting closing times just shifts the problem to a neighbouring area or to an earlier time. We tested this displacement hypothesis and found no such effect. Further, we found evidence of reduced assaults before the 3.30am closing as well,” Professor Kypri said.

In 2008, due to the high rates of alcohol-related violence and social disorder occurring in Newcastle CBD, the NSW Liquor Administration Board (since abolished) imposed restrictions on 14 CBD venues. Pubs and clubs were required to close at 3.30am and to implement a 1.30am lockout to prevent more patrons from entering the venue. Governments throughout Australia have so far resisted introducing earlier closing times. “One has to wonder what sort of reduction in harm would occur if licensed premises across Australia were to cease serving alcohol at 2am, as is required, for instance, everywhere in California, and how many serious injuries could be prevented,” Professor Kypri said.

Kypri K., Jones C., McElduff P. and Barker D. Effects of restricting pub closing times on night-time assaults in an Australian city. Addiction 2010; 105: doi:10.1111/j.1360- 0443.2010.03125.x

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03125.x/abstract

Preventing alcohol related harm in drinking environments

A major European study has examined research from across the world to identify what works to reduce alcohol-related harm in drinking environments. Pubs, bars and nightclubs are often the scenes of high levels of alcohol use, drunkenness and related-harm, particularly in young people. For example:

• 7 out of 10 young nightlife users in Europe report having been drunk in the last 4 weeks
• In England, the average alcohol use of young nightlife users on a single night out exceeds their entire recommended weekly limits
• A third of European nightlife users have taken a lift from a driver who was under the influence of alcohol or drugs during the past month
• A fifth of all violence in England and Wales takes place in or around pubs, bars and nightclubs.

As well as damage to health, alcohol-related harm places huge burdens on business and public services, for example through absenteeism, medical treatment, criminal justice sanctions and street cleaning after a night’s entertainment. Drinking environments are also workplaces for millions of individuals across Europe, who can be the victims of other people’s drinking, for example through violence.

The FASE (Focus on Alcohol Safe Environments) project was co-funded by the European Commission to develop a better understanding of what works to reduce alcohol-related harm in drinking environments. The project focused on interventions that can be implemented at local level, covering five key areas

• Responsible server/staff training interventions
• Interventions to reduce underage access to alcohol
• Policing and enforcement approaches
• Interventions delivered in drinking establishments
• Multi-component community interventions

It found that the best evidence of effectiveness available is for multi-component community interventions – schemes that bring together local agencies in a partnership to plan and deliver a combination of strategies to prevent irresponsible alcohol sales, address risky drinking and enforce licensing legislation at a community level.

Despite programmes such as designated driver schemes and educational campaigns frequently being used in Europe, the study found little evidence to support their effectiveness. It also found that staff training programmes and test purchasing operations often have little effect when implemented as standalone measures. However these measures can be important components within broader multi-component community interventions.

Critically, the study’s authors noted a scarcity of research conducted in European settings, with most having been undertaken in countries such as the USA and Australia. They recommended a range of action including:

• Better evaluation of interventions in drinking environments in European settings, including their cost-effectiveness
• Better sharing of evidence to prevent resources being spent on measures that have little effect
• Increased collection and sharing of data on alcohol use, alcohol availability and alcohol-related harms at local levels
• Integration of interventions in drinking environments into broader alcohol strategies to address the root causes of risky drinking behaviours.

The full report and case studies of work underway in Europe to prevent alcohol-related harm in drinking environments can be accessed on the project’s website: www.faseproject.eu.

The FASE project – Focus on Alcohol Safe Environments

In its 2007 work plan, the European Commission called for the collection of best practices in workplace strategies, drinking environments and alcohol marketing. The intention of this call is to reduce the impact of harmful alcohol consumption. The FASE project has become a result of this call. In each of the three areas a literature study was done on effective policies and interventions. Cases and examples of these interventions were gathered throughout Europe in order to provide an overview in the three different areas. This led to new guidelines for more effective policies. Information and reports on the project are available at: http://www.faseproject.eu/

Further information from Karen Hughes, Centre for Public Health, Liverpool John Moores University Tel: +44 (0)151 231 4522 k.e.hughes@ljmu.ac.uk

Actors play drunks in pub sting operations

It is reported that police in North Wales have employed actors to pretend to be drunk in pubs and bars in order to discover if they are then served alcohol by the bar staff. Altogether, 49 pubs and bars across Conwy and Denbighshire, in North Wales, were visited in a month, and in 42 of the premises the fake drunks were served alcohol, despite wearing stained clothes, acting wobbly on their feet and even telling bar staff that they were drunk. Trading standards officers then visited 25 ‘at risk’ venues – and 11 of these were deemed to be serving genuinely drunk customers.

The trade newspaper ‘The Publican’ reports that Chief Inspector Andrew Williams, North Wales Police’s licensing lead for Conwy and Denbighshire said: “I make no apologies for this tactic and it will be used again”. He told ‘The Publican’ the tactic was part of a long-term strategy to cut incidents of drunken violence.

But he added: “The emphasis with this operation, in the main, was one of education and support, and the agencies will be working with licensees in this regard”.

“However, some breaches were so appalling and repetitive that formal action will be taken in a small number of cases.”

Presumably, however, the police operation was in the nature of a precursor to an enforcement campaign and to identify ‘high risk’ premises. Under the Licensing Act 2003 it is illegal for licensed premises to serve alcohol to someone who is already intoxicated, but it is not illegal to serve alcohol to someone who is only pretending to be intoxicated.

The idea of using actors in this way is not new. A team of academic researchers mounted a similar sting operation ten years ago in Stockholm, Sweden, and found that the actors were served alcohol in 95% of the licensed premises, despite acting ‘very drunk’.

In law, however, there is some uncertainty about what counts as being ‘drunk’ in these circumstances. Case law suggests that someone is drunk if their faculties are impaired beyond what they would normally be. However, this could apply to anybody who has had even a couple of drinks, which would mean that all licensed premises in the country could be routinely committing offences every day in relation to the majority of their customers. In practice, the law would not normally come into operation until a more extreme state of intoxication has been reached, but in a busy, crowded bar, even that may not be easy for bar staff to observe and assess.

Councillor Audrey Lewis, Chair of Westminster City Council Licensing Committee comments:

“The general public believe that the first duty of a licensee is not to serve alcohol to those already drunk. They cannot understand why, therefore, town centres contain palpably drunk people. What has become clear, however, is that it is not so easy to spot as might be supposed.

“In Westminster a few years ago there was a Home Office grant for an operation where plain-clothes police spent time in pubs watching out for obvious drunks being served while in secret contact with waiting uniformed police to deal with the consequence. Despite this being carried out following intelligence, not a single instance of an obvious drunk being served was seen.

“Part of the problem is the British ‘round’. People can become drunk without ever going up to the bar counter and getting themselves a drink. And people often don’t appear drunk until they go into the fresh air or someone knocks into them.”

Alcohol and tobacco “more harmful than cannabis and ecstasy”

The present system for classifying drugs in the UK is invalid and should be replaced by a new ranking system which recognises that the legal drugs, alcohol and tobacco, are more harmful than most illegal ones, according to Professor David Nutt and his colleagues at the Independent Scientific Committee on Drugs.

In a paper published in the medical journal, The Lancet, Professor Nutt and his colleagues repeat the claims that in 2009 got him sacked by the previous Labour government as Chairman of the Government’s Advisory Council on the Misuse of Drugs. The then Home Secretary, Alan Johnson, demanded Professor Nutt’s resignation on the grounds he had lost confidence in him as an impartial adviser to the Government. Mr Johnson said that Professor Nutt could not be an adviser to Government while simultaneously campaigning against government policy: in particular, for advocating a ‘softer’ line on cannabis than the government was inclined to take (See UK Alcohol Alert Winter 2009). The new paper in the Lancet re-works the arguments that Professor Nutt and colleagues have been advocating for some years. It reiterates that drugs should be classified by the amount of harm that they do, rather than the sharp A, B, and C divisions currently in the UK Misuse of Drugs Act.

Professor David Nutt from the University of Bristol, Professor Colin Blakemore, Chief Executive of the Medical Research Council, and colleagues, identified three main factors that together determine the harm associated with any drug of potential abuse:

• the physical harm to the individual user caused by the drug
• the tendency of the drug to induce dependence
• the effect of drug use on families, communities, and society

Within each of these categories, they recognized three components, leading to a comprehensive 9-category matrix of harm. Expert panels gave scores, from zero to three, for each category of harm for 20 different drugs. All the scores for each drug were combined to produce an overall estimate of its harm.

In order to provide familiar benchmarks, for comparison with illicit drugs, five legal drugs of potential misuse (alcohol, khat, solvents, alkyl nitrites, and tobacco) and one that has since been classified (ketamine) were included in the assessment.

The process proved simple, and yielded roughly similar scores for drug harm when used by two separate groups of experts.

The new ranking placed alcohol and tobacco in the upper half of the league table. These socially accepted drugs were judged more harmful than cannabis, and substantially more dangerous than the Class A drugs LSD, 4-methylthioamphetamine and ecstasy.

Heroin, crack cocaine, and metamphetamine were ranked the most harmful drugs to individuals, whereas alcohol, heroin, and crack cocaine were the most harmful to others. Overall, alcohol was the most harmful drug, with heroin and crack cocaine in second and third places.

Drugs ordered by their overall harm scores, showing the separate contributions to the overall scores of harms to users and harm to others

Professor David Nutt, lead author of the paper, said: “Drug misuse and abuse are major health problems. Our methodology offers a systematic framework and process that could be used by national and international regulatory bodies to assess the harm of current and future drugs of abuse.”

Professor Colin Blakemore added: “Drug policy is primarily aimed at reducing the harm to individual users, their families and society. But at present there is no rational, evidence-based method for assessing the harm of drugs. We have tried to develop such a method. We hope that policy makers will take note of the fact that the resulting ranking of drugs differs substantially from their classification in the Misuse of Drugs Act and that alcohol and tobacco are judged more harmful than many illegal substances.”

Reaction

Publication of the Lancet paper generated extensive media coverage, not only in the UK but also internationally. A common feature of the coverage, however, was that the media appeared to misunderstand the message of the paper, headlines frequently stating that ‘experts had found alcohol to be more dangerous than heroin or cocaine’. For example, The Times headline read “Why drink is a bigger demon than heroin, crack or ecstasy”.

In reality, the conclusions of the paper are more ambiguous than these headlines suggest. The key to the ambiguity is that the paper distinguishes between the dangerousness of a drug, in respect of the risk of harm to the user, from its harmfulness, the damage its use inflicts on people other than the user and on the wider society. As can be seen from the graph, the paper clearly ranks alcohol as less dangerous to the user than heroin or cocaine, though it is more harmful overall because of the damage inflicted on third parties and the wider society. Presumably, however, the amount of damage to others is a reflection of how extensively any given drug is in use, and, as some critics pointed out, if cocaine were used as extensively as alcohol the picture might look different. Indeed, in their earlier paper, in the Lancet in 2007, Professor Nutt and his co-authors themselves explained that “direct comparison of the scores for tobacco and alcohol with those of the other (illegal) drugs is not possible, since the fact that they are legal could affect their harms in various ways, especially through easier availability”.

Another, more fundamental criticism, perhaps, is that Professor Nutt’s ranking system gives a spurious air of scientific objectivity to a system which, in reality, is as subjective and arbitrary as the classification system it is intended to replace. Critics suggest that weighing different kinds of harm against each other is always going to be an exercise in comparing apples and pears. If, as is claimed, cigarette tobacco kills half the people who smoke it, declaring it to be less harmful than alcohol is a value judgement, not a scientific proposition.

Nutt, D J; King, L A; Phillips, L D: 2010. Drug harms in the UK: a multicriteria decision analysis – Lancet, 2010; 376: 1558-65

Youth alcohol problems in the spotlight

To mark Alcohol Awareness Week, held in October 2010, Alcohol Concern, the national charity on alcohol misuse, focused on the alcohol problems experienced by the under 18s, both those arising from their own drinking and those caused by parental alcohol consumption. A third report flagged up the issue of youth exposure to alcohol advertising, particularly on TV during the football world cup.

Right Time, Right Place

On drinking by under 18s themselves, Alcohol Concern says that young people are damaging their health as a result of drinking at greater levels than ever. Altogether, the charity says, underage drinkers consume each week the equivalent of nearly 7 million pints of beer or 1.7 million bottles of wine, and the consequences for their health are becoming more and more evident.

Between 2002 and 2007, alcohol-related hospital admissions for under 18s increased by 32%. On average over the last seven years, Alcohol Concern says, 36 children a day were admitted to hospital due to alcohol, and this excludes admissions to Emergency Departments, where records of alcohol involvement are not routinely kept.

A striking feature of the figures is that more girls than boys are now attending hospitals for alcohol problems. Between 2004 and 2009, 28% more girls than boys were admitted to hospital from Emergency Departments.

The explanation, the charity says, is that the dramatic cultural shift in recent decades in the UK, as alcohol has become increasingly more affordable and widely available, has resulted in today’s generation of children increasingly replicating the worrying patterns of drinking among their older peers and adults, leading to disastrous health and social consequences for them and their families.

The charity says it is clear that, without effective prevention and intervention, this harmful behaviour will continue to normalise problem drinking and continue to advance pro-drinking cultural attitudes among children and young people.

Alcohol Concern’s major new report ‘Right time, right place: alcohol-harm reduction strategies with children and young people’ calls for earlier identification of young people engaged in ‘risky’ drinking such as young people attending A&E or getting into trouble with the police for alcohol, so that they can access information, advice and support. The report draws together expert practice guidance, experience from local level delivery and new research, including unpublished health data, to identify important next steps in harm reduction strategy.

The report is available to download at: http://www. alcoholconcern.org.uk/ publications/policy-reports/ right-time-right-place

“Millions of children exposed to alcohol marketing during World Cup”

Millions of children as young as four were subjected to alcohol marketing during televised England games at the world cup this summer, according to Alcohol Concern.

In a report released during October’s Alcohol Awareness Week, new figures show over a million children between four and fifteen years old were exposed to alcohol adverts from brands such as Stella Artois, Magners, Fosters, Carling and WKD during live England games shown on ITV. Alcohol Concern says the total number of children exposed to alcohol adverts during the world cup could be as high as five million when taking all the live games shown into account. 1.6 million children viewed three alcohol adverts during England’s game against Algeria and 1.4m saw four alcohol adverts during the game against USA. Even non-England games such as Uruguay vs Netherlands had 800,000 children viewing three alcohol adverts shown during commercial breaks.

The alcohol adverts were all shown between 8 and 10 pm and were deemed within advertising regulations, even though millions of children were exposed to them. The Advertising Standards Authority claim that the regulations protect children from alcohol advertising; however, Alcohol Concern dispute this and are calling for a 9 pm watershed ban for alcohol adverts and a ban on advertising alcohol on the internet. Recent research, cited by Alcohol Concern, shows that the more children are exposed to alcohol marketing the greater likelihood is that they will drink more and at an earlier age.

In a separate study of eighty 11 to 18 year olds in the East Midlands, London and the North West, carried out this summer, Alcohol Concern found that, on average, children were exposed to the equivalent of 4 alcohol adverts in the course of one day or the equivalent of 1,600 per year. In some cases, as many as 11 alcohol adverts in a 24-hour period were being seen by children as young as 11 and 12. TV was by far the most frequently cited medium of exposure, followed by adverts within shops or supermarkets and on billboards. Girls reported more exposure to spirit and wine marketing than boys, while boys reported more exposure to cider and alcopops.

Alcohol Concern Chief Executive, Don Shenker said:

“It is simply unacceptable that vast numbers of children are so frequently exposed to alcohol advertising, leading to higher levels of drinking among young people and increasingly higher levels of harm. Alcohol producers and advertising regulators are clearly not taking their responsibilities seriously enough and only a watershed ban on TV and an internet ban will prevent the vast majority of children from being exposed to alcohol marketing.”

Over the last 7 years in England on average 36 children a day were admitted to hospital due to alcohol. Alcohol Concern is calling for a number of restrictions on alcohol marketing, including a ban on showing alcohol advertisements in cinemas other than with 18-rated films and a ban on alcohol sponsorship of sports and music events.

Professor Sir Ian Gilmore of the Royal College of Physicians said:

“The evidence is clear – children are affected by alcohol marketing. It influences the age at which they start drinking and how much they then drink. Alcohol is a drug of potential addiction and if drinks producers and retailers won’t stop pushing it at our children then urgent and tough legislation is needed to protect them.”

• Alcohol Concern calls for the following recommendations to protect children from alcohol marketing:
• A 9 pm watershed ban on alcohol marketing on TV and radio and for subsequent advertisements only to be broadcast if the proportion of under-18s viewing is less than 10%
• A total ban on alcohol marketing or sponsorship on the internet, on billboards and at sports or music events
• A restriction to advertise alcohol only in cinemas showing films with 18 certificates
• Messages and images should refer only to the qualities of the products such as ABV, origin, composition, means of production, patterns of consumption
• A government health message must be included on each alcohol advertisement comprising a sixth of the advert

The report, Overexposed, can be downloaded from the publications section of the Alcohol Concern website

New toolkit on supporting young people experiencing alcohol harm

Calling Time, the South West Alcohol Improvement Programme (AIP), in conjunction with Alcohol Concern, has published a new Toolkit on alcohol and young people.

The toolkit is designed for professionals and carers concerned particularly with looked after children and young people with special educational needs.

The guidance is primarily for workers who are not alcohol specialists. However, sections of the toolkit are also relevant to specialist alcohol and drug staff and commissioners. A supplementary training course and materials have also been developed and are available separately at:

www.alcoholconcern.org.uk or www.alcohollearningcentre.org.uk

The published version of the toolkit has been kept as short as possible. It also focuses on alcohol. It is acknowledged that many young people will have poly-substance problems and young people’s substance misuse services usually work with all substance use. However, in this guide the focus is on alcohol alone.

More information can be obtained from: Laura Juett, Regional Alcohol Manager Department of Health South West Mast House Shepherds Wharf 24 Sutton Road Plymouth PL4 0HJ Tel: 01752 635031 Email: laura.juett@gosw.gsi.gov.uk

Kirklees course to stop kids drinking has 200 ‘graduates’

An example of the failure of parents or the wider society to prevent alcohol problems in children, and a possible response to them, is provided by a police run initiative in Kirklees, West Yorkshire. As reported in the Huddersfield Daily Examiner, a course aimed at stopping children as young as 13 drinking on the street has now signed up its 200th ‘pupil’. The police-run Alcohol Impact course is made available to 13 to 17-year-olds found drinking on the street. They are given the choice of attending the one-night course – or facing the threat of court action and an anti-social behaviour order. It is reported that in the two-and-a-half years since it was launched, not one of the young people who has been through the scheme has been caught re-offending.

Inspector Adrian Waugh, who leads the Huddersfield South Neighbourhood Policing Team and runs the course, said: “For 200 people to come on this course and for us not to see one repeat offender shows that we are having a positive effect on underage drinkers in Kirklees.

“Underage drinking is an age old issue, so we are not saying that we can eliminate it from society entirely, but we want to offer young people some long-term education so that they are more aware of the risks they encounter when drinking in public and of the action they face if we catch them. “We are committed to addressing anti-social behaviour in our areas and to looking at new ways to tackle the issue and achieve long term solutions.”

The way the scheme works is that police target specific areas where the public have raised concerns about underage drinking, through public meetings and calls to the NPT. Police officers work alongside West Yorkshire Fire Service, Kirklees Council and the charity, CRI, which tackles problems linked to drugs, crime and anti-social behaviour, on the course. The two-hour session runs once a month and brings 10 young people together to talk about alcohol, learn of its effects on the body and mind and raise awareness of the associated risks. A graduate of the scheme is fifteen-year-old Emily. She said: “The course is much better than just being given a fine or going to court because I have learned about alcohol and about how to spot the warning signs of drinking too much. We were shown videos of drunk people and it’s actually upsetting to see what people are like when they are out of control.”

‘No alcohol for children’ advice unrealistic?

In 2009, the UK Labour Government published Guidance on the Consumption of Alcohol by Children and Young People. In this report, the Chief Medical Officer (CMO) recommended that children under the age of 15 should avoid alcohol completely.

However, this advice has now been challenged as ‘unrealistic’ by a new report from the Joseph Rowntree Foundation.*

The new report is designed to fill a gap in knowledge. While a significant body of research exists on teenagers’ awareness of alcohol and drinking practices, much less is known about how parents teach younger children (aged 5 to 12) about alcohol and the extent to which young people’s current and future drinking habits may have their roots in childhood experiences.

Using a national survey and in-depth case studies, the new report attempts to fill the gap in knowledge by investigating parents’ and carers’ drinking practices and their attitudes towards the role of alcohol within the family, as well as their children’s knowledge and understanding of alcohol.

The study looked at ‘norms’ within families – the personal home rules and practices that individual families establish as a result of specific family structures, parents’ own childhood memories of being brought up, and families’ communication styles. It also considers society’s wider norms around parenting and drinking cultures, as generated by the law, media and social networks, for example.

The key findings of the study are:

• Parents are the most important influence on young children’s attitudes to alcohol.
• Parents largely succeed in conveying the social pleasures and risks of drinking at home, and the need for moderation. Children also learn messages about moderation from witnessing parents/relatives drinking to excess.

However, children are not taught to recognise the health consequences of drinking. Unlike social risks, health risks do not resonate with parents’ experiences of drinking. This has implications for bodies that guide parents in how to talk to children about alcohol.

Parental emphasis on learning to drink safely at home misses the opportunity to teach children about other drinking practices and environments, and the impact of drunken behaviour on others.

The authors conclude that the Chief Medical Officer’s 2009 recommendation that children under 15 should avoid alcohol appears unrealistic, ‘since alcohol is an unremarkable part of many families’ lives’, and the CMO’s recommendation may, therefore, run counter to sensible parental approaches to alcohol.

However, whether this conclusion is found persuasive by parents or other researchers and health advocates remains to be seen. An obvious retort is that there is a considerable amount of evidence to show that the likelihood of becoming a sensible drinker is significantly enhanced in young people by delaying the onset of regular drinking. Moreover, although, until comparatively recently, cigarette smoking was an unremarkable part of many families’ lives, it still was not generally considered appropriate to allow or encourage children aged under 15 to smoke.

The authors also conclude that alcohol education in schools is one way to address the gaps in what children learn at home. However, the majority of children in this study had not learned about alcohol at school. The Department for Education might beneficially review alcohol education in primary schools to improve its effectiveness. To maximise impact, such education could involve parents and/or run in parallel with campaigns targeting parents.

* Valentine, G; Jayne, M; Gould, M; 2010; Alcohol consumption and family life. Joseph Rowntree Foundation

Public enquiry needed into parental alcohol misuse, claim charities

A new report by national charities, Alcohol Concern and The Children’s Society, calls for a national inquiry into the impact of parental alcohol misuse on children.

The report, ‘Swept Under the Carpet’ estimates that, in the UK, 2.6 million children live with a parent whose drinking puts them at risk of neglect and 705,000 live with a dependent drinker. The charities argue that a national inquiry into the scale of harm and impact on society could force local areas to act quicker to protect children. The report also calls for mandatory social work training as recent research found that one third of social workers received no training on alcohol or drugs and half received just three hours of training or less.

Alcohol Concern Chief Executive, Don Shenker, said:

“It’s shocking that in spite of the worrying numbers of children affected by parents’ heavy drinking and domestic abuse, so little is being done to address this. The whole system sweeps the problem under the carpet and together with the secrecy and stigma involved, millions of children are left to do their best in incredibly difficult circumstances. A government inquiry must look into all aspects of parental alcohol misuse so that we can improve outcomes for these children.”

Bob Reitemeier, Chief Executive of The Children’s Society, said:

“I cannot stress strongly enough the harmful impact that substance abuse can have on both children and whole families; it is imperative that everyone understands these risks and we believe that education is the key. We are calling on the Government to make sure that everyone who needs either training or education to deal with parental substance abuse is given the appropriate assistance.”

Chair of the British Association of Social Workers’ Special Interest Group on Alcohol and other Drugs, Dr Sarah Galvani, also commented on the issues. She said:

“Problematic alcohol use by parents is highlighted by social workers as far more prevalent than drug use. Alongside the overlapping experiences of domestic violence and mental ill health, parental alcohol and other drug use are the three factors that repeatedly put children at risk of serious harm. We must support social workers to work as best they can in what are often very complex and challenging situations. This starts with excellent training in these issues at qualifying and post-qualifying levels, which currently is lacking.”

• Recent research estimates that 2.6 million children in the UK are living with parents who are drinking hazardously and 705,000 are living with dependent drinkers
• More than 100 children, including children as young as five, contact ChildLine every week with worries about their parent’s drinking or drug use
• There is evidence of parental substance misuse in 57% of serious case reviews (of serious or fatal child abuse). Since there is currently no routine screening by children and families services for parental alcohol misuse, this is likely to be an underestimate.
• In a study of four London Boroughs, almost two thirds (62%) of all children subject to care proceedings had parents who misused substances
• Alcohol plays a part in 25-33% of known cases of child abuse
• In a study of young offending cases where the young person was also misusing alcohol, 78% had a history of parental alcohol abuse or domestic abuse within the family In a survey of 250 recently qualified social workers, one third reported receiving no training on substance misuse on their training course whilst half of all respondents had received half a day or less
• Alcohol use is a feature in a majority of domestic abuse offences
• Women – including mothers – experiencing domestic abuse are up to fifteen times more likely to misuse alcohol than women in the general population

The report makes four key recommendations:

• Government should ensure that parental substance misuse and related domestic abuse becomes a mandatory part of all social work degree courses and launch a rolling education programme for those already qualified
• Government should ensure that parental alcohol misuse and alcohol-related domestic abuse are addressed within local commissioning arrangements for both adults’ and children’s services and that partnership working is made a condition for funding
• Government should commission a resource for professionals to use with children affected by parental alcohol misuse and support the delivery, at local level, of information for parents on the risk of heavy drinking to children
• Government should launch a national inquiry into the impact of parental substance misuse on children and the cost implications for society In a poll carried out in July for the charities, 87% of people surveyed thought heavy drinking by parents had a negative impact on children and families. 84% of respondents thought parents misusing alcohol is as harmful to children as parents who use drugs.

Swept under the carpet: children affected by parental alcohol misuse – a report by Alcohol Concern and The Children’s Society is available for free download at:

http://www.alcoholconcern.org.uk/publications/policyreports/ under-the-carpet

Stay sober or else

People convicted of an alcohol-related crime in London may be required to stay sober or run the risk of being sent to prison. The idea has been put forward by Kit Malthouse, the Deputy Mayor of London, based on a scheme already in operation in South Dakota in the USA, the 24/7 Sobriety programme devised as a more effective method of dealing with repeat drink drive offenders.

Mr Malthouse has proposed a trial of the scheme, under which those convicted of alcohol-related crimes serious enough to warrant a prison sentence are tested for alcohol twice a day at their own expense, and if they test positive they go before the court which may then impose the deferred sentence.

Strangely, Mr Malthouse did not appear to make any reference to Drink Banning Orders which are already in operation in the UK, and which have a similar purpose. (See below)

Speaking to BBC Radio, Mr Malthouse said:

‘(Alcohol related crime) is costing us a huge amount of money in terms of police time and NHS time, so we put our thinking caps on and scoured the world for a scheme that might help us.’

‘The way it works is somebody who is convicted, rather than go to prison, they go on this scheme where they get tested twice a day…so they can maintain employment.’

‘If they are found to have consumed alcohol, they go before a judge or magistrate, who decides what punishment they should have’, he added.

Mr Malthouse said the American version of the scheme had a 99 per cent compliance rate. He also said it was self-financing, because the people taking part paid a dollar per alcohol test, and it was a ‘cheaper and more cost-effective’ alternative to prison.

He said: ‘We would like to try it here. We do think drink is a great driver of crime in this city.’

Unfortunately, Mr Malthouse failed to convince Don Shenker, Chief Executive of Alcohol Concern, who immediately opposed the idea. He said: ‘The real issue we need to actually address is why people are drinking the way they are. We already have schemes called alcohol offence referral schemes where the police, once they have picked somebody up for a crime, refer them on to an alcohol service where that person receives some advice, support and even counselling if needed.

‘I don’t think you can stop it until you cure it. I think (Mr Malthouse’s) approach is to try and coerce people into sobriety and my approach, I think is a much better approach, where you coerce people into support and treatment because these people have a problem with alcohol and that problem will not disappear once they leave prison.’

However, the South Dakota scheme is reported to be working very successfully. The stated aims of the 24/7 Sobriety Project are:

• to reduce recidivism
• to improve public safety
• to serve as an alternative to incarceration that reduces the number of people in local jails and state prisons
• to allow offenders to remain in the community with their family and friends to permit offenders
• to maintain employment
• to save tax dollars because most monitoring costs are paid by the offenders and because offenders are being diverted from jail and prison where appropriate

An evaluation of the impact of the scheme found that it was working impressively, particularly given the fact that almost half of the participants have been convicted three or more times for drink driving offences. As of January 2010, almost 13,000 offenders participated in twice-daily alcohol breath testing. They took over 2.4 million tests, passing 99.6% of them. Over 66% of the offenders were totally compliant during the entire term of their participation. In addition, the large majority of participants who were surveyed about the program indicated that the program helped them stop using substances, improved their family functioning and helped them maintain or improve their employment. The evaluation also found that while early skeptics of the 24/7 Sobriety model predicted that close monitoring with a strict no use standard would fill the jails with offenders, in fact, the results of the program have been exactly the opposite. The program actually reduced incarceration leading to reductions in jail populations and jail costs.

Drink Banning Orders:

A drink banning order is a specific order from a civil court imposed on an individual who has behaved in a disorderly manner or who has committed a criminal offence while under the influence of alcohol. They were introduced by the Labour Government in 2009.

A DBO may impose any prohibition on a person that the court considers necessary to protect others from alcohol-related crime, or disorderly conduct committed while they were under the influence of alcohol. The prohibitions must include whatever the court thinks is necessary with regard to that person entering premises that sell alcohol. This could include exclusion from:

• purchasing alcohol
• consuming alcohol or being in possession of alcohol in public
• individual or sets of licensed premises
• all licensed premises in a geographically defined area

DBOs can last from two months to two years. Offenders who breach a DBO are liable to a fine of up to £2,500.

The police (including British Transport Police) and local authorities in England and Wales can apply to the courts for a DBO to be made. DBOs can also be granted on conviction for an alcohol-related offence in specified local justice areas.

The Violent Crime Reduction Act also enables courts to offer an approved course to those subject to a DBO, as a means to address their behaviour. This is on a voluntary basis. These courses focus on educating people about the serious social and health implications of heavy alcohol consumption. Successful completion of the course may lead to a reduction in the length of the order.

Currently, 50 local justice areas in England and Wales are authorised to impose DBOs, including a number of London Boroughs.

What might have been

In 1979 a report on alcohol policies was produced for the then Labour Government by the Central Policy Review Staff. However, the report was to become famous for not being officially published, either by the Government that commissioned it, or by any succeeding Government, for the next 30 years.

Here, Richard Lee gives his personal view as to why the report never saw the light of day, and what might have been different if it had been published, and acted upon.

Mr Austin Mitchell: To ask the Minister for the Cabinet Office if he will publish the report, Alcohol Policies, produced in 1979 by the Central Policy Review Staff. [217727]

Mr [David] Miliband: In common with other Cabinet Office records, the report will be considered for transfer to the National Archives after 30 years. The 1979 report is due to be transferred to the National Archives in 2010.

– Response to a written question from Austin Mitchell, MP for Grimsby, to future Labour Party leadership contender, then a Cabinet Office Minister, David Miliband, in Hansard, 7th March 2005

This question, posed by Austin Mitchell, hints at a very curious episode in United Kingdom alcohol policy, the effects of which we are living with to this day.

The Central Policy Review Staff (the CPRS, also known as the Think Tank) began life in 1970 as an independent, multidisciplinary unit within the UK Government’s Cabinet Office, with a brief to work across departmental boundaries. In March 1979 it produced a review called Alcohol Policies which set out, anonymously and away from the public gaze, to examine not only the most effective but also the most feasible responses to Britain’s increasing alcohol consumption.

The 2 volume publication was shelved at the time for reasons discussed further below – and the public were protected from it by the 30 Year Rule (under which most UK Government records are transferred to the National Archives and made available again after 3 decades.

An unofficial, pirated version of the report was published in Stockholm in 1982 but the real thing has only been available in paper copy since September 2009, and that for a mere £456.60. Its final, belated release resulted in no comment in the serious press, even the Daily Mail – the fiercest chronicler of Britain’s drink problem. It was as though Alcohol Policies came out of prison only to be tagged and placed under house arrest.

One clue to where the Think Tank might have gone wrong at the start is in the foreword. They clearly failed to bring the alcohol industry ‘on board’ as ‘stakeholders in the process’. They admit with disarming honesty that the importance of the industry view came at the bottom of a long list that included 16 Government departments with interests in all aspects of alcohol (“production, sale and consequences of its consumption;” health and social services; the police and the judicial system; private sector bodies “..most of whom devote their efforts to people with alcohol problems.”) This mistake was not to be repeated in the preparation of the 2004 Alcohol Harm Reduction Strategy.

What was it that made the conclusions of the CPRS’s fact-finding so unpalatable? At first sight Alcohol Policies’ recommendations may seem, in a very British way, modest and sensible to a 21st Century reader brought-up with the public health model of alcohol control.

The review recognised the relationship between per capita consumption and resulting harms and suggested that the best outcome would be to hold it at the current level. This would be achieved by the active use of revenue duties, keeping them in line with the cost of living as measured in the Retail Price Index (RPI).

It acknowledged that alcohol created problems that went beyond a minority of irresponsible drinkers, highlighting young people in general and women in particular as vulnerable groups.

Alcohol should not become more easily available than it already was. Lowering the minimum age at which young people could legally buy alcohol to 17 was rejected.

More research, leading to action, on alcohol in the workplace.

Action on drinking and driving (a cause of excess morbidity and mortality in the under-30 age group) by implementing the recommendations of the 1976 Blennerhassett Committee: retaining the current upper blood alcohol limit but introducing discretionary road-side testing (an idea first floated in a 1965 White Paper) with breath testing machines instead of blood and urine tests.

The setting-up of an Advisory Council on Alcohol Policies that would not merely advise but take ‘an activist role’.

But Alcohol Policies was spiked and instead, in 1981, the UK Department of Health & Social Security published Drinking Sensibly that, while covering much the same range of issues as the CPRS review, took no account of the cost of alcohol or per capita consumption. Drinking Sensibly was widely believed to be the Government’s answer to the Think Tank report: a document far more palatable to those nowadays described as the major stakeholders in alcohol policy.

The relationship between consumption and harm wasn’t a new or heretical idea in 1981. In 1956, the French statistician Sully Lederman had set out to demonstrate a relationship between average levels of alcohol consumption in a given society and the number of harmful drinkers. By 1975 Robin Room could assert that measures to control the availability of alcohol through interventions that included the manipulation of price were not only shown to be effective but “thoroughly traditional.”

Where did it all go wrong? The review laid down a challenge to the Government – not only that trends in misuse justified its concern but that it had the means at its disposal to begin acting immediately – and inevitably became a source of embarrassment. Despite being respected by civil servants, Ministers’ interest in the Think Tank had always been half-hearted. For those Government Departments concerned with employment, trade and tourism the recommendations contained in its review became a cause of tension.

The Conservative Party in the UK has traditionally been sympathetic to the drinks industry. And for obvious reasons the drinks industry didn’t like Alcohol Policies. As the review noted, strong growth in alcohol sales was predicted for the 1980s. The Party elected under Margaret Thatcher in May 1979 had embraced a neo-liberal ideology (rolling back the state, liberating business from restrictions, individual responsibility, choice – whether you wanted it or not) that sat even less comfortably with the CPRS’s interventionist recommendations.

Could it have been different? Alcohol Policies noted with concern the increase in per capita consumption that occurred in the 20 years up to 1977 accompanied by a 50% increase in liver cirrhosis, an 84% increase in diagnoses of alcoholism among men and a 145% increase among women. Interestingly, after 1979, due to economic recession, the real price of alcohol went up and consumption briefly dipped. Reports from the Royal Colleges of Psychiatrists and Physicians published in 1986 and 87 raised the alarm about rising consumption and harms, which had resumed an inexorable increase that would continue for the next two decades, while proposing similar countermeasures to Alcohol Policies.

During the same period, the use of pricing, an advertising ban and severe restrictions on where the product could be legally used, reduced tobacco consumption and changed the culture of smoking in the UK and much of Europe; the opposite of the situation with alcohol. Part of the explanation for this lies in the greater power of the drinks industry in comparison with the tobacco industry.

The Government knew what action to take – none of the CPRS’s recommendations were radical – but chose to do the opposite in full knowledge of the likely consequences. Which goes well beyond being embarrassed.

Neither the CPRS review, nor the Royal Colleges’ reports, had the prescience of Tim Ambler – at the time an executive with the Grand Met hospitality and brewing group. In an internal 1984 document Ambler identified 7 ‘threats’ to the alcohol industry’s growth which included the use of taxation to increase price, vigorous measures to counter drink-driving, restrictions on hours of sale, advertising restrictions, warning labels and most cynically of all, residential treatment for people misusing alcohol – thereby acknowledging that a minority of irresponsible drinkers are actually the best customers and should not be removed from the marketplace. None of these threats materialised – demonstrating that the leaked Ambler memo was by far the most authoritative guide to alcohol policy for a quarter of a century.

Richard Lee worked for 12 years in a specialist alcohol treatment team in the south of England and, at Glass Half Full Alcohol Training, he is an independent trainer on alcohol issues.

Alcohol problems and social workers

A new pocket guide on dealing with alcohol and other drugs has been prepared for social workers by the British Association of Social Workers. The Guide says that social workers are in the front line of health and social care services and that alcohol or other drug use can play a significant role in the lives of their clients.

However, while, in the past, alcohol and drug problems have not been high enough on the social work agenda, it is now recognised that core social work skills are ideally suited for work with people’s alcohol and drug use. Service users have the right to professional social care, delivered by well-trained, well-supervised workers. Social workers should be able to intervene confidently and effectively where they encounter alcohol and drug problems. The pocket guide seeks to support social workers to take professional responsibility for ensuring their knowledge and skills meet the needs of service users with alcohol and drug problems.

The Guide is obtainable at: http://www.aerc.org.uk/index.html

 

 

New Report – Getting the Price of Alcohol Right: Safeguarding public health and social well being

Notice of publication of new Report from SHAAP (Scottish Health Action on Alcohol Problems)

Getting the Price of Alcohol Right: Safeguarding public health and social well being

Published October 2010 and available from: www.shaap.org.uk