Issue 3 2012

Government launches Alcohol Strategy Consultation

The Coalition Government’s Alcohol Strategy is taking its final shape with the launch of a public consultation on key elements. The exercise centres around minimum unit pricing (MUP) and the question posed is about the level at which the minimum price should be set, not the principle of MUP as such. The consultation also seeks views on banning heavily discounted alcohol such as in multi-buy promotions.

However, press reports suggest that while Prime Minister David Cameron is still strongly for MUP, he has not succeeded in convincing several of his cabinet colleagues of its merits.  Education Secretary Michael Gove, Chancellor George Osborne and Home Secretary Theresa May herself, whose department would be responsible for overseeing the alcohol strategy, are all reported to have serious reservations about the policy or to be positively opposed.

Dead in the water

So, too, it is reported, is Deputy Prime Minister, Nick Clegg, apparently on the grounds that MUP would be a ‘tax on the poor’.  Some press reports suggest that Clegg’s Liberal Democrats are privately briefing the media with the line that there is so much opposition that MUP is effectively ‘dead in the water’.

Moreover, legal challenges across Europe are set to delay plans to introduce MUP in England and Wales for another two years at least, a leading Conservative proponent of MUP has stated. Conservative Health Committee member, Dr Sarah Wollaston MP, said in a letter to her constituency that it would be at least 2014 before the Government could push ahead with its plans. Her letter followed the admission of Scottish ministers that their plans for minimum pricing would not be able to proceed while it fights a legal challenge from drinks firms.

The likelihood of the European Commission being a major obstacle to MUP was further emphasised by the publication of the Commission’s legal opinion that MUP is illegal under EU law.

Government Consultation

In launching the consultation, the Government framed the issues in terms of tackling binge drinking and the impact it has on communities, hospitals, streets and towns.  The measures being proposed are designed, the Government said, to cut crime, save lives and reduce consumption.

“For the first time ever we are asking people what they think about prohibiting the sale of alcohol below a sensible, minimum price per unit.  We are also consulting on whether to ban multi-buy promotions in shops and off-licences, such as two-for-the-price of one or buy-one-get-one-free. This is NOT about stopping responsible drinking.  For example, it WON’T put an end to supermarket ‘meal for two with a bottle of wine’ deals.  But it WILL seek to address the ludicrous imbalance whereby in some instances beer is cheaper than water.”

The Government emphasises that the new consultation follows on from what has already been done, including…

“Rebalanced the Licensing Act in favour of local communities – for instance by removing the ‘vicinity test’ to ensure that anyone – no matter where they live – can input into a decision to grant or revoke a licence

“Late night levy – empowering local authorities to make those businesses that sell alcohol late at night contribute towards the cost of policing and wider local authority action

Early Morning Alcohol Restriction Order – enables local areas to restrict the sale of alcohol late at night in all or part of their area if there are problems

“Why do we need a consultation? Binge Britain and what it means for our communities and individuals

“Instead of the café culture promised by the last Government’s Licensing Act, too many of our high streets and town centres have become no-go areas on a Friday and Saturday night with just under half of all violent crimes involving alcohol and a great deal of alcohol-fuelled anti-social behaviour.

“And it is responsible drinkers, businesses and the wider community who are paying the price in terms of crime and disorder on our streets, violent, alcohol-related injuries clogging up our Accident and Emergency rooms and significant long-term health problems.

“The Government will consult on a new approach to turn the tide against irresponsible drinking which costs the UK taxpayer £21billion a year.

“It will help reverse a culture that led to almost 1 million alcohol-related violent crimes and 1.2 million alcohol-related hospital admissions last year alone.

“Our consultation is targeted explicitly at those harmful drinkers, problem pubs and irresponsible shops.

“It is NOT about stopping sensible, responsible drinking.

“Those who enjoy a quiet drink or two have nothing to fear from our proposals. The local pub – the backbone of many communities – has nothing to fear. The responsible off-licence has nothing to fear. Indeed the consultation seeks to cut red tape for responsible businesses.

“More powers for pubs to stop serving alcohol to people who are already drunk.

“Local areas will be given the powers to tackle local problems, including the ability to restrict opening and closing hours, control the density of licensed premises and charge a late-night levy to support policing.

“We have already started to target those who have shown they cannot drink responsibly – and who have been convicted of an alcohol-related offence – with new pilot sobriety schemes and the late night levy has been introduced to put an end to local people picking up the tab for irresponsible drinking.

“And a real effort to get to grips with the root cause of the problem. And that means stemming the tide of cheap alcohol.

“We will consult on Minimum Unit Pricing, so that alcohol can only be sold at a sensible and appropriate price. We found that alcohol has been so heavily discounted that it is possible to buy a can of lager for as little as 20p and a two litre bottle of cider for £1.69.

“We will also consult on introducing a ban on multi-buy promotions in shops to stop them encouraging people to buy more than they really want or need.

“The Government is now conducting a full public consultation over a ten week period.”

Reactions

The launch of the consultation was, of course, welcomed by the public health lobby as a major step forward, though virtually all of the main organisations favour a 50p unit price rather than the 45p proposed by the Government.

The Royal College of Physicians said: “The RCP has long called for the introduction of a minimum unit price (MUP) for alcohol, which the evidence tells us will reap significant health benefits across the population. While the RCP has called for a 50 pence MUP, we support the government’s intention of tackling cheap alcohol.”

For the Institute of Alcohol Studies, Katherine Brown said:

“We fully support the introduction of minimum pricing. This is a targeted policy that will tackle heavy and harmful drinkers whilst having little impact on moderate drinkers. Everyone stands to gain from the benefits of MUP as we see lower rates of crime and social disorder and a reduced strain on our health and emergency services.”

Industry

Reactions from the alcohol industry were far more diverse than those of the public health lobby, and ranged from fierce opposition to complaints that the Government’s proposals did not go nearly far enough.

For the Wine and Spirits Trade Association (WSTA), Chief Executive, Miles Beale said:

“It is hard to understand why the Government is pushing ahead with the consultation now, when there is a wall of opposition in Europe, a legal challenge in Scotland, a lack of any real evidence to support minimum unit pricing, opposition from consumers and concerns raised from within Cabinet itself.

“Minimum unit pricing and the proposed restrictions to promotions are wholly untargeted and will unfairly punish millions of consumers and businesses in the UK, while doing nothing to tackle the root causes of alcohol misuse or associated crime and disorder.

“Minimum unit pricing will punish responsible consumers with higher prices, hitting the poorest hardest and will do nothing to address the causes of alcohol misuse.

“There is no evidence that minimum unit pricing will tackle alcohol misuse – in fact the international evidence suggests that problem drinkers are the least likely to be deterred by price rises. On promotions there is no compelling evidence linking retailer promotions with alcohol misuse – indeed overall levels of alcohol consumption are falling. The most recent evaluation of the ‘multi-buy’ ban in Scotland showed that it has had no significant impact on alcohol sales. This raises serious doubts about the effectiveness of a promotions ban in reducing alcohol misuse.”

The opposite viewpoint was expressed by the Licensed Multiple Retailers’ Association’s Strategic Affairs Director, Kate Nicholls:

“We are pleased that Governments both sides of the border have now finally woken up to the fact that it is the plethora of pocket money priced alcohol promotions which are the real problem. With 70% of alcohol now bought and consumed at home, and widespread loss leading, punitive measures against pubs and bars are not delivering either Government’s public policy objectives on health and crime and disorder.

“We are disappointed that the consultation does not go further and get a grip on bulk sales, price-led advertising and in-store promotions. There is nothing here which will stop supermarkets continuing to sell wholesale quantities of alcohol to the public at prices some pubs cannot buy it. The consultation itself acknowledges that there will be net benefit to the off-trade.”

A more middling position was put by Brigid Simmonds for the British Beer & Pub Association (BBPA)

“It is good that the Government acknowledges that sensible, responsible drinking supports pubs as part of our community fabric. I hope that the policies emerging from this review will reflect that – any review of the Mandatory Code should not result in new onerous legislation or regulation for pubs. We do however welcome further clarification on the ban on promotions, to give greater clarity…. On multi-buy promotions, this would affect beer more than any other drinks as beer is the most common type of drink sold in this way.

“However, if the Government is seeking to introduce minimum pricing, it is difficult to see why they feel the need for this.

“On minimum pricing, there are differing views on its potential role in tackling alcohol-related harm. We strongly believe that alcohol should be priced in a way that is socially responsible, but there are concerns that minimum pricing would penalise a sensible majority of people who drink in moderation. The BBPA has always supported a ban on below-cost selling, and we would have been happy to work with the Government in looking at ways to achieve this.”

The European Complication

The Scottish Government’s plans to introduce MUP are facing a legal challenge domestically from the Scotch Whisky Association and its European partners, and some Member countries of the European Union have also tabled objections. In response to the Scottish proposals, the European Commission has now published a detailed legal opinion, which, while not binding, does suggest that gaining the approval of the European Court of Justice may not be straightforward.

In its Detailed Opinion, the Commission expresses sympathy with the intentions behind the Scottish proposal, but states that, while EU legislation does not prohibit MUP as such, any policy to introduce it must be compatible with other provisions of EU law, including rules on the free movement of goods. It states that EU case law is unequivocal that MUP falls within the remit of Article 34 of the Treaty, and would count as having an effect equivalent to a quantitative restriction on trade, impeding imports of alcohol products.

The Opinion states that MUP might discriminate against imports by preventing foreign manufacturers from benefiting from lower production costs. MUP could also constitute a barrier to entry into the Scottish market of new products, by denying goods seeking to enter the market lower prices to encourage supermarket listing and consumer trial.

Moreover, in the Opinion of the Commission, MUP fails the required proportionality test: the same results could be obtained by measures less distorting of the market.

The Opinion states:

“The Commission is fully aware of the importance of reduction of alcohol consumption among the population as a whole and in particular among the harmful drinkers. The Commission further acknowledges that the measure proposed is within Member States’ competence and – from a public health point of view – within the scope of the goals and objectives of the EU strategy to support Member States in reducing alcohol related harm (COM(2006)625 ).

…..However, the measure at issue raises doubts as to its compatibility with the principle of proportionality …..

Keeping in mind that most of the studies prove and there is a general agreement that affordability does have an effect on drinking patterns, the question is only about the best way to exploit this tendency. Hence, the Commission does not disagree with the proposition that increases in the prices of alcoholic drinks could, other things being equal, be expected to lead to reduced demand for those drinks. The focus in this opinion is rather on whether a MUP policy, which would lead to higher prices of many alcoholic drinks and hence to an expectation of reduced consumption, is likely to be the least market-distorting policy that could be introduced to produce such an outcome.

If the goal is, for health policy reasons, to reduce alcohol consumption via increasing the prices of alcoholic beverages, that goal can be achieved by raising alcohol taxation across the board.

The price of alcohol would thus increase without causing the market distortions that… can be expected to flow from MUP. It is the Commission’s view that there is at least one alternative, regulatory option to MUP that is less restrictive of trade and less distorting of competition in relevant drinks markets… (Furthermore, other economic distortions) might arise as a consequence of the MUP. These potential distortions arise because the MUP will create greater incentives for retailers and supermarkets in particular, to sell more alcoholic beverages as a result of the fact that they will make higher margins on products affected by the policy. This will give retailers incentives to allocate increased resources to the sale of products affected by the MUP compared with what could be expected to be the case if, for example, similar average retail price increases were caused by an across-the-board increase in duty, which is an alternative policy option for reducing consumption. In economic terms, this makes MUP a less effective means of reducing consumption than duty increases.

Indeed, Union legislation provides the Member States with the possibility to control the prices of alcohol and hence choose their level of health protection by setting the excise duties. The Scottish government provided explanations in the Regulatory Impact Assessment in page 46 of why the taxation alternative was not considered as the best option.

The Commission would like to address them accordingly at the same time stressing that raising of alcohol duties is probably the more suitable measure:

1) As regards the statements that the increase of duties will affect all alcohol on the market and not only cheap alcohol and will also affect the on-trade sales, the Commission would like to note that the objective of the measure at issue is to reduce overall drinking that is shown by the chosen level of the minimum price that will affect 73% / 66% of the off-trade market. Accordingly, the raising of duties option seems to be the most suitable to achieve that goal without providing any adverse effects on competition. Furthermore, the negative effects on the on-trade market can be reduced by adjusting the taxation system accordingly.

2) The Scottish authorities also claimed that increases in taxation of alcohol will not necessarily result in a proportionate or indeed any increase in the price of alcohol, as alcohol tax and duty increases are not always reflected in the price the consumer pays as some retailers engage in below cost selling to varying extents. To this effect, it could be mentioned that the second study of RAND 2012 carried out for the Commission examined to what extent changes in alcohol taxes are passed through to consumer prices. The findings indicate that changes in consumer prices depend to a large extent on reactions in the retail sector. Sufficient data for analysis was available from four countries. The pass-through is full when for example a €1.00 increase in excise duty for a product is associated with a €1.00 increase in the consumer price (or a duty reduction is similarly associated with a drop in the price). More than full pass-through means that the price increases more than that needed to cover the duty raise. Less-than full pass-through means the price increases less, as retailers cover the tax raise from other sources. In the countries studied, pass-through in the off-trade for changes in beer duties was less than full in two cases, and more than full in two cases. There was similar variation in the pass-through for changes in spirits duties. Comparison between off-trade and on-trade was possible for one country: there was no marked difference in the pass-through for beer, but for spirits the pass-through was more than full in off-trade and less than full in on-trade. Hence, the Commission would like to note it is not definite that the rise in prices will not be passed through as showed by the examples.

Furthermore, in the case Commission v Hellenic Republic (C-216/98) the Court addressed that question stating that “The ability of manufacturers and importers not to pass on increases in excise duty on their products is in any event limited by the extent of their profit margin, with the result that excise duty increases are sooner or later incorporated in retail selling prices”……

Moreover, there are other additional measures which the Scottish Government could adopt. For instance, according to information available health related harms are concentrated in particular areas of Scotland. Measures which are specifically targeted at these areas are likely to be more effective than measures aimed at the total population.

In conclusion, the Opinion states that:

“Following the above observations the Commission concludes that the draft at issue may create obstacles to the free movement of goods within the internal market contrary to article 34 TFEU and appears to be disproportionate under article 36 TFEU. The UK authorities are invited to abstain from adopting the draft legislation at issue.”

Alcohol Pricing – The Government’s proposals

Introduce a minimum unit price for alcohol

The availability of cheap alcohol has been a key contributing factor in the development of this country’s binge-drinking culture.

The government will no longer tolerate the sale of heavily discounted alcohol which leads to irresponsible behaviour and unacceptable levels of crime and health harms.

Alcohol has been so heavily discounted that it is now possible to buy a can of lager for as little as 20p and a two litre bottle of cider for £1.69.

Reduce alcohol consumption

Minimum unit pricing will tackle the issue of excessive alcohol consumption and heavily discounted alcohol sold in supermarkets and off-licences. This approach aims to reduce alcohol consumption and curb practices such as ‘pre-loading’ before a night out.

Example retail prices

Based on a 40p minimum unit price (for illustrative purposes) the minimum selling prices for various product types would be as shown below.

 

Consultation on a ban on multi-buy alcohol promotions in supermarkets and off-licences

The proposed ban would remove the incentive for individuals to buy more than they actually want. A ban would prevent alcohol retailers from applying discounts to multi-packs of alcohol and would prevent multi-buy offers such as ‘buy-one-get-one-free’, ‘3-for-the-price-of-2’ and ‘buy-6-get-20%-off’.

Multi-buy alcohol promotion examples – The following promotions would be banned:

 

 

MUP “unpopular with the public”

One factor which is bound to weigh heavily with politicians is that, while the results of opinion surveys have been mixed, the overall impression is that the public are generally sceptical that MUP is a good idea.

A recent study*, based on focus group discussions with participants representative of the UK population, found little evidence to suggest that people would support the introduction of MUP.  Some of the views expressed were simply based on misinformation, such as the belief that MUP is just an additional tax under another name, but it was scepticism about the effectiveness of the policy that appeared to be the biggest barrier to public support.

Participants thought it unlikely that MUP would have any lasting, significant impact on either alcohol consumption or the associated harm. They believed that MUP would not work for heavy or problem drinkers, who would just continue drinking as before, or who might be driven to commit crime to get the extra money needed to drink, and that MUP would boost alternative sources of alcohol such as home brewing.

Participants were also inclined to think that MUP penalised moderate drinkers and the poor.

Participants generally expressed some qualified support for the intentions behind the policy of MUP but believed it would only work as part of a wider campaign including other educational elements.

The researchers concluded that clearer educational messages are needed to dispel misconceptions regarding the effectiveness of MUP, and that introducing MUP as part of a package of wider initiatives to address excess alcohol consumption might be the best way to attract public support.

*Lonsdale, A J; Hardcastle, S J; Hagger, M S:  A minimum price per unit of alcohol: A focus group study to investigate public opinion concerning UK government proposals to introduce new price controls to curb alcohol consumption. BMC Public Health, 23 November 2012

Royal Navy ‘should introduce random breath tests’

The widow of Lieutenant Commander Ian Molyneux, has welcomed a coroner’s recommendation of random breath testing for Royal Navy personnel, following the shooting dead of her husband by a drunk naval rating on a nuclear-powered submarine, as reported by the Press Association (PA).  Southampton coroner Keith Wiseman told the inquest into Lt Cdr Molyneux’s death that he would write to the Navy about implementing random breath testing.  Lt Cdr Molyneux, from Wigan, was murdered by Able Seaman Ryan Donovan, who was over the drink-drive limit and on guard duty on HMS Astute in April 2011. The hearing previously heard that Donovan had drunk 20 pints of cider and lager, cocktails and double vodkas in the 48 hours before he was put on a guard duty with the SA80 rifle.

The PA reports that Gillian Molyneux, speaking outside the court, said her husband had given his life to protect the boat and its crew and stop Donovan’s rampage and his death had left a “huge void”.  She was “heartened” the coroner would send her proposals to the Navy and she called for the service’s own recommendations to be acted upon. “I can only hope that these recommendations will be fully implemented and improvements will become evident across the service and Ian’s death will not be in vain,” she added.

Binge Drinking Culture

During the two-week hearing much evidence was heard about the “binge-drinking culture” of the crew of HMS Astute while on shore leave during the goodwill visit to Southampton. Police investigating the murder were so concerned about crew being “drunk out of their minds” while ashore that the senior officer wrote to his chief constable to highlight the issue and it was passed to military authorities.  The Royal Navy has since tightened its rules on alcohol consumption before duty. At the time sailors were allowed 10 units in the previous 24 hours with no alcohol in the 10 hours before duty, which has now been changed to five units.

Mr Wiseman recorded a narrative verdict that the officer was unlawfully killed and explained he would incorporate recommendations from Lt Cdr Molyneux’s widow into what is called a Rule 43 letter to the navy. Those proposals include the random crew breath testing, the use of a breathalyser for all those going on armed sentry duty, a look at alcohol allowances while onboard ships and, in particular, on submarines, work to tackle the culture of binge drinking in the Navy and the issuing of handheld breath testing devices to all personnel.

Action needed on liver disease, alcohol – Chief Medical Officer

Comprehensive action is needed to stop the rising tide of liver disease, this is one of the key findings to emerge from Chief Medical Officer Professor Dame Sally Davies first annual report on the state of the public health.

The report, which is the first of two volumes, provides a comprehensive picture of England’s health by bringing together a number of data sources in one place for the first time.  Liver disease and, therefore, alcohol are necessarily highlighted in the report because England is one of the few countries in the European Union where this major cause of preventable death is on the increase.

Between 2000 and 2009, deaths from chronic liver disease and cirrhosis in the under 65s increased by around 20 per cent while they fell by the same amount in most EU countries. And all three major causes of liver disease – obesity, undiagnosed infection, and, increasingly, harmful drinking – are preventable. However, the report states, the individual’s role in responding to the threat of liver disease is often undermined by the fact that it progresses unnoticed for many years.  Liver disease does not manifest with obvious symptoms or signs until a relatively late stage.

Professor Dame Sally Davies said:

“I have done a comprehensive analysis of the state of the country’s health, and found some areas where we are doing really well and others where there is still a lot of improvement needed.

“I was struck by the data on liver disease particularly. This is the only major cause of preventable death that is on the increase in England that is generally falling in other comparable European nations. We must act to change this…..”

“… Preventative measures should involve a combination of public health policy initiatives (action on obesity and harmful alcohol use) and better awareness amongst the public of their liver health.   Equally important, service providers should continue to improve their efforts to detect early signs of liver disease.  This will entail appropriate risk assessment strategies in their populations, and use of appropriate tests to identify liver disease that can be reversed or treated.   These measures need to be integrated across all aspects of service provision for optimum efficacy but in particular, a proactive approach needs to be adopted so that we reduce presentations at a late stage of disease.

Recommendation

Action on preventing, identifying and treating liver disease is a priority and needs to be included in local health and wellbeing strategies.”

Scotland : alcohol deaths down – but still a long way to go

An evaluation of the Scottish alcohol strategy by NHS Scotland shows recent improvements in alcohol-related mortality but Scotland’s alcohol-related mortality rate still being over two and a half times higher than in the early 1980s. Scottish alcohol deaths remain nearly twice as high as in England and Wales, and this represents one of the highest alcohol mortality rates in Western and Central Europe.

The social patterning of harms caused by alcohol is also shown. People living in the most deprived areas of Scotland are over 5 times more likely to die from an alcohol-related cause than people in the least deprived areas. Nevertheless, there has been a 24% reduction in alcohol-related deaths in the most deprived fifth of the population between 2007 and 2011, while the rates in the least deprived fifth of the population remained static. The inequality in alcohol-related deaths in Scotland has, therefore, narrowed.

The report also highlights the adverse alcohol-related health consequences for children using findings from the 2010 Scottish Schools Adolescent Lifestyles and Substance Use Survey (SALSUS). These show that among the 60% of 13- and 15-year-old Scottish schoolchildren who reported having ever drunk alcohol, 31% of those had vomited in the past year as a result of drinking alcohol.

The reduction in alcohol-related harms has coincided with a recent decline in the volume of alcohol sold per adult, which fell by 5% between 2009 and 2011. Despite this decline, alcohol sales in Scotland remain 10% higher than they were in 1994. In 2011, 11.2 litres of pure alcohol were sold per adult in Scotland, an average of 21.6 units per adult per week. This means that 20% more alcohol was sold per adult in Scotland than in England & Wales, where 9.3L of pure alcohol was sold per adult (or 17.9 units per adult per week). This difference was mainly due to higher off-trade sales of lower priced spirits in Scotland, particularly vodka.

Clare Beeston, Principal Public Health Adviser at NHS Health Scotland, said:

“It is good news that we are seeing these improvements and our analysis suggests that policy interventions such as the delivery of over 272,000 Alcohol Brief Interventions may have had a modest impact. The analysis also supports the well established relationship between alcohol affordability and consumption, and some of these improvements are likely to be the result of the recession rather than permanent changes in consumption patterns, which history shows tend to reverse when the economy improves. It is important to ensure that Scotland continues to implement the comprehensive alcohol strategy to ensure that these improvements are sustained.”

The Alcohol (Minimum Pricing) (Scotland) Act 2012 was passed by the Scottish Parliament in May 2012 and has yet to be implemented. It legislates for a minimum price per unit of alcohol to be applied to all alcohol sold through licensed premises in Scotland. The Scottish Government has proposed that the initial price will be set at 50 pence per unit). The report shows that this would have affected 66% of all off-trade alcohol sold in 2011. However, this has declined from 81% in 2008, highlighting the importance of the Scottish Government’s proposed two-year review process of the level at which the minimum price for alcohol is set. The UK Government has announced it is taking similar measures to control the level of alcohol consumption and related harm.

Plan to lower Scots drink drive limit endorsed

The Scottish Government has published proposals seeking views on lowering the drink driving limit in Scotland.

The consultation follows the recent transfer of the power to set the level of the drink drive limit from Westminster to the Scottish Parliament.  It seeks views on reducing the existing blood/alcohol limit of 80mg/100ml to 50mg/100ml and consequential equivalent reductions in the breath and urine limit.

Speaking outside the Scottish Parliament as he launched the consultation alongside Deputy Chief Constable Tom Ewing, Road Policing lead for ACPOS, Justice Secretary Kenny MacAskill said:

“This Government has made it clear that we want a lower drink driving limit as we believe it will help make Scotland’s roads safer.  While drink driving is now rightly recognised by the vast majority of motorists as dangerous and reckless, too many drivers still ignore the warnings and put lives at risk by drinking and driving.  The consequences can be devastating for victims, their families and our communities. The launch of this consultation today marks another important step in tackling the scourge of drink driving.

“We strongly believe that reducing the drink driving limit will save lives. Tragically, the latest Reported Road Casualty figures estimate that just over one in nine deaths on Scotland’s roads involve drivers who are over the limit. This equates to an average of 30 deaths on Scotland’s roads every year.

“That is 30 too many, and we are proposing action to help reduce this number. This consultation seeks views on reducing the drink driving limit to a level which would bring Scotland into line with most of Europe and which will help save lives on our roads.

“Estimates of how many lives can be saved with a lower limit do vary, but there is evidence that indicates between three and 17 lives each year could be saved on Scottish roads from a lower limit of 50mg/100ml.

“With the UK Government having failed to take action for many years to reduce the drink driving limit, it is only now, with recently secured Scotland Act powers, that the Scottish Government is able to set the drink driving limit in Scotland. This swift use of the newly devolved powers on drink driving shows we are ready to make use of these new powers to help make Scotland a safer place.”

In November 2012 in a debate in the Scottish Parliament, Scottish MPs voted overwhelmingly to endorse the Government’s plan to cut the legal limit. A motion backing the Scottish government’s consultation on cutting the limit was passed in parliament by 100 votes to 12.

See more about this story at: http://www.scotland.gov.uk/News/Speeches/drinkdrivedebate01112012

Further support for London’s ‘sobriety scheme’ for offenders

An innovative alcohol monitoring program imposed upon thousands of alcohol-involved offenders in South Dakota, USA, helps reduce drink drive arrests and domestic violence arrests, according to a new RAND Corporation study.

The findings are encouraging for London which, as an initiative of the Mayor of London, Boris Johnson, is currently piloting a similar scheme based on the Dakota model.

Examining the first six years of South Dakota’s 24/7 Sobriety Project, Rand researchers found that frequent alcohol testing with swift and moderate sanctions for those caught using alcohol reduced county-level repeat drink drive arrests by 12% and domestic violence arrests by 9%. There was mixed evidence about whether the program reduced traffic crashes.

The results, published online by the American Journal of Public Health, are from the first assessment of the program published in a peer-reviewed journal.

“The South Dakota 24/7 Sobriety Project is reducing both repeat DUI (drink drive) and domestic abuse arrests at the county-level,” said Beau Kilmer, the study’s lead author and a senior policy researcher at RAND. “The results suggest that frequent alcohol testing with swift, certain and modest sanctions for violations can reduce problem drinking and improve public health outcomes.”

Under the South Dakota program, individuals arrested or convicted of an alcohol-involved offense can be required to undergo twice-a-day breathalyzer tests, typically once in the morning and once in the evening, or wear continuous alcohol monitoring bracelets. Individuals who fail or skip required tests are immediately subject to a short jail term, typically a day or two.

The concept was proposed by the South Dakota Attorney General in 2004 and by the end of 2010 more than 17,000 of the state’s nearly 825,000 residents had participated in the program, including more than 10% of the males aged 18 to 40 in some counties.  From 2005 to 2010, program participants were ordered to take approximately 3.7 million breathalyzer tests, with the pass rate exceeding 99% (99.3% clean, 0.36% failed, 0.34% no shows), suggesting the programme may have helped reduce heavy drinking among those enrolled.

The 24/7 program is now used throughout South Dakota and similar efforts have been adopted in North Dakota and other jurisdictions.

Beau Kilmer, Nancy Nicosia, Paul Heaton, and Greg Midgette.  Efficacy of Frequent Monitoring With Swift, Certain, and Modest Sanctions for Violations: Insights From South Dakota’s 24/7 Sobriety Project. American Journal of Public Health: January 2013, Vol. 103, No. 1, pp. e37-e43.

doi: 10.2105/AJPH.2012.300989

Teenage binge drinking: it’s in the genes, say brain scientists ….Or…

Scientists claim to have discovered why some teenagers binge drink while others do not: it is the result, they say, of their genetic inheritance, the consequence of which is that they experience higher levels of psychological reward from alcohol than other teenagers.

The claim, which some other researchers in the alcohol field may regard as a fairly large one, is made in a new study, led by King’s College London’s Institute of Psychiatry (IoP) and published in Proceedings of National Academy of Sciences (PNAS) and which provides what is stated to be the most detailed understanding yet of the brain processes involved in teenage alcohol abuse. Alcohol and other addictive drugs activate the dopamine system in the brain, which is responsible for feelings of pleasure and reward. Recent studies from King’s IoP found that the RASGRF2 gene is a risk gene for alcohol abuse; however, the exact mechanism involved in this process has, until now, remained unknown.

Professor Gunter Schumann, from the Department of Social, Genetic and Developmental Psychiatry (SGDP) at King’s Institute of Psychiatry and lead author of the study says: “People seek out situations which fulfill their sense of reward and make them happy, so if your brain is wired to find alcohol rewarding, you will seek it out. We now understand the chain of action: how our genes shape this function in our brains and how that, in turn, leads to human behaviour. We found that the RASGRF-2 gene plays a crucial role in controlling how alcohol stimulates the brain to release dopamine, and hence trigger the feeling of reward. So, if people have a genetic variation of the RASGRF-2 gene, alcohol gives them a stronger sense of reward, making them more likely to be heavy drinkers.”

Approximately 6 out of 10 young people aged 11-15 in England report drinking, a figure which has remained relatively stable over the past 20 years. However, binge drinking has become more common, with teenagers reportedly drinking an average of 6 units per week in 1994 and 13 units per week in 2007. In the UK, around 5,000 teenagers are admitted to hospital every year for alcohol-related reasons. Teenage alcohol abuse is also linked to poor brain development, health problems in later life, risk taking behaviour (drunk driving, unsafe sex) and antisocial behaviour.

The study initially looked at mouse models without the RASGRF2 gene to see how they reacted to alcohol. They found that the absence of the RASGRF-2 gene was linked to a significant reduction in alcohol-seeking activity. Upon intake of alcohol, the absence of the RASGRF-2 impaired the activity of dopamine-releasing neurons in a region of the brain called the ventral tegmental area (VTA) and prevented the brain from releasing dopamine, and hence any sense of reward.

The research team then analysed the brain scans of 663 14 year-old boys – who at that age had not been exposed to significant amounts of alcohol. They found that individuals with genetic variations to the RASGRF2 gene had higher activation of the ventral striatum area of the brain (closely linked to the VTA and involved in dopamine release) when anticipating reward in a cognitive task. This suggests that individuals with a genetic variation on the RASGRF-2 gene release more dopamine when anticipating a reward, and hence derive more pleasure from the experience.

To confirm these findings, the researchers analysed drinking behaviour from the same group of boys at 16 years old, when many had already begun drinking frequently. They found that individuals with the variation on the RASGRF-2 gene drank more frequently at the age of 16 than those with no variation on the gene.

Professor Schumann concludes: “Identifying risk factors for early alcohol abuse is important in designing prevention and treatment interventions for alcohol addiction.”

The study is part of the IMAGEN Consortium led by Professor Schumann and funded by the European Union with additional funding from the UK Medical Research Council (MRC). The consortium brings together scientists across Europe to carry out neuroimaging, genetic and behavioral analyses in 2,000 teenage volunteers in Ireland, England, France, and Germany. The IMAGEN project aims to investigate the roots of reinforcement behaviour and mental health in teenagers.

Paper reference:  Stacey, D. et al. ‘RASGRF-2 regulates alcohol-induced reinforcement by influencing mesolimbic dopamine neurone activity and dopamine release’ Proceedings of the National Academy of Sciences (PNAS)  2012

….. it’s all down to bad parenting – says DEMOS

Better parenting is the solution to youthful binge drinking, according to a new report from the left-leaning think tank Demos

The report, ‘Feeling the Effects’, argues that, while the focus of public policy tends to be on tackling public disorder, the worst damage done by hazardous drinking in the UK is in the home.  According to the latest figures, more than 2.5 million children in the UK, including 90,000 babies, are living with a parent who is drinking alcohol ‘hazardously’.

In the report, Demos research found that parenting style has a significant impact on children’s drinking behaviour as teenagers and later in life as adults. ‘Tough love’ parenting – a parenting style that combines warmth with consistent discipline – is the best protection against young people drinking hazardously. In this report we go further to consider the impact of parental drinking behaviour on parenting style. Based on original quantitative analysis as well as in-depth interviews with 50 alcohol-affected families, our findings suggest that the more a parent drinks, the less likely they are to be a ‘tough love’ parent.

Parenting can be stressful, the authors say, and the majority of parents drink alcohol responsibly. But parents need to be aware of the impact of their parenting style and how drinking excessively can affect this. This report argues for targeted information awareness campaigns aimed at parents to help them consider their parenting style and the impact of alcohol on parenting ability. The report also recommends that ‘family-based’ interventions should put more emphasis on parenting advice, to ensure that those struggling with alcohol misuse can still be effective parents.

The report can be downloaded free at http://www.demos.co.uk/publications/feelingtheeffects/

Weakness in working memory predicts progression of alcohol use in early adolescents

Weakness in a cognitive skill called “working memory” predicts both the initiation and the escalation of alcohol use in adolescents ages 10 to 15, according to a longitudinal study by researchers at the Annenberg Public Policy Center of the University of Pennsylvania and the Children’s Hospital of Philadelphia.

Working memory is the cognitive function that allows us to deliberate before acting, a process that is critical for making decisions and planning behaviour.  It depends heavily on parts of the brain that control impulses and allow one to consider the consequences of behaviour. Past research has suggested that alcohol use during adolescence causes a reduction in this ability by adversely affecting the development of the adolescent brain.

“By repeating assessments on the same children over four years during early adolescence, this project is the first to show that individual differences in working memory precede and predict early alcohol onset and progressive drinking behaviors in adolescents,” noted Atika Khurana, lead author of the study. Khurana conducted this study while she was a post-doctoral fellow at the University of Pennsylvania; she is now an Assistant Professor in the Dept. of Counseling Psychology & Human Services at the University of Oregon. “It is still quite likely that heavy alcohol use during adolescence is responsible for decrements in this ability, however our research shows that at least some of these weaknesses are already present before adolescents even begin using alcohol.”

Recently published in the journal Addiction, the study followed a community cohort of 358 adolescents from the Philadelphia area over a period of four years. The researchers conducted extensive neuropsychological testing of the children beginning at ages 10 to 12, prior to their initiation of any alcohol use, and at each annual follow-up. Assessments of impulsivity, sensation seeking, and alcohol use were also conducted at all four time points.

Youth who had weak working memory exhibited greater levels of impulsivity as assessed by tendencies that reflect lack of self-control, such as acting without thinking and inability to delay gratification. Adolescents with higher levels of impulsivity were more likely to have lower working memory ability, and also more likely to report early initiation and progression of alcohol use.

In contrast, adolescents who reported attraction to exciting activities, a personality trait known as sensation seeking, were not more likely to use alcohol once the effect of impulsivity was controlled for. This is consistent with the finding that unlike youth that are impulsive, sensation seekers tend to have stronger (and not weaker) working memory. Research with animals also suggests that although sensation seekers are likely to experiment with drugs, it is impulsivity that more strongly predicts adverse effects of drug use.  Early use of alcohol is a strong predictor of later alcohol abuse. According to the CDC, excessive use of alcohol accounts for nearly half of traffic accidents in persons aged 20 to 44 and half of all homicides in the U.S.

“Because early alcohol use is a predictor of later alcohol abuse, our findings suggest that children with weak working memory ability and associated forms of impulsivity could be targeted for early intervention to prevent later problems,” said Dan Romer, co-author of the study and Director of the Adolescent Communication Institute at the Annenberg Public Policy Center of the University of Pennsylvania. “The findings also suggest that adolescents high in sensation-seeking, often thought to be at risk, may actually be somewhat protected by their better working memory ability.”

“Recent research suggests that working memory ability can be improved with training. This suggests a promising avenue to intervene to reduce impulsive tendencies associated with weak working memory, and consequently to prevent alcohol abuse as teens mature,” Khurana added. “This is a possibility that should be studied in future research.”

“While working memory abilities continue to develop during adolescence, these skills depend on early experience and learning, so interventions should be applied as early as possible to maximize their effect,” says Laura Betancourt, the senior clinical researcher on the team from the Children’s Hospital of Philadelphia.

The research was supported by the National Institute of Drug Abuse; however, the conclusions are solely those of the authors.

Khurana A, D Romer, LM Betancourt, NL Brodsky, JM Giannetta and H Hurt (2012) Working memory ability predicts trajectories of early alcohol use in adolescents: the mediational role of impulsivity. Addiction, 108: doi: 10.1111/add.12001.

Under the influence? Alcohol discussion kit

An ‘alcohol discussion kit’ has been developed to encourage citizen-led discussions about alcohol use and risks. The idea is to promote discussions among groups of citizens about alcohol and to prompt ideas about how to reduce the harms associated with it.

Under the Influence? was developed by Our Life, in partnership with NHS North West and NHS Western Cheshire, and was published during Alcohol Awareness Week 2012.

This kit is based on the findings of the Talking Drink: Taking Action – Ellesmere Port Alcohol Inquiry

Using it 

The kit is made up of four main sections – an instruction booklet, a set of story cards, a set of influencer cards and a planning grid.

Through the use of a set of cards, groups can consider a range of opinions before suggesting what they think is the best course of action.   The kit can be used in groups of up to 10 people or as few as three and allows people to lead their own deliberative processes in whichever venue they like, with whoever they want to.

The kit is available as a free download, and the downloads have been designed in colour as well as black and white to facilitate photocopying.

The publishers suggest that, having downloaded the material, the next step is to find a group of people to use the kit with. This could be a group that meets already, for example, a residents group or staff from a workplace or any other group; or it could be a group of friends or family; in fact anyone that may have an interest in discussing alcohol.

They say that the kit does not need a trained facilitator to lead it. However, it is useful if someone in the group takes on the role of the ‘dealer’. It is best if the ‘dealer’ looks through the kit before the group gets together (this will take only 5-10 minutes).

More information and the Discussion Kit itself can be downloaded from: http://www.ourlife.org.uk/ourlife/en/case-studies/the-ellesmere-port-alcohol-inquiry–talking-drink-taking-action/

NICE Alcohol guidance for local authorities

Tackling the harm caused by alcohol and addressing health inequalities are among topics covered in the set of local government public health briefings provided by the National Institute of Health and Clinical Excellence (NICE).

From April 2013, councils in England will be taking on the new role of improving the public health of their communities. To help councils with this task, NICE has been developing a range of local government public health briefings. The briefings provide tailored guidance for councillors and local authority staff to help them provide effective, best value actions to improve the health of people in their area.

Alcohol

In the alcohol briefing, NICE says that alcohol misuse continues to be a problem in the UK, with an estimated 1.5 million people showing signs of alcohol dependence. Diseases related to alcohol account for 1 in 8 NHS bed days, and up to 35 per cent of all accident and emergency call outs are alcohol related. The total cost of this to the NHS is estimated at £2.7 billion per year.

NICE recommends taking a two-pronged approach to this problem, with a combination of interventions aimed at the whole population and at individuals.

Local authorities and partner organisations should ensure that children and young people are protected from alcohol advertising as much possible.  Furthermore, local data on health and crime should be used to map alcohol-related problems within an area before developing or reviewing a licensing policy. This is to ensure a range of leisure and cultural-based activities are available rather than providing just alcohol-related entertainment.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said:

“We’re pleased to publish the second batch of local government public health briefings which summarise our main guidance recommendations relating to the Public Health Outcomes Framework, as well as those related to tackling the harm caused by alcohol and health inequalities.

“This tailored information highlights why each topic is an important issue to tackle and how local communities will benefit as a result.

“For example, alcohol-related harm is estimated to cost England around £12.6 billion a year, of which £2.9 billion are healthcare costs.”

He added: “Reducing alcohol-related harm, by encouraging a more sensible drinking culture, will improve health by reducing the number of deaths from cardiovascular disease (including heart disease and stroke), cancer and liver disease. It will also reduce the number of low birthweight babies, and reduce the levels of violent crimes (including sexual violence) and domestic abuse.”

NICE has a range of other public health briefing topics currently in development, which include behaviour change, health cost effectiveness and return on investment, and walking and cycling.

Fall continues in numbers of under 18s receiving substance abuse treatment

The number of young people in England who need help for drug or alcohol use has fallen for the third year running, according to the latest statistics released by the National Treatment Agency for Substance Misuse. The number treated for Class A drugs such as heroin, cocaine or ecstasy has reduced by more than two thirds from five years ago, to 631 from a peak of 1,979 (in 2006-7). The number receiving specialist treatment for alcohol problems is also in decline.

The figures show that specialist services are intervening quickly and effectively: in 2011-12 the average wait for a young person to start getting help was just two days. Overall the figures suggest that young people are increasingly turning away from the most problematic drugs, and that for the few highly vulnerable young people who do need help with those, services are well equipped to provide a range of support. As resources are tightened, services should ensure that support continues to be available to young people, and that they are ready to respond to emerging need.

 

Graph produced using data included in the NHS Information Centre’s Health Survey for England – 2011, Health, social care and lifestyles

The national statistics and trends are analysed in an NTA report, Substance Misuse among Young People 2011-12.  Key findings include:

• The overall number of young people accessing specialist substance misuse services has fallen for the third year running, to 20,688 from a peak of 24,053 in 2008-9.
• Very few are treated for Class A drugs such as heroin, cocaine or ecstasy, and the number has again reduced since last year from 770 (in 2010-11) to 631 in 2011-12. This compares to 1,979 five years ago.
• The vast majority of under-18s (92%) receive support for primary problems with cannabis or alcohol.  The numbers seeing specialist services for alcohol dropped again, from 7,054 last year to 5,884 this year.
• The proportion of under-18s who left specialist services having successfully completed their programme rose to 77% in 2011-12 from 50% five years ago.

The number of cases seen by specialist services for primary cannabis use was up from 12,784 in 2010-11 to 13,200 this year. As evidence suggests that, overall, young people’s cannabis use is declining, the rise in numbers seeing specialist services could be down to a combination of stronger strains of the drug causing more harm, greater awareness of the issues surrounding cannabis, and specialist services being more alert and responsive to the problems the drug can cause for under-18s.

Rosanna O’Connor, NTA Director of Delivery, said: “Any substance misuse among young people is a cause for concern. The signs that fewer need help, and that a higher proportion are successfully completing their programme of support, is encouraging.

“In the current climate of increased pressure on local authority funding, these figures give a clear message that any disinvestment in young people’s drug and alcohol programmes will be detrimental. All young people’s services need to continue to work together, to give vulnerable young people the best possible chance of overcoming problems before they become entrenched.

“The numbers needing specialist interventions remain low and evidence shows that fewer young people are using drugs. However the advent of new substances and risks of ongoing cannabis and alcohol use in particular present a significant challenge. The positive news is that services are well placed to meet a range of problems, and that for those young people who do need help, it’s readily available and effective.”

The National Treatment Agency for Substance Misuse (NTA) is a National Health Service (NHS) special health authority which aims to improve the availability, capacity and effectiveness of drug treatment in England.  From April 2013, the NTA’s core function will transfer to Public Health England, and the NTA will cease to exist as a separate organisation.

The NTA report Substance Misuse among Young People 2011-12 is available at www.nta.nhs.uk/uploads/yp2012vfinal.pdf and the statistical report and tables are available at http://www.nta.nhs.uk/statistics.aspx

Alcohol treatment system “working well”

The system for treating problem alcohol use amongst adults in England is working well for many people, the National Treatment Agency reports. More people who need help for alcohol use are coming forward for specialist treatment. The number who successfully complete their treatment programme is increasing, with fewer people dropping out.  Waiting times are low and improving.

The latest figures released by the NTA were published as local authorities prepare to take on responsibility for commissioning alcohol services, supported by a new national body, Public Health England (PHE), from April 2013. Alcohol treatment will be a significant priority for PHE.

The national statistics and trends are analysed in an NTA report ‘Alcohol treatment in England 2011-12’. Key findings include:

• 108,906 people received alcohol treatment in 2011-12, down 2% from the year before. This includes 74,353 new entrants to treatment during the year, a rise of 1% compared to 2010-11
• 38,174 people successfully completed their treatment, 6% more than the previous year
• Most people (38%) referred themselves into treatment, 19% were referred by their GP
• 70% of all those in alcohol treatment were concentrated in the 30 to 54 age range and the average age of a person in treatment was 42. Men accounted for nearly two thirds of the treatment population during the year.  By far the biggest ethnic group was white British (88%)

NTA Director of Delivery Rosanna O’Connor said: “The high number of people who require help with problem drinking remains a great cause for concern. The signs that more are seeking to overcome their alcohol misuse and more are successfully completing treatment are, however, encouraging. This progress will continue to be driven by Public Health England, working with local authorities to ensure that the full range of effective alcohol services are available and accessible.

Pop star ‘drank herself to death by accident’

Pop star Amy Winehouse died at the age of 27 of accidental alcohol poisoning, it was confirmed by the second coroner’s inquest into her death. The first inquest had to be disregarded when it was discovered that the coroner had been technically unqualified to preside over it.  However, the second inquest confirmed the conclusion of the first.

Officially, the verdict was recorded as death by misadventure. The coroner concluded that she was “satisfied on the balance of probability that Amy voluntarily consumed a large amount of alcohol in a deliberate act that took an unexpected turn and led to the death of a talented young woman at such an early age.”

Immediately following Winehouse’s death there was speculation as to whether it had been drug related, but the inquest confirmed that it was due to alcohol alone. There were no traces of recreational drugs in her body at death but she had a blood alcohol level approximately five times the legal alcohol limit for driving. Two empty vodka bottles were found on the floor of the bedroom where Winehouse died. The evidence presented to the inquest suggested that the singer had been in good form in the period leading up to her death, and had spent the time watching videos of her own performances.

Amy Winehouse had a long history of mental health problems including drug and alcohol abuse.  She attended various private clinics for treatment, and she appears to have succeeded in overcoming her drug problems.

After her death, her father Mitch Winehouse announced that the family planned to set up a charitable foundation in her name and use it to establish a rehabilitation centre to help people struggling to overcome an addiction but who lack the means to pay for private treatment.

But it’s not all about teenagers – Alcohol Concern says ‘baby boomers’ are draining NHS resources through alcohol misuse

The first ever map of alcohol-related health costs, launched by Alcohol Concern, reveals that the baby boom generation are the greatest burden on the NHS compared to all other age groups.

The figures reveal the inpatient cost of the 55-74 age group, closely aligned to the baby boom generation, is over ten times greater than the 16-24 age group, often negatively associated with ‘binge drinking’ and their impact on NHS resources. Furthermore, the baby boom generation inpatient costs are greater than the 16-24 age group inpatient costs plus all alcohol-related A&E costs put together.

The findings, taken from the Alcohol Harm Map, are the first complete picture of alcohol-related health costs across England by local authority. The launch of the map comes six months before local authorities take on responsibility for public health.

The cost of alcohol-related inpatient admissions in England for 55 to 74 year olds was £825.6m compared to £63.8m for 16 to 24 year olds in 2010/11.

The Alcohol Harm Map found over 8 times as many 55 to 74 year olds (454,317) were admitted as inpatients compared to 16 to 24 year olds (54,682).

The cost of alcohol-related inpatient admission was £1,993.57m, over 3 times greater than the cost of A&E admissions, £636.30m.

The cost of alcohol-related inpatient admissions for men was £1,278.4m, just under double the cost for women, £715.1m.

Commenting on the results, Alcohol Concern Chief Executive, Eric Appleby, said: “It is the common perception that young people are responsible for the increasing cost of alcohol misuse, but our findings show that in reality this is not the case. It is the middle-aged, and often middle class drinker, regularly drinking above recommended limits, who are actually requiring complex and expensive NHS care. There needs to be more investment in local alcohol care pathways and services by Local Authorities for this group, to prevent them from ending up as an in-patient.”

Commenting on the significance for the NHS, Professor Sir Ian Gilmore, President of the British Gastroenterology Society and former President of the Royal College of Physicians, said: “It is the unwitting chronic middle-aged drinkers who are taking serious risks with their health. They present in hospital with conditions attributable to their alcohol consumption such as stroke, heart disease, cancer and liver disease. People simply do not realise that chronic drinking significantly increases their chances of suffering health problems. Indeed it is these people who are costing the NHS the most.”

The Map also shows that:

• The cost of inpatient admissions ‘partly attributable’ to alcohol was £1,545.46m, over 3 times greater than the cost of ‘wholly attributable’, £448.11m.
• Over 10 million people are drinking above the Government’s recommended limits, unaware of the health problems that they are storing up.

The picture across all local authorities is captured in the Alcohol Harm Map, produced by Alcohol Concern, in partnership with Lundbeck Ltd – www.alcoholconcern.couldthisbe.com. The purpose of the map is to reveal the real harm and cost of alcohol at a local level, so that local authorities and local health providers can ensure that alcohol prevention and treatment services are available to those with drinking problems.

The map includes data, by each local authority, for:

• Alcohol-related healthcare costs, broken down by age and gender
• Alcohol-related hospital admissions, broken down by age and gender
• Alcohol-related deaths
• Number of people drinking too much

The Alcohol Harm Map can be viewed at http://www.alcoholconcern.org.uk/campaign/alcohol-harm-map

Over the Limit: The Truth about Families and Alcohol

The national charity 4Children has warned of a silent epidemic of alcohol misuse by British families. In a new report, ‘Over the Limit: The Truth about Families and Alcohol’, the charity warns that too many parents remain oblivious to the negative effects that alcohol can have on their parenting.  It says that an alarming 19% believe alcohol has a positive effect on their parenting ability and 62% of parents say that their drinking behaviour has no impact on their family at all. Over the Limit says it does.

Over the Limit: The Truth about Families and Alcohol highlights the stark impact of drinking in family crisis and demands better support and information for families to turn around their dependency and prevent chronic problems from taking root.

Over the Limit highlights that:

• 22% of children live with a parent who drinks hazardously
• 6% of children (around 700,000 across the country) live with a dependent drinker
• 62% of children who were subject to care proceedings were from families with parental alcohol misuse
• More than a third of all domestic violence cases involve alcohol

The report warns of the stark reality of life for families where drinking has reached hazardous levels and is calling for a series of wide-ranging reforms including a commitment from the alcohol industry to recognise their responsibility to the wellbeing of consumers by diverting 1% of revenue to fund a new alcohol awareness campaign aimed at families.

Research from the report reveals that:

• Just under a quarter of parents continued to drink as much alcohol as before their baby’s birth and that 17% actually increased their consumption.
• 29% of mothers and 30% of their partners drink more than the recommended units per week.
• 5% of mothers increased their drinking during pregnancy and 8% continued to drink the same amount as before they became pregnant.
• Only 9% of parents recognised that there was a negative impact of drinking or drug use on their family life.  19% said that their drinking impacted ‘positively’ on their children.
• 9% of parents who drink on a weekly basis thought their families benefited financially.

Anne Longfield OBE, 4Children Chief Executive, said:

This report demands that we think again about our relationship with alcohol for our families’ sake. The statistics speak for themselves with consumption of alcohol known to be a major factor in family crisis – from domestic abuse and family conflict to a breakdown in family relationships and the ability to parent.

It is no use waiting for alcohol and drugs to take their grip on families and only intervene when a child protection case is called. We need to see a greater focus on families within wider strategies around addiction.

Addiction and the subsequent breakdown in many families is the end of a story that often starts with so-called ‘normal’ use. With proper warnings to parents and better awareness of the impact that alcohol can have, we can avoid the crises that addiction can cause.”

Sally Russell, Netmums founder said:

“While it’s always the priority that children are kept safe, it’s also vital that parents feel supported in order to begin to change behaviour, rather than feeling preached at. No parent wants to be an addict harming their own children, so services must work together to provide the best environment for change.

“Families blighted by drug and alcohol abuse need to know there are family-focused services that will help them tackle their problems and become better parents – and professionals working with these families on a day to day basis must have the confidence and skills to broach the issue and ensure troubled parents can access this help.

Getting this right would make an enormous difference to the lives of children in the families affected, and make substantial inroads into ending the devastating emotional and economic effects of substance abuse.”

Recommendations of the report:

• A revision of the ‘responsibility deal’ with the UK alcohol industry to ensure they recognise their responsibility to the wellbeing of consumers and their families by diverting an additional 1% of revenue (approximately £60m) to fund new alcohol awareness campaigns and treatment services, particularly those aimed at families.
• Supplement existing ‘danger warnings’ for pregnant women on alcohol packaging with additional labelling warning of the potential impacts of drinking on children.
• Alcohol awareness – ‘Beer Goggles’ – sessions should be offered widely through schools, children’s centres, and youth clubs to ensure we are all fully informed of the dangers of drinking alcohol when raising children.
• Midwives and Health Visitors need to redouble efforts to identify families for whom alcohol or drugs are a problem and, in addition, provide clear and unambiguous advice to all expectant and new parents about the harm that alcohol and drugs can do.
• A ‘whole family’ approach must be adopted to providing support to those suffering from alcohol or substance misuse to ensure we harness the resource of the family to support those in treatment, and to effectively identify and reduce harm to other family members.

Alcohol Concern calls for total abstinence – but only for a month

More than four and a half million working days in the UK could be lost to hangovers this January, Alcohol Concern claimed as it launched its campaign to get people to give up alcohol for 31 days – Dry January.

Alcohol Concern said it is estimated that around two hundred thousand people go to work with a hangover every day in the UK, costing the economy around £6.4 billion each year. And, it says, it’s not just at work that the cost of alcohol misuse is racking up: overall alcohol related harm is now estimated to cost society £21 billion every year.

Emily Robinson, Director of Campaigns, Alcohol Concern, said: “Many of us think the way we drink isn’t a problem, but even having just a few beers after work or a few glasses of wine at home too often can take you over safe limits and store up problems for the future. We’re challenging people to take part in Dry January and try giving up booze for 31 days and if it sounds like a big ask you’re exactly the person we want to join us and have a go. We’re not being killjoys or telling people to never drink again, we just think this provides the perfect opportunity for all of us to take a breather and get thinking about our drinking.”

The Dry January campaign was launched weeks after Alcohol Concern published its Alcohol Harm Map, which found the biggest drain on NHS resources were baby boomers, not young binge drinkers as many assume. People who regularly drink over recommended limits are more likely to find themselves with health problems because of it, including liver disease, heart disease and high blood pressure; alcohol is also the second biggest risk factor for cancer after smoking.

Alcohol Concern challenged people to sign up to Dry January 2013 and aim to stay booze free for the entire month. It was hoped those taking part would use it as an opportunity “to ditch the hangover, reduce their waistline, save some pennies and take time to think about whether their drinking is really working for them.”

More information about the campaign can be found at http://www.alcoholconcern.org.uk/campaign/dry-january

A computer-based test that could help heavy drinkers reduce their alcohol consumption has been developed by researchers at the University of Liverpool

Methods of restraint

Research at Liverpool has shown that the habit of consuming alcohol can be interrupted when people practice methods of restraint whenever they see images of alcoholic drinks.  The team developed a computer test that required participants to press particular buttons when an image of alcohol or soft drink appeared on screen.  They were asked to perform this task at speed, but when they heard a tone sound they were expected to stop immediately.

In one group the tone was presented at the same time as alcohol pictures appeared on screen, and in another group the tone was not matched up to images of alcoholic drinks.

“We wanted to investigate whether a person could learn to apply self-control automatically, in the hope that this might override the ingrained habit of drinking alcohol”, researchers said.

Following the task, participants were given the option of drinking beer.  Researchers found that participants who learned to exercise restraint when alcohol images were shown subsequently drank less beer than the control groups that did not practice the same method.  The team aim to develop the computer intervention for online use as part of a wider Medical Research Council (MRC) funded project on computerised interventions to boost self-control in heavy drinkers.

Professor Matt Field, from the University’s Institute of Psychology, Health and Society, said: “It is thought that people who drink alcohol at unsafe levels do so because drinking behaviour has become an over-learned habit that they perform without really thinking about it.  Similar to the practiced activity of brushing your teeth in the morning, a person may regularly drink a few glasses of wine with their evening meal.

“This kind of habit can lead to serious health problems, and in extreme cases, alcohol dependence.”

Exercised self-control

“We wanted to investigate whether a person could learn to apply self-control automatically, in the hope that this might override the ingrained habit of drinking alcohol. We found that if participants repeatedly exercised self-control in response to images of alcoholic drinks, they drank less alcohol when the opportunity was later offered to them in the laboratory.

“We hope to develop this computer intervention to see whether people can use the intervention, outside of the laboratory environment, in their daily lives.  This may take the form of an online activity to support those people who want to reduce their intake of alcohol.”

The research is published in the journal Experimental and Clinical Psychopharmacology

Jones, A and Field, M (2012) The effects of cue-specific inhibition training on alcohol consumption in heavy social drinkers