Alcohol Policy UK

Ritson: face the facts on minimum pricing

Dr Bruce Ritson, former consultant psychiatrist at Rotal Edinburgh Hospital and now chair of SHAAP (Scottish Health Action on Alcohol Problems) has set out a clear case for minumum pricing of alcohol in a letter to The Scotsman, here:

Sir Ian Good, chairman of Famous Grouse maker Edrington, is concerned that the introduction of a minimum price on alcohol will have deleterious effects on Scottish industry. I fully appreciate his commitment to his shareholders and the maintenance of the excellent marketing position of one of Scotland's most profitable businesses and its contribution to exports.

However, facts must be faced. We recently learned that one in four of all men aged 35 to 44 in Scotland dies of an alcohol attributable condition; the number of people diagnosed with alcoholic liver disease has risen by 52 per cent since 1998; A&E departments in Scotland deal with more than 70 alcohol-related assaults a day; and alcohol-related problems are estimated to cost Scotland more than £2 billion a year. The chief constable of Strathclyde Police recently stated: "Cheap drink is fuelling crime in Scotland."

This burden of disease and social problems is closely related to the amount of alcohol a population consumes. Abundant evidence shows that the most effective and cost-effective way of reducing consumption and harm is increasing the price of alcohol relative to disposable income. In the past, major retailers have been able to absorb tax increases on alcohol by below-cost selling. However, the most effective measure is the one so roundly opposed by Sir Ian – a minimum pricing policy.

We cannot go on drinking more and more without incurring an ever-increasing health and social cost burden. Unpalatable as it may seem, a minimum pricing policy is likely to be far more effective than any amount of education, exhortation or attempts to change the national moral climate.

Stirling Addiction Studies - Certificate in Drug & Alcohol Studies

The Certificate in Drug & Alcohol Studies begins in September each year. The Course makes use of internet technologies (including: e-mail, on-line discussion groups etc.). Students will therefore undertake the Course from their own home or workplace. The total commitment is equivalent to 52 study days. The course may be taken over one or two years with a minimum of one module to be completed in any academic year and is offered in two modules:

• Module 1-Policy & Practice
• Module 2-Understanding & Evaluating Addiction Treatment

Details of current fees, pre-course workshops and availability are available here.

Southwark cocaethylene campaign poster and leaflet

Southwark has produced a cocaethylene poster and leaflet with support from the London Drug Policy Forum.  Unlike most similar projects (see for example Nottingham's award winning campaign here) the materials could be used anywhere.  For more details, contact  Dionne Cameron, Southwark's Alcohol Strategy Coordinator.

Discussion lists for alcohol misuse and APUK news

Alcohol Policy UK

From today we will be posting more frequently on APUK, to coincide with the development of the AERC Alcohol Academy which launched last month (full details to come shortly).  If you can't get to the site every day, you can get these posts by email (max one per day) by signing up here.  Alternatively, we can email you a weekly digest; simply email us to request this.  Our RSS feed is http://feeds.feedburner.com/AlcoholPolicyUk.  We have also started Twittering again now that more people are using this service.  Follow us at alcoholpolicyuk or Vodafone users can text "follow alcoholpolicyuk" to 86444.

Alcohol Academy discussion list

We have set up a discussion list/forum for local alcohol coordinators and strategic leads.  It is restricted to those people at present, and has had a lot of interest and good debate.  To subscribe, send an email with your details to forum-subscribe@alcoholacademy.net

Alcohol Misuse discussion list

Rowdy Yates from the Scottish Addictions Studies unit at Stirling University runs this list, and posts frequently with research news and information.

This is a free list, open to anyone with an interest in alcohol-misuse and its treatment, including:

• staff working in alcohol treatment services
• service users in alcohol treatment services
• academics and students studying alcohol misuse

Joining the list is free and allows you to contact over 100 list members with an interest in alcohol misuse. The list is useful for: keeping in contact with friends and colleagues;  discussing issues; receiving e-mail alerts for all English-language addiction journals;  announcing conferences, events, job vacancies etc; asking for information and advice.  Sign up here.

Rowdy has also asked us to mention The Scottish Addiction Studies On-line Library, a major internet-based resource for: policy makers,  service planners, managers, practitioners, teachers, researchers, students and service users.  Initially established as a resource for on-line students at the University of Stirling in Scotland, the library was made publicly available 7 years ago. It offers access to over 7,500 full-text documents.  Unlike many other on-line libraries, the Scottish Addiction Studies On-line Library specialises in full text documents, reports and books.  During the course of the next two years, the library collection will be increased and the structure will be enhanced to include a section on journal articles and a section on therapeutic communities. 

Also see:
European Federation of Therapeutic Communities (EFTC) on-line discussion list  details here


European Working Group on Drugs Oriented Research details here

BMA continues calls for minimum pricing and advertising ban

Last week the British Medical Association (BMA) annual conference passed a motion to continue calling for a minimum price and a ban on alcohol advertising. The decision comes as previous calls to introduce minimum pricing have been rejected by the government, with the Prime Minister arguing that they would not 'punish the sensible majority'.

However many groups such as the BMA reject this argument based on research that shows the limited impact a minimum price would have on moderate drinkers - in research drawn up by the university of Sheffield "Moderate drinkers would only pay an extra £12 a year, whereas a harmful drinker, because they buy so many more units, would pay an extra £163 a year." (see story here).

However not all GPs at the BMA conference supported the motion with accusations of 'nanny-state politics', as highlighted in reports from the Daily Telegraph and The Guardian.

Earlier in the year the Chief Medical Officer called for a minimum price in his annual report which was widely backed by health professionals. Scotland are also set to move forward with minimum pricing measures.

Instead Brown's government have focused on increasing duty and a new mandatory code. The code plans to ban irresponsible promotions  and take other measures such as ensuring pubs and bars offer smaller measures. The proposals are currently out for consultation until 5th August 2009. A short Alcohol Concern survey is also available on the code.

See here for the BMA's 'Memorandum of evidence from the BMA to the Health Select Committee inquiry on alcohol'

Jobs: Alcohol Strategy Coordinator, Medway council

Medway are seeking an alcohol strategy coordinator to sit in the Medway Public Health Team, a directorate which crosses NHS Medway and Medway Council.

• Alcohol Co-ordinator (Ref: CA0656C)
• Salary: PO1 £27,573 - £35,953 per annum
• Hours: 37 per week
• Location: Gun Wharf, Chatham
• Closing date: 17 July 2009.

See here for further details on the NHS jobs site.

For any informal discussion about this post please contact Aeilish Geldenhuys, Senior Public Health Manager on 01634 333147. For an application pack or to apply visit www.medway.gov.uk or phone 01634 333333 Mon to Fri 8am-8pm, Sat 9am-1pm or 01634 332843 24-hour answerphone. Alternatively email jobs@medway.gov.uk quoting the reference.

Safe. Sensible. Social. Selling Alcohol Responsibly - consultation events

The Home Office are running a series of ten events around England and Wales in July and August 2009 as part of the consultation on the code of practice for alcohol retailers.  They want participants from the alcohol retail industry, licensing authorities, health bodies or enforcement agencies.

These events "will inform the future development of this policy in order to ensure that it gets the balance right by achieving reductions in alcohol related harms such as nuisance, crime and disorder, public safety, protection of children and the health impact, in a targeted and proportionate way that does not harm businesses that are behaving responsibly."

The dates are:

• Newcastle 7 July
• Hull 9 July
• Liverpool 14 July
• Nottingham 16 July
• Birmingham 21 July
• Cambridge 23 July
• Portsmouth 28 July
• Cardiff 30 July
• Weymouth 4 August
• London 6 August

Details and registration here.

Parliamentary review body highlights continuing gaps in alcohol treatment

The All Party Parliamentary Group (APPG) for alcohol misuse has released its first report 'The Future of Alcohol Treatment Services'. The review examines whether recent policy developments have made an impact on treatment delivery and considers what needs to be done to increase longer term access and provision of alcohol treatment.

The APPG report largely considers the ongoing challenges for alcohol treatment as it continues to be under-resourced to varying degrees across the country. This comes despite the increased profile of alcohol-related harm though does recognise some gains for alcohol provision. However the report estimates that on average only 0.1% of Primary Care Trusts' total annual expenditure is spent on alcohol services.

Last year the National Audit Office produced an extensive review of alcohol treatment services with similar findings and recommendations to improve strategic planning and resourcing for alcohol services.

Key recommendations of the All Party Parliamentary Group:

• Government needs clear cross-departmental leadership to tackle England's growing alcohol problem.
• Government needs to measure alcohol harms differently, by targeting a reduction in heavy drinking amongst all age groups and a reduction in alcohol-related crime as well as hospital-related admissions. All primary health care services should understand and be able to deliver Screening and Brief Interventions (SBI).
•  All PCT areas should have effective specialist alcohol services which are accessible to local communities.
• Specialist alcohol treatment must meet the needs of all those affected by alcohol misuse.
• There needs to be clear protocols and pathways in place to tackle alcohol misusers with more complex needs.
• In order to tackle alcohol harms, PCTs must understand the scale of the problem they are facing and share data as required.
• The Department of Health should update and reissue existing guidance and support implementation with regional training.
• There needs to be an ongoing training programme for alcohol commissioners.
• Strategic Health Authorities must ensure that PCTs are assessing need in their area and commissioning alcohol treatment commensurate with that need.
• Clear guidelines are required about how different parts of the alcohol treatment sector are to work effectively together.
• The National Institute for Health and Clinical Excellence (NICE) should look at how the Quality and Outcome Framework (QOF) for GPs can be amended to help tackle alcohol misuse.
• Access to accurate alcohol misuse and dependency data must become a priority for the Department of Health.

North East launches Big Drink Debate as North West reports successes

The North East Big Drink Debate has been launched, encouraging the region to consider the impact of alcohol and report their views and consumption via this questionnaire. Local press coverage here.

North West Big Drink Debate findings
In 2008 the neighbouring North West region carried out a Big Drink Debate and claimed its success prompted the Chief Medical Officer to encourage other regions to deliver their own Big Drink debates (see 'Key achievements of the Big Drink Debate'). Findings of the evaluation showed:

• 80% of NW respondents said they thought low price and discounts increased people’s drinking;
• 75% of NW respondents believe large measures are key to increased drinking;
• 68% of NW respondents say allowing street drinking increases alcohol use;
• Over half of NW respondents believe advertising (56%) and extended drinking hours (54%) are factors that increase drinking;
• Nearly half the NW respondents avoid town centres because of the drunken behaviour of others

Big Drink Debates are being rolled out as Social Marketing projects that are recommended as one of the Department of Health High Impact Changes for reducing alcohol-related harm. See the National Social Marketing Centre for guidance.

A new Home Office binge drinking campaign is also running this summer as part of the national Know Your Limits social marketing campaign.

Too much too young? Alcohol misuse amongst young Londoners

The London Assembly has published Too much too young? Alcohol misuse amongst young Londoners. The report reviews evidence of alcohol use in London amongst 11-21 year olds and makes a number of policy recommendations across all levels.

The key findings of the report include:

• Young people in the capital are less likely to drink, and less likely to get drunk than young people elsewhere in the country.
• More than a third (35 per cent) of Londoners aged 11-21 drank regularly in 2005-06.
• Londoners aged 11-15 now drink around 307,391 units of alcohol a week
• 11-15 year old women now have similar drinking habits to young men of the same age.
• Around 80 to 90 per cent of 17-21 year olds have ever had an alcoholic drink, compared to 15 per cent of 11 year olds and 60 per cent of 15 year olds.
• In 2005-07, ten per cent of Pakistani and 12 per cent of Bangladeshi young people drank at least once a year (up from 4% and 2% respectively in 2001-04).
• Alcohol-specific hospital admissions for 11-21 year old Londoners have almost doubled in recent years. In 2006, there were 1315 hospital admissions for 11-21 year olds, compared to 690 in 2002 – an increase of 91 per cent.
• The alcohol-specific hospital admission rate for young women (at 14.0 admissions per 10,000) was almost twice as high as the rate for young men of the same age (at 7.4 admissions per 10,000).
• In 2003, there were 1,272 incidents where 11-21 year olds were accused of alcohol–related offences, compared to 2,370 in 2007; nearly double.
• Underage drinking was the least frequently reported issue in a survey on alcohol-related disorder conducted with community safety staff in London boroughs.

Recommendations (summary):

1. The Greater London Alcohol and Drugs Alliance (GLADA) should monitor the alcohol consumption of young Londoners between 2009 and 2012 to assess whether recent increases in drinking among young women and among young Pakistani and Bangladeshi Londoners are part of ongoing trends.
2. The Mayor should commission an immediate review of GLADA’s membership, resourcing and remit to ensure it can effectively implement the Regional Statement of Priorities for Alcohol and provide strong regional leadership on alcohol misuse.
3. The Mayor should outline initiatives to tackle the disproportionate impact of alcohol on the health of people from deprived communities in his upcoming Health Inequalities Strategy.
4. By March 2010, London boroughs where alcohol-specific hospital admissions for under-18s are higher than the national average (currently Kingston and Sutton) should appoint an alcohol harm reduction champion.
5. A London borough and local police service working with the Retail of Alcohol Standards Group should pilot the St Neots community alcohol partnership model to reduce alcohol misuse by under 18s during 2009/10. Representatives of both the on- and off-licence trade should be engaged in this partnership.
6. The Department for Children, Schools and Families and the Qualifications and Curriculum Authority should ensure that alcohol education is effectively covered in the mandatory PSHE curriculum, currently under development. Alcohol should be given the same prominence in this curriculum as drugs, and the focus should be on how to reduce alcohol harm. The curriculum should cover how and why alcohol tolerance varies between men and women. It should also include first aid techniques, so that young people know how to help in emergencies such as a friend collapsing because of alcohol.
7. By June 2010, The Department for Children, Schools and Families and the Home Office should run a national FRANK campaign around alcohol that focuses on the consequences of drinking, and also promotes the information FRANK can provide about alcohol and local services.
8. By December 2010, GLADA should co-ordinate a London wide social marketing campaign that aims to reduce alcohol harm, in association with external partners. The campaign should target groups including parents and carers, young women aged 11-15 and young Pakistani and Bangladeshi Londoners.
9. By March 2012, NHS London should ensure that Screening and Brief Intervention Initiatives are in place at every London Accident and Emergency Department, and available to adults and to young people. A detailed evaluation of the impact of Screening and Brief Interventions on young Londoners’ drinking behaviour should be conducted by March 2014.

Interestingly the report does not extensively refer to the draft guidance from the Chief Medical Officer (CMO) issued earlier this year, though it does claim to support it: "The Committee welcomes [the CMO] guidance, but believes that once the guidance has been finalised, it should be disseminated together with information about alcohol treatment and support services for young people and for their parents and carers."

The Youth Alcohol Action Plan was released as the government's national strategy for young people in 2008.

Tools released to assess local impact of increasing alcohol treatment and interventions

A number of tools and documents have been released by the Department of Health's Alcohol Learning Centre (ALC) to assist commissioners predict the likely impact of increasing alcohol interventions and treatment. The tools 'can be used by commissioners as an aid for needs assessment, treatment capacity, service impact and planning your responses in local alcohol service delivery.'

The main tool is the Ready Reckoner v1 which generates data to identify the potential impact of increasing alcohol interventions and treatment for local PCTs. By selecting your PCT and entering possible increased provision (in the yellow boxes), the tool will calculate the costs, potential cost savings and predicted impact on hospital admissions. The ready reckoner calculates the possible impact of increasing High Impact Change interventions of A&E nurse specialists, hospital ward Alcohol Health Workers, Primary Care brief interventions and psychosocial interventions for dependent drinkers. A guidance document for using the tool is available.

The ALC have also highlighted the Rush report as a resource to assist commissioners in assessing the need for treatment capacity.

Information on the Purple Report is also available, whereby commissioners can access alcohol data collected from local treatment services via NDTMS.

Home Office binge drinking summer campaign

The Home Office will be running advertising for the Know your Limits binge campaign this summer, starting on Monday 8th June. The latest Know Your Limits bulletin from Forster reminds us that in June last year the Home Office launched a new campaign which posed the question to the 18-24 year-old target audience ‘You wouldn’t start a night like this so why end it this way?’. The campaign seeks to challenge attitudes around the acceptability of drunken behaviour amongst 18-24 year olds. The long term aim is to the change drinking behaviour amongst this audience thereby reducing alcohol related harm and anti social behaviour.

Advertising launched last year included TV, radio, online and print advertising. According to Forster campaign awareness is very high at 96% of 18-24 year olds; of those, 67% agreed the TV advertising made them think more carefully about their drinking behaviour and 65% agreed the campaign is making them think about how much they drink on a night out.

TV, radio, print and online advertising will be running as follows:

• TV advertising – male and female versions of the TV ad will be aired from 8th June - 27th July
• Press advertising – 15th June - 27th July
• Radio advertising – 13th July - 3rd August
• Online advertising – 8th June - 27th July

The Home Office has produced two new print adverts and one new radio advert aimed primarily at 18-24 year old women. There is also a new online viral targeting 18-24 year olds which will be available on YouTube from Saturday 6th June and officially launched on Monday 8th June.

The Home Office are also partnering with Hollyoaks this summer on twelve spin off online episodes which will be shown online in July. These episodes bring to life some of the consequences of binge drinking such as aggression and violence and vulnerability. They follow on from an independently planned storyline on binge drinking in the TV soap. The spin off episodes will be shown here.

The stakeholder website  will be updated on Saturday 6th June to include the new print adverts and the viral. The new radio advert will be added at the end of June, prior to its launch in July.

Efficacy of A&E brief interventions for injury; targeted vs universal approaches

The Drug and Alcohol Findings policy and research site has published two new bulletins reviewing key alcohol-related studies:

• A systematic review of emergency care brief alcohol interventions for injury patients.

The review found confirmation that brief advice to risky drinkers identified in accident and emergency departments can cut drinking and reduce the chance of further injuries and readmissions; the issue now is why this happens sometimes but not always.

• A preliminary study of the population-adjusted effectiveness of substance abuse prevention programming: towards making IOM program types comparable.

One of the biggest strategic decisions facing prevention planners is whether to target high-risk groups or to prioritise universal programmes. This analysis won't decide the issue, but it does create an important new tool for comparing these strategies.


The report examines the efficacy of universal or targeted interventions against different substances

Report examines transferable lessons for alcohol policy

Joseph Rowntree Foundation have published a report that examines case studies of non-alcohol related issues and considers the learnings and parallels for UK alcohol policy. The report, 'Changing attitudes, knowledge and behaviour: A review of successful initiatives', examines 7 key international case studies which offered potential learning for alcohol approaches:

1. Consistency in campaigning: Switzerland’s STOP AIDS campaign
2. Awareness raising, advocacy and policy formulation: Smokefree Scotland
3. Making travel greener: the InMotion campaign
4. The Florida ‘Truth’ tobacco counter marketing campaign
5. The Australian responsibility in gambling campaign
6. New approaches to speeding: Foolsspeed and ‘Pinkie’
7. Positive role models: the Trevor Project (gay and lesbian mental health)

The case study topics were chosen for their similarities with alcohol misuse as widely practised but harmful behaviours. The cases were identied as often addictive, socially condoned but where moderation or abstinence was seen as unappealing, difficult or socially embarrassing. The report found a number of key lessons that were transferable to alcohol harm reduction and policy including:

• Long term commitment is required to ensure a change in social norms
• Ownership of the problem needs to be mutually accepted - not only the problem drinker must play a role in changing alcohol ham in society
• (Re)Framing the problem and changing social norms is often important in engaging support and finding solutions. For example the case of framing smokefree legislation as a public health issue allowed it to overcome the counter-arguments of 'freedoms' and profits.
• Understanding the target(s) was imperative in looking at where behavior change needed to take place and the motivators for change. For example the 'Truth' tobacco campaign showed young people were not interested in health risks but were engaged by the idea of protest against the tobacco industry and it's manipulative practices.
• Planning is important in achieving defined and measurable objectives for change
• Positive offering - showing humour, empathy or positive messages can engage people's emotions as effectively as fear based messages.
• Multiple approaches are important as complex problems require multi-faceted responses in order to be effective.
• Competition was effective and necessary in some cases, tobacco initiatives faced active competition from the industry as public health and industry profit objectives are fundamentally opposed. Therefore voluntary self-regulation was not effective and strong statutory responses were required. (sound familiar?!)
• Research was important in developing and evaluating effective interventions

The report therefore presents some exciting ideas and further steer for alcohol policy direction. The importance of ongoing attention to strategic alcohol work and planned policy is highlighted through concluding:

"The cases support a lot of existing public health learning: complex problems need complex solutions; culture and norms take time to change; research is the foundation of effective action. They also generate some new ideas: that branding and relationship building also have traction in public health; that strategic planning is essential; that competitive analysis is a useful tool, and that positive appeals, humour and empathy can work as well as dire warnings."

Statistics on alcohol for England 2009 released

The NHS information centre has released the latest figures for alcohol related harm in the report Statistics on alcohol, England 2009.

The report aims to present a broad picture of health issues relating to alcohol in England and covers topics such as drinking habits and behaviours among adults and school children, drinking related ill health and mortality, affordability of alcohol and alcohol related costs.

The report follows the recent release of the JRF report on UK drinking trends.