Alcohol Policy UK

Evaluation of Lewisham's Locally Enhanced Service for alcohol

The new General Medical Services contract for GPs (nGMS), introduced in 2004, gives PCTs a contracting mechanism to provide and promote alcohol screening and brief intervention in GP practices through Locally Enhanced Services (LES).  An alcohol LES was commissioned by Lewisham PCT in early 2006 (see earlier post), and the pilot stage has now been evaluated by the PCT's Jessica Mookherjee (Download full report).

31 out of 50 practices in the PCT participated, receiving a £1000 retainer for which each practice was required to train at least 2 staff in delivering screening and brief interventions (SBI’s) and record their interventions & return their data &  GP evaluation questionnaire (every 6months)  to Lewisham Primary Care Trust (PCT). 

Many patients were identified with an AUDIT (Alcohol Use Disorders Identification Test) score of >8 (indicating hazardous/harmful drinking levels).Screening was offered to:

• All new registrations to the practice
• All Ante/Post natal patients
• All patients with chronic diseases such as Diabetes, Chronic Heart Disease, Depression, Hypertension & Epilepsy
• All those identified with alcohol related conditions (Gastro-Intestinal complaints, trauma or assault)

The most popular time to intervene was when initially presenting with symptoms.

Aims of the Alcohol LES

• To introduce opportunistic screening for alcohol misuse in primary care
• To increase referrals to alcohol services
• To increase awareness among primary care staff of alcohol services
• To motivate and empower staff to use brief interventions

Outcomes

• 18 of 31 (56%) practices referred to local agencies
• 167 patients were referred on for support/treatment
• ALL GP’s recorded some awareness of the local alcohol treatment services
• 100% of participating GP’s gave some form of advice after identifying alcohol misuse, most commonly information on units and harm reduction advice on safely reducing consumption
• Half used the  AUDIT tool, half used other less formal means
• Only 40% practices (13/31) offered community detox

Problems identified

• Poor data quality
• No quality check that GP’s interpreted their data in a uniform way
• The pilot was hard to evaluate as there was no baseline
• Practices frustrated by alcohol services and the delay in detox admission

Recommendations

• The Alcohol LES is a good opportunity to screen in primary care and should continue
• More systematic training and follow up support is needed for practices, preferably one to one support
• The recording process needs to be simplified and clearer

Further information from Hannah Lindsell, Lewisham Alcohol Strategy Co-ordinator on 020 8314 6487 or hannah.lindsell AT lewisham.gov.uk

See also evaluation of alcohol screening and brief interventions in Community Pharmacy

Regulations still failing to protect children from alcohol - Alcohol Concern

Hundreds of thousands of children are regularly exposed to drinks advertising on television, a new report by Alcohol Concern reveals.  Not In front Of the Children-Child Protection and Advertising compares the number of drinks adverts shown before and after the watershed during two weeks in December 2006 and March 2007.

Its findings include that:

• In both weeks the number of drinks adverts rose dramatically during the hours of 3pm and 5pm when children are returning from school.
• Family programmes like Coronation Street, which is allowed to carry drinks adverts attract more than a million viewers aged 4-19.  Other programmes found to be carrying drinks ads included ‘The Simpsons’, ‘Home and Away’, and ‘The X-Factor’
• There are twice as many supermarket alcohol adverts shown before the 9pm watershed than after.

Drinks ads on television are only prohibited if the number of children watching is 20% greater than the proportion of children in society. The report argues that this high threshold for television advertising violates the spirit of the child protection policies and makes it impossible for parents to accurately predict which programmes do not carry drinks adverts. The regulations are also significantly weaker than those for non-broadcast advertising.

Srabani Sen, Chief Executive of Alcohol Concern said:

“Three years ago Ofcom tightened the rules in order to protect children. However, at the time they refused to even consult on a watershed ban. Our report, when coupled with the evidence on the impact of alcohol advertising on children shows that it is time to revisit this decision. In our view a watershed ban is the only way to give parents the peace of mind of knowing that their children can be kept safe from the influence of advertising.” 

Alcohol Concern is recommending a number of changes to the regulatory regime in light of the report’s findings:

• Drinks adverts should be banned between 6am and 9pm (the watershed) to ensure that the vast majority of children aren’t able to see alcohol advertising.
• In programmes which run after the watershed but are still likely to appeal to children, e.g. sporting events, alcohol adverts should not appear where more than 10% of the audience are likely to be children.
• The regulations covering scheduling need to be made clearer and the sanctions for when these are contravened should be publicly promoted.
• Broadcast and non broadcast codes should be brought into line with a clear definition of programming likely to appear to children identified and promoted.

The alcohol industry has rejected Alcohol Concern's arguments (as reported by BBC News):

David Poley, chief executive of the Portman Group which represents nine drinks companies, said:

"The advertising rules, which were toughened two years ago, ban adverts from targeting or appealing to under-18s. "Shielding this age group from any images of alcohol is not helping them grow up with sensible and balanced attitudes to drinking."

Advertising Association spokesman Jonathan Collett said a pre-watershed ban would be "unnecessary and disproportionate." The Broadcast Committee of Advertising Practice said it was not considering a change to its alcohol codes.

New police power: direction to leave

Police now have the legal right to ban people who cause problems from areas such as town centres or village greens for up to 48 hours. The new 'direction to leave' power is another weapon in the police arsenal for dealing with low-level crime such as anti-social behaviour. Combined with other powers - including anti-social behaviour orders and acceptable behaviour contracts - it will help fight binge drinking and discourage violent, alcohol-fuelled activity.

Practical advice and guidance is being sent to all police forces to explain the circumstances under which direction to leave orders would be appropriate, and to give clear information on the procedures for issuing such orders.

Stopping problem drinkers Home Office Minister Tony McNulty said the new power fits in well with the government's new alcohol strategy, which calls for challenging unacceptable drinking behaviour.

'It allows officers to deal with, and diffuse, a situation immediately out on the streets before it reaches offending levels or the courts.  "Powers like these are crucial if we are to reduce the harm that alcohol causes to individuals, families and communities."

Home Office

Drink driving by women rising

The number of women caught drink driving has risen sharply in recent years, Liberal Democrat research has found. The research shows:

• A 58% increase in women of all ages found guilty of drink driving since 1995, compared with a slight fall amongst men;
• There has been an increase of nearly 50% in women younger than 30 found guilty of drink or drug driving since 1995, compared with just 4% for men in the same age group.

Commenting, Liberal Democrat Shadow Transport Secretary, Alistair Carmichael MP said:

We warmly welcome moves to put Britain's drink driving laws in line with other European countries. Instead of focusing drink driving campaigns only on men, these figures show women also need to be targeted.

Know Your Limits update

The Know Your Limits campaign team funded by the Home Office and Department of Health has published Stakeholder Update 5, which summarises work to date, including outcomes of the campaign:

• 84% of respondents recognised TV/Cinema advert when prompted
• 82% of respondents felt it made them rethink the consequences of drinking too much
• Most respondents aware of units, but less than half know how many units are in their usual drinks

  Details of the campaign from knowyourlimits@forster.co.uk or phone: 020 7403 2230

Unfortunately the campaign leaflets and posters have been out of print for some weeks now, and the Portman Group is no longer supplying materials. 

NDTMS to include alcohol from April 2008

The NTA Business Plan 2007/08 says this:

During 2006/07 the NTA was asked to scope what use could be made of existing alcohol data in current NDTMS (including TOP) and a national system for the monitoring of structured alcohol treatment use, mirroring NDTMS. The Department of Health will decide whether to commission a National Alcohol Treatment Monitoring System (NATMS) early in 2007/08 and NTA will take subsequent action.

It seems the decision has been taken to stick with NDTMS (National Drug Treatment Monitoring System) but to start processing data on primary alcohol users now.  From April 2008 all drug and alcohol treatment providers are asked to submit data to NDTMS on alcohol users; this includes alcohol-only services.

The NTA is recruiting an Alcohol Treatment Implementation Manager (details here), to coordinate the implementation of data collection on alcohol treatment through the NDTMS.

All this is good news.  The NTA and Department of Health will quickly get a clear and objective picture of the state of alcohol treatment and the inequality between provision for drug and alcohol users (if they were ever in any doubt).

However, treatment providers that do not receive NTA funding through the Pooled Treatment Budget (ie all alcohol-only serivces, in theory) may find the new requirement a burdensome imposition. 

What do you think?  Please get in touch - leave a comment here, or email us.

Further information

 

• The London NTDMS bulletin annouces the news (in a very low key way)
• LDAN's London Alcohol Statistics Project report

Drug and Alcohol Findings update: issue 3 now online

Mike Ashton writes:
ISSUE 3 of the Drug and Alcohol Findings magazine is now available as free downloadable PDF versions of the published content. Access the entire issue by clicking here.

Prevention specialists will find the article Education's uncertain saviour, our analysis of two decades of research on the Life Skills Training curriculum, studies which have done most to salvage drug education's prevention credentials. Indeed this work is impressive, but the deeper we dug, the shakier seemed the foundations. Later our concerns were confirmed in a painstaking analysis for the Scottish Executive.

Despite the concerns, there is much to learn from this important body of work. Also for prevention specialists, in issue 3 we discovered the Strengthening Families Program, later spotted by a Cochrane reviewer as the most promising "effective intervention over the longer-term for the primary prevention of alcohol misuse".

Our Nugget is titled Family skills programmes delay adolescent drinking but recruitment is a problem. From the EXTENDED TEXT... button in the PDF you can also view our later more extensive analysis of the programme.

Treatment specialists will find the careful work of Robert Fiorentine which confirms many counsellors' instincts - that how well they relate to their clients is an important (perhaps the most important) factor in their recovery. The title of the Nugget summed up the implications: Client-receptive treatment more important than treatment-receptive clients. Later we elaborated this theme in to the four-part Manners Matter series to be released as PDFs later in our web publishing programme.

Alcohol misusers at risk: fatties, ladettes, bar staff, and Saga louts

• Britons are drinking an extra day’s worth of calories every week through alcohol, and triggering higher protection insurance rates.  According to research commissioned by Standard Life with 3,278 adults, the average UK resident is drinking enough lager, wine, cider and spirits to pack on almost 3,000 calories a week. Mick James, protection marketing manager for Standard Life, said: 'The indirect financial impact of a growing nation can affect anything from your private medical insurance to life insurance and critical illness insurance, which can all be far more expensive if you have a body mass index over the average for your height and age. In the worst case scenario you might actually be declined cover.'  He added: 'Someone with a body mass index over 30 is technically obese. We would typically charge an extra 75% for someone’s life insurance with a BMI between 32.6 and 35.' Citywire

• Growing ladette culture means young women who work in offices are twice as likely to drink themselves to death as the rest of the population.  They are apeing the macho office culture and dying from liver disease, cirrhosis and alcohol poisoning, according to figures.  Actresses and female entertainers who are accused by many of promoting ladette behaviour are also among the most likely to die from drink. Alcohol-related deaths have doubled since 1991 - up from 4,144 to 8,386 last year. And experts fear the toll will rise as the 24-hour drinking culture begins to affect the nation's health. Rising levels of binge-drinking have been blamed for high numbers of mouth cancer cases and babies with developmental problems.  The figures from the Office for National Statistics showed that among women, the third most dangerous occupation in terms of risk of dying from alcohol was the office junior.  These are young workers who carry out tasks such as photocopying, delivering mail and data entry.  They are 1.92 times more likely to die from alcohol than the rest of the population.  Daily Mail

• Bar staff are the mostly likely workers to die of alcohol-related problems, figures for England and Wales indicate. The Office for National Statistics data shows bar staff are twice as likely as average to die from conditions such as liver disease or pancreatitis. Least likely to die, according to the figures from 2001 to 2005, were farmers among men and educational assistants among women. Alcohol-related deaths have doubled since 1991. Last year the Office for National Statistics (ONS) revealed alcohol deaths, which include poisoning but not alcohol-induced accidents, topped 8,000 in 2005, up from just above 4,000 in 1991. The latest study looked at 13,011 deaths among men aged 20 to 64 and 3,655 deaths among women. It showed male bar staff were 2.23 times more liked to die from alcohol than average, while their female colleagues were 2.03 times more likely. BBC News

• A new breed of Saga louts - retired people who drink too much - has been identified by a top psychiatrist, who claims they are second only to twenty-somethings in their appetite for alcohol. Dr Peter Rice says the typical Saga lout is retired, acquired a taste for drinking at home as alcohol prices dropped in the 1970s and 1980s, and is well off enough to enjoy regular evenings knocking back their favourite wines and beers. Rice, a consultant psychiatrist based at Sunnyside Royal Hospital, Montrose, is concerned by the growing number of elderly binge drinkers on his patient list. Rice is so concerned he has flagged up the problem to a Scottish Parliament think-tank, Scotland's Futures Forum, which is investigating ways to reduce alcohol and drug misuse. Recent figures obtained by Scotland on Sunday reveal that in 2001/2 the number of people over the age of 60 admitted to Scottish hospitals with an alcohol-related illness was 8,500. This rose to 10,573 in 2005/6. But the trend among youngsters is down, with 1,733 teenagers aged 15 to 19 admitted in 2001/2, compared with 1,462 in 2005/6.  Scotland on Sunday

Managing alcohol in the NTE: Newmarket, Cheltenham, Avon & Somerset

• A Police campaign to cut street violence and disorder has been extended for an extra six weeks.  Operation Staysafe was due to finish at the end of this month, but Suffolk police will continue with it until mid-October. The campaign involves putting extra police on the streets of Newmarket and other towns in the west of Suffolk at weekends when the "night-time economy" is in full swing.  Newmarket, with three nightclubs and several pubs with late licences, is one of the busiest towns in the area on Friday and Saturday nights.

Part of the campaign has involved officers issuing fixed penalty "on the spot" fines for minor public order offences. In the first three months of the operation - May, June and July - 179 fixed penalties were issued across west Suffolk. Supt Jon Brighton said: "Levels of serious violence in a public place have fallen by 12 per cent year on year between April and July and Operation Staysafe has played a big part in this reduction in serious crime.  "Getting an £80 fine seems to be making people think twice about their behaviour on a night out." Cambridge Evening News

• South West minister Ben Bradshaw visited Cheltenham last week to see how pioneering methods are being used to tackle alcohol-fuelled violence in the town.  The project is led by Cheltenham's Community Safety Partnership, which includes Cheltenham Nightsafe.

The partnership works with the community, businesses and other organisations to cut crime and disorder. Officers say their project has an approach not seen anywhere else in the UK. The partnership liaises with bars, nightclubs and restaurants in Cheltenham to encourage them to police themselves. Officers developed a document called the Codes of Practice - a list of guidelines for night-time venues to adhere to.

 

Mr Bradshaw said "I came to Cheltenham to look at what they're trying to do to reduce alcohol-related violence" . "They've come up with this new strategy and it's very positive. "I've asked them to keep me informed. If it's successful here, it could be used elsewhere." He added: "It's good to see everyone working together - pubs, clubs, taxi drivers - with a joint approach. I would urge all licensees to get on board."   This is Gloucestershire  Download Cheltenham’s Night Time Economy Strategy 2004 to 2007

 

• Police arrested 59 people and issued 144 anti-social behaviour warnings in a crackdown on drink-related crime across the Avon and Somerset force area. Alcohol was seized from 82 under-18s during Operation Relentless on Friday night and the early hours of Saturday. Licensing and trading standards checks were also made on 231 pubs, clubs and shops in the city. Asst Ch Cons Steve Mortimore said reducing alcohol-fuelled crime was a day-to-day priority for officers. BBC News

Safe. Sensible. Social....summary

The government has published a summary of the updated alcohol strategy for England.  Safe. Sensible. Social. The next steps in the National Alcohol Strategy – a summary also includes lots of practice examples from around the country.