Alcohol Policy UK

Alcohol dependence a significant predictor for depression and anxiety disorders

The British Journal of Psychiatry (BJP) has published research which suggests that alcohol dependence is a significant predictor of future episodes of anxiety or depressive disorders, whereas alcohol abuse is not.

The study explored whether the course of depression or anxiety disorders were conditional upon the type and severity of alcohol problem. Severe dependency was linked to the persistence of anxiety and depressive disorder incidences at 2 year follow-up. However, the study found no significant difference in people with alcohol abuse (or moderate problems), compared to people with no lifestyle problems at a 2 year follow- up.

This study is the latest in a long line of research aimed at teasing out the complex nature of the links between alcohol and depression/anxiety disorders. A 2005 study by Haynes et al found that alcohol was not a significant risk factor for the onset of anxiety and depression, whereas abstinence was associated with a lowered risk of onset. A study in 2011 by Liang et al found that common mental health disorders, such as anxiety and depression, may increase the risk of alcohol dependency and misuse.

For more information on alcohol and mental health see the Mental Health Foundation site. For access to an E- Learning suite on dual diagnosis for professionals, service users, carers and the public, please visit the National Dual Diagnosis E-Learning Resource. NICE clinical guidelines on psychoses with co-existing substance misuse are an extra resource for professionals.

Latest Findings alcohol reviews: curbing anti-social behaviour; Naltrexone & Disulfiram efficacy; caution over computer based interventions

Recent bulletins from the drug and alcohol Bank:

Community involvement and law enforcement safeguard clubgoers
In pubs and clubs, especially for young patrons, out-of-control intoxication is sometimes the aim rather than an undesirable outcome to be prevented. How in these circumstances to reduce use and harm has been investigated in the 17 studies analysed in this review; involve the community and stiffen good intentions with enforcement is the message.

Alcoholism medication review recommends newly UK-licensed Naltrexone
Last year Naltrexone was licensed for the treatment of alcohol dependence in Britain, meaning the UK now has the full suite of major medications licensed for this purpose. As this US review of these and other medications confirms, it represents a valuable addition, and one usually found more effective than the main alternative.

Threat of aversive Disulfiram reaction does deter drinking
Given effective supervision from family or clinicians to help ensure patients keep taking the tablets, this first systematic synthesis of research finds that on average the drug disulfiram, which produces an unpleasant physical reaction to drinking, does act as an aid to abstinence in the treatment of alcohol dependence.

Half century of evidence on which drugs aid alcohol treatment
Largely from a primary care perspective, this US review examines a half century of evidence for whether drugs aid recovery from dependence on alcohol and which work best. Top candidates are Naltrexone (newly licensed for this role in the UK), Topiramate, and Acamprosate.

Scottish health service cautious about computer-based alcohol advice and therapy
Worth trying, but unproven for the UK and for general populations and in need of further evaluation, were the messages of this review for the health service in Scotland of computer-based alcohol interventions as possible ways to extend treatment and the national brief intervention programme.

NTA consultation on introduction of alcohol outcome measures into NDTMS; DH Update on Public Health Funding

NTA consultation on alcohol treatment outcome measures

The National Treatment Agency (NTA) has opened a consultation for a three month period on the introduction of outcome measures into the National Drug Treatment Monitoring System (NDTMS) alcohol dataset.

The proposed outcome measures are outlined in this consultation document which explores 10 specific questions relating to developing outcome recording. The questions seek views on key outcome indicators including consumption, physical and mental health, housing status and other measures.

The deadline for responses is 20th September 2012. Existing national alcohol treatment data can be seen here, and details on the Payment by Results pilots here.

DoH update on Public Health Funding

The Department of Health have released Healthy Lives, Healthy People: update on Public Health Funding - DH release here.

The document outlines conditions on the ring fenced public health grant which will be under the control of local authorities to fund drug and alcohol treatment from April 2013. The document indicates how the grant may be used, including proposals for local authority financial reporting requirements on public health spend.

Latest from the IBA blog: When to do extended brief interventions; young people's IBA resources; is self-completing AUDIT OK?..

A selection of recent posts from the IBA blog, a resource promoting news, links and ideas relating to alcohol brief interventions are included below:

• Extended Brief Interventions: who, when, where, and other questions?
• IBA for children and young people: evidence, guidance and resources?
• Is self-completing the AUDIT OK for IBA?
• IBA for alcohol… and diet…and physical activity…and smoking….and…
• A breath of fresh air: when GPs do IBA
• How to decide what to do, whatever the evidence.
• Is the unit message getting through?
• INEBRIA Conference 2012
• Audiovisual resources can be invaluable in IBA training

The IBA blog was set up to promote learning, understanding and the delivery of IBA through regular items and updates on IBA from a range of contributors. It also aims to highlight other resources and links such as INEBRIA and the Alcohol Learning Centre IBA pages.

RCGP release GP guidance on domestic abuse

The Royal College of General Practitioners (RCGP) has released guidance to help GPs respond more effectively to patients at risk of domestice abuse. The guidelines advocate that a senior member of each primary care team is tasked with co-ordinating an effective response to patients at risk of domestic violence. See RCGP press release.

The ability to respond to patients effectively remains a Department of Health strategic priority. Each practice should explore local service provision and engage with relevant services. It should commission training for staff to help all members of the primary care team to be able to recognise the signs and symptoms of domestice abuse, to be able to raise the issue and to respond sensitively to the patient.

Clear pathways into local sevices should be developed, alongside information sharing protocols.The practice should also identify a designated person, who may be a domestic abuse expert or a suitably trained member of the healthcare team. This person is responsible then for carrying out risk assessments, having a case load, referral on to further specialist support and for ensuring the team have clarity around child protection issues.

At a strategic level the RCGP recommends that the Clinical Commissioning Groups have an overview of the commissioning and co-ordination of services which all form part of the jigsaw of recognition and support for people suffering from domestic violence. These services will include A&E, alcohol specialist services, maternity services and child protection services.

The guidelines are supported by Identification and Referral to Support Safety (IRIS) and by Co-Ordinated Action against Domestic Abuse (CAADA). See this link for the Home Office's definition of domestic abuse.

Alcohol Concern have produced an Embrace knowledge resource on domestic abuse.

Scotland reports and news: latest hospital statistics, drink drive limit to be lowered; alcohol retail and pricing reports

Alcohol Related Hospital Statistics 2012

Scotland's Information Services Division (ISD) has published alcohol-related hospital discharge statistics in the latest Alcohol-related Hospital Statistics report (full pdf report here). Key findings include:

• In 2010/11, there were 38,825 alcohol-related discharges from a general acute hospital in Scotland (a rate of 695 discharges per 100,000 population).
• In 2010/11, the rate of alcohol-related discharges from general acute hospitals was 7.6 times greater from patients living in the most deprived areas (category 1), compared to those living in the least deprived areas (category 5).
• Rates of alcohol-related discharge were highest in the 50 to 54 years age group with a rate of 1,319 discharges per 100,000 population.
• The rate of alcohol-related discharges from a general acute hospital decreased by over 2% between 2009/10 and 2010/11.
• Alcohol dependence was recorded in 69% (2,807) of all alcohol-related discharges from psychiatric hospitals

Statistics for England can be found here.

Scottish Drink Drive limit to be lowered

The drink-drive limit in Scotland will be lowered "as a priority", according to the BBC. Justice Secretary Kenny MacAskill said plans to lower the limit from 80mg of alcohol per 100ml of blood to 50mg will be brought forward later this year. Doctors welcomed plans according to The Herald.

Last year in England the Government decided to keep the 80mg legal limit despite a report advising it to be lowered in line with most of Europe.

Retail sales data and discount ban impact reports

Two reports have been recently released as part of the Monitoring and Evaluating Scotland’s Alcohol Strategy:

• A review of the validity and reliability of alcohol retail sales data
• Preliminary descriptive analysis of the impact of the quantity discount ban on off trade alcohol sales in Scotland

Scotland's Alcohol Minimum Pricing Bill was passed last month, meaning a 50 pence minimum unit price (MUP) could be in place north of the border by April next year.

'Community Alcohol Networks: A Practitioners Toolkit' - Lancashire partnerhsip approach to young people's drinking

In Lancashire, Community Alcohol Networks (CANs) have been developed by the Trading Standards Alcohol and Tobacco team, in conjunction with Lancashire Constabulary, to adopt a partnership approach to reduce alcohol-related crime and problems amongst young people.

Lancashire have released a CAN Practitioner Toolkit and a CAN Problem Oriented Partnership report.

The project was established with the aims of reducing young people's access to alcohol in order to reduce risky drinking and alcohol fuelled anti social behaviour. It also aimed to reduce problems by tackling proxy purchasing through enhanced enforcement activity in identified hotspots. In addition it aimed to raise awareness of alcohol related health and social issues amongst young people, parents and the wider community.

Over 12 weeks the Community Alcohol Networks were claimed to have achieved:

• 51 per cent reduction in alcohol fuelled anti social behaviour
• violent crime has reduced by 22 per cent
• criminal damage has seen an 11 per cent reduction

The approach appears similar to Community Alcohol Partnerships (CAPs) which aims to tackle public underage drinking through co-operation between alcohol retailers and local stakeholders, such as Trading Standards, police, local authority licensing teams, schools and health networks. See here for a presentation on Islington Community Alcohol Partnership.

See here for a bank of local alcohol initaitives or an Alcohol Concern factsheet Alcohol, Crime and Disorder in the Night-time Economy [pdf], written by Dr Phil Hadfield (University of Leeds) and Dr Andrew Newton (University of Huddersfield).

Consultation on alcohol-related hospital admissions data - the end of 'alcohol-related' figures?

Consultation on the methods used to estimate alcohol-related hospital admissions for England has been opened by the North West Public Health Observatory (NWPHO).

Download the consultation document here [pdf] and response form available at www.lape.org.uk/downloads/response.doc.

It was announced that the hospital admissions data would be reviewed when the Public Health Outcomes Framework was released earlier this year, stating 'the preferred option is for an indicator based on just alcohol-related primary diagnoses, to minimise the risk of perverse consequences from any changes in coding practice so the indicator rewards local areas for good performance.'

Hosptial admissions data was formerly used to monitor 'National Indicator (NI) 39' performance under 'Local Area Agreements' (LAA). However LAAs were scrapped under the Government's Localism agenda, although areas can still monitor hospital admissions data through the Local Alcohol Profiles for England (LAPE) site and are reviewed in the annual national alcohol statistics.

The Morning Advertiser reported that the trade is concerned that such data influences Government alcohol policies. Kate Nicholls, strategic affairs director at the Association of Licensed Multiple Retailers said "Too often in the past we have seen alcohol-related statistics over-stated and over-played or used as a public health political football."

Concerns may reflect alcohol-related admissions figures which now top over a million attributable admissions per year, attracting media headlines. Primary alcohol diagnosis admissions are however less than 200,000 per year. Alcohol-related admissions account for the impact of conditions such as hypertension where alcohol misuse plays a significant role in many cases.

The consultation document states:

The aim is to engage with the users about the methods used to construct the estimates to ensure that the figures remain relevant, easy to interpret and meaningful.

The consultation has been driven by an improved understanding of the methodological issues associated with estimating alcohol-related admissions and, linked to that, the inclusion within the Public Health Outcomes Framework of an alcohol-related admissions indicator and the need to ensure this indicator is the best available for that purpose.

The consultation will run for 12 weeks from 31st May 2012 to 23rd August 2012. A response form can be downloaded from www.lape.org.uk/downloads/response.doc.

News & updates June 2012: Half a unit per day would save lives; 1 in 8 working age deaths alcohol related; welfare plans under attack; ASDA donates £1m to Addaction; diary dates

Headlines that half a unit a day would save thousands of lives have been triggered by a BMJ article which modelled the impact of changes in consumption. Lead author Dr Melanie Nichols said: “It is likely that government recommendations would need to be set at a much lower level than the current ‘low risk’ drinking guidelines in order to achieve the best possible outcomes for public health.” But the authors did not directly call for a lowering of the guidelines, which currently under review. See reports from the BBC, Telegraph, Guardian and an explanation from NHS Choices.

Headlines also reported that 1 in 8 deaths under the age of 64 are caused by alcohol, following comments from Professor Eileen Kaner who called for tougher policy action including a ban on marketing. A Newcastle University conference heard that European alcohol consumption is more than twice the global average - see Press Association and Daily Mail reports. However the source of the data has been questioned, meriting an analysis on FullFact.

Plans to dock benefits of drug and alcohol abusers who reject help have come under fire. Drugscope have written to Iain Duncan Smith to clarify welfare plans he is expected to announce shortly - BBC, Guardian & Drugscope statement. Meanwhile the Commons Speaker John Bercow has said more MPs are seeking help for alcohol problems as Parliament attempts to crack down on Westminster's drinking culture- Telegraph report.

Dedicated alcohol ambulances are to treat drinkers over the Queen's Diamond Jubilee, Olympics and European football championships - Daily Telegraph. Alcohol sensors should be in every car to cut drink-related road deaths and injuries, says the government's former chief drugs adviser David Nutt - BBC report.

Trade & industry news

Supermarket giant ASDA has pledged £1m to Addaction, a national charity that helps young people and families tackle problems with alcohol. The £1m will fund ‘Reach Out’, a new support programme run from Addaction services in Barnsley, Cornwall and Liverpool.

National Pubwatch (NPW) has launched an online mapping tool to help the organisation draw up a list of pubwatch schemes across the UK. SABMiller and the BII are set to launch a new scheme aimed at helping bar staff battle against alcohol abuse and under-age sales.

A licensed trade consultant has launched an e-petition calling on the Government to take action against under 18-year-olds who attempt to buy alcohol in pubs. The industry petition calling to end the beer duty escalator has hit 50,000 signatures - half way to forcing a debate on the issue in Parliament.

Tax duty stamps can be counterfeited, a HM Revenue and Customs (HMRC) official admitted last week. A current inquiry into beer tax fraud is taking place.

Events & dates

A Drinkaware seminar on Influencing young people’s attitudes and behaviours towards alcohol at the University of Leeds, Thursday 14 June 2012, 9.30 – 1.30pm. Email kevans@drinkaware.co.uk to register. City Health 2012 will take place in the City of London’s historic Guildhall on 22nd and 23rd October 2012. See here for other events.

Applications for Middlesex University's MA in Comparative Drug and Alcohol Studies close on the 18th June.  

'Statistics on Alcohol: England 2012' confirms continuing upward admissions trend

The latest annual statistics on alcohol for England 2012 have been released by the ONS, confirming a continuing rise in alcohol-related and primary alcohol attributable hospital conditions. Alcohol-related admissions rose 11% on the previous year with primary diagnosis conditions up 2.1%.

This comes despite falls since 2004 in the proportion of adults reporting drinking alcohol. Continuing admissions - many being long term conditions - are thought to be linked to decades of rising consumption prior to 2004. Additionally indications that amongst some groups, those who are drinking are drinking more.

Some key facts from the report include:

• A 2.1% increase in primary diagnosis alcohol conditions (198,900 for 2010/11) since the previous year and a 40% increase since 2003 (142,000).
• A 11% increase on alcohol-related admissions (based on attributable fractions) totalling 1,168,300 for 2010/11.This is more than twice as many as in 2002/03 (510,700).
• A long-term downward trend in the proportion of adults who reported drinking in the week prior to interview. In 1998 75% of men and 59% of women drank in the week prior to interview compared to 68%men and 54% of women in 2010.
• 13% of secondary school pupils aged 11 to 15 reported drinking alcohol in the week prior to interview in 2010 compared with 18 per cent of pupils in 2009 and 26 per cent in 2001.
• In 2011, there were 167,764 prescription items for drugs for the treatment of alcohol dependency. This is an increase of 4.7 per cent on the 2010 figure (160,181) and an increase of 63% on the 2003 figure (102,741).
• The cost of these prescription items was £2.49 million in 2011. This is an increase of 45% on the 2003 figure (£1.72 million).

Alcohol Concern's Emily Robinson commented in a Daily Mail report:

"As a country we face a huge NHS bill because of health problems caused by alcohol. That means we need the Government to take action across a whole range of policy areas such as advertising, pricing, availability and investing in treatment to help bring down the number going to hospital because of alcohol."

Drinkaware's Chris Sorek commented in a Morning Advertiser Report:

“It is encouraging to see a fall in average weekly alcohol consumption among young adults. Yet despite an overall decline in recent years, over one in five young men (22%) and one in five young women (17%) are still binge drinking. The figures confirm the worrying trend of Britain’s hidden binge drinkers (25-44 year olds) who drink more heavily and more regularly than young adults."