Alcohol Policy UK

Drinkaware independent review raises questions for industry funded alcohol charity

The industry funded alcohol education charity Drinkaware has released an independent review of its activities, with mixed findings over its effectiveness to date. Download the report here [pdf] or appendices.

The review was carried out by consultancy firm 23Red which in the executive summary identifies its main findings as:

2.1 This is a mixed report. The reviewers found that much has improved since the last review of the Drinkaware Trust, notably the funding position. On the other hand, while some things are now well done, others are poorly done or are lacking entirely. No stakeholder group is entirely happy with the current status quo.

2.2 In consequence, while recognising that there are inevitable tensions facing an organisation with the remit and funding base of Drinkaware, this report calls for substantial changes to the way in which Drinkaware operates. These changes affect the way the Trust is funded, its governance model and the way it carries out its core activities.

The report identified successes including achieving "near-ubiquity for the Drinkaware.co.uk URL", improved stakeholder engagement, improved approaches to campaigns and some success against some KPIs, particularly relating to 11-17 year olds. However the report states that:

"...all groups of stakeholders are dissatisfied with the status quo to some degree. Their dissatisfaction focuses on three key areas:

• The lack of an evidence base, both to inform what Drinkaware does and to evaluate how it does it
• A perception of industry influence resulting in a suspicion that Drinkaware is not truly independent of the alcohol industry
• Weak stakeholder engagement, resulting in Drinkaware’s isolation within the alcohol harm reduction community"

Also of concern are findings from a currently unpublished study by London Southbank University and Kings College London (Moss, Dyer et al) which found that exposure to Drinkaware posters actually appeared to increase alcohol consumption. Drinkaware Posters from the 'Why let the good times go bad' posters were used in a simulated bar environments and lab settings, where drinkers consumed more when posters were displayed.

In 2009 Professor Iain Gilmore warned of "very little evidence that health messages work to prevent binge or harmful drinking" when the campaign was announced. Then Alcohol Concern Chief Exec Don Shenker also wrote of a "real concern that the very message ‘Why let the good times go bad’ will actually reinforce the notion that you need alcohol to have a good time" in a DDN article cynical of tactics behind industry funded activity.

Drinakware have however since been engaging with the authors of the study to explore the implications and have reportedly ended the ‘Why let the good times go bad’ campaign. The findings however raise questions for all drug and alcohol related information campaigns and evaluation methods. Other studies such as a US anti-drug media campaign have previously suggested the potential for counterintuitve responses.

Looking forward, Drinkaware has certainly not yet convinced the public health community at large of its role or ability to delivery activity that genuinely addresses alcohol misuse. However its publication of an arguably critical independent report may go some distance to improving its future standing. With a new Chief Executive at the helm since earlier this year, Drinkaware certainly faces some real challenges.

News and updates Mar 2013: minimum pricing plans in doubt; UK health bodies support 'statement of concern' over industry; other news

The Government has emphasised it is yet to confirm its decision on minimum unit pricing (MUP) as Home Office minister Jeremy Brown said the Government were listening to "powerfull arguments on both sides" following the recent consultation. The Home Office website still states it "will introduce a minimum unit price for alcohol" - but for how long?

Last week fresh reports that the Prime Minister had u-turned on minimum unit pricing emerged, suggesting he had given in to pressure from a number of cabinet ministers. However speaking in the House of Commons, David Cameron insisted he was "determined" to deal with cheap alcohol. Health bodies urged the Government to stand firm on MUP.

Global 'Statement of Concern' against alcohol producers involvement in policy

Last month a number of UK organisations backed a  Statement of Concern' (pdf) sent to the World Health Organization (WHO) after thirteen of world’s largest alcohol producers announced commitments to support the WHO’s Global Strategy.

However the statement said that based on alcohol producer's "lack of support for effective alcohol policies... and their lobbying against effective public health measures" a united public health response against industry involvement was needed. The Global Alcohol Policy Alliance (GAPA) are calling for individuals to endorse the statement by sending a name, title, affiliation and country to gapa@ias.org.uk.

Other news

A selection of other recent news is highlighted below. For full round ups of media and news reports follow Drugscope Daily or the LAPE alcohol e-shot.

The Department of Health are 'working' with drinks industry to add calorie information to labels - Guardian report. The controversial 'Responsibility Deal' said in 2011 it would "provide simple and consistent information as appropriate in the off-trade" including calorie content.

Can politicians save Britain's pubs? asks a BBC report. It explores a range of challenges facing the decline of the pub, including the smoking ban and imbalanced beer taxes compared with the off-trade.

'Beer googles' are a myth, but the dis-inhibitor effect is key says a scientist according to a Telegraph report. "Alcohol switches off the rational and decision making areas of the brain while leaving the areas to do with sexual desire relatively intact, and so this explains beer goggles."

Brighton and Hove Council are considering whether to ask parents to sign contracts pledging not to give their children alcohol - BBC. Alcohol Concern said parents were often the main source of alcohol for underage drinkers and alcohol posed significant health as well as safety risks to young people, urging parents to support alcohol-free childhoods in line with CMO guidance.

Plans to film binge drinkers  in Cardiff and show them footage of their drunken behaviour to help them change their ways will go ahead - BBC report.

Doctors call for pregnant women to be tested for alcohol intake - Channel 4 news. The news was in response to the FASD Trust publishing recommendations for medical staff to tackle foetal alcohol disorder caused by drinking alcohol during pregnancy - BBC.

Britain sobers up as drinkers cut back on wine and spirits according to projections that suggest the country will drink millions fewer bottles of wine and spirits over the next few years - Telegraph. The news contrasts with recent media coverage of research on adults under-estimating their consumption - see our recent guest post.

Under-reporting: media, myths, and policy implications?

Sadie Boniface, who is currently writing up her PhD in UCL’s Department of Epidemiology & Public Health, has contributed the following guest post. It explores some of the key issues that were neglected in recent media reports of this paper about under-reporting of alcohol consumption, the NHS Choices Behind the Headlines summary of which appears here.

Under-reporting is persistent and global

We know that the way our work was reported in the media was not really ‘news’ to those working in the field. Epidemiologists and public health researchers with even a vague interest in alcohol will be familiar with the fact that what participants say they drink amounts to a lot less than what is actually sold. This sort of ‘favourable’ reporting is also known for other health behaviours such as energy intake, and also for seemingly more objective measures such as height and weight. For Britain, where self-reported consumption in the General Lifestyle Survey is compared with alcohol sales from HM Revenue and Customs, reported consumption has amounted to between 50% and 60% of alcohol sales since 1992.

Low alcohol sales coverage is something that has been known for a long time, and is certainly not peculiar to the UK, with international studies consistently finding alcohol sales coverage of 40-60%. There has been a huge amount of research done internationally on under-reporting of alcohol consumption, and in particular the extent to which this can be mitigated with improved survey design has been investigated. In contrast, the demographic, social, and alcohol-related factors that may be associated with under-reporting have been explored to a far lesser extent (and that’s what this PhD research is mainly about).

‘It’s all in my cellar’

General Lifestyle Survey 2011 confirms drop in risky drinking - but causes and long term trend unclear

The 2011 General Lifestyle Survey has been released, including Chapter 2: drinking (pdf). The GLS 2011 explores trends in reported alcohol consumption since 2005 and confirms a fall in frequency of drinking above the guidelines amongst men and women. However health groups are keen to emphasise a significant longer trend rise in alcohol misuse and harms since the 1950s. 

Respondents to the 2011 GLF were asked questions relating to average weekly alcohol consumption and the maximum amount drunk on any day in the last week. Key findings included:

• The proportion of men drinking on five or more days a week fell from 23% in 1998 to 16% in 2011, and for women from 13% to 9%.
• The proportion reporting drinking alcohol in the last seven days fell from 72% in 2005 to 66% in 2011 for men, and from 57% to 54% for women.
• The proportion of men exceeding four units (daily guideline) on their heaviest drinking day was 41% in 2005 and 34% in 2011. The proportion of women exceeding three units was 34% in 2005 and 28% in 2011.

It is unclear to what extent various factors account for falls in reported consumption. Lower disposable income since the recession; national and local action to reduce alcohol misuse; or a general 'peaking' of consumption in 2004 may all play significant roles.

Clare Gerada, chair of the Royal College of GPs, suggested "It may be linked to income – as we have less disposable income, we drink less," she said. Others have previously warned that consumption and harms may begin to rise again as or when the economy picks up, as heavier drinker's income are disproportionately squeezed in harder times.

Extensive media coverage was recently given to the issue of 'under-reporting' following a UCL study. However media reports generated some particularly sensationalised interpretations, as explored in this behind the headlines report. More to come on this.

Earlier this year findings from the the Health Survey for England (HSE) 2011 were released, comprehensively exploring consumption patterns. See the HSE chapter 6: drinking patterns and chapter 7: drink diary. Also earlier this year the ONS released the latest Statistical bulletin for alcohol-related deaths in the UK (2011).

See here for the NHS Statistics on Alcohol 2012 report.

Change4Life 'Sneaky drinks' ad re-iterates alcohol message; alcohol apps & links

The Department of Health's Change4Life campaign has launched a second alcohol advert warning how drinking can ‘sneak up on you’, encouraging people to check their drinking online using the Change4Life Drinks Checker. The advert is a similar version of the 'Dont' let the drink sneak up on you' campaign launched last year. A supporting leaflet (pdf) is available to order.

  

As part of the campaign the Change4Life team asked 19 people to keep a detailed drinks diary for 2 weeks. Those that took part were drinking the equivalent of an extra large glass of wine each day, or 40% more than they thought. Although this level of underestimation may be supported by differences in reported consumption in national surveys versus recorded sales, the recent Health Survey for England 2011 showed significant but lower levels of under-reporting.

The Change4Life team also reported that after keeping a drinks diary for a week, the 19 participants were offered simple tips on cutting down and as a result they:

• cut their alcohol consumption by over a third
• saved around £33.35 a week – or over £1,730 a year
• consumed 1,658 fewer calories a week an average of 236 calories a day – around 10% of the average person’s daily intake and the equivalent to 125ml (a small wine glass) of cream per day

There is however limited evidence to support the effectivness of communications campaigns in changing individual drinking behaviours. However as the small Change4life sample involving individuals recording and measuring their drinking suggests, individual approaches such as 'Identification and Brief Advice' (IBA) have stronger evidence of research effectiveness. Nonetheless, no single approach to addressing the overall level of alcohol misuse is expected to work in isolation, so a cumulative impact of national policy and individual level interventions are advised by WHO for effective national strategy.

Last year the alcohol industry funded organisation Drinkaware launched 'My Drinkaware', which also offers online tools, an app and guidance to help people keep track of units and understand the risks. Another app, www.drinkcoach.org.uk, recently joined the market.

NHS Choices also offer comprehensive alcohol pages, including how to find local services. Drinkline can also be contacted 24 hours a day for advice and support on 0800 917 8282.

Individuals can also access online IBA tools such as www.dontbottleitup.org.uk and www.downyourdrink.org.uk/. Proffessionals can visit www.alcohollearningcentre.org.uk or www.alcoholiba.com for guidance and resources.

Last chance for minimum pricing consultation as arguments over evidence escalate

As the Government's consultation on Minimum Unit Pricing (MUP) and other measures draws to a close next week (6th February), various industry and health groups are making their cases for and against. See here for the online response form.

Leading the pro-MUP arguments, Alcohol Concern and the Alcohol Health Alliance
have challenged anti-MUP messages from sections of the alcohol industry. Alcohol Concern have stated "parts of the alcohol industry are currently trying to discredit the research on minimum unit pricing and are attempting to sway the public by putting out misleading information", and encouraging people to respond to the consultation. See Alcohol Concern's consultation response.

The AHA have said the drinks industry is now using tactics of Big Tobacco against minimum unit pricing. Dr Nick Sheron said the industry is "trying to undermine evidence-based alcohol policy measures which would save lives" and that MUP is "a targeted policy that will impact heavy drinkers whilst leaving the majority of moderate drinkers unaffected, and the international evidence (from Canada) shows that it works." See here for the full AHA response.

Sections of the industry and other bodies have been re-iterating various arguments against MUP, largely questioning the evidence base, predicted impacts, EU legal issues or suggesting it as an unfair measure that will 'penalise poorer drinkers' or a 'responsible majority'. The Adam Smith Institute (ASI) ,a free-market think tank, released a report refuting MUP and in particular the statistical modelling done by the University of Sheffield as "entirely speculative and do not deserve the exalted status they have been afforded". Sheffield have published a response to the claims here.

Bodies such as the IFS suggest using tax should be the preferred lever, though may have a less direct effect on prices on the floor. Other groups within the alcohol or retail industry also support MUP such as Greene King who see cheap alcohol as behind the decline in the pub trade.

A recent BBC report looked at the battle over minimum pricing. Other analysis includes an Information Daily feature and a selection of other recent MUP news and updates we recently featured. See here for a previous recent round up of MUP news and developments or the intial responses to MUP and the Government Alcohol Strategy released last year.

Both for and agiainst MUP websites are availabe:

• The pro-MUP www.minimumpricing.info website is supported by various alcohol organisations including Drinkwise Noth West
• The anti-MUP www.whyshouldwepaymore.co.uk is spear-headed by WTSA  

The consultation closes on 6 February 2013. See here for the online response form or download the consultation pdf.

Minimum pricing: consultation deadline approaches; Scottish legal challenge; Newcastle try 'MUP' on bars; news and views

There are less than 3 weeks left to respond to the Government's consultation on Minimum Unit Pricing (MUP) and other measures set out in the strategy. See here for the online response form. A selection of MUP reaction and news is highlighted below.

Alcohol Research UK have said they support the Government MUP proposals but warn of cross-border purchasing if a 45 pence MUP is adopted in England and a 50 pence MUP in Scotland. Alcohol Concern are calling for a 50 pence MUP, though only a 45 pence option is proposed in the consultation.

In Scotland a legal challenge against the SNP's minimum pricing is underway, headed by the Scotch Whisky Association (SWA). The SWA says MUP would be “in breach of the UK’s European Union Treaty obligations as it would restrain trade”. However there is much uncertainty over the legal position, with the Office of Fair Trading (OFT) previously stating that in its view "UK competition law does not prevent legislation to set a statutory minimum price for alcohol".

The Information Daily recently published a feature 'Minimum pricing is not what it seems' which seeks to dispel public mis-conceptions about how MUP would be expected to work. It followed an earlier anti-MUP piece by the Wine and Trade Spirit Association claiming it would hit 'responsible consumers'.

David Cameron last month claimed that responsible families are “actually subsidising the binge drinker” because supermarkets increase the price of food to fund loss-leading on wine, beer and cider. Supermarkets have previously been accused of such strategies but the British Retail Consortium said the remarks were “nonsense”.

MUP plans were reportedly under threat due to opposition from a number of Cabinet members, the Telegraph also reported last month. It claims an alliance of senior Ministers, including the current Home Secretary who is responsible for the strategy, are opposed to MUP.

The boss of the pub and brewer giant Greene King has backed minimum pricing citing home drinking as a driver for binge drinking. However in a Telegraph report Carlsberg chief executive Jorgen Buhl Rasmussen said he is strongly against MUP.

Meanwhile Newcastle City Council have applied a novel but controversial local 'minimum pricing' approach to two bars in the city centre. A press release states the £1.25 minimum price has been "agreed as a license condition in order to maintain standards and to keep the street as the city’s premier street". A Morning Advertiser piece suggest the move is legally "questionable".

See below for other key MUP reports and research:

• University of Sheffield modelling on pricing impacts for England and Scotland
• Home Office report on The likely impacts of increasing alcohol price: a summary review of the evidence base [pdf]
• Could minimum pricing "backfire" as claimed?
• A SABMiller commissioned report by the CEBR outlining arguments against minimum pricing
• An Alcohol Insight into 'The Cost of Alcohol: The Advocacy for a Minimum Price per Unit in the UK'
• SNP pages on minimum pricing and the Scottish Alcohol Bill.
• An interim report on Manchester's proposed local minimum pricing
• BMJ report urging a VAT reduction for the on-trade 
• Aberdeen University research arguing minum pricing does not target lower income groups

News & updates: Dry January; alcohol guidelines still questioned; press snapshots

Dry January? Thousands opt for month off the booze

Both Alcohol Concern and Cancer Research UK have promoted alcohol-free January challenges, attracting a fair bit of media attention. Alcohol Concern's Dry January site reports 4,306 people signed up who could expect to "feel better... ditch the hangover, reduce the waistline, and save the pennies." Cancer Research UK also promoted a Dryathlon, claiming 35,000 have signed up to help raise money for the charity.

In response, the Independent's Jamie Merrill, having undertaken a dry January in 2012, explores Is there any point in giving up booze for January?. The Telegraph's well known columnist Peter Oborne wrote a frank piece, admitting "A month without alcohol - the thought fills me with terror" as he fears he is 'in danger of becoming alcohol-dependent'.

The Guardian have two features, Should I stop drinking in January? briefly assesses the impact on the liver and the importance of moderating use throughout the year. A Guardian Science blog asks Alcohol: friend of Foe?, arguing the importance of the many social and economic benefits.

Drinkaware have a feature 'De-toxing for January? We have a better idea', which suggests and explores "the problem with so called “detoxing” is that it can imply it’s okay to regularly drink too much at all other times and undo the damage with a month-long break – which is not true."

Alcohol limits: a place for tailored recommended guidelines?

A BBC article suggests the alcohol message 'is confused' following a Dr Michael Mosley Radio 4 programme You and Yours on the alcohol guidelines. It explores the problems of one size fits all 'low risk' guideline for all adults considering genetic and individual differences, and low unit awareness. Last year MPs on the Science and Technology Committee called for greater efforts to help the public understand alcohol guidelines and for a further scientific review to build public confidence.

Other news and reports

A recent Economist feature, Their cup runneth over, explores Britain's alcohol problem and it's history. Despite dipping consumption since 2004, the piece suggests "Britons manage to combine Scandinavian bingeing with liver-pickling Mediterranean levels of consumption." See here for latest alcohol consumption data from the Health Survey England.

Alcohol contributes to at least 38% of pedestrians killed in London road accidents, reports the Evening Standard. Nearly half of pedestrian fatalities aged 30 to 49 and 38% of those aged 16 to 59, being under the influence was idntified as a “contributory factor” in their death.

A Conservative MP has proposed preventing benefits being spent on alcohol by creating a welfare cash card that can be used on "essential" items only. See BBC Democracy report and clip. Alec Shelbrooke said the card could be provided to out-of-work people on benefits to pay for travel, food, clothing, energy and housing but could not be spend on alcohol, cigarettes or luxury items.

Young Britons cut back on drink and drugs, an Observer report argues. Another Guardian piece explores Boozy Britain – why do we drink so much?. Amy Winehouse was killed by too much alcohol, a second inquest has confirmed.

A Mentor UK blog post has highlighted research identifying early drunkenness as a key predictor of problem drinking, urging a further Government policy focus. Research on stress and risk of dependence has been covered in a Daily Mail article Peril of drinking to relax. New blog posts by home drinking researcher John Foster cover reflections on alcohol and culture and the role of eduction.

A minimum pricing update will be coming shorty.

Demos re-iterates importance of parenting style in preventing problem drinking

The think-tank Demos has produced a follow up report further emphasising the influence of parenting style on children’s drinking as teenagers and later in life. Demos claim that ‘tough love’ parenting – a parenting style that combines warmth with consistent discipline – is the best protection against young people developing later life alcohol problems.

Download Feeling the Effects and see a summary blog piece by one of the authors. An NHS Choices review of the report is also available.

In 2011 Demos produced a report based on a study of over 15,000 children stating parenting style is one of the most important and statistically reliable influences on children's later life alcohol use.The findings appeared to be corroborated by a JRF report that emphasised the importance of parents in influencing teenager's drinking, and research reviews assessing parenting interventions.

However a critical blog post by Phil Mellows suggests 'blaming the parents' is a poor policy approach, which neglects to consider wider environmental factors. Mellows questions the analysis and points out the report was sponsored by SABMiller who wish to scupper the Government's minimum pricing plans.

Demos' latest report nonetheless claims that parenting-focused initiatives should be the central tenet of alcohol harm reduction policy. The report's recommendations include:

• Information campaigns targeted at parents to increase understanding of alcohol misuse and the benefits of a 'tough love' parenting style
• Identification and brief advice (IBA) to help parents reduce alcohol misuse
• Early identification of and support for parents who may have a drinking problem, while their children are still young
• Alcohol support initiatives to include ‘parent-child engagement sessions’ to give children a voice.
• Alcohol support programmes to focus on parenting and advise on parenting techniques

Drinkaware has a web-page for parents aimed at promoting earlier conversations about alcohol. Further reports and guidance related to children and young people can be found here on the Alcohol Learning Centre, including the CMO guidance. Last year two reports called for the protection of children from alcohol harm.

Health Survey for England 2011: latest figures on reported consumption

Findings from the the Health Survey for England 2011 have been released, including chapter 6: drinking patterns and chapter 7: drink diary. See here for the trend tables, trend commentary and press release.

The report broadly reflects known general consumption patterns. Young adults are more likely to drink heavily (binge) on a single occasion, but drink on fewer days in the week. Adults over 45 are more likely to drink on most days, but tend to drink less per day. Those from higher socio-economic groups are more likely to drink above the guidelines and do so more regularly. Men drink significantly more than women across most age groups.

The drink diary chapter is a new addition to test how reported consumption matches up when recorded by the drinker. Although reported frequency of drinking tended to match, consumption levels tended to be under-estimated when compared with a drinks diary. The survey data is still considered reliable in determining consumption patterns and variations across age, sex, region and income groups.

Some specific findings include:

• Focusing only on those who drank alcohol in the last week, over half exceeded recommended limits on at least one day in the previous week (56% of men, 52% of women), while over a quarter drank more than twice the recommended limit (31% of men, 25% of women). Men drank an average of 7.7 units, and women an average of 5.0 units on the day they drank the most in the last week.
• Younger people were the most likely to drink heavily on a single occasion: 67% of men and 68% of women aged 16-24 drank above the recommended level, and 45% and 46% respectively drank more than twice the recommended amount.
• The proportion of men consuming more than four units on the heaviest day’s drinking in the last week did not show substantial change between 2006 and 2011 (39 per cent in 2011), and similarly the proportion of men that drank more than twice the recommended amount showed little change over the period (22 per cent in 2011).
• The picture was different among women: there was a decrease between 2006 and 2011 both in the proportion consuming more than three units on the heaviest day’s drinking last week (from 33 per cent to 28 per cent), and in the proportion drinking more than twice the recommended amount (from 16 per cent to 13 per cent).

The figures prove interesting given indications that overall alcohol consumption has been falling since 2004. However consumption it still significantly higher as a longer term trend, and it has been suggested that consumption may have dipped in part due to the recession. A continuing rise in alcohol-related and primary alcohol attributable hospital conditions is also set to continue for sometime.

See here for the comprehensive statistics on alcohol for England 2012.