Alcohol Policy UK

Latest from the IBA blog: discussion forum launched; AUDIT Vs shorter tools; INEBRIA 2013; alcohol and the workplace; IBA - making it happen? & more

The alcohol IBA blog was set up to promote learning, understanding and the delivery of IBA through news, links and ideas on IBA from a range of contributors. 

The blog now has a discussion forum for anyone to share their views, comments or questions on any IBA issues. 

Recent posts from the IBA blog are highlighted below:

• Full AUDIT screening Vs shorter tools (FAST, AUDIT-C etc) for IBA The 10 question full AUDIT is the ‘gold standard’ screening tool for the identification of alcohol use disorders. But does IBA always require the full AUDIT to be completed Read more here...

• INEBRIA Conference 2013  The annual conference of INEBRIA is an excellent opportunity to hear the latest IBA research and practice developments - the 10th Annual Conference will be held in Rome on 19th and 20th of September 2013. Read more here...

• Supporting colleagues with drink problems  How do you respond when a colleague you respect is drinking at levels which affect their work? How do you address this if you are their manager? Read more here...

• IBA – making it happen?  It’s no secret that the big challenge is to get IBA happening large scale. That means in such a way that it will reach many of the 10 million or so adults regularly drinking above the guidelines... Read more here...

• Why ask staff about drinking in the workplace?  36 million people are in work in the UK and we know that the majority of problem drinkers are also in employment and do not seek help or treatment. Read more here...

• SBI & Health Inequalities? What do we know about how SBI (aka IBA) may impact on health inequalities?  The evidence we have so far is fairly limited on this. Read more here...

The blog also has specific 'About IBA' and 'IBA tools' pages and also aims to highlight other resources such as INEBRIA and the Alcohol Learning Centre IBA pages. See here for the Alcohol IBA Twitter Updates (@Alcohol_IBA).

Regional updates: London regional activity now 'Safe Sociable London Partnership; Balance North East & DrinkWise latest

In 2011 the Department of Health led Alcohol Improvement Programme (AIP) concluded a number of initiatives including most of the regional alcohol programmes. With localism a key Government objective, local partnerships are responsible for determining their own priorities. However a number of areas have maintained regional approaches as updated below.

London

In London the 'Safe Sociable London Partnership' (SSLP) has now been established to continue the regional activity previously undertaken by the shadow London Health Improvement Board (LHIB).

The SSLP is a London Partnership supported by local boroughs, Public Health England and the Greater London Authority (GLA) to deliver alcohol improvement work at local and regional level in London. The SSLP is continuing to support and develop a range of projects spanning health, licensing and other areas.

In particular, work around strengthening Public Health team's input into licensing processes is being developed following the release of a Licensing toolkit. A number of projects are also being delivered to support the implementation of Identification and Brief Advice (IBA) across the capital including an IBA network, a London 'minimum standard', pathways work, and a London Probation Alcohol Champions project. Pilot projects are also being delivered around Pharmacy scratchcards, sexual health and IBA for homeless groups.

North West

Drink Wise is commissioned by all the North West Local Authorities to lead on alcohol harm reduction. This includes advocay on minimum unit pricing (MUP) including www.minimumpricing.info, promotion and placement of alcohol. Work around enablement also sets out a programme of work around the regulation of alcohol. Since April 2012 Drink Wise have been merged with Our Life.

North East

Balance is the North East's regional alcohol office set up to follow in the footsteps of tobacco control by taking a population level, de-normalisation approach to alcohol harm. Balance aims to change the culture around alcohol and reports progress in areas such as: awareness of alcohol harm; support for policy change; and early signs that consumption and harm is falling in the region.

Balance say partners in the North East have shown vision and commitment to tackling alcohol-related harms and continuing to support Balance. Work includes ensuring alcohol remains a priority for public sector organisations in the region, alongside work on building public and political support for measures to reduce the affordability, availability and desirability of excessive consumption.

Balance recently found 80% of police officers in the North East will be subjected to an alcohol-related assault during their career.

Also...

Public Health England, which has now taken over responsibilities of the former NTA, will also be working to support and develop strategic action around alcohol and sets out its overal alcohol objectives here. Other non statutory organisations will also be continuing to deliver various programmes - watch this space.

'Statistics on Alcohol: England 2013' admissions still rising along with increasing drug treatment prescribing

The latest annual statistics on alcohol for England 2013 have been released, confirming a continuing rise in alcohol-related and primary alcohol attributable hospital conditions. Alcohol-related admissions rose 4% on the previous year with primary diagnosis conditions up 1%. Prescribed drugs for treating alcohol dependence were up 6%. Download the full report here (pdf).

This comes despite falls since 2004 in the proportion of adults reporting drinking alcohol. Continuing admissions - many being long term conditions - are linked to decades of rising consumption prior to 2004. A useful interactive Guardian data blog includes a table which allows admission types to be selected. Related acute admissions such as violence or accidents and injuries show falling or more stable trends, whereas long-term conditions such as cardiac, hypertensive or cardiac admissions show clear upwards trends.

Key findings from the report:

• In 2011/12, there were an estimated 1,220,300 admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (broad measure). This is an increase of 4% on the 2010/11 figure (1,168,300) and more than twice as many as in 2002/03 (510,700).
• In 2011/12, there were 200,900 admissions where the primary diagnosis was attributable to the consumption of alcohol. This is a 1% increase since 2010/11 when there were 198,900 admissions of this type and a 41% increase since 2002/03 when there were around 142,000 such admissions.
• In 2012, there were 178,247 prescription items prescribed for the treatment of alcohol dependence in primary care settings or NHS hospitals and dispensed in the community. This is an increase of 6% on the 2011 figure (167,764) and an increase of 73% on the 2003 figure (102,741). The Net Ingredient Cost (NIC) of these prescriptions was £2.93 million in 2012.

The report also identifies that on-trade alcohol sales in particular have fallen by 46% over 10 years, whereas off-trade sales have risen by 32% overall since 1992. Alcohol is also 62% more afordable than in 1980.

The report also provides a comprehensive overview of alcohol related health and consumption data including regional breakdowns. It also covers knowledge and attitudes to alcohol amongst the adult population.

Media reports so far have focused on headlines such as the 50% rise over the last decade in overall alcohol-related admissions - Guardian - and a 75% increase in drug treatment prescriptions over the last 9 years - see BBC and Information Daily reports.

News & updates May 2013: 'middle class drinkers know better'; MPs admit to 'unhealthy drinking culture'; other news

Some recent media stories and other reports are highlighted below.

'Middle classes are in denial' or 'know better than experts' were recent headlines responding to research published in the BMC. The study had explored the attitudes of managerial and professional roles, finding low acceptance or awareness of health risks. In part this was attributed to perceptions that alcohol problems were confined to 'others' including younger 'binge drinkers', and belief that 'home drinking' was without risk.

Of course those in the field know professional roles tend to drink more and more frequently, and off-sales wine has accounted for most of the overall rise in consumption since the 1950s. 'Middle-class' drinkers, often associated with 'de-stress' drinking, therefore pose a challenge to public health roles wanting to reduce long term health impacts of those less likely to contemplate their drinking. On the flip-side, the “alcohol harm paradox” suggest drinkers from lower socio-economic groups experience greater harms. A 'behind the headlines' piece analyses the findings versus media reaction.

"MPs admit to an unhealthy drink culture" according to an Alcohol Concern survey. The survey of 150 MPs attitudes found 26% thought their colleagues drank too much. It also suggested that £1.33m was spent in the nine bars at the House of Commons in the year to March 2011. In a subsequent Guardian poll 39% of respondents answered yes to the question 'Is there a culture of excessive boozing at your workplace?'. See reports from the BBC, and a blog comment in the Independent.

Local initiatives & reports

Shop ban on high-strength booze cuts street drinking crime by 50%, reports the Telegraph. The scheme is now being considered by other forces - BBC.

Drink-related anti-social behaviour in part of Stoke-on-Trent has reduced by over two-thirds after an alcohol restriction zone was introduced - BBC.

Police in Scotland are warning parents not to buy alcohol for their underage children after an increase in drunken incidents involving young girls, reports the Scotsman.

Other reports & info

Binge drinking in your 20s can trigger heart disease- Daily Mail.

Do young people’s attitudes to alcohol make them more likely to be violent when drinking? is explored on the Closer blog.

Alcohol advertising pre-disposes young people to have favorable attitudes toward drinking, a NewsMedical.net report explores.

A lawyer says there has been a 70% increase in men citing alcohol misuse in divorce over the past five years - Daily Mail.

A new Drinkaware video highlights the effects of alcohol, and a new page highlights the dangers of cheap alcohol.

EU's alcohol strategy needs further push, MEPs say according to EurActiv.com.

To get full regular media reports you can sign up to the alcohol e-shot or Drugscope Daily.

For the Alcohol Policy UK newsletter email subscribe@alcoholacademy.net

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.

Findings bulletins & hot topics: peer influence; commissioning; motivational interviewing; mental health & normative approaches

Recent bulletins from the drug and alcohol bank:

TEENAGE PEER INFLUENCE ON DRINKING IS NO ILLUSION

Is the peer influence on which many prevention programmes are based an illusion due to other factors like pupils sharing similar environments or choosing like-minded friends? Not entirely, finds this unusually rigorous US analysis; the chances of a given child drinking rise by 4% for every 10% more of their school year-mates who drink.

WHAT ABOUT EVIDENCE-BASED COMMISSIONING?

Though central to implementing policy and embedding evidence in practice, the process of ensuring that the pattern of services in an area coherently and efficiently meets local needs is itself relatively unevidenced. Such reports as we have from the UK often graphically portray the shortfalls, though there is evidence that things can be done which work.

MOTIVATIONAL INTERVIEWING - THE SWISS ARMY KNIFE OF SUBSTANCE USE COUNSELLING

Popular and with a strong theoretical and evidence base, the great advantage of motivational interviewing is its applicability across the board from risky but as yet non-problematic substance users to established addicts, yet the research yields some surprises and some negatives. 

COPING WITH MENTAL ILLNESS

With as many as three quarters of their clients suffering from mental health problems, deciding how to respond is a major and long-standing concern for British drug and alcohol services. Should they or psychiatric services take the lead in caring for the patient, how can they coordinate care with mental health services, should dependence be treated first, or should treatment run in parallel?

EVERYONE’S *NOT* DOING IT MESSAGE OFFERS HOPE FOR PREVENTIVE EDUCATION

Science is littered with shining discoveries which became somewhat tarnished as accumulating data forced a reappraisal. In substance misuse, normative education (contrasting how common pupils think substance use is with the reality) retains some of its shine, but what seemed the great hope for school- and college-based prevention now seems a tactic of limited application and with inconsistent impacts - and, some believe, one way the drinks industry avoids truly effective restrictions.

Public Health England publishes 2013/14 priorities - much space for alcohol?

Public Health England (PHE), the new national body set up to lead on the promotion of health and wellbeing, has published its 2013/14 priorities.

PHE now includes national remit for drug and alcohol policy having now integrated the former National Treatment Agency and alcohol policy team. However local Health and Wellbeing Boards (HWBs) and Directors of Public Health (DPH) are able to set the local prioritisation of public health budgets.

PHE's priorities for 2013/14 do not explicitly focus on alcohol misuse, but the document does state "the most significant factors that lead to poor health [are]: smoking; high blood pressure; obesity; poor diet; lack of exercise; and excessive alcohol consumption."

PHE has 5 key priorities including a first priority of reducing preventable deaths and ill health through addressing key factors including alcohol misuse:

1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol
2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency
3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics
4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme
5. Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

Indeed alcohol misuse can be seen as significant to priorities 2, 4 and 5 given alcohol's cross-cutting impact on disease, disability, problems within families and workplace health. Additionally priority 1 includes the roll out of the NHS Health Checks programme, which now includes alcohol IBA as part of the lifestyle intervention to be offered to up to 15 million 40-74 year olds over coming years. But with a Government strategy with little attention to treatment and prevention, should it say more on alcohol?

NTA survey seeks to establish national picture of alcohol services in hospital settings

Commissioners in England are being asked to partake in a survey of alcohol services in hospital settings in England by the National Treatment Agency (NTA). The NTA are to be part of Public Health England (PHE) as of 1st April.

Investment in a variety of models of hospital based alcohol services has increased in recent years, particularly since 2009 Department of Health alcohol guidance identified 'Appoint an Alcohol Health Worker' as a 'High Impact Change'. However the extent, nature and sustainability of these services is unknown.

The survey will provide the first ever national picture of the number and nature of the alcohol services in England’s hospitals and PHE will go on to develop guidance and materials to support the continued development and delivery of such services. Iain Armstrong of the NTA has indicated around half of the key Local Authority areas have completed the survey to date, with the survey remaining open to commissioners until 5th April 2013.

An NHS Evidence QIPP case study is available on Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care. In 2010 Alcohol Concern published Alcohol Health Workers - description and review of the AHW posts

Further alcohol hospital resources are available here on the Alcohol Learning Centre, including on hospital based Alcohol Health Work. See here for NICE alcohol commissioning guidance.

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’