Alcohol Policy UK

Latest Findings alcohol research: licesning, treatment and student based interventions

Recent research from the drug and alcohol Bank:

Licensing

Late opening for pubs and bars aggravates alcohol-related harm

UK research is inconclusive, but international research from developed nations reviewed for a national US task force supports the belief that increasing on-licence opening hours leads to more drinking and more alcohol-related harm.

Weekend alcohol sales equals more weekend alcohol-related harm

International research from developed nations reviewed for a national US task force offers some support for the belief that allowing or disallowing Saturday or Sunday alcohol sales affects drinking and alcohol-related harm.

Treatment and recovery

Home visits cost-effectively aid alcohol treatment

In Brazil adding home visits to a three-month alcohol detoxification and treatment programme cost-effectively increased the abstinence rate at the end of treatment. British study suggests that what happens in such visits is critical.

Group therapy wins on cost-effectiveness grounds

For US problem drinkers and drug users not at the severest end of the spectrum, four sessions of group were as effective as four of individual therapy but required far fewer therapist hours per patient. The little research we have suggests this a common finding, commending group approaches on cost-effectiveness grounds.

Student and college based interventions

Group motivational interviewing works for college drinkers

US students who broke college drinking rules and were required to undertake an alcohol programme responded better to three hours of group motivational interviewing than six of alcohol education; enhanced confidence that they could resist risky drinking was the key. For colleges it offers an effective but economical response to problem drinkers.

Drink moderation strategies ineffective unless students want to cut down

What happens when instead of asking students to cut drinking, you ask them to use more moderation strategies such as spacing drinks or avoiding heavy drinking situations? The results of this US study suggest that changes in strategy use can bear little relation to changes in drinking, and that intention to cut back is the most important factor.

Brief motivational interviewing works best for thinkers

This US study found that different types of heavy-drinking college students responded best to different types of brief intervention to promote moderation. In particular, those who as well as hard drinking liked hard thinking were most affected by being led to reflect via motivational interviewing on how their drinking compared to that of the average student.

Small rise in alcohol-related deaths in 2010

A slight rise in alcohol-related deaths has been reported for 2010, according to the ONS (bulletin here). Figures show a rise of 126 to 8,790 from 8,664 in 2009. Last year a slight fall was reported, though Alcohol Concern Chief Executive Don Shenker attributed the drop to a fall in consumption triggered by the recession. See BBC and Press Association reports.

Key points from the bulletin include:

• In 2010 there were 8,790 alcohol-related deaths in the UK, 126 more than in 2009 (8,664)
• There are more alcohol-related deaths in males than in females, with 67 per cent of all alcohol-related deaths in the UK in 2010 being male
• Alcohol-related death rates were highest for those aged 55-74 and lowest for those aged under 35 over the last ten years
• UK males aged 55-74 years showed a sharp and statistically signficant increase in alcohol-related death rate from 41.8 per 100,000 in 2009 to 45.2 per 100,000 in 2010
• Alcohol-related death rates varied between the regions of England and tended to be highest in the North and lowest in the East of England over the last ten years

Last year alcohol-related hospital admissions passed the one million per year mark and are still rising. However the definition maybe reviewed following news of the changes to the public health outcomes framework. See the Statistics on Alcohol: England, 2011 report for wider data on alcohol-related consumption trends and harm.

Alcohol research updates - web based reviews: online peer support; web-based self-help; online feedback to students

The role of online peer-support?

A new Insight from Alcohol Research UK has explored the value of alcohol-related online support groups to their users. The Insight Problem Drinking and Peer Support in Cyberspace looked at the experiences and motives in using online support groups. Reasons included dissatisfaction with AA, accessibility & convenience, anonymity and the ability to connect to others. Positives were also cited as ready access to connect with others and find information. However disadvantages were also identified, including misunderstandings, lack of social contact, group dynamics, a lack of response and dis-inhibited behaviour.

Given the growth in online resources and groups, the Insight emphasises the importance of sites maintaining up to date, accurate and reliable information. Moderators play an important role in providing good online peer support, whilst users ought to be made aware of the pros and cons.

Best evidence yet for web-based alcohol self-help

Also highlighted on the Alcohol Research UK blog, the Findings review of the potential effectiveness of web-based self-help resources. Given the rise and rise of the web, it explores the significance and potential effectiveness of online self-help and who may benefit most.

Providing web-based feedback and social norms information to reduce student alcohol intake

A further Insight has explored the feasibility and effectiveness of a web-based intervention including feedback on consumption and social norms. It indicated some small reduction in drinking and concluded that monitoring alone is likely to reduce weekly consumption. However keeping students engaged in online programmes required further work.

Scientists gleam further insight into alcohol's effect on brain reward system

Further insight into the effect of alcohol on the brain's reward system has been reported in the journal of Science Translational Medicine. It found alcohol effects the orbitofrontal cortex and results in a release of endorphins, previously only proven in animal studies. These naturally produced pain relieving proteins have an action akin to morphine, leading to drinkers experiencing pleasurable feelings.

The study found that heavier drinkers found alcohol more pleasant than non-drinkers. It also describes how the endogenous opioid function in the brains of chronic drinkers appears to change, in a sense 'over-learning' problem drinking behaviours. See reports in the Telegraph and Daily Mail.

The study may help to explain the mechanism by which antagonists such as Naltrexone work successfully, which could lead to the further development of pharmacological treatment approaches. Nonetheless, from the position that environment and learned behaviours also contribute to the development of problem drinking, successful alcohol treatment approaches emphasise the role of psychosocial as well as medical interventions. See here for the review into the effectiveness of alcohol treatment and NICE guidance.

Recently the message of a little but not often came out for preventing the development of alcohol problems. Sir Iain Gilmore, Chair of the Alcohol Health Alliance stated that having at least 2 alcohol free days each week was "a very good indicator of not being addicted". He emphasised the key is not to let regular consumption and rising tolerance end up as daily dependence, as experienced by as many as 1.6 million people in England.

This echoes calls from the Science and Technology Committee of MPs recently to urgently review alcohol guidelines and help the public to understand units better. The Change4Life website now contains public health messages about alcohol use within the context of a healthy lifestyle, and NHS Choices has useful tips for cutting down.

BBC Timeshift explores the social and cultural history of drinking in Britain

BBC Four's Timeshift, a documentary series into Britain's social and cultural history, featured episode 11 on 'The Rules of Drinking' this week and is available for a further 5 days on BBC iplayer.

The Rules of Drinking synopsis:

In the pubs and working men's clubs of the forties and fifties there were strict customs governing who stood where. To be invited to sup at the bar was a rite of passage for many young men, and it took years for women to be accepted into these bastions of masculinity. As the country prospered and foreign travel became widely available, so new drinking habits were introduced as we discovered wine and, even more exotically, cocktails.

People began to drink at home as well as at work, where journalists typified a tradition of the liquid lunch. Advertising played its part as lager was first sold as a woman's drink and then the drink of choice for young men with a bit of disposable income. The rules changed and changed again, but they were always there - unwritten and unspoken, yet underwriting our complicated relationship with drinking.

Another BBC feature 'Inside Out London' also featured alcohol this week - available on iplayer until 16th January. In it Wendy Hurrell goes attempts to 'go dry' in December whilst also talking to people who've experienced alcohol problems - and professionals trying to address alcohol misuse.

Working with Older Drinkers: Alcohol Insight warns of growing need to recognise alcohol problems amongst older people

An Alcohol Insight funded by Alcohol Research UK has explored alcohol problems and treatment needs need amongst older adults. The project found that evidence suggests a significant and growing number of older people are at risk of alcohol-related harm: 

• 20% of men and 10% of women aged 65 and over exceed recommended drinking guidelines and 3% of men and 0.6% of women aged 65-74 are alcohol dependent.
• There has been a steady increase in the amount of alcohol consumed by older age groups in recent years.
• Consumption patterns suggest that the ‘baby-boomer’ cohort is likely to have higher levels of alcohol consumption in old age than previous cohorts of older people.

The Insight found alcohol problems are less likely to be detected in older people as a result of complex physical and social problems, including a lack of awareness amongst professionals in recognising alcohol misuse, or barriers for older people to access help. See the full report here.

However older drinkers are just as likely to benefit from intervention as younger drinkers, though approaches should focus on quality of life in addition to issues surrounding alcohol and aim to promote independence and reduce risk. The Insight recommends further understanding amongst health and social care staff and substance misuse practitioners into the complex factors affecting older adults and alcohol misuse. It also suggests further recognition by commissioners and prevention programmes that address risk factors and strengthen protective factors.

Earlier this year a report from the Royal College of Psychiatrists advised over 65's should not drink more than 1.5 units of alcohol a day, and separate recommended guidelines should be considered. An Alcohol Concern Wales briefing paper was released earlier this year and presentations from an alcohol and older people event are available here. See here for a RCP leaflet outlining the key alcohol issues and risks for older people.

Findings brief interventions bulletins: all Primary Care staff can deliver; dependent drinkers respond to extended brief interventions in A&E

Recent research bulletins from the drug and alcohol Bank:

Alcohol brief interventions: doing without the Doctor

It works when the doctor does it, but what if the nurse or other primary care staff briefly counsel risky drinking patients? According to this synthesis of the research, it still works - maybe not as well, but perhaps more patients can be reached more cheaply. Modest impacts and imperfect methodologies mean it remains an open question whether meaningful drinking reductions would be found in usual practice.

Even dependent drinkers respond well to alcohol brief interventions

In the north of England just a few (and often just one) counselling sessions by a specialist alcohol nurse had a remarkable impact on drinkers seeking medical care at an accident and emergency department. What made it remarkable was the fact that these patients were not just heavy drinkers, but dependent and drinking as much as patients at alcohol clinics.

Brief interventions, also know as 'Identification and Brief Advice' (IBA) are a key part of alcohol harm reduction approaches as identified in NICE alcohol prevention guidance. However the difference between simple IBA, extended brief interventions and brief treatment approaches has been much debated, as explored in the briefing 'Clarifying brief interventions'.

See here for a recent briefing paper on mainstreaming brief interventions, or here for resources, e-learning or the INEBRIA webpage.

A forthcoming SIPS conference will release the results of the largest brief intervention pilot study conducted in the UK in March next year.

Findings offender-related alcohol research: need for offender services; alcohol diversion schemes

Recent research bulletins from the drug and alcohol Bank:

Blockages to adequate alcohol-related services for offenders
Based on exhaustive consultations in the south west of England, this report diagnoses the blockages to providing adequate alcohol-related services to offenders and makes recommendations to improve commissioning, coordination and practice.

No prison-community care pathway in north east England
Problem drinking offenders in north east England benefit from creative partnership working, but still this report baldly states that for prisoners whose sole substance use problem is drinking, a prison-community care pathway simply does not exist.

Young Hertfordshire alcohol offenders pay for their own alcohol education
Enticed by a halving in their fines, young 'binge' drinkers in south east England penalised for alcohol-related nuisance undertook a brief course which was followed by reductions in drinking and better management of potential flash points. The fines they did pay helped finance the courses.

Drinking and problems fall after educating young alcohol offenders in Derbyshire
Enticed by a halving in their fines, young 'binge' drinkers in northern England penalised for alcohol-related nuisance undertook a brief course which was followed by substantial reductions in drinking and alcohol-related problems. The fines they did pay financed the courses.

Alcohol-related Offender Health pages and relevant publications are available on the Alcohol Learning Centre, including NOMS alcohol interventions guidance.

Report says alcohol enforcement laws are not fully used, but enforcement alone is not the solution

A new report explores whether UK laws relating to the sale and consumption of alcohol are 'fit for purpose' and are being effectively enforced. The report finds that many laws are not being fully utilised, although a variety of measures are still required to achieve alcohol harm reduction.

Download ‘Lost Orders?: Law Enforcement and Alcohol in England and Wales’ or download the Executive Summary.

The report, commissioned by the Portman Group, was authored by Dr Fiona Measham of Lancaster University and research consultant Dr Phil Hadfield. It finds that laws designed to tackle underage drinking are not being used to their maximum effect, and that enforcement is rarely actioned against consumers rather than suppliers.

In a press release, Dr Measham said that prosecuting individuals for offences such as underage drinking, proxy sales and the serving of alcohol to intoxicated persons were regarded as too expensive and time consuming to pursue. The findings appear to re-iterate past messages that the 2003 Licensing Act powers have not been fully utilised - 2009 Home Office alcohol guidance referenced evidence that crime and disorder had remained stable but powers were underused.

Dr Phil Hadfield said: “One of the main messages of our findings is that there seems little point in Government introducing new tough sounding measures to tackle alcohol-related harms in the community if these laws are not actually enforced in practice. The rush to introduce new legislation has occurred at the expense of ensuring that the laws we already have are being implemented and effectively used.”

The report emphasises the importance of partnership working, local innovation and a greater recognition of health priorities. It also highlights that "regulation works best when embedded within community focused multi-component programmes (MCPs) that encompass broader approaches to harm reduction". A comprehensive report on multi-component pogrammes to reduce alcohol-related harm was published by the Joseph Rowntree Foundation in 2007.

A factsheet on Alcohol, crime and disorder in the Night Time Economy was published last year, and a recent London event explored some current initiaives including Licensing reform.

Brief interventions: achieving widespread delivery?

A briefing paper has been released exploring the barriers and challenges to implementing routine alcohol brief interventions (or 'IBA') across England. The paper also explores whether the 'lifestyles agenda' - a wider focus on all health behaviours - offers an opportunity or threat to mainstreaming alcohol brief interventions.

Download the report 'Brief interventions: achieving widespread delivery? Opportunities and challenges for the further delivery of alcohol ‘Identification & Brief Advice’ (IBA) across England'  [pdf]

The briefing follows a recent Alcohol Academy event and outlines much of the discussion on the day. The event looked at delivering brief interventions across a range of settings. Findings from the SIPS trial in Primary Care, A&E and Criminal Justice settings were also presented, although the official reports are yet to be released.

Speakers and audience members agreed overall that the 'lifestyle agenda' presented an important opportunity for integrating alcohol, particularly given the strong links between unhealthy behaviours and universality of health behaviour intervention approaches. However concern that alcohol specific tools or advice might be 'left-off' need to be carefully considered, especially given the efficacy for alcohol specific interventions.

The need to address practical and commissioning barriers were also raised. The implementation of IBA within Primary Care is still regarded as patchy or lacking, despite national incentive schemes. Many non-alcohol workers who should routinely deliver IBA may need further support, training or resources to be confident in asking about alcohol use. Whilst many areas are making progress, the paper calls on commissioners and public health leads to sustain and build on what has been achieved.

See here for further information and resources on IBA, including an e-learning course and a previous Academy briefing paper on 'Clarifying brief interventions'. Local DES implementation guidance is available, as is NICE alcohol guidance.