Alcohol Policy UK

Latest Findings alcohol research: parenting, web-based and student interventions reviewed

Recent research from the drug and alcohol Effectiveness Bank:

Parenting intervention has remarkable impact on teen drunkenness
In this initial developer-led trial in one county in Sweden, routine parent-school meetings encouraging commitment to take a strong stand against underage drinking had a remarkable impact on adolescent drunkenness.

Benefits fade after fine-tuning prevention to high risk personality traits Addressing the substance use promoting tendencies of the personality traits of London schoolchildren at particular risk of substance misuse led to persistently lower drink-related problems, but after a year drinking itself was not significantly affected.

Parent-child intervention prevents heavy drinking in Dutch teens In this Dutch study, promoting parental rule setting and classroom alcohol education together nearly halved the proportion of adolescents who later went to drink heavily. Rarely have such strong and sustained drinking prevention impacts been recorded from these types of interventions.

Preventing drinking and drug use among students in London This bulletin highlights three attempts to prevent substance use among London school or college students. The first two used the same system to adjust counselling to the personality of the student and had at least some short-term success, even when using school staff as counsellors. The third individualised the approach via motivational interviewing but without success.

UK trial of web-based alcohol prevention program for college students
Would the US tactic of telling college students how little the average student really drinks work with their hard-drinking British counterparts? This UK trial was not altogether convincing, but the US evidence is on balance positive.

National alcohol treatment statistics report (NATMS) 2009/10

The second national report on alcohol treatment has been released by the National Treatment Agency (NTA):

'Statistics from the National Alcohol Treatment Monitoring System (NATMS) 1st April 2009 – 31st March 2010' [pdf]

Excerpts from the executive summary include:

• There were 111,381 clients in contact with structured treatment aged 18 and over who cited alcohol as their primary substance in 2009/10. This is an increase of 11,283 (11%) from 100,098 clients in the previous year.
• There were a further 31,733 clients who cited alcohol misuse as a secondary problem to other primary problematic substances.
• Clients’ median age at their first point of contact with treatment in 2009/10 was 41 and 65% of clients in treatment were male.
• Most clients were White British (97,089 or 88%), while other ethnic groups each accounted for no more than two percent of clients.
• Where reported, 26,662 (37%) were self referrals and 15,166 (21%) were referrals from GP’s. Onward referrals from other substance misuse services together accounted for 8,474 clients (12%).
• More than three quarters (54,242 or 79%) of all clients waited less than three weeks to commence treatment.
• The most common intervention type received was ‘structured psychosocial’ with 45% of clients receiving this in their latest journey (50,379 interventions).
• Where reported, one in twenty five clients (2,416 or 4%) had No Fixed Abode on presenting for treatment; a further 10% of clients (6,510) had other housing problems.
• Of the 63,632 clients exiting treatment in 2009/10; 30,533 (48%) were no longer dependent on alcohol and a further 4,640 (7%) were transferred for further treatment within the community

Also available is local level alcohol treatment data (register here for restricted access). The NATMS alcohol data is a subset of the NTA's NDTMS data sets on drug treatment. See the the NTA site here for further information and last year's national report.

In 2005 the Alcohol Needs Assessment Research Project (ANARP) was published but calls for further investment in alcohol treatment continue.

NTA seek views on 'building recovery' approach to treatment

The National Treatment Agency for substance misuse (NTA) is seeking views on a new service framework to deliver the new drug strategy. The consultation page asks 'what should a recovery-oriented drug treatment system look like?', highlighting:

Among the key issues for discussion are whether treatment for drug and alcohol dependence should be closely integrated, and how all treatment inside prisons and out in the community can be better brought together in a seamless service.

The new framework should also reflect the importance of assessing and meeting the wider physical, mental and social needs of substance misusers, and promote a new culture of ambition that enables people to choose recovery.

See here for the consultation questionnaire [pdf] whilst queries can be sent to yourviews@nta-nhs.org.uk. The consultation suggests submissions of evidence and/or examples of good practice to support responses. Consultation closes on 4 May 2011.

A separate Home Office consultation on More effective responses to anti-social behaviour runs until 03 May 2011. It proposes to streamline a number of existing anti-social behaviour powers, though is not expected to significantly affect existing alcohol-related powers.

News and comments Dec 2010: reaction to Drugs Strategy, Public Health White Paper and Licensing reforms; further news

Early responses to the new 2010 Drugs Strategy have been released by Drugscope, Addaction and the NTA. Reports from the BBC, Guardian and a Telegraph comment. Follow DS Daily for more.

Following the release of the public health White Paper, a summary of alcohol references have been highlighted on the ALC. An article in the Independent asks whether Lansley's policies are 'Nudge or Fudge', the Telegraph reporting 'no more nanny state'. The Guardian published a supportive GP comment and a radical critique on responding alcohol misuse. The Conservative MP Sarah Wollaston expressed support for minimum pricing in an outspoken interview on public health policy.

Following the announcement of the Licensing Act changes, there have been many reports and comments from the trade journals such as the Morning Advertiser (MA) and The Publican. The MA have continued to highlight concerns for the on trade and accusations of policy makers paying lip service to pubs. Another report, Government explains off-trade inaction is backed by a comment on 'the government assault on progress' whilst trade chiefs have said the reforms could cost them £1m per week. Publican reports have included will the late-night levy become a legal battleground? but also highlighted MPs speak up for pubs in Westminster debate.

Other news reports

As home drinking becomes an increasingly popular topic for debate, the Telegraph reports Supermarket sells smaller wine bottles to curb home drinking.

Drinkaware have suggested soaps should change their portrayal of alcohol from 'perpetuating a false and potentially damaging view of alcohol'. A research report suggested that little or no representation of the everyday effects of excessive drinking may normalise a false belief of consequence free binge drinking. Drinkaware are meeting with TV producers to advise soaps to better depict the risks associated with alcohol. See more here.

In other news, binge drinking doubles heart risk a British Medical Journal report finds. Research from Mintel expects a fall in Christmas alcohol sales this year reports the BBC. Underage test purchases are 'not effective' according to a study which says a more holistic approach is required. The Publican reports students are unhappy over media's portrayal of drinking habits.

Drug strategy 2010 outlines joint drug and alcohol treatment objectives

The 2010 drugs strategy Reducing demand, restricting supply, building recovery: supporting people to live a drug-free life has been released by the Home Office. It outlines that "severe alcohol dependence raises similar issues [to drug dependence] and that treatment providers are often one and the same. Therefore, where appropriate, this strategy will also consider severe alcohol dependency."

An alcohol chapter on page 7 states:

'Alcohol plays an important part in the cultural life of this country, with large numbers employed in production, retail and the hospitality industry. Pubs, bars and clubs contribute to community and family life and also generate valuable revenue to the economy. However, alcohol is a regulated product. Some individuals misuse it, contributing to crime and anti-social behaviour, preventable illness and early death.

The estimated £18-25 billion a year cost of alcohol misuse spans alcohol related disorders and diseases, crime, loss of productivity in the workplace and health and social problems experienced by those who misuse alcohol and the impact this has on their families14. For the NHS alone, the estimated financial burden of the harmful use of alcohol (regularly drinking at increasing or higher risk levels) is around £2.7 billion.

The evidence suggests that a dependent drinker costs the NHS twice as much as other alcohol misusers and that the largest and most immediate reduction in alcohol-related admissions can be delivered by intervening with this group through the provision of specialist treatment.

It is estimated that 1.6 million people have mild, moderate or severe alcohol dependence. About a third of these will face some challenges that are similar to those dependent on drugs in needing support to help them recover. It is specialist alcohol treatment, for those in this group who would benefit from treatment, that this strategy aims to improve.'

Also released this week was the Ministry of Justice Green Paper and consultation Breaking the cycle: effective punishment, rehabilitation and sentencing of offenders. Last week the public health White Paper was released, outlining the new Public Health England service and ring-fenced budget for local authorities.

New public health White Paper outlines future alcohol health policy

The Department of Health has published the new White Paper Healthy lives, healthy people: our strategy for public health in England. It sets out the framework in which a new public health service, named Public Health England, will manage a ring-fenced budget of around £4 billion. The paper proposes Public Health England will take on full responsibilities from 2012 with the ring-fenced funding allocated to local government from April 2013 as Primary Care Trusts are removed. 

The White Paper states it will "end central control and give local government the freedom, responsibility and funding" to address public health locally. In the foreword, the Health Secretary Andrew Lansley says it aims to avoid "nannying" but "empowers individuals to make healthy choices". The paper confirms the controversial Responsibility Deals - industry led groups tasked with promoting healthier lifestyles on areas such as alcohol and obesity.

Limited detail is given in respect of alcohol specific treatment and interventions, though states it will "align funding streams on drug and alcohol treatment services across the community and in criminal justice settings" and will "incentivise recovery outcomes". Further details will be outlined in the forthcoming Home Office drugs strategy. A consultation page for the White Paper is available here. The proposals will need to be approved by Parliament as part of the Health and Social Care Bill.

See reports on the White Paper from the Guardian, BBC and the Telegraph. See statements and comments from Drugscope, the King's Fund and the Faculty of Public Health.

Britain top for cocaine use in Europe

Britain has the highest rate of cocaine use in Europe according to the 2010 Annual report on the state of the drugs problem in Europe. The report states 6.2% of Brits aged 15-34 reported using cocaine in the past year, compared to a European average of 2.3%.

The report was produced by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). It highlights 9.4% of 15-64 year olds in England and Wales have taken cocaine at some point in their life, rising to 14.9% for 15-34 year olds. Use amongst the 15-34 year old group has risen by close to 50% since 2003 with a proportional increase in related deaths (161 in 2003 to 325 in 2008). Cocaine is the second most popular illicit drug in Europe after cannabis. 

See reports in the Guardian and Telegraph, and an Observer comment piece on Why Britain tops world drug use league.

In a press release, the EMCDDA stated:

'The diverse patterns of drug use in Europe today call for treatment services to respond to a more complex set of needs than a decade ago. With more cannabis, stimulant and polydrug users now in contact with services, there is a growing call for interventions to address problems other than opioid use.'

The report said surveys found that the prevalence of heavy episodic drinking is much higher among cocaine users than in the general population. Next month the Home Office is expected to release the new drugs strategy which is expected to set out a more holistic approach to drug and alcohol treatment.

Earlier this year a briefing paper Cocaethylene: responding to combine alcohol and cocaine use was released by the AERC Alcohol Academy. It highlights a need for better recognition of the effects of combined alcohol and cocaine use through further policy and treatment attention.

The EMCDD report also highlighted the challenges faced by Europe in tackling new patterns of use and supply, including higher numbers of older drug users seeking help.

Lancet study says alcohol causes greatest overall harm

A study published in the Lancet suggests alcohol is the most harmful drug when factoring in the cost to society as well as individuals. Drug harms in the UK: a multicriteria decision analysis, was co-authored by Professor David Nutt who hit the headlines last year after he was sacked from his advisory role to the last Government.

The findings develop on an earlier study by Professor Nutt which called for the classification system of drugs to be reviewed in line with harm. Nutt is continuing to call for a change in Government policy; "The Misuse of Drugs Act is past its sell-by date and needs to be redone."

See reports from the BBC and the home editor's comment. A Guardian story outlines Professor Nutt's ideas around a new classification system.

 

The new Lancet study claims to have taken a more advanced approach to assessing harms, using a wider range of 16 criteria. These include an assessment on each drug's affects on users' physical and mental health, social harms including crime, family problems, environmental damage and economic costs. "Overall, alcohol is the most harmful drug because it's so widely used" Nutt has said.

Latest Findings alcohol research Oct 10: Naltrexone aids treatment; Drink-driving cut by 30 minute talk; treatment aids families too

Latest alcohol research from the Findings database:

Naltrexone aids primary care alcohol treatment The large-scale US COMBINE study reinforced evidence that the opiate-blocking drug naltrexone also helps dependent drinkers and extended its potential to the kind of drinkers and the kind of treatments found in primary care settings.

Drink-driving cut by 30-minute talk with hospital patients Risky drinkers admitted to a US hospital following a traffic accident had fewer arrests for drink-driving after a short talk with hospital staff about their drinking, the first such finding and one which strengthened the case for hospital-based brief alcohol interventions.

Patient-focused alcohol treatment aids wives and children too Whether families benefit from alcohol treatment as well as the patients has rarely been studied. This US analysis demonstrated that they do, positioning treatment as also a child and family welfare intervention. Such added value should help sustain treatment in the face of current financial cutbacks.

Drug strategy and NHS commissioning reform consultation responses

Two consultations relevant to alcohol policy recently closed; the Home Office led 2010 Drugs Strategy consultation and the NHS commissioning reform proposals. Below we've highlighted responses from some key organisations.

Drugs strategy responses

Drugscope, the national charity for drug misuse, have supported the overarching aims set out in the consultation. In its response it highlighted members support a focus on "recovery and social (re)integration and applaud the recognition that delivering on this recovery vision requires a holistic approach". However a range of recommendations were made including 'a clear commitment to an evidence-based approach to drug policy', 'maintaining a ring fenced budget for drug and alcohol treatment' and 'consideration to the development of a joint drug and alcohol strategy'. See Drugsope's consultation response overview [pdf].

See here for responses from Transform, the drug policy and law reform organisation, Domestic Violence organisation the Stella Project, and drug and alcohol service providers Addaction & Westminster Drug Project UK.

NHS commissioning reform responses

The King's Fund response, Liberating the NHS: too far, too fast, suggests how the reforms should be implemented, also producing a guide that examines the past and future role for GPs in commissioning - A focus on GP commissioning.

The NHS Confederation's response sets out 40 suggestions for improving the new system but warned it will be 'exceptionally difficult to deliver major structural change and make £20 billion worth of efficiency savings at the same time.'

The Royal College of General Practitioners (RCGP) response included a press release which said 'GPs support stronger clinical leadership for commissioning services for patients, but training, time and resources are necessary to make it a success.'

The AERC Alcohol Academy's response said it was imperative that continued investment in alcohol treatment and prevention was vital and that alcohol's voice nust not be lost amongst the wider changes. It also called for recognition of the need for specific alcohol commissioning skills.