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Also of concern are findings from a currently unpublished study by London Southbank University and Kings College London (Moss, Dyer et al) which found that exposure to Drinkaware posters actually appeared to increase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.

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.

Mentor toolkit supports schools to implement good drug and alcohol policies

Guest post courtesy of Claire James, Policy Officer at Mentor, a charity that works to protect children and young people from the harms of drugs and alcohol, which has recently produced ‘Reviewing your drug and alcohol policy: a toolkit for schools’.

The Department for Education commissioned Mentor to produce resources on drug and alcohol education and prevention for schools. Government policy is now to minimise guidance given to schools where possible, so the current DfE & ACPO Drug Advice for Schools is just 12 pages, focusing mainly on schools’ responses to drug and alcohol incidents. Mentor’s toolkit aims to build on this, helping schools take a wider view and a proactive approach to drug and alcohol use.

Where school drug and alcohol policies are considered carefully, they are much more likely to be effective and result in good outcomes. Yet many policies end up being made as a rushed response to an unforeseen incident. One suggestion in the toolkit is that schools consider whether their policy adequately deals with a range of scenarios. Schools can then be better prepared and be clear with pupils, parents and staff about the rules that are agreed. Key aspects to review might include:

• What are the rules about alcohol use on school trips? This should include thinking about staff responsibilities. For secondary schools and colleges, should there be different rules for 18 year olds?
• Should wine be provided at evening events for parents or offered as a raffle prize for fund-raising?
• Are there any particular sensitivities around alcohol that need to be taken into account when planning the school’s drug education, for example at a school with many Muslim pupils?
• Can the school support parents in setting rules around alcohol? As well as providing information to parents, being able to discuss this issue in groups can help parents feel more secure in setting reasonable rules, for example around teenage parties.

Good links with local drug and alcohol services and a proactive approach can enable schools to refer young people to appropriate support – not only after an incident but when there is any other cause for concern, or even through self-referral by young people.

Mentor believes consultation is key in creating a good school drug and alcohol policy. It can improve the policy content, raise awareness of the issues, and secure greater commitment to the final policy where people feel their views have been taken into account.

Visit www.mentor.org.uk for more information.

Further alcohol-related reports and guidance related to children and young people can be found here on the Alcohol Learning Centre, including the CMO guidance or see the Drinkaware web-page for parents. Adfam exist to improve the quality of life for families affected by drug and alcohol use - and have a find help here page.

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.

Alcohol 'discussion kit' aims to encourage citizen-led conversations

An 'alcohol discussion kit' has been released during Alcohol Awareness Week 2012 to encourage citizen-led discussions about alcohol use and risks. Under the Influence? was developed by Our Life, in partnership with NHS North West and NHS Western Cheshire.

The discussion kit aims to get people thinking more about alcohol and some of the factors that influence people's relationship with alcohol. The kit is made up of four main sections; an instruction booklet, a set of story cards, a set of influencer cards and a planning grid. Through the use of a set of cards, groups can consider a range of opinions before suggesting what they think is the best course of action.

The components of the discussion kits can be downloaded below:

Black & white copy

• Instruction Booklet
• Story Cards
• Influencer Cards
• Planning Grid

Colour copy

• Instruction Booklet
• Story Cards
• Influencer Cards
• Planning Grid

The kit was based on the findings of the ‘Talking Drink: Taking Action' Ellesmere Port Alcohol Inquiry.

Binge drinking influences on young people: Alcohol Concern & Balance report calls for action

A new Alcohol Concern and Balance North East report explores binge drinking, attitudes and influences amongst young people and argues a 50 pence minimum price is needed.

Download 'Binge – Drinking to get drunk: Influences on young adult drinking behaviours' [pdf]

An Alcohol Concern press release reported that the UK’s young people say it is cheaper to get drunk than go to the cinema. One thousand 16-24 year olds were asked about their views and experiences by a specialist survey research agency. Those surveyed agreed that 'drinking to get drunk' is the defining feature of how young people relate to alcohol. 

The report also states young people aged 15 and 16 years in the UK are more likely than those in almost any other European country to have been drunk at least once in the last month; are more likely to have experienced being drunk by the age of 13; and have by far the most positive expectations of drinking. See coverage from the Daily Mail and Sky news.

Balance, the North East Alcohol Office, have run previous activity to raise awareness of the impact of alcohol on young people, including a campaign against marketing targetting youngsters. Balance are calling for members of the public to sign a petition for a minimum unit price of at least 50p per unit.

Recently a JRF report explored regional variations in young people's drinking. NHS statistics produce annual data in Smoking, drinking and drug use among young people in England.

Further alcohol-related reports and guidance related to children and young people can be found here on the Alcohol Learning Centre, including the CMO guidance or see the Drinkaware web-page for parents.See here a post on IBA for young people our see all Alcohol Policy UK young people tagged reports.

Findings alcohol bulletins: preventing underage sales; fewer under-18s needing treatment; health promotion gains limited; alcohol testing lorry drivers?

Recent bulletins from the drug and alcohol bank:

Road-tested good ideas to prevent underage alcohol sales 

No controlled studies, but lots of ideas which seem to have worked from case study areas across the UK featuring innovation and cooperation in promoting compliance with laws banning sale of alcohol to under-18s and in reducing related public nuisance.

Fewer under-18s need specialist treatment in England 

National Treatment Agency for Substance Misuse documents increasingly successful specialist treatment of children with alcohol and drug problems in England. Patient numbers have fallen in line with falls among young adult patients and the general population, a sign of fewer drug problems generally, though cannabis bucked the downward trend.

Few sustained gains from health promotion session with college students

US university students at first cut back their drinking and cannabis use in response to a brief face-to-face contrast of their desired image versus their health-related behaviour, but the gains were no longer apparent a year later. Yet still at that time they had at least experienced more positive trends in how well they felt than students who had just read a fitness brochure.

Too little evidence to recommend drug/alcohol testing lorry drivers 

Exhaustive search finds just two rigorous studies of workplace testing for alcohol and/or drug use of people employed as drivers. For drugs there was some evidence of a long-term effect averting injuries and deaths, but in respect of both drugs and alcohol the evidence was too thin to support any particular policy.

Parents and children both affected by alcohol misuse: Adfam and Children's Commissioner reports call for further recognition & action

Children and teenagers recognised too as perpertrators

A new report has identified parents as sufferers of abuse and violence from substance misusing children. The report by Adfam and Against Violence and Abuse (AVA) explores and documents Child to Parent Violence (CPV) and consulted with 88 parents seeking support from services.

• Between a rock and a hard place - Project report (pdf)
• Between a rock and a hard place - Executive summary (pdf)

Key findings from the research found:

• Children as young as 11 and as old as 40 are physically, emotionally and/or mentally abusing their parents
• There is a significant correlation between substance misuse and perpetrating domestic violence
• 88% of victims of abuse were female and 12% were male
• That abuses range from lower grade emotional manipulation to at the extreme end deaths. Metropolitan Police Service records show that in 2009, 6 out of 7 non-partner/ex partner victims were mothers or fathers killed by sons – with substance misuse or mental health problems considered a key factor

The report makes reccomendations including calls for better understanding of CPV, how to respond to requests for help and referral mechanisms are needed for front-line workers (such as police, social workers and GPs). It argues family support services are a cost effective resource, providing essential support to parents at a fraction of the cost that other health and social care services. 

Children's Commissioner re-iterates calls for protection of children

A new report from the Children's Commissioner urges the Government to give as much attention to alcohol abuse among parents as to other drug misuse, and to train the relevant authorities to spot the signs of problem drinking in families earlier. See BBC report.

The Children's Commissioner exists to promote the best interests of children and young people in England. It's report suggest more than a fifth of all children in the UK, approximately 2.5 million, are living with a hazardous drinker (risky) drinker. The research also suggests 26,000 babies in England are living with a parent who is a dependent drinker, which is equivalent to 31,000 across the UK.

• Silent Voices - A briefing on the key themes and findings from the report
• Silent Voices – Supporting children and young people affected by parental alcohol misuse (Full report)

A similar report from Turning Point was released last year. In 2010 Alcohol Concern produced a report as part of Alcohol Awareness week 2010. Alcohol Concern's Embrace project was set up to develop better policy and practice around alcohol and children, families and domestic abuse.

Further alcohol-related reports and guidance related to children and young people can be found here on the Alcohol Learning Centre, including the CMO guidance or see the Drinkaware web-page for parents. Adfam exist to improve the quality of life for families affected by drug and alcohol use - and have a find help here page.

Willing consumers? Alcohol Concern Cyrmu 2012 marketing conference presentations

Presentations from Alcohol Concern Cymru's annual conference on 6 September 2012 have been made available. The event explored 'how alcohol marketing promotes a positive image of drinking, and how we can effectively challenge it' and received coverage on Wales Online and the BBC.

Presentations included:

• Andrew Misell, Alcohol Concern Cymru Manager: Alcohol marketing in Wales
• Maran Waran, London School of Marketing: Marketing fundamentals
• Gerard Hastings, Stirling School of Management: Alcohol marketing
• Alan Tapp and Katie Collins, Bristol Social Marketing Centre: Social marketing techniques to achieve social good
• Tom Smith, Alcohol Concern Youth Policy Project: Young people challenging alcohol marketing
• Colin Shevills, Balance North-East: Sam's snaps: Hitting them where it hurts
• Conference agenda

Alcohol Concern Cymru have previously published a number of reports relating to Wales and alcohol.

A blog post 'The drip feed' by James Nicholls was recently published exploring alcohol marketing and it's history.