Alcohol Policy UK

Alcohol pricing: Findings research bulettins; Commons pricing debates

Following the recent below cost ban and Home Office publication of the likely pricing impacts, the drug and alcohol Bank has released a series of bulletins:

• UK government assesses the likely impacts of alcohol price rises
• How alcohol pricing might affect the health of the British population
• Higher prices and taxes on alcohol help prevent crime
• Economic impacts of alcohol pricing policy options in the UK
• Will the poor be most affected by an end to cheap alcohol?

Ministers discuss...

The issue of minimum pricing and alcohol taxation was also a long subject of debate in the commons last month. The Prime Minister also hinted that mandatory labelling was an unlikely prospect, but instead favoured "...the tax system to deal with problem drinks, which we are looking at, and at tougher minimum pricing for alcohol."

Mayor's report proposes 'alcohol sobriety scheme' for London

Members of the Metropolitan Police Authority (MPA) have received a report from the Mayor on the proposal of an alcohol sobriety scheme for London:

'The compulsory alcohol sobriety scheme is an enforcement approach providing specific powers for the court to order sobriety as an order for alcohol related violence offences. The Mayor is tabling an amendment to the Police Reform and Social Responsibility Bill for changes in the current law to enable the courts to make this order. The compulsory alcohol requirement will involve twice daily testing and failure of the test will result in immediate breach and sanctions, such as custody.'

'It is based around some key principles:

• The judges opt to use compulsory sobriety as a sentencing option instead of choosing to incarcerate offenders.
• The convicted individual is required to check into a designated venue twice daily to be breathalysed for alcohol consumption.
• If the terms of the sentence are breached, the individual is arrested, put into a police cell over night and presented to the judge the following day. The judge has the discretion to decide what happens to the offender, for example incarcerate them, put them back on community sentence etc.
• Individuals pay for their testing.'

The Evening Standard reported the news, highlighting high levels of alcohol-related violence in the capital. However the idea attracted scepticism when announced last year; Don Shenker of Alcohol Concern said he was "dubious about the long term success", instead suggesting alcohol arrest referral programmes required further funding.

Currently Alcohol Treatment Requirements (ATRs) are often used as a voluntary alternative to custodial sentences for those with alcohol dependency. See here for full guidance on addressing alcohol-related offending, and recent documents on IBA for offenders.

NICE 'Alcohol dependence and harmful alcohol use' clinical guidelines

The final guidance on alcohol dependence and harmful alcohol use has been released by the National Institute of Clinical Excellence (NICE). See press release here. 

The clinical guidance (CG 115) offers evidence-based advice on the diagnosis, assessment and management of harmful drinking and alcohol dependence in adults and in young people:

Alcohol use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence [pdf] 

See here for the full 654 page document.  

A 24 page quick reference guide is also available summarising the recommendations made.

Further NICE alcohol guidance is available including:

• Public Health guidance (PH24) Alcohol-use disorders - preventing harmful drinking
• Alcohol-use disorders: physical complications (CG 100)
• School-based interventions on alcohol (PH7)

See the Alcohol Learning Centre for further alcohol-related guidance and resources.

'Can nudging improve population health?' asks BMJ

The British Medical Journal (BMJ) has published a free article assessing the nudge approach now popular with US and UK health policy makers. Judging nudging: can nudging improve population health? explores the concept of 'nudge' and whether it can make an impact on areas such as alcohol harm and obesity.

It explains nudging as 'an approach to behaviour change that focuses on altering environmental cues to prompt healthier behaviour', rather than relying on the provision of information such as through health campaigns. Citing the popularisation of the term 'nudge' in the book (and now blog) of the same title, it says:

"...nudging could include a wide variety of approaches to altering social or physical environments to make certain behaviours more likely. These might include providing information about what others are doing (“social norm feedback”) ... changing the defaults that surround the serving of food and drinks, or altering the layout of buildings to cue physical activity." 

The article sets out a table of nudge examples including making alcohol available in smaller glasses or raising awareness of lower alcohol consumption behaviours. The Health Secretary has emphasised an approach of "social responsibility, not state regulation" set out in the public health White Paper. Plans have been announced to make smaller glass sizes available, whilst the controversial Responsibility deals are expected to stay close 'social norm' approaches. The Change for Life campaign now includes a 'drink swap' element.

However the report warns of limitations to the evidence, potential for harmful nudges or 'perverse responses', and the role for regulatory measures. In conclusion, the article writes:

"Nudge and similar recent popular texts have stimulated policymakers to think about altering environments to change behaviour. These developments are to be welcomed. Evidence to support the effectiveness of nudging as a means to improve population health and reduce health inequalities is, however, weak. This reflects absence of evidence as well as evidence of little or no effect.

Without regulation to limit the potent effects of unhealthy nudges in existing environments shaped largely by industry, nudging towards healthier behaviour may struggle to make much impression on the scale and distribution of behaviour change needed to improve population health to the level required to reduce the burden of chronic disease in the UK and beyond."

An interesting collection of 'alcohol nudges' can be found on the nudge blog.

Guardian attacks Government alcohol policy claiming responsibilty deal 'on the rocks'

The Guardian last week published a series of articles questioning the Government's alcohol policy and the state of the responsibilty deal. In the article 'Alcohol policy in tatters as health experts revolt', the Guardian claimed health members planned to walk away, angry at their limited influence in favour of industry agendas. It reports "The so-called responsibility deal will do the "bare minimum", such as putting information on beer mats", whilst issues such as marketing and promotion were said to be "outside the parameters of the discussions".

The Guardian, which runs an alcohol page on its website, also published a series of further articles critiquing alcohol policy. The paper had also commissioned an investigation into the recent plans to ban the sale of alcohol below duty + VAT, reporting that 'Minimum alcohol price would hit one in nearly 4,000 drink deals.' However some such as The Economist and Professor Ian Gilmore have suggested the move was a 'step in the right direction', whilst we have continued to highlight the differences between a below cost ban and minimum pricing.

The Guardian published in its letters section a number of responses, including from the Chief Executive of Diageo stating they "have signed up to work together to improve the health of the public". However the Guardian continues to speak out on alcohol policy, today warning failure to act will cost 250,000 further lives by 2015.

A recent YouGov survey indicated British opinion is split over whether Government alcohol policy should go further and introduce minimum pricing; 47% are reportedly in favour with 44% against.

WHO release global alcohol strategy and status reports

The World Health Organizaion (WHO) has released the Global strategy to reduce harmful use of alcohol [pdf]. The strategy calls for wider implementation of policies to save lives and reduce the health impact of harmful alcohol drinking. The global strategy focuses on ten key areas of policy options and interventions at the national level and four priority areas for global action. WHO press release.

Each year the harmful use of alcohol kills 2.5 million people internationally, including 320,000 young people between 15 and 29 years of age. It is the third leading risk factor for poor health globally, and harmful use of alcohol was responsible for almost 4% of all deaths in the world, according to the estimates for 2004.

Also released is The Global status report on alcohol and health (2011) which presents a comprehensive perspective on the global, regional and country consumption of alcohol, patterns of drinking, health consequences and policy responses in Member States - see press release. 

Separate profiles can also be accessed including Europe and individual countries including the UK factsheet.

National alcohol treatment statistics report (NATMS) 2009/10

[update: see here for Statistics from the National Alcohol Treatment Monitoring System (NATMS) 1st April 2010 - 31st March 2011]

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.

'Making alcohol a health priority': invest to save says Alcohol Concern amidst rising hospital admissions

Alcohol-related hospital admissions could hit 1.5 million a year by 2015 if further investment in alcohol is not prioritised, say Alcohol Concern. The charity calls for increased investment as the rising trend of alcohol-related hospital admissions could bring to the cost of alcohol to the NHS to £3.7 billion per year.

Read the report 'Making alcohol a health prority: opportunities to reduce alcohol harms and rising costs' [pdf]

An Alcohol Concern press release states:

"If the 100% rate of increase continues, it will waste billions of pounds to the NHS...The campaign group has called for Government to invest in alcohol health workers in every hospital, A&E unit and GP practice. This will save the NHS £3 for every £1 spent, according to the report, as well as reduce the current level of 15,000 alcohol-related deaths per year and 1.2m incidents of violent crime."

See here for news reports from the BBC and The Publican.

National and local alcohol hospital admissions rates can be found from the North West Public Health Observatory. For further alcohol information and resources see the Alcohol Learning Centre, including the data and weblink sections.

Alcohol awareness and general information is available from NHS Choices and Drinkaware.

'Wine, supermarkets and British alcohol policy'

A paper has been released by the History & Policy body exploring Wine, supermarkets and British alcohol policy. It explores the current alcohol policy context and parallels with history.

The paper in particular explores the focus of recent public debate and policy on public and on-trade consumption, in its conclusion asking whether 'a greater policy focus on domestic consumption would better reflect the balance of risks posed by alcohol today'.

Excerpts from the executive summary include:

• Recent concerns over cheap drink have led to a policy debate on minimum unit pricing and the banning of the 'below-cost' sale of alcohol
• A dramatic increase in wine drinking has contributed significantly to the marked rise in per capita consumption of alcohol over the last forty years
• Supermarkets and off-licenses have played a pivotal role in the expansion of domestic wine drinking in the UK
• Parallels between current public alcohol policy debates and that taking place in 1860 such as pricing, the roles of the drinks and licensing industries, British drinking culture and on and off-trade tensions
• Policy discussions tend to dwell on the negative impacts of public drinking; a more critical focus on domestic drinking may be appropriate in future

The paper was authored by James Nicholls, a Senior Lecturer in the School of Humanities and Cultural Industries at Bath Spa University and author of 'The Politics of Alcohol: A History of the Drink Question in England' (Manchester University Press, 2009).

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 [email protected]. 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.