Alcohol Policy UK

Latest Findings alcohol research: Web-based interventions can work & what works best for young drinkers

Recent research from the drug and alcohol Bank:

REVIEW CONFIRMS THAT COMPUTER-BASED ALCOHOL INTERVENTIONS CUT DRINKING
Computer-based and in particular internet-based therapies open doors to treatment for drinkers who cannot get or do not want face-to-face-help. This review finds they do curb drinking, but its sub-finding that they are as effective as alternative therapies should not be taken to mean computers can replace therapists.

MODERATE DRINKING OVER THE WEB: THERAPY PROGRAMME BOLSTERS MUTUAL AID
Does it help to add a structured internet-based therapeutic programme to web access to a mutual aid network also geared to moderate drinking? Sustained extra moderation in the form of fewer days drinking was the clearest positive effect; less clear was whether it led to greater reductions in drink-related problems.

REVIEW OF STUDIES ON WHAT WORKS BEST WITH YOUNG DRINKERS
Though some studies may have been persuasive, this review of recent attempts to find which therapeutic approaches work best for young risky drinkers was unable to reach firm conclusions due to variability in the studies and methodological inadequacies. Still, the tentative verdict favouring cognitive-behavioural therapy, family therapy and community reinforcement accord with UK guidance.

Other recent Findings bulletins include:

• Emergency department nurses can screen for risky drinking
• Opioid antagonists useful supplement in alcohol treatment
• Spanish GPs target binge-drinking patients
• New Zealand commission calls for alcohol price rises and licensing reform

Hot topic searches can also be run on key issues including:

• Matching alcohol treatments to the patient
• Alcohol licensing, price and taxation

Fewer 11-15 year olds drinking finds NHS survey

Latest figures from a national survey of 11-15 year old pupils suggests fewer young people are drinking, and are less accepting of drunkenness. However it also finds no clear trend in consumption levels for those that do drink. The findings come from an annual survey which in 2010 included 7,296 pupils from 246 schools.

Smoking, Drinking and Drug Use Among Young People in England

Some key findings from the report includes:

• Between 2009 and 2010 the percentage of 11-15 year olds who had tried alcohol fell from 51% to 45%.
• In 2010, the mean amount consumed by pupils who had drunk in the last week was 12.9 units. Mean consumption levels have varied between 11.6 units and 14.6 units since 2007, with no clear trend
• The proportion of pupils who had never drunk alcohol rose from 39% in 2003 to 55% in 2010. Less than half (45%) of pupils aged between 11 and 15 said that they had drunk alcohol at least once in their lifetimes.
• The proportion of pupils who drank alcohol in the last week fell from a peak of 26% in 2001 to 18% in 2009.
• Pupils are more likely to be given alcohol than to buy it, most commonly by family or friends. However, about half (48%) of pupils who ever drink also said they buy alcohol, despite being below the legal age
• Of pupils that had drank in the last week, more than half (59%) drank more than four units on average.
• 68% of 11 and 12 year olds who drank alcohol usually drank with their parents, and 65% said they usually drank at home. By the age of 15, pupils were most likely to drink with friends
• Since the late 1990s, there has been an increase in the proportion who buy alcohol from other people and a fall in the proportion who buy from off-licences. The proportion of pupils who drink who buy alcohol in pubs and bars has also decreased

Chief executive of The NHS Information Centre Tim Straughan said the figures "point to an increasingly intolerant attitude among young people in today’s society when it comes to the use of cigarettes, alcohol and drugs." Chris Sorek, chief executive of Drinkaware, said the figures were "an early sign of a change in the nation’s drinking culture." But Sorek also highlighted that the chief medical officers recommend an alcohol-free childhood as best, whilst Addaction said referrals for young people needing help were rising. The NHS release said future data will establish how the findings fit into the longer term trend. See reports from the Telegraph and BBC.

A recent JRF report on drinking influences on young people found "family and friends have a strong influence on teenagers’ drinking patterns, and are stronger influences than some other factors – such as individual well-being, celebrity figures and the media."

See here for a range of further reports on young people and alcohol including the CMO guidance.

'Safe' drinking guidelines to be reviewed

A Commons Select Committe will review the evidence behind the recommended guidelines for alcohol. The move has been welcomed by both health and industry groups in order to strengthen the evidence base -  scepticism over the validity of the guidelines has been continually questioned since the first introduction of weekly guidelines in 1987.

News reports speculated it could lead to a relaxing of the guidelines based on other European levels (as featured here). However a recent Royal College of Psychiatrists report called for lower guidelines for older people. See press coverage in the Telegraph and Independent.

The guidelines currently advise adults not to regularly exceed:

• Men: 3-4 units per day
• Women: 2-3 units per day

Daily guidelines replaced a weekly message of 21 units per week for men and 14 for women, reportedly changed to prevent people from 'saving them up'. However critics have suggested that daily guidelines falsely infer daily drinking is safe and that guidance of at least two alcohol free days is overlooked. Alcohol free days are considered important to reduce the risk of dependency and health problems.

Other issues have been highlighted in relation to units - a recent survey suggested only 42% of adults could correctly equate units to certain drinks. This has been in part attributed to the increasing strength of alcohol and larger servings. For instance a 250 ml glass of 13% wine would have 3.3 units and a pint of 5.2% lager 3 units. A single 25 ml measure of spirits is 1 unit, but many premises serve 35 ml servings and home measures are likely to be more.

Further industry-led activity to raise unit awareness is expected following commitments outlined in the Responsibility Deal, including 'clear unit labelling on over 80% of alcohol by 2013'. However the Deals have been controversial with key health groups withdrawing and a recent report that 'nudge' approaches alone are not enough.

See blog posts on the news, Are the recommended guidelines 'nannying'? and Is the writing on the wall for alcohol units?

Behavioural interventions most effective for higher risk drinkers, NWPHO report shows

A report from the North West Public Health Observatory (NWPHO) demonstrates brief interventions for alcohol are the most cost effective, followed by interventions for smoking, sexual health and physical activity. 

Changing Health Choices - A review of the cost-effectiveness of individual level behaviour change interventions

Key findings include:

• The cost-effectiveness of brief interventions is strongest for interventions among high risk drinkers.
• The average costs of an intervention differ depending on the duration of the intervention, which health professional delivers it and the topic covered. For example, an intervention delivered by a GP is around double the cost of that delivered by a nurse, in terms of salary costs
• Training for nurses and other health professionals to undertake more brief interventions could therefore potentially lead to real cost savings or increased efficiencies. This is providing it can be shown that they are equally as effective as GPs in delivering these interventions, and that other costs (such as administration) are not increased

For resources and guidance on alcohol brief interventions (also known as Identification and Brief Advice) see here on the Alcohol Learning Centre. Findings from the SIPS trial are expected later this year which will provide insight into the most effective approaches for alcohol brief interventions.

The North West Public Health Observatory (NWPHO) hosts the Local Alcohol Profiles for England which provide alcohol related harm data and indicators for areas across the country.

The NWPHO  is based at the Centre for Public Health (www.cph.org.uk), Liverpool John Moores University. 

'Nudge alone is not enough' says Lords Committee report as BBPA reveal Responsibility Deal unit campaign

A Lords Select Committee report on behaviour change was released today, stating 'nudge' approaches alone are not sufficient for achieving population level public health improvements. Launching the report, Committee Chair  Baroness Neuberger said a "package of measures" was needed ranging from nudges to taxes and regulation.

Writing in a BBC report, Neuberger stated:

"There's no doubt that, when it comes to our health, our environment really matters. But the government must recognise that "nudging" isn't the only way to make a difference. Sometimes changing the environment will require something stronger. The move to introduce higher alcohol pricing is a good example of how legislation can be used to change our behaviour by changing our environment.

The government is also trying to "nudge" businesses to behave differently, through voluntary agreements rather than regulation. But we were unimpressed by the agreements that have been reached so far under the public health responsibility deal."

The report calls for further understanding about behaviour change and an independent Government advisor to give evidence based guidance. It also calls for steps to implement a traffic light labelling system on food packaging. See a Guardian analysis of the report which suggests there are many further considerations in assessing behaviour change.

Nudge approaches have been scrutinised since the Health Secretary Andrew Lansley said the government would go for "nudge" not "nanny" in November 2010. The publication of the Public Health white paper and announcement of the controversial Responsibility Deals followed shortly after.

The report coincided with the British Beer and Pub Association's (BBPA) release of first designs for a new national campaign to raise unit awareness amongst pub goers. The BBPA said posters, tent cards and beer mats featuring the slogan ‘how many units in your drink?’ are being piloted in selected BBPA member pubs over the summer, after which the materials will be available for pubs to order on a wider scale. See the poster here.

Andrew Lansley MP, Secretary of State for Health, commented on the campaign saying:

"This is another example of the Responsibility Deal giving people the information to make their own choices about their health and lifestyle. Everyone should drink responsibly and within the recommended alcohol limits. Women should not regularly drink more than 2-3 units a day; and men should not regularly drink more than 3-4 units a day. "

News & updates July 2011: wine strength stronger than labelled; Licensing and industry news; Public Health reforms & PbR updates

Wine makers "systematically" understate the strengths of wines, according to a Guardian report. A study found that that 57% of the wines analysed were stronger than on the label; average ABV content was found at 13.6% but the average labelled strength was 13.1%. The analysis also revealed that strength of wine across the world has risen by almost once per cent in recent years.

Pricing, trade and industry

The Guardian explores the minimum pricing plans in Scotland and Greater Manchester. The Scottish National Party have vowed to make action on cheap alcohol a top priority, according to the Daily Record. An interim evaluation report into the 2005 Scottish Licensing Objectives has been published.

A free journal article from PLoS Editorial suggests the corporate alcohol interests get off lightly in an article 'Let's be straight up about the alcohol industry'. In contrast, a recent MA comment exploring the production and marketing of lower strength 4% lagers argues industry goals of maximising profits do not equate to maximising consumption.

New Licensing fees in England could add 13p to a pint say the ALMR. It claims the Police and Social Responsibility Bill could add an additional £100 million in costs as local authorities will be able to charge fees, although a cap on the late night levy is expected. The Church of England could pull its investments from supermarkets which fail to meet minimum alcohol standards reports The Mirror.

'Crunk Juce', a 12% abv energy drink that will ‘leave you wondering what happened’, is to be reviewed by the Portman Group's Independent Complaints Panel. Police in Southampton have linked Crunk Juce to violent incidents according to the The Metro. 

Health and treatment

An update from the Department of Health on the Public Health reforms has been released, including a time-line for operational developments. News on the alcohol Payment by Results (PbR) pilot sites is on the Alcohol Learning Centre. The pilot phase will run from July 2011 until the end of March 2012 to test nationally developed products including assessment tools and outcome measures.

Scotland meeting brief interventions targets, show ISD statistics. In 2010/11 there were 88,138 alcohol brief interventions delivered as part of the HEAT H4 target.

Alcohol damages the DNA of unborn children a new study has found, as reported in The Independent and Medical Research Council. Alcohol can worsen stress according to recent research, whilst binge drinking can reduce girl's memory skills a BBC report says.

A NICE chief has warned of risks with 'nudge' approaches to public health, GP UK reports. A similar caution was made by a BMJ article earlier in the year. A Guardian piece titled 'A society in need of rehab' reflects on the change in understanding of addiction following the recent death of Betty Ford.

Articles on 'teetotal' young people and celebrities have been in the news. The Independent published 'The rise of the teetotal generation', whilst The Guardian published a facetious piece titled 'Young, gifted and dry'. Figures have shown continued rises in the proportion of young people not drinking, but those who do drink are drinking more - see recent statistics report and a 2009 JRF report.

Rise in illegal alcohol manufacturing hits news after fatal blast

Reports of a rise in counterfeit alcohol production have hit the news following a blast that killed 5 people in Boston, Lincolnshire.

In a BBC report on the Growing problem of illegally distilled alcohol, Trading Standards said that in some parts of the UK up to a quarter of licensed premises had been found to be selling counterfeit alcohol. It also reported that alcohol fraud costs the UK about £1bn a year in lost revenue, including £300m from illegal spirit sales, according to government estimates. Over £13 million of smuggled alcohol was seized last year.

An article in The Independent suggested producing counterfeit vodka was relatively simple, requiring only 'basic equipment'. It reported in certain areas the trade in counterfeit spirits was an 'open secret among the large community of migrant workers and the network of continental stores that has grown to serve them.' Trading-standards officers identified drinks that contained large quantities of methanol which can cause blindness.

A Channel 4 news feature includes a report on the drivers behind illegal alcohol production. Further reports in The Guardian and the Daily Mail.

Report finds ATRs reduce consumption and 'related' crime, but do not address all alcohol-related needs

An independent study by the Institute for Criminal Policy Research (at Birkbeck, University of London) has found that probationers on Alcohol Treatment Requirements (ATRs) reduced the overall rate of their known offending by 60 per cent. However the rate of reduction was identical to that for a matched comparison group of alcohol misusers supervised prior to the introduction of ATRs - though it found the ATR group had different and often more complex needs. This is likely to have presented a range of challenges to the Probation Trust in meeting the supervision and treatment needs of the ATR cohort.

The research also indicated that over the life of the ATR there had been a 37 per cent overall reduction in the self-reported number of drinking days (as measured by the Treatment Outcomes Profile), with nearly half (46%) moving from dependency during the course of the requirement. However high levels of on-going alcohol-related need were still identified even for those completing the ATR. The authors concluded that the main implications of their research relate to developing effective strategies to ensure that:

1. ATRs and overall court orders reach completion;
2. Offending outcomes for a large minority of the ATR group are improved;
3. Adequate provisions for on-going throughcare and aftercare in non-CJS settings, post-ATR completion, are in place.

See here for a summary of key findings from the research, funded via the National Offender Management (NOMS) alcohol best practice initiative. See here for NOMS Alcohol Interventions Guidance.

See here for further Offender Health documents and resources and evaluations of ATRs in Cheshire and a Liverpool ATR pilot.

Alcohol Diversion Scheme reports: Herts and Derbyshire

Reports on Alcohol Diversion Schemes (ADS) in Herts and Derbyshire have been released by Druglink. 

The schemes were set up to reduce alcohol-related crime and disorder by offering those fined for alcohol-related offences the chance of a reduced payment by attending a 3 hour course. Individuals given Penalty Notices for drunk & disorderly, drunk & incapable or Section 5 Public Order offences were offered the option of halving the £80 fine to a £40 course attendance fee.

Druglink says the course encourages 'offenders to face up to the reality' of their behaviour in terms of personal health risks, whilst also being 'encouraged to think of the consequences of alcohol fuelled violent behaviour to others around them.' The reports provide further details of the project including feedback from participants and course outcomes based on surveys.

The Derbyshire report states:

"Post course interviews saw a significant reduction in unit intake; the average units per person had decreased from 36 units to 15 units per week... 11% were still drinking above the safe guidelines falling within the 25-35 units per week, however this represented an overall reduction of 60% who were previously drinking at [hazardous or harmful] levels."

"Pre course interviewees were drinking on average 4 days a week, this was reduced post course by 50% to 2 days a week... Attendees reported actively managing and reducing frequency of consumption; they considered this a key element of managing their drinking and reducing the incidents of binge drinking."

Further alcohol-related Offender Health projects and reports are available on the Alcohol Learning Centre. A Home Office guide to Alcohol Arrest Referral schemes is also available.