Alcohol Policy UK

IAS Alcohol Alert 2011 issue 3

The Institute for Alcohol Studies' (IAS) latest Alcohol Alert is available, with the cover feature exploring the Prime Minister's recent indications of support for minimum pricing. See our recent report here after the Cameron spoke out on Britain's "alcohol scandal".

Also featured in the issue is a round up of news, activities and research over recent months, including Scots re-thinking alcohol licensing, London to prioritise alcohol harm via the London Health Improvement Board, and falling rates of drink drive fatalities.

The IAS also has a series of free alcohol factsheets.

Alcohol and Obesity: National Obesity Observatory report explores links

The National Obesity Observatory has published a report on the links between alcohol consumption and obesity:

Download: Obesity and alcohol – an overview

The report states that although there is no clear causal relationship between alcohol consumption and obesity, there are associations between the two which are heavily influenced by lifestyle, genetic and social factors. Many people are also not aware of the calories contained in alcoholic drinks which can contain "nutrient poor" calories, for instance there are up to 180 calories in a large glass of wine and 250 calories in a pint of strong lager.

Further key points from the report include:

• The effects of alcohol on body weight may be more pronounced in overweight and obese people
• Alcohol consumption can lead to an increase in food intake
• Heavy, but less frequent drinkers seem to be at higher risk of obesity than moderate, frequent drinkers
• The relationships between obesity and alcohol consumption differ between men and women
• Excess body weight and alcohol consumption appear to act together to increase the risk of liver cirrhosis
• There is emerging evidence of a link between familial risk of alcohol dependency and obesity in women

Many factors may be at play. Men tend to drink more beer, which may account for increasing waist measurements in males. Moreover, excess body weight coupled with alcohol consumption act together to increase the risk of liver cirrhosis. The links are important considering rising levels of obesity. 

In 2010 the  Liverpool John Moore's University published the report 'Alcohol and food: making the public health connections' which called for a "move away from seeing alcohol as a means to achieve inebriation to regarding it as an accompaniment to food with both being consumed in moderation."

Alcohol Concern have called for a greater public awareness of calories in alcoholic drinks, and for calorific information to be available at the point of sale.

Medical experts warn of "tipping point" in prevantable alcohol deaths

A new comment in The Lancet outlines the opinions of leaders in the medical field that England and Wales are approaching a "tipping point" in the level of alcohol-related deaths.

Professor Iain Gilmore, former president of the Royal College of Physicians, and Dr Nick Sheron, from the National Institute of Health Research, together with members of the British Society of Gastroenterologists, set out a "worst case scenario" of up to 210,000 preventable deaths over the next 20 years.

The projected figures include a possible 70,000 deaths from liver disease. With an estimated £2.7bn cost to the NHS from alcohol related harm, the comments by Professor Gilmore and his associates come swiftly after the British Liver Trust described deaths from liver disease as the equivalent of a jumbo jet crashing every 17 days.

The group are critical of the government's Responsibility Deal, and claim it is "entirely within the power of the UK government" to address the level of alcohol-related harm through legislative action on pricing, availability and marketing.

Alcohol Concern Chief Executive, Eric Appleby, said: "What we have to accept is that doing nothing is no longer a responsible option for alcohol policy, and that trying to 'nudge' drinking culture through information and persuasion has proved to be little better than doing nothing."

However Henry Ashworth, chief executive of the Portman Group spoke out against the claims. Ashworth said "painting doomsday scenarios" and "calling for Soviet Union-style population controls" would only serve to alienate the majority of people who drink responsibly. See BBC, Guardian and Morning Advertiser reports.

See here for a factcheck on alcohol-related deaths  and costs to the NHS from FullFact.org. David Cameron recently pledged to "tackle the scandal of alcohol abuse" - a new National Alcohol Strategy is due out later this year.

Mayor announces London sobriety scheme for offenders will go ahead

The Mayor of London Boris Johnson and his Deputy Mayor for Crime and Policing, Kit Malthouse, have announced that London will pilot the first sobriety scheme for persistent alcohol-related offenders in the capital.

The scheme aims to reduce re-offending by ensuring that alcohol does not act as a precursor to criminal activity. Offenders who have committed crimes such as assault and criminal damage may be offered compulsory sobriety as an alternative to custody. This will involve them being routinely monitored with a bracelet which can detect alcohol levels in the blood. See a here for a report on the scheme submitted to the MPA last year.

The scheme is based on a project for drink drivers in South Dakota, where a "fail = jail" message seemed to work. The UK scheme will consider charging the offender a small amount for daily alcohol monitoring. It appears to have wide support from London residents who were surveyed in a telephone poll. The Mayor has said the Government has backed the scheme, although it still requires legislation to be passed.

The pilot was first mooted in 2010 and also drew attention when Malthouse spoke on a BBC radio 4 feature saying London faced a "disproportionate" problem - a claim accepted by a fullfact.org exploration. Then the scheme drew sharp criticism from the Guardian. Now, however, it gets a "cautious welcome" from Alcohol Concern, who state that the pilot should offer sobriety testing as part of a "wider regime" of support rather than punishment.

The National Offender Management Guidance outlines the range of current options for rehabilitating offenders with alcohol-related offending patterns. Alcohol Treatment Requirements (ATRs) are often used as an alternative to a custodial sentences for those with alcohol dependency. See here for full guidance on addressing alcohol-related offending, and recent documents on IBA for offenders.

Panorama: Britain's Hidden Alcoholics - Alastair Campbell explores 'middle class' drinking

A Panorama feature this week explored the issue of "Britain's hidden alcoholics" and is available on BBC iplayer until 4th March 2012.

The programme is an account from Alastair Campbell, Tony Blair's former spokesman, on 'the British middle class's troubled relationship with alcohol and his own long and complicated history with drink.' A supporting article is available to read here.

BBC programme synopsis:

Alastair Campbell meets some of the increasing number of Britain's middle-class professionals for whom one glass of wine after work is never enough, and asks if we all need to reassess our relationship with drink.

Alastair, Tony Blair's former closest advisor, knows from bitter experience the true cost of excessive boozing: his alcoholism contributed to his nervous breakdown.

With nearly 9,000 people dying from alcohol-related diseases every year and leading medical experts describing it as a health crisis, Campbell ventures into the world of Britain's hidden alcoholics and asks how much is too much.

Building Safe, Active Communities report supported by £1m local councils fund

A fund to support local action against alcohol harms has been announced by Baroness Newlove, the government's Champion for Active, Safer Communities. A report which captures progress on innovative projects to make communities safer was also released.

The £1m Department of Communities and Local Government (DCLG) fund will be available to Local Authorities to spend over a 2 year period. It will be spread between 10 communities, each receiving £50K. Commitment to collaborative working by local agencies and residents will be integral to receiving the funding. The DCLG report, Building Safe, Active Communities: strong foundations by local people sets out  tackling alcohol harms as one of Baroness Newlove's key priorities. 

The report highlights key issues which need to be addressed in the forthcoming alcohol strategy. In particular it highlights the need to reduce alcohol-related harms in young people including: setting good parental examples, encouraging young people to take responsibility for their own behaviour, mentoring, and giving young people and residents a say in how drinking problems in their locality can be tackled.

It builds on the "grass roots" approach, in which action is taken as a result of active collaboration between local residents, the Police, Local Authority, Health and local businesses. The report cites good practice examples, such as the Newquay Safe Partnership, which saw joined up action to reduce the number of fake IDs and proxy buying lead to a 30% reduction in reported anti social behaviour incidents.

The report also call for further action on the part of the drinks industry, and evidences the decision by Heineken to stop producing cheap ciders as an example of corporate social responsibility.

Minimum pricing speculation continues as Prime Minster speaks out on 'alcohol scandal'

Alcohol policy hit the headlines again this week with David Cameron talking tough on the "alcohol scandal" costing the NHS close to £3 billion per year. Visiting a hospital in north-east England, the Prime Minister spoke of the unacceptable impact of public drunkenness on the NHS and police services across the country.

Cameron called for "innovative" approaches including "drunk tanks" to divert the intoxicated from busy A&Es, and for further enforcement from police to tackle alcohol-fuelled disorder. However the Police Federation criticised the calls saying they are already struggling to resource existing workloads.

The Prime Minister has attracted support from health groups for highlighting the issue of cheap alcohol as part of the problem. Cameron has previously sparked speculation that the Government will seek to introduce minimum pricing in the forthcoming national alcohol strategy.

However in truth the strategy is unlikely to set out direct pricing measures beyond the below cost ban due later this year, which is not expected to affect prices under a 'Duty + VAT' definition of cost. But the Government is likely to continue to pursue taxation measures as already outlined and advised by the IFS, but strongly opposed by the on-trade.

Speaking on the issue, Cameron said:

"We are going to look at the issue of pricing. I am quite convinced that there's deep discounting through supermarkets and sometimes convenience stores of alcohol that is causing part of the problem, but we're looking at this carefully to try and find the right answer.

The issue has attracted widespread media attention. Channel 4 news explored the alcohol policy issue, highlighting conflicts between alcohol industry voices opposing minimum pricing instead in favour of education - an approach often rejected by health groups as ineffective. A Guardian comment also explored alcohol policy tensions, highlighting the controversial Responsibility Deal and Scotland's determination to secure minimum pricing and test EU law on the issue.

See Guardian, Telegraph and BBC reports and interesting pricing and policy analysis in The Spectator. The Guardian's cartoon also satirised the news against Hogarth's depiction of the 18th Century Gin Lane.

Drug and alcohol guidance for IAPT workers released by NTA and Drugscope

A guide for IAPT mental health workers for supporting those with co-existing mental health and substance misuse problems has been released by the NTA and Drugscope:

Positive practice guide for working with people who use drugs and alcohol [pdf]

Improving Access to Psychological Therapies (IAPT) services support those with common mental health issues such as anxiety or depression, both closely linked to alcohol misuse - however IAPT services are not typically required or trained to work with drug and alcohol issues.

The guide was therefore developed to support IAPT workers to work confidently and inclusively with those who have common mental health problems and non-severe drug or alcohol problems. It explains how simple assessment can identify IAPT clients whom will be suitable for brief interventions for their drug or alcohol misuse.

Routine assessment or 'identification' of current use of drugs and alcohol is  recommended for all IAPT clients. Many of the general cognitive and behavioural techniques used by psychological therapy workers are transferable to working with drug or alcohol use, where a non-judgemental approach should be maintained.

The guide highlights that substance misuse clients with mental health problems should have access to NICE-recommended psychological interventions, including CBT for depression and anxiety. It states there is no evidence that substance misuse per se makes key psychological therapies ineffective. Between 70 and 80 per cent of clients in drug and alcohol services have common mental health problems, largely anxiety, depression and trauma.

However the guide highlights the expertise available within drug and alcohol treatment services to provide evidence-based psychological interventions for mental health issues will often be limited. IAPT services may therefore crucially provide one of the only local resources for clients of drug and alcohol services to access psychological therapies for common mental health problems.

Alcohol and mental health factsheets are available here from the Mental Health Foundation, the Institute of Alcohol Studies and Alcohol Concern.

Find out more on IAPT services here. For further information on mental health see NHS Choices mental health pages, MIND, the Mental Health Foundation or Centre for Mental Health. The Samaritans offer a 24/7 confidential support service for anyone experiencing feelings of distress or despair.

News & updates Feb 2012: MPs debate alcohol policy; Scotland's 45 minimum pricing impact revised

Alcohol strategy gets Westminster debate

A Westminster debate on alcohol policy and the forthcoming strategy has been highlighted by Alcohol Concern - see part 1 and part 2 of the debate which includes statements from MPs across the parties.

Public health Minister Anne Milton said the forthcoming national strategy included ambition to "remove a significant number of units of alcohol from the UK market through changes in how alcohol is produced and sold". See a Morning Advertiser (MA) report or the the Daily Mail's take. See recent news on lower strength drinks here.

After calling for the debate, Dr Sarah Wollaston, a Conservative MP who has previously called for tougher regulatory and pricing measures re-iterated the case for stronger action. An open letter from health groups has also asked MPs to support minimum pricing following Alcohol Concern's call on the public to push MPs to support it.

Scotland

The University of Sheffield have produced an updated review into the likely impacts of minimum pricing in Scotland (report here). It suggests a slightly smaller effect on consumption than first estimated, but would still be expected to save thousands of lives and millions of pounds. A minimum price of 45p per unit of alcohol would reduce consumption by 4.3% rather than the previously estimated 4.7%. See BBC and Guardian reports.

Controversy over whether the European Commission had given a supportive indication to the Scottish Health Secretary over the legality of minimum pricing within EU law is outlined in a BBC report.

A Scottish Government alcohol campaign is encouraging women to 'drop a glass size', warning of the risks of regular consumption, similar to England's recent Change4Life campaign. A ‘drinking time machine’ app is also part of the campaign.

Other news

Portman Group Chief Executive Henry Ashworth, Chair of the Responsibility Deal’s Alcohol Network (RDAN), has said the Responsibility Deal will suffer without health partners involvement - see MA story.

National Pubwatch has teamed up with drinks giant Diageo to launch an awards scheme to recognise responsible drinking - MA report. The introduction of the Late Night Levy could cost the industry as much as £25 million according to the Home Office consultation, the MA reports.

Liverpool may go for local minimum pricing, following in the footsteps of Manchester hoping to introduce it via local by-law changes. Ireland could also be going for minimum pricing according to the MA.

New Guidance for Mental Health Liaison services highlights role of alcohol in mental health problems

The Royal College of Psychiatrists has released guidance for Commissioners of Mental Health Liaison Services in Acute Care. The guidance document is one of a suite of four documents for commissioners covering all aspects of mental health commissioning.

There is a strong connection with substance use and mental health issues. The Institute of Alcohol Studies reports that up to 6% of patients with two or more neurotic disorders are alcohol dependent, as opposed to 2% of the general population.

Frequently alcohol is implicated in self-harm, whether as a substance of regular misuse or as an agent for the self harm. A briefing paper by Alcohol Concern echoes the links between alcohol use and mental health co-morbidity, stating that alcohol is a significant factor in suicides, with up to 65% involving alcohol misuse. With the advent of community care, people with severe mental health problems are more likely to be living in the community and exposed to easy access to alcohol.

Identifying and supporting people with mental health and alcohol problems as they enter Acute Care is a challenge. The new guidance showcases the Birmingham Rapid Assessment Interface and Discharge (RAID) model as good practice. The RAID service offers consultant and liaison support to A&E, MAU, Medical, Maternity and Surgical wards. It offers a holistic approach which addresses the patient's mental health, physical health and social needs. This inclused assessment and support for addictions and an important "all age appropriate" service.

The guidance calls for the better assessment, management and signposting of mental health issues, including alcohol-related problems. The benefits of better liaison services would include: reduced Out Patient attendances, reduced hospital admissions and re-admissions and better protection of patients from avoidable harms. Both alcohol and mental health problems carry huge stigma, and it is hoped that by following a holistic approach to patient care this could be significantly reduced.

The guidance documents are launched a year after the DH released No Health without Mental Health, the cross government mental health outcomes strategy.