Alcohol Policy UK

JSNA support pack for drug and alcohol commissioners

A JSNA support pack for substance misuse commissioners has been published by the National Treatment Agency.

From April 2012, Public Health will sit within Local Authorities and will be responsible for the commissioning of drug and alcohol services. It is intended that there will be a more integrated approach to treatment with a strong focus on recovery.

The overarching principle is that "drug and alcohol commissioners work closely with all relevant partners to commission services based on outcomes". Pilots into Payment by Results for alcohol treatment and drugs are also underway.

There are 4 main tenets to the new JSNA support pack.

1. Improved access both to early, preventative interventions and to treatment
2. Treatment should be recovery-orientated, effective and protective
3. Treatment should deliver recovery-orientated outcomes
4. Sustained recovery is key.

The pack is intended to support the development of a local needs assessment, planning and delivery of treatment services prior to the establishment of Public Health England. Although the focus of the document is mainly on commissioning for drug use, the basic principles apply for commissioning services for dependent alcohol users.

Full NICE alcohol quality standards and commissioning guidance is set out for alcohol treatment services.

Forthcoming 2012 events: NDSAG, Drug and Alcohol Today, City Health, Alcohol Academy symposiums, and more

New Directions in the Study of Alcohol Group (NDSAG) 2012 is fast approaching; this year Professor Stephen Rollnick headlines the main day exploring 21 years of experience and the future for motivational interviewing.

The conference takes place from Thursday 24th May 2012 to Sunday 27th, in Llandindrod Wells, Powys, Wales. Other keynote speakers will include Professor Keith Humphreys and Professor Nick Heather. See the NDSAG 2012 conference programme, the NDSAG 2012 booking form or here for any further information.

A conference City Health 2012 is being delivered in partnership with the London Drug and Alcohol Policy Forum. The conference will take place in the City of London’s historic Guildhall on 22nd and 23rd October 2012 and will examine policy and practice in relation to public health in cities, with a special focus on health behaviours – including on diet, alcohol, sex, drugs, smoking, nightlife and entertainment venues.

The Drugs & Alcohol Today 2012 event takes place on the 5th July 2012, hosted in partnership with Brighton & Hove Drug & Alcohol Action Team. It features a programme of  seminars on current practice and national policy, drawing upon regional issues and examples of best practice. It also includes the exhibition of local, regional and national organisations and projects.

The Alcohol Academy is planning a number of events for strategic alcohol leads and commissioners to explore local implications of the new alcohol strategy. The first event takes place in London on the 27th April, with more to follow across the country. If you would like to enquire about or help organise an event for alcohol leads in your region please get in touch.

This week the London Borough of Haringey launches a 'Recovery Pride Week', which includes a Recovery Pride Charter. The week aims to celebrate, empower and promote recovery, and tackle stigma against those with drug and alcohol problems. Download the press release here.

From June 30th 2012, the People's History Museum in Manchester will run an exhibition Demon Drink? Temperance and the Working Class.

Jobs: IAS Research and Information Officer

The Institute of Alcohol Studies are inviting applications from graduates for the post of Research and Information Officer to be based at the London office. The appointment is for a fixed term of 12 months:

• Post title: Research and Information Officer
• Salary: £24,000
• Contract: 12 months fixed-term contract
• Location: Alliance House, 12 Caxton Street, London, SW1H 0QS
• Responsible to: Director of Policy.

For a job description and further information click here.

Government's Alcohol Strategy: 2012 national strategy confirms minimum pricing for England and Wales

The rumours were true; the Government's Alcohol Strategy has confirmed minimum pricing is to be brought in for England and Wales. Although the unit price is still to be set, in a press release the Prime Minister said "if it is 40p that could mean 50,000 fewer crimes each year and 9,000 fewer alcohol related deaths over the next decade." 

The strategy sets out key policies including: 

• a minimum unit price for alcohol;
• banning the sale of multi-buy discount deals;
• zero tolerance of drunken behaviour in A&E departments;
• a late night levy to get pubs and clubs helping to pay for policing; and
• improved powers to stop serving alcohol to drunks.

The strategy, today released by the Home Office, sets itself out as a plan to reduce binge-drinking in a bid to drive down crime and tackle health issues. It includes a continued support for effective health measures such as brief interventions, alcohol treatment and hospital Alcohol Liason Nurses.

The decision to introduce a minimum unit price means that alcohol will not be allowed to be sold below a fixed price per unit - a policy advocated by health groups and Alcohol Concern for a number of years. As the release states, it "will put an end to cheap white ciders, spirits and super-strength lagers". It is expected to go out for consultation, with a possible introduction by 2014.

In the foreward to the strategy, the Prime Minister says:

“When beer is cheaper than water, it’s just too easy for people to get drunk on cheap alcohol at home before they even set foot in the pub.

“[Minimum pricing] isn’t about stopping responsible drinking, adding burdens on business or some new kind of stealth tax - it's about fast immediate action where universal change is needed.

“And let’s be clear. This will not hurt pubs. A pint is two units. If the minimum price is 40p a unit, it won’t affect the price of a pint. In fact, pubs may benefit by making the cheap alternatives in supermarkets more expensive.

“Of course, I know this won’t be universally popular. But the responsibility of being in government isn’t always about doing the popular thing. It's about doing the right thing.

Minimum pricing has always seemed broadly unpopular with the public, often of the view it would "punish the responsible majority" - a view emphasised by sections of the alcohol industry. The past Government shied away from minimum pricing despite calls from its CMO and Health Select Committee. But overruling the views of the Health Secretary, David Cameron has repeatedly expressed his desire to act on cheap alcohol, including the heavy discounting or "loss-leading" commonly seen in supermarkets.

Eric Appleby, Chief Executive of Alcohol Concern, described it as "a victory for common sense" and that "all the research shows there is a link between price and consumption and we know that lives can be saved if a minimum price is introduced.” Alcohol Concern however highlighted the need for significant investment in alcohol treatment and interventions, starting that "current health spending priorities really need to be rebalanced if these excellent objectives are to be translated into real progress on the ground."

Chris Sorek, Chief Executive of the industry funded alcohol awareness charity Drinkaware, expressed concern that "the strategy does not include measures to tackle the worrying trend of Britain’s hidden binge drinkers. Recent ONS statistics confirm Drinkaware’s evidence that 25-44 year old working professionals are drinking more heavily and more regularly than young adults." See the full Drinkaware press release and a Morning Advertiser round up of industry reaction. 

To support the strategy, minimum pricing infographics have been produced to demonstrate the likely impact of a 40 pence minimum price. A series of 'myth busting facts' were also outlined. A series of Guardian reports can be found here, one describing the move as "the biggest public health intervention since the Labour government's smoking ban", and "follows months of Whitehall infighting over the legality, effectiveness and politics of imposing a minimum price". See also reports from the Daily Mail and The Telegraph.

Minimum pricing has been at the forefront of the national alcohol policy debate, particularly since the release of research from the University of Sheffield modelling the likely benefits of introducing various minimum unit prices. However opponents of minimum pricing, particularly sections of the alcohol industry and retailers, have argued minimum pricing is a blunt measure and could contravene EU legislation. Scotland is currently introducing a minimum price, whilst the IFS advise lobbying for EU law changes to allow tax restructuring to achieve a minimum pricing effect.

Previous national alcohol strategies were released in 2004 and 2007.

News & updates March 2012: Budget continues alcohol duty escalator; Scotland's minimum pricing moves a step closer; other news

Budget 2012 - alcohol duty escalator continues

The 2012 budget has been announced the continuation of the alcohol duty escalator of 2% above inflation (RPI), first started in 2008. With inflation over 3%, the above 5% rise in duty is expected to add 11 pence to a bottle of wine, 41p on a 70cl bottle of spirits and 3p to a pint of beer. See a Daily Mail report on the rise or a BBC budget summary.

Pub industry and trade groups continued to speak out against the duty escalator, which they say amounts to a 42% rise in beer duty since its 2008 introduction, having a "devasting impact" on the pubs and employment. The BBPA's Brigid Simmonds also said the rise had not produced a proportionate increase in revenue and was damaging the economy.

The Coalition had previously outlined tax increases as part of its tax policy to 'tackle problem drinking', including changes to duty on weak and strong beers. Taxation has been called for by the IFS as the preferred approach to minimum pricing measures, though does not prevent supermarkets "loss-leading", a strategy much disliked by the Prime Minister.

The Chancellor George Osbourne also announced a rise in cigarette duty and a consultation on anti-fraud measures to address illicit alcohol. Reports of conterfeit and smuggled alcohol appear to have increased in recent years.

Scotland's minimum pricing steps forward

The Scottish government's Alcohol (Minimum Pricing) Bill passed its first parliamentary stage last week, with no opposition votes - see BBC report. The Scottish Conservatives and Lib Dems are now supporting the Bill, but Labour MSPs still oppose it saying it will bring a "windfall" to retailers.

The Scotch Whisky Association still claim the move is illegal and will be challenged under EU law. England's forthcoming alcohol strategy is expected to set out its position on minimum pricing within the next month.

Other news

A Tory MP and Doctor, Daniel Poulter, says the NHS must focus on prevention rather than cure in a Guardian piece, which backs minimum pricing and a focus on early intervention. The Association of Chief Police Officers (ACPO) have also backed minimum pricing measures, and Sussex police have spoke out in support of the forthcoming Late Night Levy.

Analysis of past studies showed the hallucinogenic drug LSD helped problem drinkers. A prescription drug used to treat anxiety may assist alcohol dependency, according to researchers at Cambridge University.

Proposed tourism reforms could lead to an increase in underage binge drinking say the LGA. Though supporting many of its suggestions for cutting top-down red tape, the LGA warn that deregulation of licensing, planning regulations and other rules could result in high streets with poorly run licensed premises with less enforcement of ID checks.

SIPS alcohol screening and brief interventions findings released

Findings from the SIPS trial, the largest UK alcohol screening and brief intervention study, have been released.

The study took place across key settings of Primary Care, Emergency Departments and Probation and tested the effectiveness of a range of brief intervention approaches and screening tools. A conference event took place on the 5th of March 2012 to launch the findings, with presentations available to download.

Download the 3 key SIPS factsheets:

• Alcohol Screening and Brief Intervention in Emergency Departments
• Alcohol Screening and Brief Intervention in Primary Health Care
• Alcohol Screening and Brief Intervention in Probation

SIPS covered 9 Emergency Departments, 29 GP surgeries and 20 Probation Offices across London, the South East and the North East of England. During the 13-month data collection period 10,530 patients were screened with 2,481 recruited into the study. The trial tested three key 'brief intervention' approaches of:

1. Feedback [of screening result] + Patient Information Leaflet (PIL)
2. Feedback + five minutes of structured advice using the SIPS brief advice tool + PIL
3. Feedback + 20 minutes of 'Brief Lifestyle Counselling' (BLC) + PIL

For Emergency Departments, the Modified Single Alcohol Screening Question (M-SASQ) was found to be the most efficient and effective screening tool. However successful implementation in EDs required champions and dedicated staff. In terms of results, all three approaches showed positive outcomes on drinking behaviours, with greater effects at 12 than 6 months. However when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. However lifestyle counselling was considered to have a greater cost impact due to greater QALY gains and a greater reduction in societal costs.

In Primary Care settings, the FAST alcohol screening tool was the most efficient and effective screening tool. Successful implementation though required financial incentives, training and ongoing specialist support, though longer lifestyle/extended interventions were harder to implement. All brief intervention approaches resulted in reductions in alcohol use, but when compared to simple feedback and leaflet, brief structured advice or longer 20 minute lifestyle counselling did not offer any significant advantage in terms of drinking behaviour or alcohol use disorder outcomes. Feedback and leaflet was found to be the most cost-effective approach.

In Probation (Criminal Justice) settings, the FAST was also found to be the most effective screening tool. Successful implementation was challenging, requiring managerial support and ongoing specialist input to maintain activity. For 'increasing risk' [hazardous drinkers] who scored between 8-15 on the AUDIT, simple feedback and leaflet was as effective as longer interventions or lifestyle counselling. However for 'higher risk' [harmful] drinkers scoring 16 or more on the AUDIT, more intensive interventions were beneficial.

For tools and resources to support the delivery of alcohol brief interventions see here on the Alcohol Learning Centre. See the SIPS website for forthcoming further analysis and details of the SIPS 'junior' trial which will explore the impact of brief intervention approaches on young people.

Home Office evaluation of Alcohol Arrest Referral pilots: ARRs do not appear cost-effective

The Home Office has published a report on the findings of the two Alcohol Arrest Referral (AAR) pilots. The AAR pilots took place between 2007 and 2010 in twelve police forces, but the evaluation did not find measurable reductions in re-offending or overall cost efficacy, despite evidence of reduced drinking.

The AAR pilots built on the early success of schemes such as the AAR in Dudley and Worcester, which were evaluated by Professor Doug Sharp in 2004. These early schemes appeared successful and roll out of similar schemes was supported by the 2007 national alcohol strategy. However a 2009 Home Office guide to setting up ARRs warned of the challenges.

The pilot schemes aimed to refer those arrested and deemed drunk to an alcohol worker to receive a brief intervention (IBA). Brief interventions included linking alcohol and the offence, with the aim of motivating a reduction in alcohol consumption and in re-offending rates. However the interventions were targeted at at-risk drinkers, yet a significant 37% to 38% of offenders identified were found to be alcohol dependent.

At an average cost of between £62 and £826 per brief intervention the schemes were not deemed cost-effective. This may be because the users of the AARs are not prolific offenders, and therefore would not be expected to show a reduction in re-offending over a relatively short period of time. The report also highlights the possibility that the brief interventions do not sufficiently tackle criminogenic needs of the offenders, as a reason for their apparent lack of effectiveness in reducing further criminal activity.

There did, however, seem to be some evidence of a reduction in consumption by scheme users. The report recommends mandatory over voluntary referral approaches to increase attendance on first appointment to maximise this opportunity for engagement. It notes a key feature of AARs working effectively was good co-operation between the Custody Suite and specialist alcohol services, coupled with high level Police commitment to champion scheme development.

Alcohol Treatment Requirements presently exist for dependent offenders, and alcohol diversion schemes have also been established. SIPs research has also examined the suitability of brief interventions in probation settings with more promising results. Resources used with offenders and more information on AAR schemes can be accessed on the Alcohol Learning Centre site. Nevertheless, the Centre for Mental Health say support for offenders with alcohol problems remains inadequate.

Drugscope express concern over lack of drug and alcohol recognition in proposed COF

DrugScope have published a consultation response calling for inclusion of specific references to alcohol and drugs within the Commissioning Outcomes Framework (COF). They call for a specific indicator for dual diagnosis (co-morbidity), and ask for alcohol and drug problems to be recognised as long-term conditions.

COF will enable the NHS Commissioning Board to identify how the Clinical Commissioning Groups (CCGs) are achieving the priorities for health improvement as outlined in the NHS Outcomes Framework. The COF contains indicators which derive mostly from NICE evidence based standards and the NHS Outcomes Framework. However no specific reference to alcohol was made in the draft COF indicators.  It is intended that COF becomes operational in April 2013.

Although alcohol services will be commissioned by Public Health through Local Authorities, the CCGs will have reason to address the needs of many people who have alcohol problems. Other key links such as health inequalities and family or parental misuse are also cited as reasons to ensure substance misuse is sufficiently recognised in the COF.

Alcohol is recognised, however, within the recently published NHS Public Health Outcomes Framework, as part of the Health Improvement domain. This includes a committment to monitor alcohol-related hospital admissions, though the definitions may change. A new alcohol strategy is expected later this month. Information on the new public health system has been produced by The Department of Health as a series of factsheets.

Below-cost ban would stop fewer than 1 in 50 alcohol discount offers

A recent  bulletin suggests the forthcoming below-cost ban would stop fewer than 1 in 50 alcohol discount offers:

As the British government reportedly tussles over whether to set a minimum per unit price for alcohol, evidence from Newcastle that the alternative below-cost ban would have prevented less than 1 in 50 discount offers.

Policy debates on pricing alcohol in Britain in order to reduce alcohol-related harm have focused on two options: setting a minimum price per unit of alcohol; or banning below-cost sales. Unit prices which have been considered include the £0.50 recommendation from the UK government's former chief medical adviser. Instead of this, for England the government has proposed a below-cost ban based on on the rate of duty plus value added tax (VAT – the tax levied on sales to consumers in the UK). At the time of the featured study, this would have resulted in a minimum unit price of around £0.21–£0.28 depending on the type of drink.

Read the full bulletin here and see our previous review of why a below-cost ban is not minimum pricing, as is often confused in media reports.

A Guardian report had previously suggested the below cost ban would only affect one in nearly 4,000 drinks. The ban is due to come in under forthcoming Licensing changes this year and the Home Secretary has stated it was expected to result in 7,000 fewer alcohol-related incidents and 1,000 fewer hospital admissions. Nonetheless, a commitment to minimum pricing by 2015 may be outlined in the new national alcohol strategy, expected by late March 2012.

National Liver Disease Strategy moves one step closer

The development of a National Liver Disease Strategy (NLDS) is moving closer after first being announced over 2 years ago.

With excessive alcohol consumption, obesity and hepatitis B and C infections as the main causes of liver disease, early identification and treatment is key to success. The strategy will seek to ensure improved partnership working in order to address the major lifestyle behaviours affecting liver disease rates.

To influence the development of the liver strategy, NHS Liver Care are hosting a number of workshops for health specialists around the country, and have revealed a new on-line newsletter called Liver Matters to kick-start discussions and interest in liver disease.

The British Liver Trust recently called for a national liver screening strategy following their Love Your Liver roadshows in major cities across the UK in January 2012. Overall 28% of the general public who had their liver health assessed were referred back to their GPs for further assessment and Liver Function tests (LFTs). Those in Glasgow seemed to have the most unhealthy livers, with 41% of those tested referred back to their GP, compared with only 10% in Birmingham. 

Andrew Langford, the Chief Executive of the British Liver Trust said "We are faced with unprecedented levels of Liver Disease over the next couple of decades due to the lifestyles we now lead." He emphasised that drinkers should have at least 2-3 consecutive days off alcohol each week to give the liver a chance to recover. A 63% rise in liver disease amongst young people was recently reported in the North East over the last 7 years.

The Government recently announced the new Change4Life campaign "Don't let drink sneak up on you" to emphasise the the importance of alcohol free days, a message some argue was lost in the switch from weekly to daily guidelines.