Alcohol Policy UK

Alcohol & Gambling: Alcohol Concern report explores links and recommendations

Alcohol Concern Cymru and the Royal College of Psychiatrists (RCPysch) Wales have published a joint report on the links between alcohol misuse and gambling, exploring key policy implications and recommendations.

Download 'A losing bet? Alcohol and gambling: investigating parallels and shared solutions' [pdf]

The press release includes warnings from professionals who identify links in addictive behaviours and the limited recognition of problem gambling and associated research. The report includes a "snapshot" survey of 66 people from which one in six respondents who had sought help for alcohol misuse said they had also experienced problems with gambling. BBC report here.

Mark Leyshon from Alcohol Concern Cymru said:
 
“Both alcohol misuse and excessive gambling can be regarded as significant public health problems, with adverse consequences to individuals and the wider society... It is likely, however, that mechanisms proposed in the alcohol field, such as restricting the availability of alcohol, tightening marketing rules, and providing tougher measures to protect the young, may be equally effective in curtailing problematic gambling.

Professor Jim Orford from Gambling Watch UK backed the report’s findings:
 
“The field of gambling studies has a great deal to learn from its alcohol counterpart, which is much better and longer established. Gambling Watch UK welcomes this report and fully endorses its recommendations. Problem gambling is now as prevalent as the problematic use of illicit drugs, but gets minimal attention by comparison. We need to start taking it far more seriously.”

The report’s key recommendations include:

• Further research into: the effects of curtailing gambling opportunities, the identification of problematic gambling, and new treatments that can be used to tackle this issue
• Access to treatment for both alcohol and gambling problems to be available and well-funded, and screening for gambling problems should be routine in substance misuse services
• Greater protection to children and young people against potentially addictive products such as alcohol and gambling
• A national database to capture the scope of problems associated with gambling, and this should feed into national strategies for managing addictions.

GamCare provides support, information and advice to anyone suffering through a gambling problem. Gambleaware also offers signposting and support and information on Gamblers Anonymous is here. See here for alcohol support or call Drinkline 0800 917 82 82.

Is it time for global alcohol consumption guidelines?

A comparison of drinking guidelines around the world shows there is little consensus between countries on what constitutes ‘safe’ or lower risk alcohol consumption. In this guest post, Dr Richard de Visser, a Senior Lecturer in Psychology at the University of Sussex explores the study conducted with Doctoral student Ms Nina Furtwængler. It was published this month in Drug and Alcohol Review.

The study examined government alcohol consumption guidelines in 57 countries, including all 27 European Member States, and found a remarkable lack of agreement about what constitutes harmful or excessive alcohol consumption on a daily basis or weekly basis.

Key findings were:

• Muslim countries and eight of the 27 EU member States (including Cyprus, Greece and Hungary) do not have readily accessible guidelines. Some countries refer to standard drinks, but do not define them in grams of ethanol  (e.g., Kenya, Malta)
• Some countries do not define standard drinks, but offer general guidance encouraging moderate alcohol consumption and/or abstinence in certain circumstances  (e.g., Belgium, India, Norway, Western Samoa)
• The alcohol content of a “unit” or “standard drink” ranges from 8g in the UK  to 14g in Slovakia and the USA.
• In some countries the weekly maximum is simply seven times the daily maximum, whereas in others there is an explicit statement that drinkers should have at least one alcohol-free day a week
• There is no consensus as to whether it is safe for women to drinking as much as men

Additional analysis of drink-driving legislation found surprisingly wide variation in legal blood and when driving:

• Of the 145 countries for which limits are available, 21 (14%) allow no alcohol in the blood of drivers
• Among the 124 countries that allow drivers to have alcohol in their blood, there was a ten-fold variation between the least and most generous .

Specific guidelines are likely to be more useful for individuals and health professionals than vague advice to “drink moderately”. However, it is important to note that people who possess knowledge of unit-based guidelines do not necessarily know how to use them or feel motivated to apply them.

Despite these caveats, it is important for people who do want to adhere to recommendations to drink responsibly that there are internationally agreed standard definitions of alcohol units and consumption guidelines. Agreed international guidelines would make it easier for people living in a globalised world to develop and use transferable skills for monitoring and regulating their alcohol consumption.

In England the Government is currently reviewing the drinking guidelines for the first time in 15 years. The Government's response follows the recent House of Commons' Science and Technology Committee (STC) report, which declared the existing guidelines as "confusing" and called for further clarity.

DrugScope briefing 'Public Health Reforms: What they mean for drug and alcohol services' & RCGP briefing on Primary Care treatment

Drugscope, the national organisation representing the drug treatment sector, has published a briefing exploring the public health reforms and their expected impacts on drug and alcohol services.

Download The Public Health Reforms: What they mean for drug and alcohol services [pdf]

The briefing explains the key changes including:

In April 2013, the National Treatment Agency for Substance Misuse will be abolished and its key functions transferred into Public Health England. Most of the current budget for drug and alcohol services will be transferred to Directors of Public Health employed by Local Authorities, who will also be statutory members of the new Health and Wellbeing Boards.

Directors of Public Health (DPH) will be responsible for delivering public health outcomes in their local area, will control the bulk of drug and alcohol funding and will oversee a department or directorate that will be responsible for delivering the outcomes from the local Health and Wellbeing Strategy. Health and Wellbeing Boards (HWBs) will set out local strategies through the development of Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs). A new executive agency, Public Health England (PHE), will take the national lead on public health issues from April 2013.'

The briefing also gives a detailed exploration of key issues such as 'What will happen to Drug (and Alcohol) Action Teams (DATs)?' and 'what will be the role of Public Health England (PHE) in providing the sort of national co-ordination that the NTA has provided?'.

On the subject of 'How much will be invested in drug and alcohol services in the new system' the briefing details:

On 10 January 2013, the Government announced the ring fenced public health grants for upper tier and unitary local authorities for 2013-14 and 2014-15. A total of £2.66 billion in 2013 -14 and £2.79 billion in 2014-15 will be available to local authorities to spend on public health services for their local populations. This money absorbs an estimated £800 million to a £billion plus of current drug and alcohol funding. This means that approximately a third of the local authority grant for public health will be comprised of money that has to date been invested in drug and alcohol interventions, including what was contained in the 2012-2013 pooled treatment budget and the former health support component of DIP (total around £460 million).

RCGP & SMMGP briefing on primary care treatment commissioning

A briefing on Primary Care Drug and Alcohol Treatment: Commissioning and Provision Against a Backdrop of Localism has been produced by The Royal College of General Practitioners (RCGP) and Substance Misuse Management in General Practice (SMMGP). The briefing considers the future impact of the changing commissioning environment on primary care drug and alcohol treatment.

The Cabinet Office and the LGA are launching an academy to help senior public servants improve commissioning, reports the Guardian.

WHO release 'European action plan to reduce the harmful use of alcohol 2012–2020'

The World Health Organization (WHO) have released the European action plan to reduce alcohol problems across the continent.

Download the European action plan to reduce the harmful use of alcohol 2012–2020 [pdf]

WHO summary:

The European action plan to reduce the harmful use of alcohol 2012–2020 was endorsed by all 53 Member States in the WHO European Region in September 2011. It includes a range of evidence-based policy options to reduce the harmful use of alcohol. This publication also includes WHO Regional Committee for Europe resolution EUR/RC61/R4, a list of indicators (with definitions) linked to the indicators used in the European Information System on Alcohol and Health, and a checklist or set of questions for Member States. The action plan is closely linked to the 10 action areas of the global strategy to reduce the harmful use of alcohol adopted by the World Health Assembly in May 2010.

The primary audience for the action plan is the national authorities in the WHO European Region responsible for alcohol policy, mainly the health and other ministries (including finance, education, social welfare, transportation and criminal justice), nongovernmental and civil-society organizations, researchers, the private sector and international partners.

Previous WHO alcohol reports include:

• Handbook for action to reduce alcohol related harm
• Evidence for the effectiveness and cost–effectiveness of interventions to reduce alcohol-related harm
• Alcohol problems in the criminal justice system (2013)
• The Global status report on alcohol and health (2011)
• The Global strategy to reduce harmful use of alcohol

Latest Findings alcohol bulletins: NICE treatment update; NTA alcohol figures review; electronic alcohol screening/advice findings

Recent alcohol bulletins from the drug and alcohol bank:

UK clinical guidance on treating dependent drinkers

Assessment by the National Institute for Health and Clinical Excellence (NICE) of what evaluation research means for alcohol dependence treatment in Britain, distinguished by comprehensive reviews of the literature. Updated analysis cites evidence update released in January 2013 which was not considered to require changes to the original 2011 guidance.

Unmet need undermines contribution of alcohol treatment in England

More problem drinkers started specialist treatment in 2011/12 but more successfully completed it, slightly reducing the overall numbers; scope for many more to benefit from treatment is indicated by the low levels of referrals from primary medical services.

Leadership commitment needed to implement electronic alcohol advice prompts

Computerised reminders to consider an alcohol brief intervention have led to high rates of advice-giving in primary care, yet at a service for US ex-military personnel the same system was rarely used and made no difference to patients’ drinking. Lack of leadership commitment and incentives seemed the explanation.

Electronic prompts mean more primary care patients get advised about drinking

When a patient has screened positive for risky drinking, up pops a computerised prompt to remind the clinician to consider counselling. In one service for US ex-military personnel, this resulted in nearly three quarters of patients being counselled and a hint of consequentially reduced drinking; at another, findings were negative. Why the difference?

See the Alcohol Learning Centre, Alcohol Research UK, NHS Evidence alcohol page or NICE alcohol guidance and resources for further resources and information.

Change4Life 'Sneaky drinks' ad re-iterates alcohol message; alcohol apps & links

The Department of Health's Change4Life campaign has launched a second alcohol advert warning how drinking can ‘sneak up on you’, encouraging people to check their drinking online using the Change4Life Drinks Checker. The advert is a similar version of the 'Dont' let the drink sneak up on you' campaign launched last year. A supporting leaflet (pdf) is available to order.

  

As part of the campaign the Change4Life team asked 19 people to keep a detailed drinks diary for 2 weeks. Those that took part were drinking the equivalent of an extra large glass of wine each day, or 40% more than they thought. Although this level of underestimation may be supported by differences in reported consumption in national surveys versus recorded sales, the recent Health Survey for England 2011 showed significant but lower levels of under-reporting.

The Change4Life team also reported that after keeping a drinks diary for a week, the 19 participants were offered simple tips on cutting down and as a result they:

• cut their alcohol consumption by over a third
• saved around £33.35 a week – or over £1,730 a year
• consumed 1,658 fewer calories a week an average of 236 calories a day – around 10% of the average person’s daily intake and the equivalent to 125ml (a small wine glass) of cream per day

There is however limited evidence to support the effectivness of communications campaigns in changing individual drinking behaviours. However as the small Change4life sample involving individuals recording and measuring their drinking suggests, individual approaches such as 'Identification and Brief Advice' (IBA) have stronger evidence of research effectiveness. Nonetheless, no single approach to addressing the overall level of alcohol misuse is expected to work in isolation, so a cumulative impact of national policy and individual level interventions are advised by WHO for effective national strategy.

Last year the alcohol industry funded organisation Drinkaware launched 'My Drinkaware', which also offers online tools, an app and guidance to help people keep track of units and understand the risks. Another app, www.drinkcoach.org.uk, recently joined the market.

NHS Choices also offer comprehensive alcohol pages, including how to find local services. Drinkline can also be contacted 24 hours a day for advice and support on 0800 917 8282.

Individuals can also access online IBA tools such as www.dontbottleitup.org.uk and www.downyourdrink.org.uk/. Proffessionals can visit www.alcohollearningcentre.org.uk or www.alcoholiba.com for guidance and resources.

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.

NICE harmful drinking and alcohol dependence (CG115): 2013 Evidence Update

The National Institute of Clinical Excellence (NICE) have released an evidence update to its 2011 guidance alcohol dependence and harmful alcohol use (CG 115).

Download the Alcohol use disorders: harmful drinking and alcohol dependence Evidence Update - January 2013 (pdf)

The update includes the latest evidence relating to the use of drugs in supporting alcohol treatment and other findings including: 

Principles of care: 

• Evidence suggests that involving the family in treatment is beneficial to responding to the individual needs of family members.

Interventions for alcohol misuse:

• Motivation enhancement therapy during detoxification may help to initiate and maintain people in aftercare inpatient treatment programmes compared with treatment as usual plus a peer delivered twelve-step facilitation intervention.
• Telephone monitoring and counselling may produce better alcohol use outcomes for relapse prevention than telephone counselling and ‘treatment as usual’.
• Using symptom-triggered benzodiazepines in an outpatient setting appears no more effective in reducing alcohol withdrawal symptoms than a fixed dosage regimen, and concerns remain about the safety of high dosage and potential for benzodiazepine misuse in largely unsupervised settings.
• The cost of treatment for alcohol dependent people after withdrawal may be offset by a reduction in social costs.

NICE alcohol commissioning guidance is available to support attainment of the alcohol quality standard which builds on:

• NICE CG115 - alcohol dependence and harmful alcohol use
• NICE PH24 - alcohol-use disorders - preventing harmful drinking
• NICE CG 100 - alcohol-use disorders: physical complications
• Supporting resources including alcohol pathways and further tools.

See the Alcohol Learning Centre, Alcohol Research UK, NHS Evidence alcohol page or the Findings Bank for further resources and information.

Events & dates: NDSAG 2013 conference

New Directions in the Study of Alcohol Group 2013 conference

New Directions in the Study of Alcohol Group (NDSAG) has announced its 2013 conference which will take place at the Copthorne Hotel, Birmingham, England from 25th April to 28th April 2013.

The conference will address a number of themes including alcohol and the family - see the 2013 conference flyer. Keynote speakers will include Professor Jim Orford, Dr. Alex Copello, Pip Mason, Professor John Booth Davies, Dr Jim McCambridge, James Nicholls, Mike Ashton, Sarah Galvani, Robin Davidson and others - see the draft conference programme here.

A call for papers is also open for presentations, and attendees can also apply to give poster presentations. The annual Ron McKechnie prize also offers a fully paid bursary place (including attendance, residential fees and meals) for the winner of the competition to submit a paper for publication in the New Directions in the Study of Alcohol Group Journal.

The conference will also feature the annual Alcohol Research UK (formerly AERC) symposium which this year will have a special UK alcohol policy focus. For more infromation visit the NDSAG site or blog, or download the booking form. For queries email [email protected].

Alcohol Research UK 2013 conference

Alcohol Research UK's 2013 conference takes place on the 12 March 2013. The one day event will take place at the Wellcome Collection Conference Centre, 183 Euston Road, London NW1. Click here to download a full version of the programme or download a booking form here.

Don't forget the Government alcohol strategy consultation closes 6th Feb 2013.