Alcohol Policy UK

'Statistics on Alcohol: England 2013' admissions still rising along with increasing drug treatment prescribing

The latest annual statistics on alcohol for England 2013 have been released, confirming a continuing rise in alcohol-related and primary alcohol attributable hospital conditions. Alcohol-related admissions rose 4% on the previous year with primary diagnosis conditions up 1%. Prescribed drugs for treating alcohol dependence were up 6%. Download the full report here (pdf).

This comes despite falls since 2004 in the proportion of adults reporting drinking alcohol. Continuing admissions - many being long term conditions - are linked to decades of rising consumption prior to 2004. A useful interactive Guardian data blog includes a table which allows admission types to be selected. Related acute admissions such as violence or accidents and injuries show falling or more stable trends, whereas long-term conditions such as cardiac, hypertensive or cardiac admissions show clear upwards trends.

Key findings from the report:

• In 2011/12, there were an estimated 1,220,300 admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (broad measure). This is an increase of 4% on the 2010/11 figure (1,168,300) and more than twice as many as in 2002/03 (510,700).
• In 2011/12, there were 200,900 admissions where the primary diagnosis was attributable to the consumption of alcohol. This is a 1% increase since 2010/11 when there were 198,900 admissions of this type and a 41% increase since 2002/03 when there were around 142,000 such admissions.
• In 2012, there were 178,247 prescription items prescribed for the treatment of alcohol dependence in primary care settings or NHS hospitals and dispensed in the community. This is an increase of 6% on the 2011 figure (167,764) and an increase of 73% on the 2003 figure (102,741). The Net Ingredient Cost (NIC) of these prescriptions was £2.93 million in 2012.

The report also identifies that on-trade alcohol sales in particular have fallen by 46% over 10 years, whereas off-trade sales have risen by 32% overall since 1992. Alcohol is also 62% more afordable than in 1980.

The report also provides a comprehensive overview of alcohol related health and consumption data including regional breakdowns. It also covers knowledge and attitudes to alcohol amongst the adult population.

Media reports so far have focused on headlines such as the 50% rise over the last decade in overall alcohol-related admissions - Guardian - and a 75% increase in drug treatment prescriptions over the last 9 years - see BBC and Information Daily reports.

News & updates May 2013: 'middle class drinkers know better'; MPs admit to 'unhealthy drinking culture'; other news

Some recent media stories and other reports are highlighted below.

'Middle classes are in denial' or 'know better than experts' were recent headlines responding to research published in the BMC. The study had explored the attitudes of managerial and professional roles, finding low acceptance or awareness of health risks. In part this was attributed to perceptions that alcohol problems were confined to 'others' including younger 'binge drinkers', and belief that 'home drinking' was without risk.

Of course those in the field know professional roles tend to drink more and more frequently, and off-sales wine has accounted for most of the overall rise in consumption since the 1950s. 'Middle-class' drinkers, often associated with 'de-stress' drinking, therefore pose a challenge to public health roles wanting to reduce long term health impacts of those less likely to contemplate their drinking. On the flip-side, the “alcohol harm paradox” suggest drinkers from lower socio-economic groups experience greater harms. A 'behind the headlines' piece analyses the findings versus media reaction.

"MPs admit to an unhealthy drink culture" according to an Alcohol Concern survey. The survey of 150 MPs attitudes found 26% thought their colleagues drank too much. It also suggested that £1.33m was spent in the nine bars at the House of Commons in the year to March 2011. In a subsequent Guardian poll 39% of respondents answered yes to the question 'Is there a culture of excessive boozing at your workplace?'. See reports from the BBC, and a blog comment in the Independent.

Local initiatives & reports

Shop ban on high-strength booze cuts street drinking crime by 50%, reports the Telegraph. The scheme is now being considered by other forces - BBC.

Drink-related anti-social behaviour in part of Stoke-on-Trent has reduced by over two-thirds after an alcohol restriction zone was introduced - BBC.

Police in Scotland are warning parents not to buy alcohol for their underage children after an increase in drunken incidents involving young girls, reports the Scotsman.

Other reports & info

Binge drinking in your 20s can trigger heart disease- Daily Mail.

Do young people’s attitudes to alcohol make them more likely to be violent when drinking? is explored on the Closer blog.

Alcohol advertising pre-disposes young people to have favorable attitudes toward drinking, a NewsMedical.net report explores.

A lawyer says there has been a 70% increase in men citing alcohol misuse in divorce over the past five years - Daily Mail.

A new Drinkaware video highlights the effects of alcohol, and a new page highlights the dangers of cheap alcohol.

EU's alcohol strategy needs further push, MEPs say according to EurActiv.com.

To get full regular media reports you can sign up to the alcohol e-shot or Drugscope Daily.

For the Alcohol Policy UK newsletter email [email protected]

Latest guidance offering to commissioners of drug and alcohol services

A new guidance document for commissioning drug and alcohol services has been released by the Joint Commissioning Panel for Mental Health (JCPMH).  

Guidance for commissioners of drug and alcohol services [pdf] presents an overview of key considerations for those with local remits for developing treatment services. It highlights ten key messages ranging from the invest to save case, utilisting NICE guidance, commissioning for outcomes, building partnerships and workforce development.

A wide range of guidance and resources now exists to support drug and alcohol commissioning. NICE has a comprehensive set of alcohol guidance and quality standards, including alcohol pathways and further tools. NICE also recently released Public Health Guidance for local authorities.

Previous to the NICE resources, alcohol commissioning guidance was released by the Department of Health in 2009, titled 'Signs for Improvement'. It identified a number of 'High Impact Changes', including IBA, alcohol liaison roles and improving treatment effectiveness and capacity. Models of Care for Alcohol Misusers was released by the then National Treatment Agency in 2006.

The NTA also published a range of other commissioning resources including 'commissioning for recovery', a JSNA support pack and annual alcohol treatment statistics reports.

This year DrugScope released a briefing on 'Public Health Reforms: What they mean for drug and alcohol services'. A recent RCGP briefing explores Primary Care Drug and Alcohol Commissioning.

Scotland's multi-buy promotions ban sees decrease in off-trade alcohol sales

NHS Health Scotland have published a report that evaluates the impact of the Alcohol etc (Scotland) Act on off-trade alcohol sales in Scotland.

The report found the introduction of the Act, which included a ban on multi-buy promotions, was associated with an overall 2.6% decrease in off-trade alcohol sales, largely driven by a 4% decline in off-trade wine sales.

The Act was also associated with an 8.5% decline in pre-mixed alcohol beverages, although these account for a very small proportion of the overall off-trade market.

The Act, implemented in Scotland on 1st October 2011, included a ban on quantity based discounts and restrictions on the display and promotion of alcohol in Scotland’s off-trade. The evaluation used time-series analyses of data for a 52-week period post-implementation and a comparison with England & Wales, and states in its conclusion:

"...the results from this study suggest that the introduction of the Alcohol Act reduced off-trade alcohol sales in Scotland, largely driven by a statistically significant decrease in off-trade wine sales [4%). The Act was also associated with reduced RTD [Ready to Drink] sales, although these account for a very small proportion of total off-trade sales. Similar changes were not observed in England & Wales, where the Act does not apply, which lends weight to the hypothesis that the changes witnessed in Scotland were as a result of the Act rather than due to other unmeasured factors."

See here for BBC news and Herald reports.

Further work evaluating Scotland's strategy to reduce alcohol misuse is available through the Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) 2nd Annual report. A recent legal challenge to Scotland's minimum pricing plans was recently dismissed, althouhg a challenge to the decision is expected.

Alcohol consumption in adolescence and early adult life: What are the consequences? CLOSER event presentations

This month an event took place exploring 'Alcohol consumption in adolescence and early adult life: What are the consequences?'. It was organised by the Cohorts and Longitudinal Studies Enhancement Resources (CLOSER), a consortium of the UK’s leading birth cohort and longitudinal studies.

'High alcohol consumption – especially among young people – continues to be a major social and public health concern in the UK. As drinking can often lead to long-term health problems, some of which only emerge after several years, this conference focused on the unique perspective provided by longitudinal evidence. It looked at the trajectories of alcohol consumption, and the health and social consequences of high levels of consumption during the transition to adulthood.

The symposium opened up the dialogue between longitudinal researchers, policy makers and third sector organisations who are leading thinking in this area. By including speakers from both research and policy, it aimed to share the latest evidence on alcohol consumption among young people, review current and future policy priorities in this area, and to identify gaps in the evidence base.'

Presentations

• Professor Jennifer Maggs, Pennsylvania State University (keynote)
  Life-course consequences of adolescent and early adult drinking: Challenges and open questions (PDF)

• Professor Jane Elliott, Director of CLOSER
  Introduction to the symposium (PDF)

• Dr Jeremy Staff, Pennsylvania State University
  Consequences and correlates of alcohol use at 16 and beyond: empirical findings from the British Cohort Studies (PDF)

• Dr Ann Hoskins, Public Health England
  Alcohol, children and young people: Opportunities in the new public health system in England (PDF)

• Neil Dube, Department for Education
  Policy making and its relationship with evidence and research (PDF)

• Dr Carly Lightowlers, Liverpool John Moores University
  Drinking patterns and violent behaviour amongst young people in England and Wales (PDF)

• Dr Gareth Hagger-Johnson and Dr Nicola Shelton, UCL
Drinking and non-drinking in young people: Evidence from British Cohort studies (PDF)

Alcohol Research UK 2013 annual conference FEAD videos

Alcohol Research UK's 2013 conference took place on 12 March 2013, exploring alcohol and British society. Now videos of the conference have been made available via the the Film Exchange on Drugs & Alcohol (FEAD), and the presentations are also available.

The conference theme explored the role of alcohol in contemporary British society as key to targeting the harms it can cause addressing issues such as:

• Why alcohol harms are unevenly spread across different social groups
• How policy interventions impact on different communities
• Methods for the identification and prevention of harmful...

Presentations included:

1.

Robin Davidson on Alcohol Research UK

2.

Sir Ian Gilmore and Mark Bellis on health and inequalities

3.

Jonathan Chick and Dr Jan Gill on cheap alcohol and British society

4.

Paul Wallace and Stuart Linke on ten year experience with Down Your Drink (DYD)

5.

David Foxcroft on early development and adverse outcomes and different prevention approaches

6.	Keith Humphreys and Ilora Finlay, Baroness Finlay of Llandaff on science and developing alcohol policy in Britain

Events May - June 2013: FASD; history and future of drug and alcohol regulation & more

A number of upcoming events coming up shortly may be of interest:

Foetal Alcohol Spectrum Disorder (FASD): Evidence, Policy and Practice

This week Middlesex University host a free evening seminar: Foetal Alcohol Spectrum Disorder (FASD): Evidence, Policy and Practice taking place on Thursday 16 May, 5pm- 7:30pm in North London. Guest speakers to this event include Professor Moira Plant, Professor in Alcohol Studies, University of the West of England, Bristol. See the flyer here.

Under Control? Alcohol and Drug Regulation, Past and Present

Coming up in June, 'Under Control?: Alcohol and Drug Regulation, Past and Present' is a three-day international conference exploring all aspects of alcohol and drug control costing only £150 or £75 concessionary rate for the full 3 days.

The conference will take place at the London School of Hygiene and Tropical Medicine from June 21st-23rd.  Keynote speakers include Professor Virginia Berridge (LSHTM); Professor Paul Gootenberg (Stony Brook University) and Professor James Simpson (Carlos III University, Madrid). There are over 30 confirmed panels, including papers on contemporary alcohol policy; temperance history; the social control of drinking in pubs and the home; alcohol and citizenship; intoxicated identities; and the international alcohol trade. There will also be a number of fringe events -see here for more.

Other events

This week also sees the RCGPs 18th national conference on managing drug & alcohol problems in primary care. It takes place in Birmingham on the 16 and 17 of May: full conference is £318 with day rates available.

Later this month, a Westminster Forum Projects event explores The Future of Alcohol Policy at a cost of £190+VAT (concessionary rates available). Next month Public Policy Exchange host an event 'Calling Time on Binge Drinking and Alcohol-Fuelled Violence: The Changing Role of Local Authorities' places currently priced from £156- £315.

No announcement on England's minimum pricing decision as Scotland gets legal go ahead

Rumours that the Queen's speech would confirm whether Minimum Unit Pricing (MUP) had been scrapped were proven false this week. However when later asked in the House of Commons, the Prime Minister David Cameron promised to deliver a 'package of measures' to deal with cheap alcohol:

"On minimum pricing for alcohol, it is important that we take action to deal with deeply discounted alcohol, with cans of lager sometimes selling for as little as 25p in supermarkets. We will be bringing forward a package of measures, and it is important that we get this right."

Recently Home Office minister Jeremy Brown had said the Government was yet to confirm its decision on MUP and were listening to "powerfull arguments on both sides" following the consultation.

The Government has yet to publish its response to consultation, but it has been widely touted that a decision to u-turn on MUP has been made as a result of Cabinet pressure. A Guardian article by the IAS's Katherine Brown suggests "Intense lobbying from alcohol producers would appear to have killed-off this ground-breaking policy". Opponents largely argue MUP as a measure unfair to responsible drinkers, summarised on the WTSA sponsored anti-MUP site.

However advocates of MUP saw a victory as a legal challenge to Scotland's MUP plans was recently dismissed. The Scotch Whisky Association (SWA) had spearheaded a campaign claiming that MUP was in breach of EU competition law. A number options to appeal the decision are expected to be pursued by the SWA, suggesting Scotland's 50 pence MUP plans are still some way off.

As for England, should the Government's committment to introducing MUP be replaced by other measures to 'tackle cheap alcohol', health groups are unlikely to be convinced that they will replace the need for MUP. Increased taxation, an approach called for by the IFS, certainly has some recognition amongst health groups, but a number of issues are highlighted.

In particular, taxation rises can be absorbed by producers or retailers, for instance through 'loss-leading'. It is claimed some tax increases would have to be dramatic to achieve the same impact of a 45 pence MUP. Indeed the alcohol duty escalator has  been delivering alcohol tax rises already, but the beer trade successfully argued that hikes in beer tax were having a negative impact on the hospitality sector, halting the beer duty rise in this year's budget.

Dr Petra Meier, who conducted the University of Sheffield modelling on pricing impacts has previously said both taxes and minimum pricing should be used, so it should not be an 'either or' argument. Initially the Coalition had committed to a "below cost ban", however difficulty over definitions of 'cost' and implementation challenges seemed to leave few convinced, including the Home Office. No further word on plans set out in the Strategy to ban the sale of multi-buy discount deals.

Drinkaware independent review raises questions for industry funded alcohol charity

The industry funded alcohol education charity Drinkaware has released an independent review of its activities, with mixed findings over its effectiveness to date. Download the report here [pdf] or appendices.

The review was carried out by consultancy firm 23Red which in the executive summary identifies its main findings as:

2.1 This is a mixed report. The reviewers found that much has improved since the last review of the Drinkaware Trust, notably the funding position. On the other hand, while some things are now well done, others are poorly done or are lacking entirely. No stakeholder group is entirely happy with the current status quo.

2.2 In consequence, while recognising that there are inevitable tensions facing an organisation with the remit and funding base of Drinkaware, this report calls for substantial changes to the way in which Drinkaware operates. These changes affect the way the Trust is funded, its governance model and the way it carries out its core activities.

The report identified successes including achieving "near-ubiquity for the Drinkaware.co.uk URL", improved stakeholder engagement, improved approaches to campaigns and some success against some KPIs, particularly relating to 11-17 year olds. However the report states that:

"...all groups of stakeholders are dissatisfied with the status quo to some degree. Their dissatisfaction focuses on three key areas:

• The lack of an evidence base, both to inform what Drinkaware does and to evaluate how it does it
• A perception of industry influence resulting in a suspicion that Drinkaware is not truly independent of the alcohol industry
• Weak stakeholder engagement, resulting in Drinkaware’s isolation within the alcohol harm reduction community"

Also of concern are findings from a currently unpublished study by London Southbank University and Kings College London (Moss, Dyer et al) which found that exposure to Drinkaware posters actually appeared to increase alcohol consumption. Drinkaware Posters from the 'Why let the good times go bad' posters were used in a simulated bar environments and lab settings, where drinkers consumed more when posters were displayed.

In 2009 Professor Iain Gilmore warned of "very little evidence that health messages work to prevent binge or harmful drinking" when the campaign was announced. Then Alcohol Concern Chief Exec Don Shenker also wrote of a "real concern that the very message ‘Why let the good times go bad’ will actually reinforce the notion that you need alcohol to have a good time" in a DDN article cynical of tactics behind industry funded activity.

Drinakware have however since been engaging with the authors of the study to explore the implications and have reportedly ended the ‘Why let the good times go bad’ campaign. The findings however raise questions for all drug and alcohol related information campaigns and evaluation methods. Other studies such as a US anti-drug media campaign have previously suggested the potential for counterintuitve responses.

Looking forward, Drinkaware has certainly not yet convinced the public health community at large of its role or ability to deliver activity that genuinely addresses alcohol misuse. However its publication of an arguably critical independent report may go some distance to improving its future standing. With a new Chief Executive at the helm since earlier this year, Drinkaware certainly faces some real challenges.

Findings bulletins & hot topics: peer influence; commissioning; motivational interviewing; mental health & normative approaches

Recent bulletins from the drug and alcohol bank:

TEENAGE PEER INFLUENCE ON DRINKING IS NO ILLUSION

Is the peer influence on which many prevention programmes are based an illusion due to other factors like pupils sharing similar environments or choosing like-minded friends? Not entirely, finds this unusually rigorous US analysis; the chances of a given child drinking rise by 4% for every 10% more of their school year-mates who drink.

WHAT ABOUT EVIDENCE-BASED COMMISSIONING?

Though central to implementing policy and embedding evidence in practice, the process of ensuring that the pattern of services in an area coherently and efficiently meets local needs is itself relatively unevidenced. Such reports as we have from the UK often graphically portray the shortfalls, though there is evidence that things can be done which work.

MOTIVATIONAL INTERVIEWING - THE SWISS ARMY KNIFE OF SUBSTANCE USE COUNSELLING

Popular and with a strong theoretical and evidence base, the great advantage of motivational interviewing is its applicability across the board from risky but as yet non-problematic substance users to established addicts, yet the research yields some surprises and some negatives. 

COPING WITH MENTAL ILLNESS

With as many as three quarters of their clients suffering from mental health problems, deciding how to respond is a major and long-standing concern for British drug and alcohol services. Should they or psychiatric services take the lead in caring for the patient, how can they coordinate care with mental health services, should dependence be treated first, or should treatment run in parallel?

EVERYONE’S *NOT* DOING IT MESSAGE OFFERS HOPE FOR PREVENTIVE EDUCATION

Science is littered with shining discoveries which became somewhat tarnished as accumulating data forced a reappraisal. In substance misuse, normative education (contrasting how common pupils think substance use is with the reality) retains some of its shine, but what seemed the great hope for school- and college-based prevention now seems a tactic of limited application and with inconsistent impacts - and, some believe, one way the drinks industry avoids truly effective restrictions.