Alcohol Policy UK

The alcohol evidence matrix: evidence map of alcohol treatment

The Alcohol Matrix has been developed by Drug and Alcohol Findings for the Substance Misuse Skills Consortium. The Matrix is concerned with the treatment of alcohol-related problems among adults (a similar table deals with drug-related problems). The alcohol matrix can be found here.

The alcohol matrix has been developed as a resource to support practitioners, managers and commissioners to access the key research and evidence relevant to the delivery and organisation of alcohol treatment services in a range of contexts. Areas of interest across the contexts include: harm reduction, brief interventions, cross-cutting treatment issues, medical treatments, psychosocial therapies, and criminal justice work.

Within each cell of the matrix are the major historical and contemporary research landmarks, reviews offering a panoramic view, expert guidance, and an option to explore beyond these dozen or so selected documents.

The Substance Misuse Skills Consortium said: 

'These are the documents you should read if you read nothing else! Familiarity with these few documents indicates an important dimension of the quality of an organisation and its staff – an appreciation of the key evidence on which practice has been built and can be improved'.

Institute of Alcohol Studies launch new website & latest Alcohol Alert

The Institure of Alcohol Studies (IAS) has launched a new website www.ias.org.uk and twitter account to support its aim of 'advocating for the use of scientific evidence in policy-making to reduce alcohol-related harm'.

The IAS produce reports on key alcohol policy areas and also a regular 'Alcohol Alert' magazine - see below for some of the features in the current issue.

• Experts call for tough action on alcohol pricing to be introduced UK wide

• Limited progress in tackling alcohol duty fraud

• A paradox: European law invoked to frustrate alcohol policy

• Global public health community issues warning on alcohol industry conflict of interest

• NHS Atlas gives new insight into liver disease epidemic

• Great expectations - The role of nurses in dealing with alcohol related problems

• British children more exposed to alcohol promotion than adults

• North East of England school children petition for more controls on alcohol advertising

• School-based psychological interventions "reduce risk of alcohol misuse"

• Peace dividend from declining alcohol consumption

See here for more about the IAS and what they do.

A review of patients who died with alcohol-related liver disease: report calls for improved prevention and treatment

A review of patients who died with alcohol-related liver disease has been released by the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD). The report calls for improvements in alcohol brief intervention (IBA), access to treatment, alcohol care teams and improved pathways across hospitals.

Download the full report Alcohol Related Liver Disease: Measuring the Units (2013) here or the Executive Summary.

The report reviews the process of care for patients who are treated for alcohol-related liver disease (ARLD), previously known as alcoholic liver disease (ALD). ONS data reports there were 8,748 alcohol-related liver disease deaths in the UK in 2011. It also highlights a statement from the Atlas of Liver Care for England of an "88% rise in age-standardised mortality from chronic liver disease, the only one of the major diseases which is still increasing, of which alcohol-related liver disease is one of the primary causes".

Principle recommendations include

• All patients presenting to hospital services should be screened for alcohol misuse. An alcohol history indicating the number of units drunk weekly, drinking patterns, recent drinking behaviour, time of last drink, indicators of dependence and risk of withdrawal should be documented. (All Doctors)
• All patients presenting to acute services with a history of potentially harmful drinking, should be referred to alcohol support services for a comprehensive physical and mental assessment. The referral and outcomes should be documented in the notes and communicated to the patient’s general practitioner. (All Doctors)
• Each hospital should have a 7-day Alcohol Specialist Nurse Service, with a skill mix of liver specialist and psychiatry liaison nurses to provide comprehensive physical and mental assessments, Brief Interventions and access to services within 24 hours of admission
• A multidisciplinary Alcohol Care Team, led by a consultant with dedicated sessions, should be established in each acute hospital and integrated across primary and secondary care. (Medical Directors)
• All patients admitted with decompensated alcohol related liver disease should be seen by a specialist gastroenterologist / hepatologist at the earliest opportunity after admission. This should be within 24 hours and no longer than 72 hours after admission to hospital.(Consultants)
• Escalation of care should be actively pursued for patients with alcohol-related liver disease, who deteriorate acutely and whose background functional status is good. There should be close liaison between the medical and critical care teams when making escalation decisions.

A planned National Liver Strategy is still yet to materialise. See here for a 2012 presentation by Dr Martin Lombard who was appointed to lead on the strategy. See here for a NHS Choices video on liver disease.

The British Liver Trust have previously carried out campaigns to promote liver health including reducing alcohol misuse. A 60% rise in cases of Alcoholic Liver Disease (ALD) in young people over the last seven years was reported in the North East last year. 

See here for NICE alcohol guidance and resources.

Latest Findings alcohol bulletins: teaching teenagers 'safe drinking'; IBA in college settings; lessons for treatment; benzos still best for withdrawal

Recent bulletins from the drug and alcohol bank:

Should we teach teenagers to drink more safely?

Official guidance for England supports 'safer drinking' lessons for teenagers, based partly on the results of an Australian curriculum, but it was unclear whether its approach and results would transfer to the UK. Now this study from Northern Ireland has confirmed that in the UK too the lessons curb the growth in alcohol-related problems and also mean pupils drink less.

College health clinics can do mass alcohol screening and brief advice

College health clinics can themselves implement widespread screening and brief alcohol advice is one conclusion of this first large-scale test conducted at five North American universities. The other main conclusion - that by doing so they make worthwhile reductions in drinking and related harm - is weakened by the small size of the impacts.

Can therapists be too good?

Rarely has counselling been so deeply analysed as in this US study of mainly alcohol and cocaine dependent patients. The far-reaching implications are that some counsellors generate relationships with clients which feed through to better outcomes – but also that the 'best' relationship builders are not on average the most effective.

Leaders and service ethos set context for training to affect treatment practice

Message from this large US study is that 'bottom-up' practice improvements in treatment services initiated by counsellors are still strongly influenced by the climate-setting and support offered by an organisation's leadership and ethos, especially how far they foster professional development.

Anticonvulsants yet to better benzodiazepines for alcohol withdrawal

Drawbacks of the favoured benzodiazepine drugs used to ameliorate alcohol withdrawal have led to trials of anticonvulsants, but this German trial found one promising anticonvulsant effective only among less severe cases – and some patients seemingly doing well later developed seizures, one of the most severe consequences of alcohol withdrawal.

Minimum pricing: influence, politics and... waiting

Since the Queen's speech failed to confirm whether Minimum Unit Pricing (MUP) truly has been ditched, the jostling, debate and politics surrounding the issue goes on.

In particular, the question over industry influence over alcohol policy has been under the media spotlight. Conservative MP Sarah Wollaston, who has been a outspoken supporter of MUP, accused Cameron of caving in to lobbyists last month. Similar concerns held by many minimum pricing supporters were summarised in an article by the Institute of Alcohol Studies' Katherine Brown in 'The red-faced ranters have won'.

The issue also gained attention following a recent study on Industry Use of Evidence to Influence Alcohol Policy. The research suggested that industry submissions to the Scottish Government's 2008 consultation included deliberately mis-representative and unsubstantiated claims - replicating past 'big tobacco' industry tactics. See here for a Guardian analysis of the research and a critical take of it on Phil Mellows' blog.

The Guardian and other papers have continued to take a keen interest in alcohol stories. Dr Kieran Moriarty, alcohol lead for the British Society of Gastroenterology argues Alcohol is killing too many of us. Moriarity argues for minimum pricing given headline alcohol statistics, including the falling average age of serious alcohol conditions and rising admissions.

The Information Daily published a piece questioning whether without minimum pricing, Is this Government's alcohol strategy the worst yet?. The piece suggests that asides of its commitment to a likely 45 pence MUP, the strategy was not highly regarded by the health field. With a rhetoric of 'binge drinking' and 'drunks', it had little space for outlining important health and treatment interventions, let alone any commitment to advancing their implementation. A coalition of health groups subsequently published an 'independent alcohol strategy' as an alternative model.

On the counter-side, Miles Beales of the Wine and Spirit Trade Association (WSTA) re-iterated the common anti-MUP arguments in Why should responsible drinkers pay more?. Beales suggests that building on approaches like Community Alcohol Partnerships (CAPs) and alcohol education are whats needed. A message that appears to remain effective with many of the public still opposed - see a recent exploration of public opinion on plain cigarette packaging Vs MUP from the Mentor blog.

For the meantime, it sounds rather like England's minimum pricing will be going down as one of the Coalition's U-turns; the last words from the Prime Minister on the matter was that a 'package of measures' was to be brought forward to address cheap alcohol. Meanwhile in Scotland, an EU legal battle continues as industry opponents continue to try and stop, or at least further delay it. So perhaps the 'anti-MUP camp' have won England's MUP battle for now, or perhaps there is just more political sense in waiting to see what happens north of the border.

Latest from the IBA blog: discussion forum launched; AUDIT Vs shorter tools; INEBRIA 2013; alcohol and the workplace; IBA - making it happen? & more

The alcohol IBA blog was set up to promote learning, understanding and the delivery of IBA through news, links and ideas on IBA from a range of contributors. 

The blog now has a discussion forum for anyone to share their views, comments or questions on any IBA issues. 

Recent posts from the IBA blog are highlighted below:

• Full AUDIT screening Vs shorter tools (FAST, AUDIT-C etc) for IBA The 10 question full AUDIT is the ‘gold standard’ screening tool for the identification of alcohol use disorders. But does IBA always require the full AUDIT to be completed Read more here...

• INEBRIA Conference 2013  The annual conference of INEBRIA is an excellent opportunity to hear the latest IBA research and practice developments - the 10th Annual Conference will be held in Rome on 19th and 20th of September 2013. Read more here...

• Supporting colleagues with drink problems  How do you respond when a colleague you respect is drinking at levels which affect their work? How do you address this if you are their manager? Read more here...

• IBA – making it happen?  It’s no secret that the big challenge is to get IBA happening large scale. That means in such a way that it will reach many of the 10 million or so adults regularly drinking above the guidelines... Read more here...

• Why ask staff about drinking in the workplace?  36 million people are in work in the UK and we know that the majority of problem drinkers are also in employment and do not seek help or treatment. Read more here...

• SBI & Health Inequalities? What do we know about how SBI (aka IBA) may impact on health inequalities?  The evidence we have so far is fairly limited on this. Read more here...

The blog also has specific 'About IBA' and 'IBA tools' pages and also aims to highlight other resources such as INEBRIA and the Alcohol Learning Centre IBA pages. See here for the Alcohol IBA Twitter Updates (@Alcohol_IBA).

Scotland's Licensing Act evaluation indicates progress - lessons for England?

An evaluation of Scotland's Licensing 2005 Act has been released, reporting positive impacts such as fewer irresponsible promotions and benefits of an appointed Licensing Standards Officer (LSO) for each council.

Download the Licensing (Scotland) Act Evaluation Final Report.pdf 

Scotland's Licensing Act came into effect in September 2009 and outlaws promotions providing alcohol free of charge, or at a discounted price on the purchase of one or more drinks. It also bans licensed premises from offering happy hours, drinking games or speed drinking deals.

The report also found that mandatory training for LSOs, Board members and trade staff has increased knowledge and standards of professional practice. However the report also identified a number of challenges and less successful aspects, including limited progress on off-sales and the public health objective.

Dr Evelyn Gillan, Chief Executive of Alcohol Focus Scotland said in a press release:

"The Licensing Act has reduced irresponsible promotions in pubs and clubs, but cheap, high strength alcohol is still being sold in off-sales, particularly supermarkets. To address this, we need minimum pricing implemented without further delay."

In 2011 Alcohol Focus Scotland and the Scottish Health Action on Alcohol Problems (SHAAP) released a report 'Re-thinking Licensing', calling for licensing boards to make more effective use of licensing legislation and outlining ideas to promote the public health objective.

NHS Scotland also recently released a report which found the Alcohol (Scotland) Act, which included a ban on multi-buy promotions, was associated with an overall 2.6% decrease in off-trade alcohol sales.

Lessons for England?

In England new licensing powers have been in effect since last year as part of the the Police Reform and Social Responsibility Act (PRSA) 2011. The changes included councils becoming 'responsible authorities' but options to implement Late Night Levys or Early Morning Restriction Order (EMROs) have not yet been taken up.

A number of toolkits and guidance documents have since been released to try and support local action, including developing effective public health responses. However with public health absent from England's licensing act core objectives, progress will rely on good data sharing to improve responses to existing objectives.

However Liverpool council have recently reported cracking down on off-licenses selling cheap alcohol using a Cumulative Impact Policy (CIP) approach. CIPs, sometimes known as saturation zones or stress areas, are deisgnated areas where new applications or longer hours are typically prevented. See here for local CIP guidance from Southwark.

All Home Office licensing guidance can be accessed here, including revised guidance issued under section 182 of the Licensing Act 2003 and amended guidance on the late night levy [pdf].

Regional updates: London regional activity now 'Safe Sociable London Partnership; Balance North East & DrinkWise latest

In 2011 the Department of Health led Alcohol Improvement Programme (AIP) concluded a number of initiatives including most of the regional alcohol programmes. With localism a key Government objective, local partnerships are responsible for determining their own priorities. However a number of areas have maintained regional approaches as updated below.

London

In London the 'Safe Sociable London Partnership' (SSLP) has now been established to continue the regional activity previously undertaken by the shadow London Health Improvement Board (LHIB).

The SSLP is a London Partnership supported by local boroughs, Public Health England and the Greater London Authority (GLA) to deliver alcohol improvement work at local and regional level in London. The SSLP is continuing to support and develop a range of projects spanning health, licensing and other areas.

In particular, work around strengthening Public Health team's input into licensing processes is being developed following the release of a Licensing toolkit. A number of projects are also being delivered to support the implementation of Identification and Brief Advice (IBA) across the capital including an IBA network, a London 'minimum standard', pathways work, and a London Probation Alcohol Champions project. Pilot projects are also being delivered around Pharmacy scratchcards, sexual health and IBA for homeless groups.

North West

Drink Wise is commissioned by all the North West Local Authorities to lead on alcohol harm reduction. This includes advocay on minimum unit pricing (MUP) including www.minimumpricing.info, promotion and placement of alcohol. Work around enablement also sets out a programme of work around the regulation of alcohol. Since April 2012 Drink Wise have been merged with Our Life.

North East

Balance is the North East's regional alcohol office set up to follow in the footsteps of tobacco control by taking a population level, de-normalisation approach to alcohol harm. Balance aims to change the culture around alcohol and reports progress in areas such as: awareness of alcohol harm; support for policy change; and early signs that consumption and harm is falling in the region.

Balance say partners in the North East have shown vision and commitment to tackling alcohol-related harms and continuing to support Balance. Work includes ensuring alcohol remains a priority for public sector organisations in the region, alongside work on building public and political support for measures to reduce the affordability, availability and desirability of excessive consumption.

Balance recently found 80% of police officers in the North East will be subjected to an alcohol-related assault during their career.

Also...

Public Health England, which has now taken over responsibilities of the former NTA, will also be working to support and develop strategic action around alcohol and sets out its overal alcohol objectives here. Other non statutory organisations will also be continuing to deliver various programmes - watch this space.