Alcohol Policy UK

Recent Findings bulletins: prevention synergy for risky substance and sexual behaviour; education approach finds favour; add 'brief advice' to punitive measures

Recent bulletins from the drug and alcohol bank:

The same prevention programme can affect both sexual and substance use risks

Different youth 'problem' behaviours overlap and share common causes, so it should make sense to implement programmes which affect several at once. That was the thesis of this Scottish review, which looked at studies reporting on both substance use and risky and underage sex. The literature was scarce but did give some reasons for optimism.

More support for harm reduction education on drinking

Alcohol outcomes from an Australian secondary school harm reduction curriculum covering legal and illegal drugs strengthened the case that such education can not only curb harms, but also reduce consumption. Results suggest this approach might offer a more fruitful focus for education about commonly used substances than simply promoting non-use.

Add brief advice to discipline for heavy drinking college students

Is being caught and disciplined all it takes to get heavy drinkers who violate university drinking rules to cut back? According to this US study, the discipline process does work, but adding brief motivational-style advice makes a worthwhile extra impact.

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.

Alcohol related deaths in young women rising in three UK cities but causes unclear

Research from the Glasgow Centre for Population Health has shown that alcohol-related deaths in women born in the 1970's have risen sharply in Glasgow, Manchester and Liverpool. The rise is much faster than in young men and goes against a national trend of stable alcohol-related deaths.

The research was recently published online in the Journal of Epidemiology and Community Health and has been widely reported in the press; see also an NHS choices review of the reporting and a comment piece on the Addaction blog.

The researchers found that in the 1980s, alcohol-related mortality in Glasgow was 3 times higher than in Manchester and Liverpool. Alcohol-related mortality then increased in all 3 cities over the next 30 years. However there was a sharp rise in deaths in the early 1990s that was unique to Glasgow for which the investigators could find no obvious cause.

Alcohol-related mortality fell in all three cities in the late 2000s, with larger falls in Glasgow. However further analysis showed that this citywide fall in alcohol-related mortality was not universally experienced across all age groups. In the youngest cohort, born in the 1970s, alcohol-related mortality increased across all three cities during this time. This was particularly notable for women, where the relative increase was greater than in men.

Researchers felt that historical rather than current factors drove the excess mortality in Glasgow. They believe policy responses to excess alcohol-related mortality therefore need to address the deep-rooted societal factors as well as the more contemporary factors such as increased alcohol availability and affordability. The negative impact of increased affordability and availability of alcohol on alcohol-related mortality has been well documented.

The Institute of Alcohol Studies (IAS) report that in the UK gaps between women's and men's drinking levels is narrowing, with increased wine consumption being a particularly significant factor. In addition, cultural and socioeconomic changes, the increased availability of alcohol in the off-trade, and alcohol advertising campaigns targeting women are also factors according to an IAS factsheet on women and alcohol).Of course overall consumption has been falling since 2004 yet a trend of rising alcohol related hospital admissions continues. 

For further information on alcohol trends and analysis see the following:

• The latest NHS alcohol statistics for England.
• Joesph Roundtree Foundation report 'Drinking in the UK: an exploration of trends'.
• Institute of Alcohol Studies (IAS) 'Alcohol - Drinking in Great Britain'
• Mark Easton's report 'The myths of boozed up Britain'
• The Alcohol Health and Research Unit's 'Future Proof' 2009 report

Latest Findings alcohol bulletins: naltrexone finds favour for treatment; acamprosate as effective for women; engaging in treatment; street drinking 'bans' reviewed

Recent bulletins from the drug and alcohol bank:

Largest US study yet favours naltrexone as alcoholism medication

Reanalyses of major US study confirmed that either naltrexone or psychological therapy improved outcomes more than medical care and placebos, while the two in combination or acamprosate added little. They also revealed previously invisible benefits when certain types of patients received certain treatments – and some hidden negatives, including a suggestion that acamprosate is counterproductive for the most needy but also most motivated alcoholics.

Acamprosate as effective for alcohol-dependent women as for men

First comprehensive analysis of whether acamprosate treatment works as well for alcohol-dependent women as for men definitively concludes that across 22 mainly European trials it had a virtually identical impact. The analysis also offers an updated and extended assessment of the drug's overall impact, finding that it helps prevent heavy drinking as well as fostering abstinence.

Clinicians can learn how to help alcohol patients stay in treatment and take medication

Getting patients to take their medication is a major issue across medicine. This US alcohol treatment study enhanced compliance with treatment through a novel and manageable approach combining brief motivational interviewing with structured clinical counselling involving feedback on the patient's real-time pill-taking record.

Winners and losers from street drinking bans

So-called 'alcohol-free zones' have proliferated across the UK, preventing an individual drinking in public if police believe their drinking is causing a problem. This review finds such measures do reassure communities, but at the expense of further marginalising street drinkers.

Government confirms no minimum pricing or multi-buy ban as health groups left reeling; Sheffield research assesses pricing impact on groups

The Government has confirmed it will not be introducing minimum unit pricing (MUP) in publishing its response to the alcohol strategy consultation. A proposed ban on multi-buy promotions has also been dropped, but previous plans for a 'below cost ban' have been resurrected, meaning alcohol will not be sold at lower than duty+VAT to 'stop the worst cases of heavy discounting'. 

In 2012 the Government's new alcohol strategy announced it would "introduce a new minimum unit price". However by 2013 it was stating it was listening to "powerful arguments on both sides" following consultation on a 45 pence MUP and other measures. Health bodies and other supporters, including Tory MP Sarah Wollaston, leveled that the Government had given in to industry lobbying.

The Home Office though insist they have not ruled minimum pricing out - in the full consultation response Home Office Minister Theresa May states "we are not rejecting MUP – merely delaying it until we have conclusive evidence that it will be effective." Words not likely to impress many health and academic groups who already regard evidence around minimum pricing as conclusive. A proposed multi-buy promotions ban was also dropped due to "no convincing evidence that it would have a significant effect in reducing consumption", despite recent evidence to the contrary from Scotland and the majority of consultation responses supporting it.

The Home Office consultation itself also irked minimum pricing supporters. The main question asked 'do you agree that a 45 pence minimum price would achieve these aims [of significantly reducing alcohol related harm]' with no option on the actual level. But when Home Office minister Jeremy Brown told the Commons that 56% of people disagreed with the statement, he did not highlight that some may have done so as they felt the minimum price should have been higher. Pressed on this issue, he stated "we do not know whether the majority disagreed because they thought it should be twice as high or half as high."

The University of Sheffield have also published new research examining the impacts on minimum pricing on specific income groups. The research, 'produced at the request of the UK Government to inform consultation and impact assessments', seems to counter many of the reasons against MUP and the Government's decision: "Minimum  unit  pricing  (MUP)  policies  would  be  effective  in  reducing ... alcohol-related  harms... Moderate  drinkers  would  experience  only  small  impacts  from  MUP  policies" it states. Further work estimated a minimal impact of a below cost ban "approximately 40 to 50 times smaller than the estimated impact of a 45p MUP".

Health groups and other supporters have certainly been taken for a rough ride; some were reported to quit memberhip of the responsibility deal. Interestingly even Public Health England expressed its disappointment. See responses from Alcohol Concern, Alcohol Research UK and the BMA.

On the other 'side', Miles Beale of the Wine and Spirits Trade Association welcomed the news having been a vocal opponent of MUP and proponent of the notion it would 'punish responsible drinkers'. Alcohol industry body the Portman Group welcomed the Government's commitment to take forward partnership working with the industry including removing alcohol units from the market and improving labelling.

So after all, Scotland will be going alone on its mission to implement minimum pricing.

Polish street drinkers: service engagement research and feasibility study

A feasibility study exploring alcohol service engagement among Polish street drinkers has been released by Alcohol Research UK.

The research aimed to identify pathways to street drinking, to explore awareness of, attitudes towards and barriers to accessing services. The research was undertaken by the Drug and Alcohol Research Centre at Middlesex University.

The key findings are:

• The street drinkers encountered difficulties with statutory and charitable organisations, particularly with respect to lack of language support.

• A lack of recourse to public funds plays a critical role, not only in triggering their homeless state, but in preventing them from accessing support.

• Given their state of homelessness, this small study of Polish street drinkers found evidence of resourcefulness and mutual support in managing their lives and coping with life on the street.

• The reserach techniques deployed during the research played an important role in securing the participation of members of this intrinsically hard-to-engage group.

• The techniques established a positive, candid interview dynamic, and enabled participants to meaningfully share ownership of the research process.

Homeless Link produce resources on on Central and Eastern European homelessness issues and conducted a 2009 report. Other organisations such as Barka UK have been set up to work with migrants facing homelessness.

See here for a breifing on 'street drinking: enforcement Vs support'. See here for previous street drinking tagged Alcohol Policy UK posts.

'On your doorstep; underage access to alcohol via home delivery services'

A new report by Alcohol Concern Cymru says children are often able to access alcohol via home delivery services. Earlier this year an online survey of nearly 1,000 people in Wales aged 14 and 17 years old explored their use of online supermarket grocery services and latenight and 24 hour alcohol home delivery services.

See the full report 'On your doorstep; underage access to alcohol via home delivery services'.

15 per cent of the young people surveyed stated they had successfully bought alcohol online, and over two thirds of these said they found it “easy” to do so. Similarly, 13 per cent said they had successfully bought alcohol by telephone from a home delivery service, and again over two thirds of these said it was “easy”. Both methods were chosen by many because they are considered easy ways to bypass age verification checks, and as a quick and convenient way of acquiring alcohol.

In March 2013 South Wales Police undertook test purchase operations in Cardiff, using 15 year olds, to find out whether they were able to buy alcohol from major supermarket grocery websites. They too, found that alcohol could be purchased online with relative ease. In 44 per cent of the test cases, alcohol was delivered to the test purchasers in person with no proof of age requested.

A previous research report last year said online alcohol sales and purchasing by friends and family are creating a significant and emerging battleground in the fight against underage drinking in England. 

Three recommendations flow from the Alcohol Concern Cymru report:

1. Supermarkets and other off-trade retailers providing home delivery services should review their existing age verification procedures at both the point of sale and delivery stages. Receipt of orders that contain alcohol must be by an adult. Retailers should ensure that delivery staff have appropriate training around requesting and identifying proof of age, and should implement these procedures as standard.
2. Further research should be undertaken in determining the proportion of children and young people who buy alcohol online and/or by telephone. More widespread test purchasing by police and trading standards is recommended.
3. The UK Government should review the efficacy of current licensing law relating to the home delivery of alcohol, in terms of whether it adequately protects children and young people from alcohol-related harm.

Newcastle approves first late night levy

Newcastle City has become the first council to agree a late night levy in the town after doubts over its likely use. The new charges will apply to city pubs and clubs open after midnight. Fees will range fron £299 to £4,400 per year depending on the rateable value of venues.

The levy is intended to provide funding for public services, primarily policing costs, involved in managing crime and disorder in and around the Night-Time Economy (NTE). The decision has been criticised in an article in the Morning Advertiser. Trade objections to late night levies suggest they are an unfair extra expense on small businesses which will impact on profits.

The full council approved the levy despite more than 60 objections from businesses in the area, but like many town centres has significant problems with alcohol-related disorder. See consultation responses here. The on-licensed trade in particular object to the fees, pointing out that it is unfair that off licenses are not subject to the fees. Many NTE users reportedly 'pre-load' with cheap alcohol obtained from off-licenses and supermarkets before accessing pubs and clubs in the evening.

A previous Alcohol Policy UK article on late night levies explained the background to the new local authority power to impose the fees. No areas appear to have yet committed to use of Early Morning Restriction Orders (EMROs) to restrict the sale of alcohol between midnight and 6am.

Investigating Parental Monitoring, School And Family Influences On Adolescent Alcohol Use

This study report has been published by Alcohol Research UK which is based on the first five years of the Belfast Youth Development study which is a Longitudinal Study of Adolescent Drug Use. The findings of this study are of importance to the academic understanding of adolescent development and alcohol use, and to the field of alcohol harm reduction, family support, and youth alcohol policy. 

Key findings of the report are:

• Children whose parents exert greater control over their free time activities tend to drink less frequently. Early control has a lasting influence on alcohol use
• Higher rates of drinking in early adolescence leads to reduced levels of parent-controlled boundaries and limits at home
• Being in a school with a higher proportion of frequent drinkers is a risk factor for frequent drinking
• Girls who attend single-sex post-primary schools tend to drink more than pupils attending co-educational schools or male-only schools

The study collected information from young people about the rates of parental monitoring, parental control, parental solicitation and child disclosure and information on frequency of alcohol use (never, rarely, monthly, weekly or more often) across each year. It also collected information on the quality of the parent adolescent relationship.

Last year the think-tank Demos produced a follow up report further emphasising the influence of parenting style on children’s drinking as teenagers and later in life. Read about it here. In 2011 the Joseph Rowntree Foundation also published a report Young People, Alcohol and Influences which took a broader look at influences on young people's drinking. 

Drinkaware has a web-page for parents aimed at promoting earlier conversations about alcohol. Further reports and guidance related to children and young people can be found here on the Alcohol Learning Centre, including the CMO guidance which says an alcohol free childhood is best. Last year two reports called for the protection of children from alcohol harm.