Alcohol Policy UK

London Pharmacy IBA Scratch Card project

A pan-London pharmacy initiative that distributed over 24,000 'IBA scratch cards' has published a UCL evaluation report detailing the project. The report indicates the potential for community pharmacies to deliver lifestyle interventions.

Scratch-cards included the 3 AUDIT-C alcohol screening questions often used as part of 'Identification and Brief Advice' (IBA). Patients scoring 5 or more, indicating some level of alcohol misuse, were offered either a leaflet, brief advice or referral. The project however aimed only to establish the acceptability of a 'scratch-card' approach, rather than evaluate IBA effectiveness in pharmacy settings.

With nearly 44% of patients scoring positive (5 or more), over ten thousands patients were offered at least an information leaflet. 92% of patients offered a scratch-card completed it within the pharmacy and anonymous data was recorded. 3% of patients refused to complete the scratch-card and the remaining 5% took the card away.

The report found wide variation in activity across the 240 participating pharmacies. Pharmacies received a payment to cover implementation costs and a further payment was offered to those recording 200 interventions. Results showed the project captured a range of age, ethnicity and occupations and an even gender split, giving good representation of London's diverse profile.

Whilst the project undoubtedly generated significant activity identifying many at-risk drinkers, it does raise key questions relevant to the broader issues of implementing 'IBA' approaches. One issue is whether shorter screening tools such as AUDIT-C only are sufficient, or whether positive scores should always be followed up with full AUDIT - see discussion here.

In the case of this project, there appeared no method to determine whether leaflet, advice, or referral was offered to those scoring positively other than the pharmacist's discretion. The report acknowledges the nature of interventions were not recorded, but as other primary care findings would suggest, this was most likely to have been highly variable.

Such initiatives may therefore be valuable in continuing to develop opportunities for IBA delivery, but debate will continue as to what level of screening, intervention and quality needs to take place. Community pharmacies seem like an obvious IBA opportunity, but experts might point out there will be no quick wins in establishing regular, high quality IBA in any setting. The appeal of scratch cards and leaflets may be strong, but should not come at the expense of good practitioner skills and clear referral options.

'Making recovery a reality through integrated mental health, drug and alcohol services'

A recent briefing on mental health, drug and alcohol services urges commissioners to tackle the poorly integrated support received by those with overlapping substance misuse and mental health needs, or 'dual diagnosis'. 

The two page report was produced by The Centre for Mental Health, Drugscope and Alcohol Concern.

The briefing explores the idea of 'recovery', the new commissioning landscape and opportunities for improving services. It highlights five recommended actions:

• First, that health and wellbeing boards should include people with both mental health conditions and substance misuse problems in joint strategic needs assessments.
• Second, that joint health and wellbeing strategies should focus on the groups whose needs are least well met.
• Third, that health and wellbeing boards should nominate a 'recovery lead' to build up local partnerships to support neglected groups of people.
• Fourth, that clinical commissioning groups and directors of public health should ensure they jointly commission integrated support for people with overlapping mental health and substance use problems.
• And finally that both sets of services focus on helping people to achieve recovery on their own terms.

Earlier this year a guidance document for commissioning drug and alcohol services was released by the Joint Commissioning Panel for Mental Health (JCPMH). It highlighted ten key messages ranging from the invest to save case, utilisting NICE guidance, commissioning for outcomes, building partnerships and workforce development.

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.

DrugScope also recently 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.

Drinkaware 2012 report reviews impact of activities - but will health groups be convinced?

The industry funded alcohol education charity Drinkaware has released a 2012 impact report, detailing its recent activities and reported impacts on target groups. Report here (pdf).

Drinkaware's existence not surprisingly divides opinions; some health groups are sceptical of indsutry led intiatives, or raise concerns over a policy focus on education based approaches. Earlier this year an independent audit gave Drinkaware a mixed review of its impact over recent years.

Regardless, Drinkaware have the lion's share of the 'alcohol awareness market' with a far greater web presence than say the NHS Choices alcohol pages. The report highlights four million people visited the Drinkaware website in 2012 and front-line public services used 1 million of their factsheets, unit and calorie wheels and unit measure cups.

Drinkaware have worked on a number of key themes for their activities. For 'Helping parents delay the age of their child’s first drink', Drinkare state their long term goal is to raise the average age of first drink to 15, highlighting the CMO guidance advising an alcohol-free childhood.

Drinkaware report that after seeing the Your Kids and Alcohol campaign, 44% of parents felt they had a successful conversation with their child about alcohol. 31,000 people visited the parents section of the website and 100,000 parental advice leaflets were distributed.

The report states the age of a young person’s first supervised drink has increased from 12.9 years in 2009 to 13.4 years in 2012. The average age of their first unsupervised drink has also increased, from 13.8 years in 2009 to 14.7 years in 2012. Of course this can not be directly attributed to Drinkaware activity, especially since overall alcohol use by 10-15 years has been falling since 2003.

For 'Changing adults’ daily drinking habits', Drinkaware's aim was to increase
knowledge of the unit guidelines and the health risks amongst those regularly exceeding them. Drinkers were encouraged to sign up to MyDrinkaware, an online tool that tracks units and the calories in drinks.

The report states 181,000 people signed up to MyDrinkaware and that "even limited use can have a positive impact on consumer understanding of the unit guidelines..". Reported alcohol consumption among active MyDrinakware users fell from an average of 5 units per day to 3.9 units", although it does not state how many were active users.

For 'challenging young adults’ attitudes to getting drunk', Drinkaware's goal was to shift attitudes to drinking and reduce the public acceptability of drunkenness. However it says:

"While results showed good reported adoption of our tips and advice, young people’s attitudes and behaviour around responsible drinking have proved difficult to shift and remain unchanged overall. In fact, the proportion of young adults who believe you need to get drunk to have a good time has gone up."

Finally, the report identifies actions around 'Developing strong partnerships', as well as detailing Drinkaware's medical advisory panel, board and funding position.

Drinkaware have had a new Chief Executive, Elaine Hindel, since earlier this year - see a recent interview here (pdf). Hindel will no doubt want to oversee further evidence of Drinkaware's impact, and perhaps equally as challenging, further acceptance from the health community of their role in supporting 'responsible drinking'.

Minimum pricing: commons briefing note provides policy overview

A Commons standard note on minimum pricing was recently published, outlining 'minimum pricing' terminology and the policy context. 

The briefing looks at the differences between a 'below cost ban' and minimum unit pricing (MUP) and the various policy shifts over recent years. It also covers Scotland, where the SNP are pushing ahead with their MUP plans despite legal challenges led by the Scotch Whisky Association.

The British Government recently confirmed it would not be introducing minimum unit pricing despite its 2012 commitment. In publishing its response to the alcohol strategy consultation a proposed ban on multi-buy promotions was also dropped. However previous plans for a 'below cost ban' were resurrected alongside other policies, meaning alcohol will not be sold at lower than duty+VAT to 'stop the worst cases of heavy discounting'.

However the challenges and limitations of a 'below cost ban' have been widely discussed, including difficulties in defining or tracking below cost selling. The University of Sheffield recently published new research that estimated the impact of a below cost ban as "approximately 40 to 50 times smaller than the estimated impact of a 45p MUP".

In 2010 Alcohol Policy UK highlighted the differences between the two policies as well tax increases as a means of price control in the table below. Last year we also looked at claims that 'minimum pricing could backfire'. See here for all APUK pricing reports.

See here for the 2012 Health Select Committe's findings on minimum pricing as part of its response to the alcohol strategy.

'Stick to the facts': Alcohol Concern call for tougher regulation on alcohol advertising

Alcohol Concern have called for a major shake up of the alcohol advertising regulation framework to achieve a better balance between public health concerns and commercial freedoms.

The 'Stick to the facts' report says advertising creates social norms around alcohol and promotes the normalisation of drinking in society. Exposure to alcohol marketing is linked to consumption, particularly in the under 18's. In light of the growing body of evidence, Alcohol Concern argue that a sensible policy response is needed and call for a ban on advertising at all sporting, cultural and music events.

Young people involved in YAAC (Youth Alcohol Advertising Council) reported minors are exposed to content which appeals to them, particularly via social media, and how advertisers make associations with prohibited themes despite the current regulations. The report also claims that alcohol advertisers are exploiting weak rules, particularly around digital and internet advertising.

Alcohol Concern report that children and young people in the UK aged 10-15 years are exposed to significantly more alcohol adverts than before. Just recently several TV companies were warned for breaching existing regulations. They also re-iterate concerns also voiced by other public health bodies; in 2011 a campaign by Balance warned how the alcohol industry targeted young people with ads which make drinkers appear popular, successful and attractive. Opponents might point out overall alcohol use by 10-15 years has reportedly been falling since 2003.

Alcohol Concern say that self-regulation by the alcohol industry is insufficient, and that regulation needs to be independent of industry influence. They call for greater restrictions on the content and channels of alcohol promotion which would reduce the appeal and exposure to underage audiences. They promote a model that draws on the principles of France’s Loi Evin which has much tighter controls.

There are 5 policy recommendations made in the report:

1. Only advertise product characteristics 
2. Statutory and independent regulation
3. Meaningful sanctions
4. Prohibit sponsorship of sporting, cultural and musical events
5. Restrict cinema advertising

EUCAM gave a luke warm welcome in 2012 to self-regulation proposals for alcohol advertising across the EU. Further APUK reports on alcohol advertising and regulation can be found here. See here for a Points blog piece on alcohol marketing by Dr James Nichols.

News & updates Aug 2013: Olympics alcohol impact; alcohol stats at risk; Drink Driving rise; trade news & more

Here's some of the recent news happening over the last month or so:

The 2012 London Olympics had no significant impact on alcohol related harms, a report published by the Centre for Public Health says. See a PHE press release which states 'the findings can be used in the future to support the use of interventions such as restricted advertising and controlled pricing strategies in event planning'.

Annual alcohol statistics could get the chop as part of programme of possible cuts being drawn up by the Office of National Statistics, a Guardian article reports. An ONS response has said that a consultation on the possible options will be released shortly, emphasising no decisions have been made.

Six out of seven supermarkets sell alcohol below cost, equating to 220 million litres a year, according to a parliamentary statement. The ALMR's Kate Nicholls of the called on the Government to take firm action on "supermarket irresponsibility".

Drink drive deaths may have increased by 25% in 2012, preliminary Government figures suggest - see BBC report. A Guardian datablog feature explores the trends behind the figures.

Channel 4 and other TV companies have been issued warnings for breaching advertising codes to prevent under 18's advert exposure, the Independent reports. The Advertising Standards Authority (ASA) code says an alcohol advertisement restriction should be applied when the number of 10 to 15-year-olds watching are 20 per cent over-represented.

A piece on the rise and fall of the alcopop was featured by the BBC. It looks at the rise of 'Ready To Drink' market, how they became synonymous with 90's 'binge drinking', and industry and media reactions.

One NHS hospital will offer some private patients alcohol, according to the Telegraph. The private patient unit is part of a project to increase hospital revenue, but a Trust official said the policy would be kept under review.

'Hangovers can make you stupid' is how the Telegraph has reported new research that explores how the after effects impact on memory and other brain functions.

Trade

Plans to introduce beer duty stamps have been abandoned, report the Morning Advertiser. A consultation last year claimed it would save £500 million in duty fraud, but the cost to the brewing industry was considered to big. 

Green shoots may be appearing for the pub industry, say an ALMR report. It reports the first positive growth across indicators 'since the sector was hit by the perfect storm of smoking ban, consumer confidence crash and recession'.

A Councilor has resigned over claims that the licensing process is bias, with decisions often made on personality - see Morning Advertiser report. Also an ex-licensee, Joe O'Riordan said the old system of Magistrates making decisions was fairer.

Blogs & comment

The charity Mentor UK have written a response to the decision on MUP, and blogs on alcohol prevention. Mentor state alcohol is the missing component of the new science curriculum and highlight that England won’t be part of the EU majority that require school based alcohol prevention.

Public Health England's Professor Kevin Fenton has written about the opportunities and challenges facing local authorities in addressing drug and alcohol misuse.

Scotland

Scottish Labour are expected to propose new action on alcohol to the Scottish Parliament this year, reports the Scotsman. Proposals include a focus on new local initiatives such as tagging bottles, cracking down on adverts near schools and banning tonic wines high in caffeine. However some of the proposals, such as tougher enforcement measures, have previously been adopted but questioned in England.

As part of a new 'Community Alcohol Partnership' (CAP), supermarkets will train smaller shops on preventing underage sales - BBC report.

New Directions 2013: FEAD videos on 'alcohol and the family' & more

A series of videos covering expert presentations on the theme of 'alcohol and the family and other key topics are now available from the Film Exchange on Alcohol and Drugs (FEAD). The speakers were filmed at the New Directions in the Study of Alcohol Group (NDSAG) 2013 conference held in Birmingham. 

The videos available cover a range of key alcohol policy and research subjects, with notable speakers such as Jim Orford, Jim McCambridge, James Nicholls, Richard Velleman and many others.

See here for presentations from the 2012 NDSAG conference inclusing videos of Professor Keith Humphreys and Steven Rollnick. Other renowned alcohol experts available to view include Professor Nick Heather, Professor Betsy Thom, Professor Robin Davidson and many others.

 

Alcohol Awareness Week 2013 runs 18-24 November; Alcohol Concern conferences

Alcohol Concern are promoting Alcohol Awareness Week (AAW) 2013 to take place from 18-24 November, encouraging local areas to promote conversations and awarenss of alcohol and its impact.

Alcohol Concern have produced an outline of ideas and materials for organisations [pdf] who might wish to take part. Last year we reviewed Alcohol Awareness Week 2012 including a variety of twitter and local activity.

On 19th November Alcohol Concern are also hosting their annual conference on the theme of 'conversations about alcohol' - details and booking here. On the 18th September Alcohol Concern are also hosting a conference on Alcohol and the World of Work: International Perspectives and Solutions in Wrexham.

Alcohol Concern are also planning Dry January 2014. See here for the guide and further Dry January information for individuals and organisations. See here for a review of last year's Dry January activity.

Smoking, Drinking and Drug Use Among Young People in England 2012

A statistical report from the Health & Social Care Information Centre gives results from an annual survey of secondary school pupils in England carried out since 1982.

The survey asks about use of alcohol, drugs and smoking but also attitudes towards them and the links between the three behaviours. It breaks down results into gender, age and ethnicity and whether children are truanting or excluded from school. The report, tables and a summary can be downloaded here.

Key findings in relation to alcohol:

• Less than half of pupils (43%) had ever drunk alcohol. Boys and girls were equally likely to have done so. The proportion of pupils who have had an alcoholic drink increased from 12% of 11 year olds, to 74% of 15 year olds.

• One in ten pupils (10%) had drunk alcohol in the last week. This continues the downward trend since 2003, when a quarter (25%) of pupils had drunk alcohol in the last week.

• Pupils who had drunk in the last week had drunk an average (mean) of 12.5 units. Median consumption, a more reliable measure, was lower (8.0 units). 

• Most pupils who had drunk alcohol in the last week had consumed more than one type of drink. Boys were more likely than girls to have drunk beer, lager or cider, whereas girls were more likely than boys to have drunk spirits, alcopops or wine.

• Half (50%) of pupils who had drunk alcohol in the last four weeks said that they had been drunk at least once during that time. Although 61% of them said that they had deliberately tried to get drunk, 39% said they had not.

• Pupils were more likely to drink alcohol if someone they live with does: 83% of pupils whose households did not include anyone who drank alcohol didn't drink themselves.

• The proportion of pupils who think it is OK for someone of their age to drink alcohol has fallen in recent years. In 2012, 28% of pupils thought that it was OK for someone of their age to drink once a week compared with 46% in 2003.

• The proportion of pupils who drank alcohol was lower in London than anywhere else; 31% of pupils in London had ever drunk alcohol. Outside London, the proportion of pupils who had ever drunk alcohol ranged from 36% in the West Midlands to 51% in the North East.

A previous report by the Joseph Rowntree Foundation found distinct regional differences in alcohol related harms experienced by young people, even though drinking behaviours in each area followed similar patterns. Download 'Local variations in youth drinking cultures' or the summary report.

The full HSCIC report also includes findings on patterns of drinking, where pupils get alcohol, beliefs and attitudes about drinking alcohol, sources of information that pupils found helpful, and personal and school characteristics associated with having drunk alcohol in the last week.

Earlier this year an event took place exploring 'Alcohol consumption in adolescence and early adult life: What are the consequences?'. The conference looked at the trends of alcohol consumption, and the health and social consequences of high consumption during the transition to adulthood. The influence of parents, school and family on adolescent drinking was studied in a Alcohol Research UK study, recently reported on APUK.

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. See here a post on IBA for young people.