Alcohol Policy UK

Minimum pricing consultation responses analysed by IAS to show respondents 'split' on MUP proposal

The Institute of Alcohol Studies (IAS) has conducted an independent analysis of the Home Office consultation on minimum unit price (MUP) at 45p per unit, indicating a different outcome from that suggested by the official response.

Earlier this year the Government confirmed it would not be introuducing MUP, despite pledging to do so in the 2012 strategy. In announcing the u-turn, Home Office Minister Jeremy Brown stated that "substantially more" respondents disagreed with the proposed 45p MUP. However, he did not clarify that some may have 'disagreed' as they felt the proposed minimum price should have been higher.

The IAS report highlights that the Government consultation report therefore failed to distinguish between responses that were against the principle of introducing MUP at any level, and those that wanted a MUP higher than the single 45p option posed. 

Results from the IAS MUP consultation analysis report [pdf] found:

• Many respondents who were noted by the Home Office as against a 45p per unit minimum price were actually in favour of a higher minimum price of at least 50p per unit

• When accounting for this discrepancy, the proportion of respondents for and against the measure was split fairly evenly (45%:46% respectively), contrary to the Home Office figures (34%:56%)

• Thousands of responses from members of the public collected by Balance North East, expressing support for a 50p minimum unit price, were omitted from the published responses and Home Office calculations, whilst other submissions from individuals appear to have been accepted.

• A lack of clarity about the purpose of the consultation; whether it was designed to seek views on the level or the principle of MUP and it is unclear what role the consultation responses played in the decision-making process to delay the introduction of MUP.

The IAS analysis acknowledges a significant number of responses from the public were excluded and questions the reasons for this.

Katherine Brown, Director of Policy at IAS said:

“Given that the consultation was designed to seek views on the level and not the principle of minimum pricing, and indeed that respondents were invited to suggest alternative levels, it is odd that the Home Office results were not presented in a way that would take this into consideration".

“We hope that our report will provide a helpful contribution to the decision making process to introduce minimum pricing. The evidence to support this policy continues to get stronger, and this report shows there is greater public support than previously thought.”

The IAS suggest the Government need to use a more considered approach to gauging public opinion on proposed policies. When annocuning the decision to drop MUP, the Home Office also said previous plans for a 'below cost ban' had been resurrected, meaning alcohol will not be sold at lower than duty+VAT to 'stop the worst cases of heavy discounting'. Watch this space or see here for APUK minimum pricing coverage. Some views from the alcohol industry on MUP can be seen in this Morning Advertiser article.

A study of alcohol and youth offending in London: Alcohol Concern report calls for alcohol skills amongst youth roles

A new report looks at alcohol use amongst young people in London's Criminal Justice System. Produced by Alcohol Concern and Mentor UK, it explores alcohol misuse amongst this group as an under-researched area, and makes recommendations for services to better understand associated risks.

'Demon Drink? A study of alcohol and youth offending in London' states 9,542 young people were involved in London's youth justice system in 2011-12, with over 20,000 offences recorded.

Nationally it is estimated that alcohol consumption amongst young people aged 10 to 17 years is responsible for 80,640 violent offences per year and for criminal activity costing in excess of £5 million annually to the criminal justice service.

The report emphasises how alcohol misuse is likely to cluster with other related risks such as poor mental health and negative educational outcomes, increasing the likelihood that misuse may be overlooked. Young people themselves may not feel they have a problem as most are not ‘addicted’ (dependent). Early intervention such as IBA to address risky alcohol misuse is therefore imperative.

The report makes 4 key summary recommendations:

1. Youth justice case workers need to be confident in addressing risky alcohol use as well as making referrals to specialist support when necessary. Case workers should be trained in Identification and Brief Advice (IBA) and motivational interviewing techniques that are shown to be effective.
2. All those working with children and young people, particularly those working with vulnerable groups such as young offenders, need to be aware of and to implement National Institute for Health and Care Excellence (NICE) guidance around alcohol and substance misuse.
3. Risky alcohol use often presents as one of a cluster of risks. Workers in both universal services (such as schools) and targeted services (such as youth offending teams) need to be aware of the heightened likelihood of alcohol use amongst ‘at risk’ young people.
4. London has a consistently low-drinking culture with lower levels of use than all other regions of the country. The findings of this study cannot be considered to be representative nationally, and further research is needed in other areas to better understand alcohol use amongst offender cohorts.

A Joseph Rowntree Foundation report Young People, Alcohol and Influences takes a broader look at influences on young people's drinking. Further children and young people reports and guidance 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. See all Alcohol Policy UK young people tagged reports.

Recent Findings bulletins: assessing the alcohol treatment gap; 12 step role in recovery; should parents introduce children to drink?; substance misuse education

Recent bulletins from the drug and alcohol bank:

How big is the alcohol treatment need/access gap in England? England had nearly 110,000 patients in specialist alcohol treatment in 2012/13 and over a third left as planned free of dependence – impressive numbers, but they probably mean most dependent drinkers who could benefit from treatment do not receive it, perhaps partly because so few find their way to treatment via their GPs and other medical services.

12-step mutual aid promises to plug the recovery resources deficit   Paralleling the rise in abstinence-based recovery in UK national strategies has been a rise in the profile of the best-known programme for achieving this goal – the 12 steps of various mutual aid fellowships and allied treatments. For the UK, these offer a way to reconcile diminished resources with the desire to get more patients safely out of treatment, but is the resurgence of interest matched by evidence of effectiveness?

Should parents introduce their underage children to drink?  Should parents introduce their underage children to drink, and if they do, is it important they are there to supervise its consumption? Opinions and guidelines differ, as do research findings. Interest centres on two follow-up studies. One from the Netherlands seemed to clear home drinking and drinking with parents from aggravating the risk of problem drinking, but a US/Australian study found that children who drank under adult supervision (maybe not the parents) were more likely later to drink and experience alcohol-related harms. Perhaps in a complex way, it all depends on the context.

Flawed evidence for drug education's preventive impacts    It may be educationally valuable, but in preventive terms, school-based drug education is largely a waste of time. That seems the message of this "trenchant critique" from a specialist at Norway's national drug and alcohol research centre. The focus is on methodological concerns which might undermine positive findings, and on whether these survive a programme's transplantation to real-world conditions.

It's magic: prevent substance use problems without mentioning drugs   The future for prevention seems more likely to lie with child development and parenting programmes which do not mention substances at all than with drug programmes. These generic approaches have recorded some of the most substantial preventive impacts ever seen – for example, the primary school classroom management technique which it was estimated would later halve drug use disorders among the boys.

News & updates Dec 2013: young people's drinking, resources for schools, MUP in Ireland & more

A selection of stories in the media since the September round up:

Young people

Department for Education returns show that local spending on alcohol and drug services for young people has been cut by 22% since 2011 reports Mentor. 

293 children aged 11 or under were admitted to A&E units across the UK in 2012/13 after drinking too much, according to the BBC, up a third from the previous year.  

A new European Commission report Eyes on Ages: A research on alcohol age limit policies in European Member States. Legislation, enforcement and research says all EU Member States have legal age limits for selling alcohol but, the age limit policies vary widely and countries differ on aspects like sanctions, type of enforcement authorities and communication strategies.

NFER has published Talk About Alcohol: an Evaluation of the Alcohol Education Trust’s Intervention in Secondary Schools which found a statistically significant delay in the onset of drinking amongst the young people in the Talk About Alcohol intervention group.

The Welsh Government's Alcohol in Higher Education Toolkit has been officially launched following extensive trials.  The toolkit has been produced to give student welfare services practical advice on addressing alcohol misuse.

Young people tend to view targeted alcohol marketing via social media sites as ''useful and informative'' instead of recognising it as advertising, research reported in The Telegraph finds.

Adfam has published Identifying and supporting children affected by parental substance use: Resource for schools for the Alcohol and Drug Education and Prevention Information Service (ADEPIS).  Aimed primarily at school governors and headteachers, it aims to summarise the key issues for children affected by parental substance use, and how schools can consider supporting them.

Demos, in its report Sobering Up has urged the government to introduce tougher punishments for parents, siblings and friends who buy alcohol for children, reports the BBC. However the report, funded by the Association of Convenience stores, has some questionable recommendations - APUK analysis to come.

A research study, Young adults and the decline of the urban English pub: issues for planning, reported in Science Daily, finds evidence for the traditional pub as a site for restrained and responsible social interaction for young adults.

Other news

The Irish Examiner reports on research which found the societal costs of the consumption of alcohol “far outweigh” the employment and tax benefits, and will inform current plans to introduce minimum unit pricing across southern and Northern Ireland. 

The Northern Ireland Chief Constable Matt Baggott (right) has urged politicians to do more to tackle the misery caused by alcohol, saying said one in five crimes in Northern Ireland are alcohol related, and 61% of street violence involved alcohol, reports the BBC.

The BBC reports that the number of motorists arrested for drink-driving the "morning after" has risen, police figures suggest - see APUK analysis here.  Meanwhile, a new report says Scottish drivers are the worst in the UK for driving under the influence of alcohol or illegal substances, reports the Herald.

Academics have criticised Newcastle's late night levy for lack of evidence, reports the Journal, whilst the Gazette says Colchester is considering such a levy to address its 'image problem' associated with drunken revellers.

To get regular media reports you can sign up to the alcohol e-shot or Drugscope Daily. For the Alcohol Policy UK newsletter email [email protected]

Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS): third annual report assesses impact of strategy

The third Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) annual report provides an update on Scotland’s alcohol strategy. See the full report, executive summary or BBC report.

The report includes an evaluation plan, trends in price and affordability, alcohol sales and consumption, and alcohol-related harm. New chapters reflect the evaluation of the Scottish Licensing Act and the contribution of the economic downturn to recent falls in alcohol-related harms in Scotland.

It suggests that Scotland's alcohol strategy is likely to be contributing to some aspects of the decline in levels of alcohol-related harms, but cautions that the role of economic downturn and still high levels of harm must not be overlooked. The second MESAS report last year reported on Scotland's significant attention to implementing alcohol brief intervention (ABI or 'IBA' in England), but also warned that any benefits should be considered modest compared to the total burden of alcohol-related harm in Scotland.

On the Licensing Act evaluation, the report says that although compliance has been high, significant limitations exist. For instance Licensing boards have found it difficult to measure overprovison, and addressing the public health objective has been challenging. Consequently it says, "the Licensing Act, as yet, is unlikely to have a large impact on alcohol consumption in Scotland."

With regards to alcohol consumption, there has been a downward trend, decreasing by a total of 8% between 2009 and 2012. Per adult sales in Scotland have however been 19-21% higher than in England and Wales over the past five years mostly due to higher off-trade sales in Scotland, particularly spirits. The downward trend in self-reported weekly alcohol consumption, particularly since 2008, has been driven by young adults (aged 16-24 years) and those characterised as drinking at ‘harmful’ levels.

On Price & Affordability, it states the affordability of alcohol has increased substantially since the 1980s, driven by rising disposable incomes. Despite falls between 2007 and 2011 probably due to the economic downturn, affordability remains high compared to the 1990s and early 2000s. Affordability has increased most in the off-trade. Sixty per cent of off-trade alcohol sold in Scotland in 2012 was sold at below 50 pence per unit. This compares with 81% in 2009, highlighting the importance of regularly reviewing the level at which the minimum price for alcohol is set.

On alcohol-related harms, it states although alcohol-related mortality in Scotland has declined in recent years, rates remain higher than they were in the early 1980s. On inequalities, the relative gap in alcohol-related mortality rates between the most and least deprived communities in Scotland has narrowed in the last ten years. The recent economic downturn appears to be a partial explanation for recent falls in alcohol-related mortality.

The executive summary conclusion states:

Scotland is experiencing a recent and sustained decline in alcohol-related harm across most measures but still at levels higher than one decade ago and is persistently higher than England & Wales. It is likely that some elements of Scotland’s alcohol strategy are contributing to this decline. Falling incomes in the lowest income deciles are also likely to explain part of the decline, although the analysis is not conclusive and other factors are probably also important.

However significantly affecting national levels of alcohol-related harm requires sustained, multiple approaches at national, local and individual levels. Scotland's strategy reflects an approach based on health backed evidence based policies, although yet to successfully implement minimum unit pricing (MUP).

Next year's New Directions 2014 Conference, 'Learning from Scottish Experiences' takes place in Dundee, exploring key themes including 'Will Independence Change Scotland’s Relationship with Alcohol?', minimum pricing and alcohol brief interventions.

'Clarifying alcohol brief interventions: 2013 update' - caution over 'IBA lite' approaches?

A new briefing Clarifying alcohol brief interventions: 2013 update [pdf] has been released by the Alcohol Academy. It updates the 2010 briefing to account for new developments in the field and key issues relating to the national implementation effort.

In particular, the briefing paper explores 'IBA lite' or 'minimal brief intervention' - an approach whereby at-risk drinkers are offered only feedback and a leaflet, as opposed to structured brief advice offered as part of IBA. Such 'minimal' or 'lite' approaches appear to have been increasingly popular, in part following the SIPS Primary Care findings which did not show better outcomes for longer intervention approaches.

The appeal of shorter approaches is understandable given the real world challenges for routine IBA delivery, particularly time pressures on busy front line roles. However the briefing cautions that although 'lite' approaches may be easier to achieve, there is a risk that brief intervention will be prematurely reduced to less than it should be. Therefore full IBA approaches, including the offer of verbal brief advice, should be sought wherever possible - but minimal approaches may be acceptable where not.

Another issue is whether shorter screening tools such as AUDIT-C or FAST can be used to lead straight to brief advice without first completing the full AUDIT. Shorter tools do not tend to differentiate risky drinking (suitable for brief advice) from probable dependent drinking (suitable for referral). Again the answer is not clear cut - ideally full AUDIT should always be used, but if time or other issues prevent this there is still likely to be value in using shorter tools alone to lead to brief advice.

The paper includes a table identifying the key brief intervention approaches and differences, now including exploration of 'minimal' or 'lite' approaches. The briefing was co-authored by Professor Nick Heather, Don Lavoie and James Morris.

For more on IBA see the IBA blog or Alcohol Learning Centre.

Alcohol Awareness Week (AAW) 2013: brief review

Alcohol Awareness Week (AAW) 2013 recently took place, running from 18-24 November. Alcohol Concern had encouraged local areas to promote conversations and awareness of alcohol and its impact, and recognise the importance of Identification and Brief Advice (IBA).

Twitter was used to highlight a range of activity by organisations across the country with #AAW13 as the suggested hashtag, although #LetsTalkDrinking, #AAW2013 and #AlcoholAwarenessWeek were also used.

Professor Kevin Fenton, Public Health England Director for Health and Wellbeing wrote a specific piece 'Having the conversation about alcohol' on the PHE blog. In it he emphasised the importance of healthcare professionals delivering IBA, stating "raising the issue of alcohol is a job for all of us [healthcare roles]."

News coverage included some degree of reporting by mainstream media. The Express covered top ten alcohol facts and Beth Burgess wrote about her battle with addiction in the Huffington Post. Alcohol Concern also held their annual conference which prompted the the Daily Mail to report on a ‘meteoric rise’ in alcohol related deaths.

Local media however gave significant coverage, with just a few examples highlighted here in the Eastbourne Herald, Fenland Citizen, This is Devon, North Devon Journal,  About Northampton, York Vision, Aberdare Online, Rochdale Online, Leicester Mercury, Portsmouth News,The Haringey Independent, The Star, Shoreham Herald and Peterborough Telegraph.

Regionally, DrinkWise held a North West Alcohol Summit - presentations will shortly be available on the DrinkWise forum plus a video from Professor Tim Stockwell on Minimum Unit Pricing. Balance, the North East alcohol office, launched a hard-hitting health campaign warning that alcohol is in the same cancer causing category as tobacco smoke and asbestos.

Please feel free to highlight any other examples in the comments box.

Drink Driving warning over 'morning after'

‘Morning after’ drink driving is on the increase with more motorists putting themselves and other road users at risk, according to figures released by LV insurance. LV obtained figures from 22 of the 45 police forces in England and Wales, finding arrests between 06:00 and 08:00 rose by 4% from 350 in 2011 to 363 in 2012.

A separate survey by LV found 46% of drivers had no idea or underestimated how long it took for alcohol to leave the body. Typically a healthy body will process around 1 unit per hour, but a wide range of variables such as body size, gender, age and other factors come into play.

Crucially, the time span of consumption will also significantly affect blood alcohol levels. There is therefore no specific number of 'units' that equates to the legal drink drive limit of 80mg of alcohol per 100ml of blood or 35mg per 100ml of breath. Drinkers who attempt to calculate alcohol processed by the body at '1 unit per hour' would be wise to add at least an extra hour and ensure they do not underestimate the number of units consumed.

Drink-driving arrests typically rise in the run up to Christmas, so LV car insurance's John O'Roarke warned: "It's easy to assume that after a good night's sleep you will be sober enough to drive the next day but, depending on how many units you've had, you may not be fit to drive." Alcohol can also negatively affect sleep so could also be a risk factor for driving the next day.

Overall rates of drink-driving appear to have stabilised following significant falls since the 1970's. However police have been unable to reduce breath test failure rates below the 5% mark, and are worried about higher rates amongst under 25s. Police in the West Midlands are encouraging people to report anyone they know to be drink driving and could recieve a £200 reward.

In 2011 it was announced the legal drink-drive limit would remain at 80mg per 100ml of blood despite an independent report calling for it to be reduced to bring it in line wth most European countries. Instead the Government said it would focus on "improving enforcement and education to tackle the drink and drug drivers who put lives at risk."

See here for the Think! road safety website, including facts and advice on drink-driving.