Alcohol Policy UK

Latest from the IBA blog: beware 'IBA lite'?, can 'nudge' help IBA?, Selincro & IBA, & 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. 

Recent posts from the IBA blog are highlighted below:

• Clarifying Brief Interventions: 2013 update – beware ‘IBA lite’?  The recent briefing looked at 'IBA lite' as increasingly popular, reflecting its simplistic appeal. But what opportunities are being lost if we are offering just a leaflet and not 'brief advice'?.. Read more here...

• Can ‘nudge’ help IBA delivery?  There may be some simple ‘nudges’ for supporting IBA delivery that are being overlooked. This blog explores what 'nudge' is and how some 'nudges' might help increase IBA activity...Read more here...

• Selincro & IBA  Selincro or 'Nalmafene' is a new drug for treatment of mild to moderate dependence in conjunction with psychosocial interventions. This post raises some very important issues and concerns – about medicalisation, and how appropriately the drug will be used in practice.... Read more here...

• Are we using social media enough to enhance alcohol working?  What missed social media opportunities are there for using Twitter, Facebook and the likes to promote substance misuse work?... Read more here...

• IBA – before addiction sets in…   One of the fundamental points about IBA is that it is an early intervention – a chance for a drinker to change their alcohol use before it becomes a problem. Read more here...

Other key IBA blog posts include:

• Full AUDIT screening Vs shorter tools (FAST, AUDIT-C etc) for IBA
• IBA – making it happen?
• SIPS Primary Care Research: not just a leaflet
• Step-by-step IBA (in a nutshell)

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.

Please get in touch if you have any IBA projects or ideas to share.  

NICE publish guidance on 'Behaviour change: individual approaches (PH49)'

NICE have released new guidance to promote and support individual level behaviour change. The guidance makes seventeen recommendations covering policy, commissioning and practice aspects of implementing individual 'behaviour change' interventions relating to alcohol, diet, physical activity, sex and smoking. 

Although 'Behaviour change: individual approaches (PH49)' clearly advocates the importance of brief intervention for all health behaviours, it does not refer explicitly to 'Identification and Brief Advice' (IBA), the most common term for alcohol specific brief intervention in England.

The guidance advocates as recommendation 9 the delivery of very brief, brief, extended brief and high intensity behaviour change interventions and programmes. However questions over the evidence for 'very brief interventions' for alcohol were highlighted by the recent Clarifying Brief Interventions: 2013 update. Although recognising that such 'IBA lite' approaches may be easier to implement, it suggested that full IBA should still be sought as a minimum standard. The NICE guidance is likely to recommend very brief or 'lite' intervention approaches largely on the basis on evidence supporting very brief smoking interventions.

Discussions around improving the delivery of alcohol IBA often include questions over how other behaviours should be addressed. Harmful or risky health behaviours are often closely inter-linked, so front line roles should be able to carry out brief intervention for any of the key health behaviours. This is largely the goal of the 'Making Every Contact Count' (MECC) agenda.

However those championing IBA may point out concerns that alcohol too often gets 'left out', despite alcohol brief intervention probably being the most cost-effective. Practitioners have sometimes reported being less willing to raise the issue of alcohol compared to smoking, diet or exercise. There is some way to go before good quality, individual level behaviour change interventions are routinely carried out, and still lessons to be learned as to what exactly works best.

See here for the Alcohol IBA blog, Alcohol Learning Centre IBA pages, NICE alcohol guidance and NICE Behaviour change: the principles for effective interventions (PH6).

Drinkaware announces changes to address issues raised by 'mixed' independent report

Drinkaware, the industry funded alcohol education organisation, has responded to the independent report released last year which gave it a 'mixed' review. As well as appointing a new chair and trustees, Drinkaware says it is delivering a number of further changes and projects in response to the recommendations - full response and activities here [pdf]. 

As well as a new Chair and trustees, Drinkaware has established new senior positions to lead on marketing, partnerships and measurement of impact. The appointments reflect the key issues raised by the independent report, namely perceptions from stakeholders of a lack of an evidence base to support its work, a perception of industry influence and weak stakeholder engagement.

The press release states Drinkaware "has since commissioned significant new research from independent sources to help inform strategy and to focus its activities to have the most impact on harmful drinking." It states it will also establish "a new strategy for engaging with all stakeholders, including NGOs and public health but also including industry and potential commercial partners" and claims "almost all of the auditors’ recommendations have been accepted and have either been implemented or are in progress."

However fully addressing concerns of some health groups may be an impossible task for Drinkaware, whose industry funding gives it a fundamental position of distrust. Last year a journal piece Be aware of Drinkaware claimed that "Drinkaware was devised by the Portman Group to serve industry interests" and warned that "working with, and for, industry bodies such as Drinkaware ... serves only to legitimize corporate efforts to promote partnership as a means of averting evidence-based alcohol policies."

Last year's independent report had also highlighted concerning findings from an 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's response says it has begun an independent review into the harm caused by drunkenness, to be informed by its recent call for evidence to inform a new binge drinking strategy. Last year Drinkaware had also published a review of its 2012 activities, claiming progress on a number of its targets.

So like it or not, Drinkaware looks here to stay, and set to continue to dominate the 'alcohol education' market above NHS Choices alcohol pages or Chage4Life drink swap. For signs of progress on its ambitions to demonstrate an evidence base and better engage with the health community, or otherwise ... watch this space.

Latest alcohol studentships, jobs & events

Studentships

Alcohol Research UK has announced co-funding for three PhD studentships. Applications are invited from recent graduates, final year undergraduates and/or those with relevant professional experience.

• Alcohol licensing: the role of stakeholders in local decision making  3 Year phd Studentship, Middlesex University (Drug and Alcohol Research Centre)

• The experiences and recovery needs of alcohol dependent patients following detoxification programmes (post detox): an exploratory qualitative study  4 Year phd Studentship, Southampton University (Faculty of Health Sciences)

• Group regulation of alcohol consumption behaviours 3 Year phd Studentship, Edge Hill University (Psychology Department)

Research position at the Sheffield Alcohol Research Group

The University of Sheffield is looking to recruit a Senior Researcher (Associate Professor pay scale) to contribute to the strategic development of the Sheffield Alcohol Research Group in ScHARR, one of the largest alcohol research groups in the UK. The role involves leading high quality collaborative and interdisciplinary research programmes within the UK and internationally, and expanding our research agenda with your own ideas, including writing applications for funding.

A job specification is available on http://www.sheffield.ac.uk/jobs/. The closing date will be the 17th February with interviews in mid-March.

Service delivery and practitioner jobs can be found on the DDN jobs page.

University of Bath: The role of social media and new technologies

Applications are invited for a full-time University studentship to work in the Department of Psychology as part of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), commencing in September 2014. The studentship 'Young people’s alcohol consumption: The role of social media and new technologies' is part of the UK Centre for Tobacco and Alcohol Studies (UKCTAS) - more download fulll information here.

Events

A first call for papers has been made for the forthcoming New Directions in the Study of Alcohol Group 2014 conference which will take place in Dundee, Scotland from 23rd April to 26th April. Details of the annual Ron McKechnie prize offering a full bursary for free attendance are also now available here. See the New Directions 2014 Conference conference flyer (pdf) or wesbite for more details.

Places are available for Alcohol Research UK's next annual conference ‘Alcohol Through the Life Course’, to be held on Tuesday, 18th March 2014 in London - see full programme here.

Alcohol sales to drunks the norm, suggests study using 'drunk' actors

A new study indicates the extent of alcohol being illegaly sold to 'drunks' in licensed premises. Researchers at Liverpool John Moores University found that on average, 84% of trained actors pretending to be drunk were served. 

It is an offence under the Licensing Act 2003 to knowingly serve alcohol to a drunk person, or to obtain alcohol for a drunk person on a licensed premises. However it remains one of the most rarely enforced laws on the statute book.

The study took place across 73 bars in the North West of England using actors who were trained to act drunk using slurred speech, unsteadiness, lack of eye focus and fumbling. Although there is no legal definition of drunkeness, police are able to act as expert witnesses for determining drunkenness. The actors were trained with police and "ensured that a very high level of intoxication was portrayed" to serving staff.

The study found that the "drunk" actors were consistently sold alcohol, ranging from 60% on Wednesdays to 94% on Fridays, and from 78% before midnight to 96% after midnight. 95% of attempts to buy alcohol were successful in venues with bouncers, compared with two-thirds in those without bouncers. In 18% of alcohol sales, servers attempted to up-sell by suggesting double rather than single vodkas.

The report states:

While debate on the need for new legislation to reduce alcohol harms continues, more could be done to better enforce existing laws. Leaving the alcohol industry to self-regulate is unlikely to be effective, as a single bar in an area still prepared to serve drunks would benefit from those rejected from compliant bars. Moreover, enforcing no alcohol sales to drunks would impact most heavily on the biggest consumers with nearly 80% of alcohol consumed by the 30% heaviest drinkers nationally.

Something to be done?

The Government's 2012 alcohol strategy, infamous for its u-turn on minimum pricing, also committed to action to address sales to drunks. The strategy stated:

Where we identify that tools and powers are being used insufficiently, we will work with the police and others to change this. For example, it is an offence, under the Licensing Act 2003, to knowingly serve alcohol to a drunk but there were only three convictions for this offence in 2010... we will work with the police to tackle the issue of serving alcohol to drunks including exploring how greater use can be made of existing powers and how test purchasing can support this.

Norman Baker, crime prevention minister, said knowingly selling alcohol to someone who was drunk was illegal, and "anyone who witnesses this irresponsible behaviour should report it". Presumably this means to the police or local Trading Standards, but exactly what follow up action you should expect to see is unclear.

'Dry January' on the rise - a win for health groups (and livers)?

'Dry January' is the new 'Movember' if a Guardian report that a quarter of Britons give up alcohol for January is to be believed. It cites a poll of nearly 2,000 people - although fewer than half attempting a Dry January thought they would last the month, and one in six said they had already broken their pledge. Saving money trumped health benefits as the main reason for those planning a dry month.

Nonetheless, Alcohol Concern's Dry January site reports 17,156 people officially taking part in their 2014 Dry January challenge, a significant uplift on last year's 4,306. The site is still open for late joiners to sign up, as it appears is Cancer Research UK's Dryathlon challenge which recently reported over 50,000 pledgers on the Dryalthlon Facebook page.

Most people aiming for a month off are unlikely to have signed up to an official campaign or sponsored attempt, so the numbers will undoubtedly be higher. Many will feel their body deserves a 'detox' after a boozey festive period, or time for their wallet to recover. As you'll have no doubt noticed, it also seems a particularly popular January pastime for journalists who can then regale us their temperance feats or failings.

Many people however may be understandably apprehensive about an attempt to give up drinking for a month, particularly if they are worried about having a level of dependency. It's not only AA'ers that like the "day at a time" approach. The campaigns have however actively promoted Dry January as something any 'normal' drinker can participate in and still feel benefits, rather than for those worried about a loss of control. Others though may also feel apprehensive about social pressures as non-drinkers, who often report getting a hard time from those imbibing.

Indeed the merits of 'Dry January' from an individual and policy perspective are much debated. The British Liver Trust's Andrew Langford has consistently opposed the Dry January approach. Launching the Trust's second Love Your Liver awareness campaign, Langford warned against the appeal of a "quick fix in January" and instead called on people to follow a 3 step liver plan including two or three alcohol free days in every week of the year. The 'Dry January warning message' has even made its way into several news reports.

However a New Scientist study has reported promising results in an admittedly very small study of 'normal drinkers' who took time off. The results showed stopping drinking for five weeks reduced liver fat, cholesterol and blood sugar, and helped lose weight. However less social contact was a negative outcome, and other improvements such as sleep, concentration and performance were only based on self-report. Dr Nick Sheron at the University of Southampton said the results were "hugely encouraging", but emphasised liver disease can develop over the course of 30 years, so a short period of abstinence needs to translate into long-term behaviour change.

Dry January or not, abstinence and indeed moderation goals form a part of many 'normal' drinker's lives. Changing life events inevitably alter drinking opportunities and influences, often forcing or nudging a change in consumption. For those contemplating a possible problem, abstinence may be a valuable litmus test. For those mulling a hangover, at least a short period of abstinence seems entirely desirable. Dry January as such won't appeal to everyone, but discussing the merits of a period of abstinence surely gets more people thinking.

Events & dates: New Directions 2014, Alcohol Research 2014 conference, Alcohol Academy & PHE treatment workshops

New Directions 2013 conference 

New Directions in the Study of Alcohol Group (NDSAG) has announced its 2014 conference which will take place in Dundee, Scotland from 23rd April to 26th April 2014 - see the New Directions 2014 Conference conference flyer (pdf).

The conference will feature 3 distinct research symposium’s:

• Will Independence Change Scotland’s Relationship with Alcohol?
• What Price a Unit? An exploration of Minimum Unit Pricing research
• Interventions and research focus - an in-depth look at the broad base of Scottish Alcohol Brief Interventions research

Keynote speakers include: Scottish Ministerial Keynote Speech (TBC), Prof. Jonathan Chick (Queen Margaret’s University), Prof. John Booth Davies (University of Strathclyde), Andrew McAuley (NHS Health Scotland), The Sheffield Alcohol Research Group, Mike Inglis (Governor, HMP Perth), Dr Robert Peat (Care Inspectorate), Prof. Niamh Fitzgerald (Robert Gordon’s Univesity) Tayside Council on Alcohol, and the Alcohol Research UK Symposium.

The annual Ron McKechnie prize offers a full bursary for free attendance at the 2014 conference. Entrants must submit a paper for inclusion in the New Directions Journal - see here for full details. A first call for papers has also been made - details here.

See here for the NDSAG 2014 Booking Form (pdf) or online booking options.

Alcohol Research UK 2013 conference

Alcohol Research UK's next annual conference ‘Alcohol Through the Life Course’, will be held on Tuesday, 18th March 2014 in London. It includes a series of leading reserach figures including Professor Robin Room, Professor Harry Sumnall, Professor Jim Orford, Tim Stockwell and many more - see full programme here. The early bird rate has closed but an Interim Rate of £95 is available until 16 January.

Alcohol Academy & Public Health England alcohol treatment workshops 

The Alcohol Academy and PHE are jointly hosting two workshops exploring alcohol treatment commissioning after the NHS reforms. The events take place on 20th January (Nottingham) and 26th February (Birmingham) offered to members of the regional alcohol networks. However a limited number of places may be made available to other commissioners or service providers - contact James Morris for further details.

Government under fire for industry meetings that 'influenced minimum pricing u-turn'

The Government has come under renewed attack for its u-turn on minimum pricing last year, prompted by accusations from a BMJ article that the consultation was a "sham". The BMJ investigation revealed that Government health officials and ministers had extensive meetings with alcohol industry groups and retailers during and after the consultation period.

The Government had pledged to introduce minimum unit pricing (MUP) in its 2012 strategy. However by 2013 it was stating it was listening to "powerful arguments on both sides" following the consultation as concerns over industry lobbying were being raised. Sure enough, the Government later confirmed it would not be introducing MUP, and has been accused of distorting the consultation findings.

The BMJ piece extensively explores many of the reported political aspects behind the scenes, including the use and timing of Government commissioned reports. The Home Office requested that the University of Sheffield publish their latest research examining the impacts on minimum pricing on specific income groups at the same time as the u-turn was announced. The research, commissioned 'to inform consultation and impact assessments', strengthened the case for MUP and showed the effect of the chosen 'below cost ban' policy to be negligible, as Sheffield researcher John Holmes explains here.

Health bodies and MUP supporters will no doubt regard the revelations as further evidence of alcohol policy being determined by influential industry lobbyists. Professor Sir Ian Gilmore, special adviser on alcohol to the Royal College of Physicians said: “The drinks industry continues to have high-level access to Government ministers and officials while no forum currently exists for the public health community to put forward its case in an environment free from vested interests.”

A spokesman for the Department of Health said it was unfounded to insinuate the meetings amounted to an improper relationship with the drinks industry. There appears to have been limited response from industry representatives, although a Grocer article rebuked the BMJ piece whilst the parliamentary beer group chairman MP Andrew Griffiths said the BMJ article read like a 'conspiracy theorists blog'.

Findings bank alcohol 'matrix bites' cover fundamental issues to alcohol treatment

Following the release of the Alcohol Matrix, the second in a series of 'matrix bites' have been released the Drug and Alcohol Effectiveness Bank. This series covers row 2 of the matrix, addressing issues at the heart of alcohol treatment; What is it for? Who needs it? What constitutes its essence?

Cell A2. The interventions: Do they do the work – or does the patient?
Have patients already done 90% of the therapeutic work before they get to the clinic? Is treatment 'merely' a socially endorsed way to 'get better' in our societies, which works because we believe it works? Perhaps we been misled by studies which exclude the sickest patients. How should we conceive of treatment: a specific technical fix forged by experts to key in to a specific disorder, or the offer of concern, hope and understanding to troubled people lacking those supports in their daily lives?

Cell B2. The practitioners: Is the relationship the treatment?
Every treatment is a human interaction. We know for sure that therapists, counsellors and clinicians differ in effectiveness, and that characteristics like gender and qualifications are generally not the explanation. Nor can we rely on hard and fast rules like, "Always express empathy", "Never (or always) tell the client what they 'must' do". The hard answers seem to lie in the soft variables – social skill, centring on the patient, intuiting which client needs which approach in which situation, being genuine.

Cell C2. Management: It can be transformational
Controlled studies can divorce interventions from the management of the service delivering them, but in everyday practice, whether treatments get adopted and adequately implemented, and whether staff are able to maintain recovery-generating attitudes and knowledge, depend on management and supervision. Research on these issues is scarce, but also exciting and inspirational; at this level, whole services can be transformed from merely going through the motions, to enthusiastic client-engagers.

Cell D2. Organisations: Focus on 'soft' values or 'hard' incentives?
Highlights the most wide-ranging investigation ever of the organisational health of British alcohol and drug treatment services. The implication was, ensure your staff experience what through them you want your patients to experience: respect, understanding, and support. In the hard-nosed era of carrot-and-stick incentives, does this really holds true?

Cell E2. Treatment systems: Messages from giants of addiction research
Introduces the two giants of addiction treatment research and theory who led the way in re-envisioning treatment as (or as promoting) long-term continuing support. Highlights the US study which exemplified the strengths and limitations of payment-by-results schemes, and asks whether these stifle patient-centred practice and engender a mentality of doing just enough to get the money, or stretch services beyond their comfort zones. More fundamentally, how many drinkers should we be treating, and what proportion are already in treatment?

See here for a round up of row 1 of the alcohol matrix covering brief interventions or visit the matrices page of the Effectiveness Bank web site for articles, presentations, and a video explaining their genesis and construction.

'Opinions and Lifestyle Survey, Drinking Habits Amongst Adults, 2012' confirms existing consumption trends remain

Data on adult drinking habits has been released as part of the new Opinions and Lifestyle Survey (OPN). The figures show recent trends continuing, including a small decline in adults who drank in the last week, down to 58% in 2012 compared to 60% in 2011.

Overall consumption has been declining since 2004, but rose significantly for the four decades prior (see IAS 2013 factsheet). However alcohol-related hospital admissions have continued to climb, indicating a lag effect between population consumption and related long term heath conditions. Some health experts have suggested consumption may start to increase again as the economy recovers.

The OPN Statistical bulletin: Drinking Habits Amongst Adults, 2012 (pdf) shows:

• In 2012, 58% of adults in Great Britain drank alcohol at least once in the last week before being interviewed.
• Young people (16-24) were more likely to have drunk very heavily (more than 12 units for men and 9 units for women) at least once during the week (27%), with similar proportions for men (26%) and women (28%). Only 3% of those aged 65 and over were very heavy drinkers.
• Very heavy drinkers were five times more likely than other drinkers to have drunk strong beer/stout/lager/cider, and more than twice as likely to have drunk spirits, on their heaviest drinking day in the week before interview.
• Smokers (25%) were more than twice as likely as non-smokers (11%) to have drunk very heavily at least once during the week.

See here for an infographic on the key findings or the reference tables.

How is drinking trends data going to be reported now?

The Office for National Statistics (ONS) now release the OPN based on a new data collection method. Drinking patterns data were previously included in the General Lifestyle Survey (GLF) formerly known as the General Household Survey (GHS), which ran from 1971-2012.

It is hoped the annual statistics on alcohol for England will continue to be released, bringing together the key health related alcohol data. However an announcement is expected this month following a consultation to cut various statistical reports including some alcohol surveys.