Alcohol Policy UK

Calls for social media to act over Neknominate - but too little too late?

The Local Government Association has called on Facebook and Twitter to introduce warnings alongside drinking game 'Neknominate' videos. The LGA urged executives from the two social media sites to meet and discuss a way to ensure warnings accompany any Neknominate videos. 

Neknominate involves people filming themselves downing alcohol, often while pulling stunts, and then nominating friends to respond within 24 hours. However the social media craze has been linked to up to five deaths in the UK and involved children as young as ten.

The LGA said some schools had asked for warning notices about neknominate to be put on noticeboards and read out at assemblies. Drinkaware have issued advice on what to do if nominated, and called on parents to take a tough stance against the game over fears that young teenagers are under pressure to take part. Alcohol Concern warned of the challenge ahead in de-normalising binge drinking.

However warnings are unlikely to significantly alter Neknominate activity given the limited effectiveness of educational approaches in changing behaviours. Indeed the 'fad' may have passed by the time any action is taken by social media sites who have shown no signs of doing so. An Independent story exploring whether prosecution for a Neknominate dare resulting in death would be possible, claimed that "Facebook timelines [are] steadily emptying of Neknominate clips as the trend loses momentum". Yet this analysis doesn't support any indication of decline in the UK.

Interestingly the main Neknominate Facebook page has since been changed so that the nomination is meant to prompt a random act of kindness. 'Donate & Nominate' has also gained some attention as a blood donation trend. So whether Neknominate quickly dies off, or grows further globally, remains to be seen.

Drinkaware 2014 conference: adolescent drinking on the brain, behaviour change projects & more

Drinkaware, the industry funded alcohol education charity recently held its 2014 conference in London.

Drinkaware funded projects and other work covered on the day included:

• 'The effects of alcohol on the adolescent brain', by Sarah-Hayne Blakmore, Professor in Cognitive Neuroscience at UCL. View the presentation and factsheet here

• The 'What's in Your Glass?' Berkshire campaign which saw 24,000 educational kits being distributed in 150 pharmacies across Berkshire. See here for the project presentation, evaluation presentation and factsheet.

• 'Parental influence and delaying the age of first drink' by Anne Foster, Drinkaware's Director of Marketing and Communications presentation here

• The 'Spot the Difference' Glasgow campaign encouraging lower strength drink purchasing. See the project presentation here  or evalutation presentation here

• A presentation on 'Do Something Different', an initiative aiming to affect behaviour change through actions. View Karen Pine's presentation here

• Drinkaware funded 'Drunken Nights Out' research on drunkenness in the night time economy. View the presentation and the factsheet on the preliminary findings

• See also the Drinkaware Digital Overview 2013 and a Storify covering Twitter activity on the day.

Drinkaware recently responded to mixed review which raised concerns over its effectiveness. In particular the independent report said there were perceptions of a lack of an evidence base to support its work, a perception of industry influence and weak stakeholder engagement.

As previously highlighted, improving stakeholder engagement with the public health community will not prove an easy task for any industry funded organisation. Many health groups will be sympathetic to warnings that such activities serve only as an inert attempt at industry responsibility, or worse a smokescreen for averting evidence based policy.

Nonetheless it was acknowledged on the day that the evidence base was weak for such educational approaches, so robust research and evaluation was crucial. Yet Drinkaware has a huge reach - the website has 6 million visitors to the website each year, equivalent to 1 in 10 of the UK population. Far more than both NHS Choices alcohol pages or Chage4Life drink swap are likely to get.

ONS alcohol-related deaths (2012): overall rates fall but concern over older men and 'neknominate' poisonings

The ONS have released the latest Statistical bulletin for alcohol-related deaths in the UK (2012) [pdf]. It shows in 2012 there were 8,367 alcohol-related deaths in the UK, 381 fewer than in 2011 (8,748).

However alcohol-related deaths are still significantly higher than 20 years ago after rising rates during the 1990s. The number of alcohol-related deaths more than doubled from 4,144 in 1991 to 8,758 in 2006.

A 2012 Lancet piece also predicted a longer term rise for the future. Some health experts also believe that consumption, which has been falling since 2004, may start to increase again as the economy recovers. Alcohol-related hospital admissions are also still rising reflecting the longer term rise in consumption.

Key findings from the bulletin include:

• Males accounted for approximately 65% of all alcohol-related deaths in the UK in 2012.
• Death rates were highest among men aged 60 to 64 years (42.6 deaths per 100,000 population) and women aged 55 to 59 years (22.2 deaths per 100,000).
• Of the four UK constituent countries, only in Scotland were male and female death rates in 2012 significantly lower than in 2002.
• In England and Wales, 63% of all alcohol-related deaths in 2012 were caused by alcoholic liver disease, with 16% of these deaths occurring among those aged 55 to 59 years.
• In England, alcohol-related death rates were highest among regions in the North and lowest among those in the South throughout the period 2002–2012.

Areas of concern: older men and 'neknominate'?

Bucking the overall recent downward trend, alcohol-related death rates for older men aged 75 and over increased significantly between 2010 and 2012 as this Guardian article warned. Nevertheless, the 2012 death rate for this group is similar to 2002, and rates in elderly women have remained stable.

Attention has also been drawn to the risk of increasing alcohol poisoning cases following the spread of 'neknominate', a drinking challenge recently spreading across social media. Alcohol poisoning was the fourth highest alcohol-related cause of death in the UK responsible for 396 deaths in 2012. The ONS said: "There has been speculation that the influence of social media drinking games may drive these figures up in the future particularly among younger people."

Local Alcohol Action Areas announced as Home Office demands more industry action

Last week the Home Office announced the twenty Local Alcohol Action Areas (LAAAs) areas across England and Wales it would support to "combat drink-fuelled crime and disorder and the damage caused to people’s health."

Although no additional funding is available to the LAAAs, each will receive support from the Home Office and relevant central health bodies such as Public Health England. The initiative follows the much larger 2008-2011 Alcohol Improvement Programme (AIP) and a 2008 Home Office scheme.

Government input is likely to cover areas identified in the PHE alcohol stocktake tool, an emphasis on industry-led Local Alcohol Partnerships and support around licensing and night time economy issues. Few if any areas seem to have 'cracked' an effective mechanism for public health input into licensing decisions following changes to the law. Just a few areas such as Newcastle and Cheltenham appear to have approved a local Late Night Levy, whilst recently Blackpool's bid to implement the first EMRO was unsuccessful.

Expect more industry-led action?

Announcing the LAAAs, Home Office Minister Norman Baker stated he was "pressing the industry itself to take more responsibility for the problems that inappropriate use of their products cause." A subsequent Independent story reports the alcohol industry has been "ordered by the Home Office to produce plans to tackle the sale and promotion of cheap super-strength beers and cider by the summer or face government action".

The Indy reports that Baker is insisting they must speed up the development of a voluntary code agreed last year to set up voluntary commitments, such as minimising alcohol advertising and confining displays and promotions to single areas. The Portman Group and the Wine and Spirit Trade Association have apparently agreed to take the industry lead on proposals.

Of course health groups wanting tougher action are unlikely to be pleased with emphasis on industry-led partnership schemes or voluntary action. Last year ASDA quit its pledge to stop promoting alcohol in its foyers after other supermarkets had not followed suit - CEO Andy Clarke said the Government needed to do more to 'level the playing field'.

ASDA had originally announced the pledge in 2011 following the controversial Responsibility Deal, which saw further health partners walk out following the minimum pricing u-turn. However industry led work to deliver on the Responsibility Deal alcohol pledges such as labelling, unit reduction and support for Drinkaware is continuing.

Recent Alcohol Research UK studies: cognitive impairment in older people; alcohol-related elder abuse; alcohol misuse and prostitution; Social Work education gap & more

Recent studies funded by Alcohol Research UK available to access include:

• Alcohol misuse and cognitive impairment in older people: An exploratory study

• Use as Abuse: A Feasibility Study of Alcohol-related Elder Abuse

• Steps to Cope: A brief intervention for children and young people (CYP) living with parental substance misuse and/or parental mental health problems

• Cycles of harm: Problematic alcohol use amongst women involved in prostitution

• Substance Use In Social Work Education: A National Survey Of Social Work Qualifying Programmes In England

See the full list of Alcohol Research UK publications and a dedicated identifying the alcohol evidence base page focused mainly on UK based sources.

Alcohol Research UK's next annual conference ‘Alcohol Through the Life Course’, will be held on Tuesday, 18th March 2014 in London.

The deadline for three Alcohol Research UK funded PhD studentships is the 3rd March 2014.

Drug and alcohol treatment & recovery: news, events, grants and more

State of the Sector 2013: report on drug and alcohol services

DrugScope have published a report detailing how policy and commissioning changes are affecting drug and alcohol services.

State of the Sector 2013 [pdf] contains the findings from a survey of nearly 170 drug and alcohol services in England. It finds the drug and alcohol sector in a period of flux and facing a number of challenges:

• Significant problems in their ability to offer clients support to improve recovery capital, particularly employment, housing and mental and physical wellbeing;
• The picture on engagement with Health and Wellbeing Boards (HWBs) and Police and Crime Commissioners (PCCs) is mixed, with positive examples, but other services reporting a lack of engagement;
• 35% of drug and alcohol services reported a decrease in funding, against 20% reporting an increase and 33% no change;
• Just over half reported a large increase in caseloads in the last year, against 27 per cent reporting a decrease;
• Almost half reported that they were employing fewer frontline staff and 6 out of 10 services reported an increase in the use of volunteers.

In 2010 Alcohol Concern published a report calling for increased support for dependent drinkers, suggesting that doubling the number in treatment could save £1.7 billion. The number of drinkers recieving treatment has risen slightly over recent years.

Building Recovery in Communities: regional events

DrugScope is hosting a series of regional summits on behalf of the Recovery Partnership, with the next ones taking place on 4th March 2014 in Manchester and 17th March in Brighton. The 'Building Recovery in Communities' events aim to provide an up-to-date briefing on policy developments, and a chance to hear from and debate with key decision-makers and service providers in the regions.

See our recent round up of forthcoming alcohol events here.

Comic Relief 'Give it up' grants to promote abstinence based recovery

Comic Relief have opened two grant programmes spearheaded by Russel Brand. First, a pilot scheme that will build a community-wide approach in local areas to increase the support available to help people sustain recovery. Secondly, grants of up to £5,000 to help ‘recovery graduates’ and others run activities and other services focused on helping people to sustain recovery and reduce stigma towards those with addictions.

Survey on the development of a treatment service Quality Framework

The Substance Misuse Skills Consortium is seeking brief views on the development of a Quality Framework for community drug and alcohol treatment services. The survey presents possible options for the development of a new framework and is aimed at commissioners, practitioners, those involved in quality assurance and standards in treatment providers, service-users and their families.

PHE residential rehab stocktake survey

Public Health England are carrying out surveys on residential rehab in response to interest in how the changes to healthcare and commissioning systems are impacting on the sector. There are two online surveys, one for commissioners and one for providers - each should take 10-15 minutes to complete. The deadline for completion is 21 February.

Also, in February’s issue of Drink and Drugs News, Jo Palmieri looks back at 50 years of social action affecting the drug and alcohol field.

Recent Findings alcohol bulletins: does schools prevention work? Drink Driving course fails; Private Vs public treatment flaws? 'Recovery is the norm' & more

Recent bulletins from the drug and alcohol bank:

Authoritative verdict on ways to prevent adolescent drinking  Reviewers helpfully amalgamate the findings of their three authoritative reviews of alcohol prevention programmes in the school, among families and parents, and combining these and/or other components. Some programmes they say work, but why and in what contexts remains unclear, and the findings give little encouragement to adding non-school based strands to drug and alcohol education programmes.

Drink-driving course unable to cut reoffending  An evaluation of a widely-implemented course for convicted drink-drivers in England and Wales found no evidence that it cut reoffending. The Drink-Impaired Drivers programme involves 14 two-hour sessions for drink-drivers given community sentences, and is accredited by HM Prison Service, but even among offenders who completed it reconviction rates were not significantly reduced.

‘Empathy gap’ in private alcohol treatment, poor NHS systems?  This small English study poses fundamental questions about alcohol treatment services: whether private services suffer from an ‘empathy gap’ and NHS services from poor systems; whether opening up treatment choice to patients with a record of bad decision-making is a good thing; and whether there can be universal criteria for what counts as quality provision.

Recovery is the norm  How common is recovery from dependence and other substance use disorders? Can we realistically hold out not just the possibility but the likelihood of recovery, even to dependent users whose problems are severe enough for specialist treatment? The message of this compendious synthesis of hundreds of studies is that "Recovery is not an aberration achieved by a small and morally enlightened minority ... If there is a natural developmental momentum ... it is toward remission and recovery".

Brief advice may may help with emergency department overload  Screening for risky drinking and offering brief advice can (but not always) reduce later emergency department visits was the main finding of this review, suggesting these programmes might ease pressure on overloaded departments.

 

Minimum pricing is targeted say Sheffield researchers as Scotland's legal battle 'could last years'

Media attention has returned to the issue of minimum pricing this week following new research from the Sheffield Alcohol Research Group published in the Lancet (pdf here). The study states minimum pricing would have negligible effects on low income moderate drinkers’ alcohol consumption and spending, therefore would not 'punish responsible drinkers', as has been claimed.

Whilst the paper accepts that harmful drinkers on the lowest incomes would be most affected by minimum pricing, it emphasises this group experiences the greatest levels of alcohol harm. Low income harmful drinkers were projected to reduce their alcohol consumption by nearly 300 units per year under a 45 pence minimum price, which would significantly reduce health inequalities and save hundreds of lives a year.

In contrast it states low income moderate drinkers do not buy much very cheap alcohol - on average less than one unit a week under 45p, so would be very minimally affected.

Professor Petra Meier, Director of the Sheffield Alcohol Research Group, stated:

“Our study finds no evidence to support the concerns highlighted by Government and the alcohol industry that minimum unit pricing would penalise responsible drinkers on low incomes. Instead, minimum unit pricing is a policy that is targeted at those who consume large quantities of cheap alcohol."

Last week the Government announced its proposals for the implementation of a 'below cost ban' following its u-turn over minimum pricing in 2013 (see here for the Government's 40p MUP infographics released in 2012). However Sheffield have said a below cost ban would be "approximately 40 to 50 times smaller than the estimated impact of a 45p MUP", whilst Alcohol Concern's Eric Appleby said it would be "close to impossible to implement".

Scotland's legal battle continues...

Meanwhile in Scotland the Government are facing the latest challenge led by the Scotch Whisky Association (SWA) in its bid to introduce minimum pricing. Court action began last week at the Court of Session in Edinburgh to appeal last year's ruling in favour of MUP.

However as the Herald reports, even if ministers win this round the fight is likely to go to the Supreme Court in England, where cases are being listed for 2015. The SWA is also prepared to go to the European Court of Justice.

Dr Evelyn Gillan, chief executive of Alcohol Focus Scotland, believes the SWA is “determined to drag out the legal process for as long as possible. In doing so, it follows in the footsteps of the tobacco industry, which spent decades delaying the implementation of public health policies that were subsequently proven to save lives.”

A piece published in the BMJ last week reported on how the alcohol industry has tried to influence opinion in Scotland, echoing the recent BMJ article suggesting industry's role in England's u-turn.

Findings bank alcohol 'matrix bites': Drink, doctors and drugs

The third series of 'matrix bites' from the Drug and Alcohol Effectiveness Bank looks at the treatment of alcohol dependence in a medical context or involving medical care:

Cell A3. Interventions: Should drug-based treatments be the norm?
In reply to the title question, some authorities think so, but in practice, doctors and patients disagree. For this ‘disease’, medications are not a cure, but aids to the patient’s impetus to get better and to processes in their lives which help realise and sustain this ambition – exemplified in the work of Jonathan Chick, responsible for all three major UK studies of the leading anti-drink medications.

Cell B3. Practitioners: Patients assess clinicians too!
The previous cell looked mainly at the medications clinicians prescribe; now we turn to the clinicians, and find that bedside manner is not just a conduit for treatment – to a substantial extent, it is the treatment. Learn from seminal studies that patients “sensitized to rejection” assess their clinicians as much as the reverse, asking above all if they are liked and accepted.

Cell C3. Management: Recruitment is the missing link
Studies may able to divorce the impact of interventions from the management of the delivering service, but in everyday practice, management and supervision determine whether treatments are adequately implemented and staff maintain appropriate attitudes and knowledge. The neglected topic of staff recruitment seems critical – so how do you identify the right people? Official advice is to start with small (and cheap) treatments and build up if needed, but is offering more to treatment-resistant patients just a waste?

Cell D3. Organisations: Is evidence-based innovation always a good thing?
The organisational context determines whether clinics, primary care practices, and inpatient units offer an environment in which staff and patients can maximise their potential. Given today’s upheavals in commissioning and service provision structures, is evidence-based innovation always a good thing, or can it produce a demoralised workforce in no position to do their best for patients?

Cell E3. Treatment systems: How can commissioners recognise a good quality service?
Spending on inpatient alcohol withdrawal can be wasted if patients don’t get follow-on care, and opportunities are lost if severely dependent drinkers seen by GPs don’t get routed to specialist treatment – examples of why treatment systems are critical. Do you share an expert group’s vision of what a good quality service should look like, and is Britain making progress on the perennial problem of organising care for mentally ill problem drinkers?

These 'bites' form the third row of the Alcohol Matrix. See here for a round up of row 1 covering brief interventions or row 2 covering fundamental issues to treatment. See here for NICE guidance, standards and tools for alcohol treatment.

'Below cost ban' (duty + VAT) confirmed as health groups highlight limited impact

The Home Office have published a guidance document detailing the 'below cost ban' which will prevent the sale of alcohol below duty + VAT. The ban was announced last year when the Government announced its u-turn on alcohol minimum pricing to the dismay of health groups.

Subject to parliamentary approval, the ban will come into force in April 2014 as an additional condition of the mandatory code. The Home Office state that 'cost' will be defined as the level of duty plus value added tax (‘VAT’) payable on the duty element of the product price, meaning typically 'cost' prices will be:

• Can of 440ml beer at 4% ABV =  41 pence
• 750ml bottle of 12.5% ABV wine = £2.41
• 70cl bottle of 37.5% ABV spirits = £8.89

Health groups of course have continued to highlight that a below cost ban is no minimum unit pricing. The University of Sheffield recently published research that estimated a minimal impact of a below cost ban, "approximately 40 to 50 times smaller than the estimated impact of a 45p MUP" as explained here.

Eric Appleby of Alcohol Concern said "The idea that banning below-cost sales will help tackle our problem with alcohol is laughable, it's confusing and close to impossible to implement... The government is wasting time when international evidence shows that minimum unit pricing is what we need to save lives and cut crime."

However the Government Minister Norman Baker insisted that the below cost ban will "stop the worst examples of very cheap and harmful drink". The Home Office impact assessment suggests consumption is expected to fall by 0.04%, but with possible savings to the NHS £5.3 million a year, crime £3.6 million and £500,000 in reduced absenteeism.

The issue may well be enforcement, down to local authority licensing teams, Trading Standards and the police. The guidance states "where necessary, enforcement officers may request a copy of the premises pricing lists and take away for analysis to compare against the duty plus VAT permitted prices."

See reports from the Guardian, Telegraph and Independent.