Alcohol Policy UK

More inclusive services for lesbian and gay people with alcohol and drug problems called for

A five-year study by the Lesbian & Gay Foundation (The LGF) in partnership with the University of Central Lancashire (UCLan) into drug and alcohol use among lesbian, gay and bisexual (LGB) people in England found significant substance dependency problems in the community.  

The LGF and UCLan’s national ‘Part of the Picture’ project looked at alcohol and drug use in the LGB community in England over a five year period and has just launched a suite of final reports. The researchers say LGB people are often unable to get the right support for problematic substance use as health services are not set up to meet their specific needs.

The research found that 'binge drinking' is high across all LGF groups, with 34% of males and 29% of females reporting binge drinking at least once or twice a week. Available comparable data suggest that LGB people are approximately twice as likely to binge drink at least once a week, compared with the general population, and have a higher likelihood of being substance dependent.

Many LGB people interviewed felt like an ‘outsider’ when accessing support services because of their sexual orientation. They reported being unable to be open about their lifestyle and reasons behind their substance use, or were afraid to come out to heterosexual service workers and peers. Drug and alcohol services often failed to address complex needs, such as mental health issues, alongside substance dependency.

The project team has published recommendations for commissioners, policy makers, GPs, drug and alcohol service providers, researchers, the voluntary and community sector to address the problematic substance use of LGB people. The recommendations call for:

• sexual orientation monitoring of patients and clients in order to understand the experiences of LGB people
• the use of this study’s evidence in designing and delivering health services
• recognition of the value of the voluntary and community sector offering complementary LGB-specific services, such as peer support groups and counselling

Recent Findings alcohol bulletins: GHB for alcohol treatment?; linking to Mutual Aid; Group treatment role unclear; Promising prevention programme

Recent bulletins and hot topics from the drug and alcohol bank:

GHB yet to prove preferable to main anti-alcohol medications

Can one of the UK’s most notorious ‘club drugs’ help alcoholic patients withdraw from and stay away from alcohol? The answer from this authoritative review is that probably it can, but results from the small and few studies to date do not warrant using it instead of safer and less abuse-prone alternatives. However, its distinctive impact on craving could prove important.

Brief intervention promotes mutual aid ‘aftercare’ in the UK

In the context of current UK policy this is a key study, testing how to extend recovery beyond formal treatment by systematically linking patients to the free resource of mutual aid groups, seen as the main way commissioners can square the circle of doing more with less. Peer counsellors almost doubled 12-step attendance, but the resulting impact on abstinence was much smaller.

Group treatments for alcohol problems – effectiveness still unproven

Treating patients in groups rather than individually seems to promise cost savings and perhaps too more effective treatment, but according to this review, research has yet to show treating problem drinkers together is clearly and consistently beneficial.

Vulnerable children benefit from promising prevention programme

An alcohol prevention intervention that combined adolescent and parent components was found to be effective at delaying the onset of regular drinking only among children with low self-control or whose parents were lenient about youth drinking, the very children most vulnerable to developing problems with drink.

Also, one of the May/June Findings Hot Topics:

Matching alcohol treatments to the patient ...

Alcohol-related brain damage - assessment and management

Functional MRI study of diencephalic amnesia in Wernicke–Korsakoff syndrome

A new report, Alcohol and brain damage in adults - With reference to high-risk groups by the Royal College of Physicians, the Royal College of General Practitioners and the Association of British Neurologists calls for clinical commissioning groups to support services that provide specialist care for patients with alcohol-related brain damage (ARBD).

The report highlights how alcohol abuse can cause changes to people’s brain function and intellect, even though many will not be aware of it. 

Specific recommendations are presented in the context of four specialist settings: alcohol treatment services, prisons, acute hospitals and pregnancy/fetal alcohol spectrum disorder (FASD).

The report provides examples of service delivery models couched in the context of a team within a mental health trust, accessing clinicians across clinical teams, an ARBD team closely affiliated with the alcohol treatment services and a team embedded within an early onset dementia team. In the absence of significant research (except in a minority of areas), the evidence is derived from descriptive studies and clinical reviews.

This follows a report from Alcohol Concern Wales last year, All in the Mind, calling for greater awareness of ARBD and clearer pathways for prevention and treatment.

Online interventions and IBA apps: web based alcohol resources for public and professionals

The availability of online alcohol resources for both individuals and professionals  continues to rise, but raises some questions over the exact role these should play in helping prevent and support those with alcohol problems.

Generally evidence seems to suggest an important role to play for web based interventions, but not as a substitute for face to face services or brief intervention. There is also less research on more recently popular phone apps and online brief intervention approaches than for more established approaches intended for addressing dependent drinking. 

Resources for individuals

The appeal of reaching straight to the public via apps and online resources is clear. Most people who recover from alcohol problems do so mainly 'on their own', and there are big questions over the implementation of face to face brief intervention by health and social care roles. Identification and Brief Advice (IBA), as a simpler form of brief intervention, also appears to lend itslef well to simple online tools or apps.

Don't Bottle It Up! www.dontbottleitup.org.uk

Don'tBottleItUp! offers users a simple online 'IBA' approach based on the gold-standard AUDIT screening tool and providing personalised brief advice.

Drinks Meter  www.drinksmeter.com

The drinks meter app provides feedback based on AUDIT and other questions, also comparing the users answers against the Drinks Meter community to give unbiased, anonymous feedback.

Down Your Drink www.downyourdrink.org.uk

Down Your Drink (DYD) is a longer established online programme based on AUDIT and also including an extended programme. User registration required.

Change4Life 'drinks swap' & checker

As part of the Change4Life campaign, a Drinks Checker page and app are available, allowing the user the check their calories, units and risk level.

MyDrinkaware via www.drinkaware.co.uk

Drinkaware is the alcohol industry funded education charity that allows users to track their drinking, calories and progress cutting down via MyDrinkaware.

NHS Choices www.nhs.uk/LiveWell/Alcohol

NHS Choices offers a comprehensive range of resources including a drinks tracker for iphone users, and an online self-assessment based on the AUDIT, as well as a local service directory.

Resources for professionals - IBA training app

An IBA training app was recently released on the apple store, Google play and also on the amazon app store. The app offers a shorter alternative to the 2 hour online IBA e-learning with more focus on visual IBA scenarios.

See here for a comprehensive list of alcohol support options or call Drinkline, the free national alcohol helpline if you're worried about your own or someone else's drinking on 0300 123 1110 (weekdays 9am – 8pm, weekends 11am – 4pm). 

Public Health England: Business Plan and Frameworks to identify alcohol actions

Public Health England (PHE) has published its 2014 to 2015 business plan, setting out its objectives - including ambitions around alcohol - for the coming year.

PHE has formally been in existence for over a year, taking national lead on the prevention of alcohol health harms, as well as assuming some roles of the former National Treatment Agency (NTA) for substance misuse.

PHE says it will publish a 'Health and Wellbeing Framework for England' in August, which will set out key interventions for improving health and reducing inequalities. The Framework will provide 'a menu of evidence-based interventions' and will aim to ensure effective interventions are 'adopted at scale and pace'. These will most likely include a significant emphasis on alcohol Identification and Brief Advice (IBA), although various efforts at implementation have been underway for some time.

For alcohol, the business plan also sets out to:

• produce a report for government on the public health impact of alcohol and possible evidence-based solutions by Spring 2015
• to review the impact of obesity as a cofactor (with alcohol and hepatitis C) in other long-term liver disease and provide advice on evidence-based interventions and practice
• expand the Longer Lives web tool to include primary care indicators for diabetes (August 2014), health checks (August 2014), cancer and hypertension (October 2014) and measures on drug and alcohol treatment and recovery (December 2014)

Public Health Outcomes Framework

Key to PHE delivery, the Public Health Outcomes Framework (PHOF) has been set up to allow local areas to assess health outcomes across 66 health measures, including 2.18 - Alcohol related admissions to hospital. See here for recent PHOF documents.

The alcohol-related admissions data comes from the well-established LAPE, which now includes a revised approach to recording alcohol-related admissions data. However alcohol's wide ranging impact means alcohol misuse will play a significant role in many of the other indicators.

Alcohol Research UK small grants scheme 2014

Alcohol Research UK have announced its 2014 small grants scheme to support small research projects or pilot studies up to £5,000 in total. 

Applications may be made for:

• Small research projects or pilot studies up to £5,000 in total;
• A contribution towards running a conference that has a clear link to our research priorities; or
• A small amount of funding to present at a conference findings that are directly relevant to our priorities.

The following criteria are used to judge all applications for small grants:

• Does the project address one of their priorities?
• Does the project have the potential to make a significant new contribution to the alcohol evidence base, either in its own right or as a precursor to a larger project?
• Are the aims well defined and achievable?
• Are the methods clear, appropriate and realistic?
• Is there a sound evaluation component to check whether aims have been achieved?

Preference will be given to projects that will have a demonstrable impact. Deadline for Reciept of Applications – 16^th July 2014

See here for the Alcohol Research UK library of previously funded projects.

NUS 'Alcohol Impact' scheme pilots across seven Universities - but questions over likely impact

The Home Office have funded a pilot 'Alcohol Impact' scheme across seven Universities in England and Wales in a bid to “create a social norm of responsible alcohol consumption by students.”

The participating Universities will be assessed across a number of criteria [xl] and will need to score 90 out of a possible 177 points to gain accreditation. The seven Universities taking part in the £90,000 NUS-led scheme are Swansea, Manchester Met, Brighton, Royal Holloway, Loughborough, Nottingham and Liverpool John Moores. 

Mandatory points, which must be achieved by the universities to gain accreditation, include:  

• A statement on responsible alcohol consumption
• A local steering group that meets at least twice per academic year
• Steps taken to establish, develop and promote a contemporary student identity based on responsible alcohol consumption
• Engagement with representatives of sports clubs and societies on responsible alcohol consumption
• Either that the students' union does not have any licensed premises or, if it does, they have achieved accreditation through Best Bar None or equivalent
• That campus bars refuse to serve intoxicated customers
• That good relationships are developed with stakeholders such as drug and alcohol services or police

The scheme has attracted criticism; as might be expected, charges of 'nanny statism' have been made on student blogs and even the Guardian. However these may be somewhat undermined by suggestions that the main measures will not been seen as significant enough to affect real change. Alistair Campbell told The Independent: “It doesn’t appear to challenge the industry and what they do to target students on arrival at university and puts it all on the universities and the students..."

Indeed the evidence for 'social norming' as the main thrust of the scheme appears mixed at best, whilst it appears price and availability will not be signifcantly affected by any of the measures. A condition of not serving 'intoxicated customers' is already national law, but perhaps successful efforts to ensure this could be of value.

The scheme will include some form of evaluation, although the  mandatory evaluation conditions focus on crime and disorder measures, so it appears consumption, health or attitudinal changes are unlikely to be assessed. Nonethelss, attention on the issue of alcohol harms in higher education settings may well be welcomed in itself.

South London HIN alcohol launch event presentations

Presentations from Professor Ian Gilmore and others are available following the recent launch of the South London Alcohol Health Innovation Network (HIN) on 9th May.

Founded by NHS England, the HIN is the Academic Health Science Network (AHSN) for South London aiming to deliver service improvement and sustainable change across key health areas including alcohol.

Professor Ian Gilmore gave a presentation [pdf] on 'The burden of health harm and the evidence of how to tackle it locally and nationally', in which he stated: 

• Alcohol costs a country 2-3% of GDP through costs such as loss of productivity, which in the UK represents a loss of £37.5b
• The rising affordability of alcohol in off-licence premises
• The significant potential impact of a 50p minimum unit price rise
• The rising death rate of people under 65 caused by liver disease

Presentations also included:

• Professor Colin Drummond, Institute of Psychiatry and HIN Clinical Director (Alcohol) on the CLAHRC South London Alcohol Theme; 
• Alison Keating, Head of Alcohol and Drugs Public Health England (London) on Working together to deliver our ambitions for alchol 2014-15
• Matthew Andrews, HIN Programme Manager (Alcohol), on the South London Landscape along with an overview of the Network's alcohol projects.

Attendees also contributed into the design and proposed rollout of the three project areas: alochol-related frequent attenders, Identification and Brief Advice (IBA), and a service support bank of expertise. For more information contact [email protected].

Alcohol and Football: Alcohol Concern warning ahead of 2014 World Cup

The FIFA World Cup 2014 starts this week, but Alcohol Concern have warned that police and A&E services will be under added pressure as alcohol consumption and related violence spikes.

Alcohol Concern's new briefing 'Alcohol and Football' reviews the links between alcohol consumption, football and marketing. It warns that pressure on A&Es is likely to rise significantly; the 2010 World Cup saw a 37.5% rise in assault attendances on England match days. It also identified domestic violence increased by up to 30% during World Cup 2006 England games, with other research showing domestic abuse rose by up to 38% when England lost in World Cup games.

Alcohol Concern say the drinks industry continues to work hard to align itself with the healthy image of sport, and that 'football and alcohol have become entwined at all levels'. In England, official alcohol sponsorship or partnership deals were held with 17 of the 20 Premier League clubs in the 2013/14 season, with high levels of exposure to alcohol adverts despite widespread viewing amongst children.

In relation to the Word Cup, the briefing highlights that Brazil's domestic law, which has banned alcohol sales from football stadiums since 2003, has been overturned following 'pressure from FIFA'. FIFA has a long-term, multi-million pound contracts with AB InBev for Budweiser to be the official beer of the World Cup. It states similar pressures are already being placed on authorities for the Russian World Cup in 2018 and Qatar World Cup in 2022 who also have bans on alcohol sales in and around stadiums.

Earlier this year the Coalition Government announced its decision to relax licensing hours nationally during the World Cup owing to late UK kick off times. The decision followed controversy after the Home Office had previously appeared to have ruled out the option and leave it with local authorities, but the Prime Minister ordered a "re-think" soon after.

The British Beer and Pub Association (BBPA) and partners have produced guidance for pubs to help ensure that venue's World Cup screenings are safe. The guidance is intended as a template for pubs, local authorities and police and provides a checklist for licensees.

Statistics on Alcohol England, 2014 - but trend analysis still to come; figures on alcohol benefit claimants

The annual Statisctics on Alcohol for England 2014 report was recently released, providing national data for key alcohol-related indicators and health harms. However the trend analysis of alcohol-related hospital admissions is not due to be released until July 2nd 2014 owing to the recent methodology change.

The report indicates the trend of falling consumption over the last ten years appears to be continuing, including amongst those reporting drinking above the recommended guidelines and school pupils. However alcohol-related hospital admissions - still at over a million a year using the broad measure - may still be on the rise, reflecting a lag effect of decades of rising consumption.

Still rising are the number of prescriptions for drugs to support alcohol dependency, totalling 183,810 at a cost of over £3 million. Alcohol-related deaths showed a decline of 4% since the previous year, but up 19% since 2001.

The report seemed to attract relatively little media attention this year, likely to be a reflection of the absence of trend data relating to the alcohol-related admissions. However a piece by James Nicholls of Alcohol Research UK was published in the Guardian exploring the historical context and likely factors for changes in consumption. A BBC report used the prescription figures as the headline.

A Twitter discussion on alcohol-related hospital admissions is planned for next week on the 11th June 8pm, using #UKalcohol.

Benefit claimants with a main disabling condition of drug and alcohol misuse

Also released last week was a report on the number of claimants receiving Employment and Support Allowance (ESA), Incapacity Benefit (IB), or Severe Disablement Allowance (SDA) who have a 'primary disabling condition of alcohol misuse and drug misuse'.

The report states 53,880 claimants of IB/SDA or ESA did so with a primary disabling condition of alcohol misuse in 2013, representing 2.2% of all claimants and a slight rise of 0.3% since 2007.