An 'addictions' policy report 'Ambitions for Recovery', was released last month by the Centre for Social Justice (CSJ), a right-leaning 'think tank' set up by Iain Duncan Smith. The report makes a number of policy recommendations, including more abstinence based recovery funded by a new alcohol 'unit tax' for off-sales.
Such reports can be tricky to summarise given the complexity of the issues, so here's a few considerations for what might be described as a 'mixed report'.
Treatment and recovery issues
Fundamentally the report calls for the Government to 'drive abstinence based recovery' as 'the most effective way to overcome addiction' through a number of proposals, including holding local authorities to account to do so. Not exactly localism, and plays to a long-running often polarised debate of 'abstinence Vs harm reduction'.
Claire Brown, editor of Drink and Drugs News responded in this month's DDN editorial that 'such wide-sweeping ownership of the word recovery is not only dismissive of other routes to treating addiction, it's also a diservice to many of those trying to develop inclusive recovery communities'.
Indeed when it comes to evidence for alcohol treatment, both NICE CG115 and before it, the Review of the effectiveness of treatment for alcohol problems, advocate both use of abstinence based approaches as well as continuing to work with and support those not aiming for abstinence. Crucially it seems, the role of the therapist as someone who works with the service user to help them explore and arrive at their own goals, is imperative to outcomes. Of course so too are many broader factors typically beyond the scope of 'treatment'.
Abstinence based approaches though are still strongly supported by NICE, including encouraging or at least highlighting the availability of local peer support groups, in reality typically AA or possibly SMART Recovery meetings. However the evidence for residential (inpatient) services - core to the CSJ report - are not as universally supported. Community based provision appears in most cases as effective (and arguably more cost-effective), unless indications of severe physical dependence or other factors are evident (see NICE section 1.3.4.5).
Furthermore, use of language describing others as 'alcoholics' or 'addicts' as found in the report often carries inherent problems, whereas 'dependent drinkers' or 'substance misusers' tend to be less labelling and more objectively defined. Without going further, the report's notions that the treatment field and its commissioners are 'anti-abstinence', along with suggestions that abstinence focused approaches for all are far superior, do not appear substantiated.
Beyond treatment - licensing, availability and a 'unit tax'
Beyond the highly contested 'recovery' debates, the report also covers some other key alcohol policy issues. On the current Government alcohol strategy, including the Responsibility Deal, it claims 'these ‘solutions’ are not fixing the problem, and alcohol abuse and dependency is getting worse in this country.' Readers will know the picture is more complicated - whilst consumption is falling, alcohol-related admissions are still rising.
On local action, the report claims 'the introduction of the late night levy and early morning restriction orders, for example, have given councils useful tools to tackle alcohol abuse' despite no early morning restriction orders having been implemented. A number of Late night levies have, of course to the displeasure of on-trade bodies who highlight the significant shift in consumption to off-sales.
More likely to find favour with those working in the alcohol field, the report advocates including the protection of health as a licencsing objective, as is the case in Scotland. Also as a 'recommendations to tackle the over-supply of alcohol', it states Police and Crime Commissioners should remind licensed premises of their duty not to sell to intoxicated persons and ensure that this legislation is enforced - but again a complicated issue (but work in progress).
The report calls for 'introducing a small, ring-fenced treatment tax on every unit of [off-trade] alcohol from 2015 that can be used to fund effective abstinence-based rehabilitation centres.' Abstinence and rehab debates aside, action around pricing and increasing treatment of course also have favour with most of the alcohol harm field. Alcohol Concern call for increased investment in alcohol treatment (but not just abstinence based), whilst of course pricing is a central policy issue. However it is unlikely a 'treatment tax' is either practical or likely to be implemented, espcially given the current complexities around alcohol tax systems and EU law.
So, perhaps we should welcome such report's contributions to the debate, but like with all these things, the politics often seems inextricable from the 'evidence'.
Acknowledgement: with thanks to Trevor McCarthy for input.
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