Alcohol Policy UK

Latest IAS Alcohol Alert: Nov 2014

The latest Institute of Alcohol Studies (IAS) Alcohol Alert: November 2014 is now available (here for PDF version).

Articles include:

• Editorial – November 2014

• IAS report finds public health measures can help solve alcohol harm paradox

• Stark north-south divide over admissions and mortality rates for alcoholic liver disease

• Public Health England prioritizes alcohol

• Scotland: Number of licensed premises linked to alcohol-related illness and deaths£25 million to help over-fifties avoid alcohol harm

• Controversy over new drug to treat alcohol dependenceAbout-turn on closing times

• Public support for Leicester street drinking ban

• 92% of people feel ashamed to drink and drive as 50th anniversary THINK! campaign is launched

• Scotland: Lower drink-drive limit before Christmas

• New SHAAP report focusses on alcohol and brain damage in teenagers

• Children's Commissioner says more must be done to protect children from parents' problem drinking

• Wales: Stark challenges posed by alcohol

• Alcohol, drugs and tobacco joint strategic needs assessment support pack

Big Lottery Fund awards £25 million to address alcohol misuse amongst older people

The Big Lottery Fund has announced £25 million to support alcohol-related harm prevention and awareness programme for the over fifties, in partnership with Addaction.

The funding will be part of a 'Rethink Good Health' programme, a UK-wide initiative which aims to 'help inform policy and practice about preventing alcohol-related harm in later life, improve health and wellbeing of people aged 50 and over who are at risk of developing alcohol problems and help build more effective services aimed at alcohol-related issues'. 

The seven year programme will include 'flagship' work taking place in Glasgow, Sheffield, Devon, South Wales and Northern Ireland - Addaction are currently recruiting for roles in Devon and Glasgow.

Simon Antrobus, Chief Executive of Addaction, said:

Problem drinking doesn’t happen in isolation – there are always other factors involved. This is especially true for the over 50s who can end up drinking at harmful levels as they face challenging life transitions such as retirement, the loss of a loved one or loneliness.

A recent report from Keele and UCL explored influences on older adult's drinking as an area of increasing significance within an ageing population. In 2012 an Alcohol Research UK report on working with older drinkers explored alcohol problems and treatment needs need amongst older adults whilst last year an Alcohol Concern briefing warned of a 150% rise in hospital admissions for over 60’s with alcohol related mental health problems. A report from the Royal College of Psychiatrists advised over 65's should not drink more than 1.5 units of alcohol a day and have a leaflet outlining the key alcohol issues and risks for older people.

A recent Telegraph report warned over the 'hidden toll of alcoholism among elderly middle class women, partly fuelled by the growth of online shopping delivery services.'

A channel 4 news report also looked at alcohol problems in older adults, and commissioned a poll on the reasons why the over 60s drink versus under 30s. See it's report on one older drinker's battle with alcohol dependency.

See all Alcohol Policy UK Older People posts here.

50 years of drink-drive campaigns as new limit for Scotland approaches

A new drink-drive advert highlights the significant reductions in drink-driving made over the last 50 years, but that that current figure of 230 a year is still "230 too many".

The history of drink-drive campaigns were reviewed in reports by the Independent and Telegraph, also identifying legislation changes and key developments such as the introduction of the breathalyser in 1967. See here for a montage of drink drive campaigns through the years.

Drink-drive incidents still account for 13% of all road fatalities. The 'Think!' campaign aims to highlight the dangers, as well as a fine of up to £5,000, a minimum 12-month driving ban and a criminal record if caught.

As from 5th December Scotland's legal blood alcohol limit for driving will be cut from 80mg to 50mg in every 100ml of blood, following new legislation recently passed. Kenny MacAskill, the Scottish Justice Secretary said there was "strong evidence that drivers with a blood alcohol reading of between 50mg and 80mg are significantly impaired" as he justified the automatic ban for anyone convicted.

In 2011 it was announced the legal drink-drive limit in England would remain at 80mg per 100ml of blood despite an independent report calling for it to be reduced to bring it in line with 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."

Last year a warning that 'morning after’ drink driving was on the increase was reported, with 46% of drivers having 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 - read more here or see www.morning-after.org.uk

  

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

More must be done to protect children from parent's problem drinking, says Children's Commissioner

A recent report looks at the number of children affected by parental alcohol misuse and at the help available to them, calling for further action.

Download "I think you need someone to show you what help there is,": Parental alcohol misuse - uncovering and responding to children's needs at a local level [pdf]

Commissioned by the Office of the Children's Commissioner from The Children's Society, the report is based on research with children and young people, alcohol misusing parents and professionals who work with them in three areas of England. The report finds that:

• local areas are committed to addressing alcohol misuse but that the focus on the effect on children of parental drinking still needs much work.
• some local services for adults with alcohol problems, and staff in children's services, may fail to adequately identify children's needs and assist them in getting help or protection.
• local services do not all work together effectively to measure and address the impact on children of parental alcohol misuse

The research follows the Children's Commissioner's 2012 report Silent Voices: Supporting children and young people affected by parental alcohol misuse, which rounded up the known and unknown knowns in prevalence, protective factors, treatment/service responses and policy issues. 

Speaking after publivation of the report last month, Maggie Atkinson, Children's Commissioner for England said:

 

"Children have a right to be kept safe from harm and adults have a duty to protect them, and this includes the damage caused by parents' alcohol misuse. Parents and carers must be made aware of the effects their problem drinking can have on children and young people, and health and social care services must get better at providing effective co-ordinated responses. Problem drinking is frighteningly common. It not only causes problems for the drinker but also, all those around them, including their children. The social and economic cost is immense."

See also previous post about the Alcohol Hidden Harm Toolkit to support managers, commissioners and practitioners involved in designing, assessing or improving Alcohol Hidden Harm services for children and families. An Adfam report on alcohol harm and families was released in 2012 which higlighted abuse that some parents suffer from their children.

Alcohol care in England's hospitals: PHE report reviews evidence and provision

A new report reviewing the provision of alcohol services in England's hospitals has been released by Public Health England (PHE).

The report, Alcohol care in England's hospitals [pdf], identifies that the majority of hospitals have at least some specialist alcohol provision, although delivery varies widely and key issues such as integration with community services is crucial.

The report summarises the available evidence and includes results of a national survey into existing provision. It found at least 139 (73%) of hospitals large enought to merit some level of specialist alcohol service did so. Only five hospitals were identified as having no alcohol service at all. The report states most of the current evaluation evidence for hospital alcohol services is for multi-disciplinary 'alcohol care teams' (ACTs) in larger hospitals, but identifies the delivery of 'in-reach alcohol care teams' and 'high impact user services' in a number of hospitals.

In terms of service provision, it states all hospital based services should be able to provide:

• case identification/identification and brief advice (IBA)
• comprehensive alcohol use assessment
• contribution to nursing and medical care planning
• psychotherapeutic interventions
• medically assisted alcohol withdrawal management
• planning of safe discharge, including referral to community services

In terms of cost effectiveness, it states the return on investment from alcohol care teams can be between £3.50 and £3.85 per £1.00 invested. Assertive outreach services that aim to reduce hospital admission and A&E visits among frequent attenders can deliver a return of £1.86 per £1.00 invested.

The recommendations from the report are that:

• every district general hospital should consider the best way to provide effective specialist alcohol care for its patients in light of the benefit to patient care and the available efficiency savings
• local partners should engage with the health and wellbeing board to ensure existing services for alcohol and other drugs are maintained and developed on the basis of local needs assessment
• hospital alcohol care teams should accelerate identification and brief advice (IBA) delivery throughout the hospital by supporting the training of colleagues in all clinical areas
• local partners should review the response to alcohol-related harm in all district general hospitals, using this document as a guide, and they should ensure that existing services are adequately integrated across primary and secondary care and that new services are implemented where there are none
• local partners should consider employing assertive out-reach or in-reach services for high impact service users in all major hospitals and existing services should be comprehensively evaluated to assess their impact on hospital and community services
• system planning should ensure that community services are accessible and available to ensure continuation of detoxification with psychosocial interventions outside of the hospital

A recent Alcohol Research UK report, A national study of acute care Alcohol Health Workers, found that services were 'frequently precarious, with limited management support, short-term funding and a lack of ownership from key agencies'.

Data on alcohol-related hospital admissions are used as a key indicator for local areas and part of the Public Health Outcomes Framework. An evaluation of a national led programme to reduce alcohol-related hospital admissions and improve local level action was published in 2013.

New research probes links between alcohol availability and harm in Scotland

Last month the Centre for Research on Environment, Society and Health (CRESH), in collaboration with Alcohol Focus Scotland, published Alcohol outlets and health in Scotland [pdf] from their research on the relationship between the number of alcohol outlets, and alcohol-related illness and death in Scottish neighbourhoods. See a blog post by CRESH on the research. 

Key findings were:

• There are large variations in numbers of alcohol outlets within neighbourhoods across Scotland.

• Across the whole of Scotland, neighbourhoods with higher numbers of alcohol outlets had significantly higher alcohol-related death rates. 

• Across the whole of Scotland, alcohol-related hospitalisation rates were
  significantly higher in neighbourhoods with the most alcohol outlets.

The authors do not make any claims for a causal relationship between the density of alcohol outlets and alcohol-related illness and death, but note that the relationship is strongest for off-sales outlets, saying:

Comparing our results for on-sales and off-sales outlets should be done with caution, but we suggest that the relationships found were stronger for off-sales outlets. This supports claims that off-sales outlets have the greatest potential for alcohol-related harm, due to their cheaper product, large volumes obtainable, accessibility for under-age drinkers, and the absence of control over the final recipient.

In conclusion, the authors suggest that reducing the neighbourhood availability of alcohol outlets, particularly in areas with the highest densities of outlets, could have significant health benefits for the Scottish population.

The research may help to inform decisions made by licensing authorities in Scotland, where the Licensing (Scotland) Act 2005 permits them to take into account an ‘over-provision’ of licensed outlets in general, or licensed outlets of a particular type, in a given locality. Where over-provision is held to apply, there is a rebuttable assumption that additional licences may not be granted, though each application must still be considered on its own merits. However in 2013 the third Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) annual report found that Licensing boards had found it difficult to measure overprovison.

In 2011 Alcohol Concern published a report stating a link between the density of off-licensed premises and harm from alcohol in underage drinkers. See the IAS paper Licensing legislation and alcohol availability for a round up of licensing law as it relates to outlet density in Scotland, Northern Ireland and England & Wales. See here for a Findings Bank analysis on a US review of limiting licensed premises density to curb alcohol-related harm.

‘Alcohol, health inequalities and the harm paradox’ - IAS report

A new report from the Institute of Alcohol Studies (IAS) calls for action to address health inequalities as a key issue for alcohol policy. In particular it addresses the issue of the 'alcohol harm paradox' - why lower socioeconomic groups experience greater health problems due to alcohol, despite drinking less than those on higher incomes.

Download ‘Alcohol, health inequalities and the harm paradox’ [pdf], the summary report [pdf] or an audio podcast featuring Sir Michael Marmot.

The research suggests that multiple factors may explain why the worst health problems – such as obesity, social disorder and mortality rates – occur among the most deprived socioeconomic groups, and that alcohol’s interaction with other unhealthy behaviours is known to compound these health problems. For example, studies have discovered a “supra-additive interaction” between obesity and alcohol consumption. A combination of smoking and drinking also significantly accelerates the risk of cancer, with tobacco and alcohol-related cancers 2 to 3 times more common in areas with the highest deprivation versus the lowest.

 

The report also suggests alcohol may be a contributing factor for almost 50% of the indicators within the Public Health Outcomes Framework for England. As such addressing alcohol-related harm could be a key route to improving public health and reducing general health inequalities.

 

Commenting on the report, Professor Sir Michael Marmot, Director of the Institute of Health Equity at University College London, said:

 

"It's a mixture of alcohol and other things that make individuals and groups more vulnerable to the effects of alcohol… given that people of low socioeconomic position are vulnerable to a whole range of different disorders, the report suggests that alcohol interacts with this vulnerability.”

 

Katherine Brown, Director of IAS, said:

 

“Health inequalities are a major cause for concern in the UK and this report shows how alcohol misuse is effectively widening the gap between rich and poor. This is why policies such as minimum unit pricing are vitally important because the biggest beneficiaries are low income and vulnerable groups.”

 

In 2012 the King's Fund published research on the clustering of lifestyle behaviours, which explored the inter-linked relationships of smoking, drinking, diet and exercise across the population. An Alcohol Research UK flagship grant into the alcohol harm paradox is also currently being undertaken by the Centre for Public Health at Liverpool John Moores University.

Responsibility Deal alcohol labelling pledge 'met' but new calls for calorie content

The voluntary alcohol labelling pledge of 80% of drinks on shelf to include agreed labelling information has been met, according to a new report. The pledge is part of the Government's Responsibility Deal in which companies agree to voluntary actions intended to improve public health, though it has been controversial with various health partners walking out.

The labelling pledge was made in 2011 by 93 alcohol companies who would "ensure that over 80% of products on shelf (by December 2013) will have labels with clear unit content, NHS guidelines and a warning about drinking when pregnant." The report details an analysis of a sample of over 500 products on sale in the UK from a range of national, regional and independent supermarkets and off-licences.

Conducted by Campden BRI on behalf of the Portman Group, the analysis found 79.3% compliance with the pledge elements as measured by products on shelf. This measurement is described as Stock Keeping Units (SKUs), though the report also assessed 'alcohol content' - the proportion of all alcohol sold which carried appropriate labeling. For this measure, 69.9% of alcohol sold was found compliant.

The report breaks down the data to show compliance across the three key information messages and across different drinks and brands. Pregnancy information was the most consistently found, followed by unit content then lower risk guidelines. For drink types, labelling compliance was highest for beer (86.6% SKU), with cider also above (82.3%). However spirits averaged 79.4% with wine at just 51.8%.

Critics might raise a number of issues over the announcement, most obviously whether 79.3% counts as meeting an 80% target (the report highlights confidence intervals) or whether it was appropriate that the Portman Group monitored the pledge as an industry funded body. Perhaps more significantly though, as yet there appears no indication as to whether the pledge is expected to be maintained going forward. Or indeed, whether the current labelling pledge provides consumers with all the information they would like...

New report calls for calorie information on labels

New calls for alcoholic drinks to include calorie content information recently hit the headlines following a new report from the Royal Society for Public Health (RSPH).

The report says 67% of people surveyed said they would welcome calorie labels on the packaging of alcoholic drinks, and calls for the drinks industry and EU Health Commissioner to introduce calorie labelling.

The European Commission has committed to make a decision on extending nutrition labelling (including calorie labelling) on alcoholic products by December 2014. Alcoholic drinks are not currently recognised as food and are therefore exempted from normal food labelling under existing EU legislation. See here for an RSPH blog on the case for calorie labelling.

The RSPH polled 2,000 people to find out what they knew about the calories in alcohol and found that the majority had little idea. More than 80% did not know, or incorrectly guessed the calorie content of a large glass of wine whilst almost 90% did not know how many calories there were in a pint of lager.

The report suggests it is unclear as to whether improved calorie labelling might be effective in reducing alcohol consumption, with further research needed. In 2011 a joint BDA (British Dietetic Association) and Alcohol Concern Cymru briefing was released also highlighting nearly 10% of drinker's calorie intake comes from alcohol.

'One too many?' Report calls for review of 'sales to drunks' legislation

A new report calls for a review of the legislation on 'sales to drunks' - one of the most under enforced laws on the statute books. Whilst identifying significant challenges, it also recommends further exploration of retailer led action and other initiatives that could improve adherence.

Download 'One too many? Sales to drunk customers: policy, enforcement and responsibility' [pdf].

The report was produced by the Alcohol Academy and Alcohol Research UK following a conference event earlier this year. However it highlights the complexity of the issue in terms of both practical implications as well as some wider questions about the spirit of the legislation itself. Areas are explored in relation to:

• Policy - such as whether the current legislation is fit for purpose;
• Enforcement - such as whether apparent barriers are a significant deterrent or further activity should be undertaken;
• Responsibility - including whether retailers and industry bodies should do more to promote compliance, for example learn from recent under age initiatives

The briefing covers research that shows in some contexts sales to those who appear 'drunk' are the norm. However with no legal definition of drunkenness, important questions such as when a refusal to serve should be made are apparent. Additionally the current legislation states a server must 'knowingly' sell alcohol to someone who is drunk to commit an offence, so proving they knew this may be a significant barrier to enforcement. At the same time, staff need some degree of protection and are often working in environments with many counter-pressures to serve.

As such, the report explores what role retailers and sections of the industry could play in improving adherence to the law. Although ensuring proper staff training appears a crucial starting point, there is no consistent benchmark for what server training should cover on this area and whether it is re-freshed. Many servers will be working in high pressured environments that may implicitly encourage 'drunkenness', and where customers will expect to be served. Considering the wider retail environment is therefore important, but opportunities for industry-led initiatives exist.

However the report also highlights that the on-trade already faces greater regulatory requirements, despite a significant shift in consumption to off-trade sales. Therefore consideration of wider issues such as price in driving 'pre-loading' also needs reviewing. As shown in many other reports, single initiatives are unlikely to produce significant lasting changes in practice, so co-ordinated 'multi-component' approaches are needed. 

Recommendations from the report include:

• A substantial review of the current legislation preventing sales to ‘drunks’
• Consideration of a requirement for premises to have a written policy ensuring adherence to the law
• Development of a national campaign to raise awareness of the law among licensees, customers and bar staff
• Improvement to staff server training to ensure appropriateness and consistency
• Review the use of on-the-spot fines for premises or staff found to be breaching the law
• ‘Multi-component’ approaches to ensure coordinated policy, enforcement and retail actions
• Further research into the relationship between drunkenness and the wider retail environment

Drugscope release guide to promoting drug and alcohol treatment and recovery & CQC to inspect treatment services

A guide on promoting drug and alcohol treatment services has been released to help make the case for investment. Produced by Drugscope and the Recovery Partnership, the guide aims to 'ensure that treatment and recovery do not slip down the political agenda' in local areas.

Download 'Making the case: A practical guide to promoting drug and alcohol treatment and recovery services locally' [pdf]

The guide details the current commissioning landscape following the various changes, and includes sections on; sourcing statistics and data, crafting key messages, developing narratives from service users and staff and building positive community relations.

To support the release of the report, Marcus Roberts, Chief Executive of DrugScope, blogged on the challenges and opportunities facing the sector against a backdrop of localism, large public sector cuts, and other key considerations for the 'recovery' agenda.

Alcohol Concern have continued to make the case for more services to support dependent drinkers, sometimes highlighting the significant gap between investment in drug versus alcohol treatment. Recently they warned of the impact of the commissioning changes on local services, though to date total numbers in alcohol treatment are still increasingly somewhat.

See here for Publuc Health England's suite of tools to help local areas develop JSNAs and joint health and wellbeing strategies, or here for NICE alcohol commissioning guidance.

CQC to inspect treatment services

Earlier this year the Quality Care Commission (CQC) set out its 'new approach' to inspecting substance misuse services 'to ensure that services are safe, caring, effective, responsive to people's needs and well-led'. The CQQ was established in 2009 to regulate and inspect health and social care services in England.

It says the first inspections will cover hospital inpatient-based services, community based services and residential rehabilitation services. The release says the way they will regulate services will:

'...reflect the key aim of the government's drug strategy to put people's recovery at the heart of its approach. This means making sure that people are able to quickly access high-quality services that assess the whole individual. It also means making sure that people's needs and choices are at the centre of their treatment.'

Download A fresh start for the regulation and inspection of substance misuse services [PDF]