Alcohol Policy UK

Rise in train and plane alcohol-related incidents raises questions over policies

Recent media attention has drawn attention to the issue of alcohol-related incidents on train and flight journeys, with reports that the number of alcohol-related incidents has tripled over the last three years on UK flights.

The Civil Aviation Authority (CAA) says the majority of the 114 passenger disturbances on UK flights in 2014 were alcohol-related, compared to a total of 39 disturbances in 2011. One aviation industry insider told The Times that many of the incidents were linked to 'long-haul stag parties', although the CAA said incidents were lower than the late 1990s peak.

The CAA emphasised that it is a criminal offence to be drunk on board an aircraft, or to refuse to comply with instructions from the captain. However a Telegraph report suggested there had been calls for limits on alcohol sales in airports. Nathan Stower, chief executive of the British Air Transport Association, told the Times: 'Airlines set tough rules around the consumption of alcohol' and that 'pubs, bars and restaurants in the UK and overseas must play their part.'

Stories in the Mail and BBC detailed various recent incidents involving flights disrupted due to alcohol-related incidents, whilst a drunk passenger was recently jailed despite attempts by London Mayor Boris Johnson to calm him.

Rumours quashed over alcohol ban on train networks 

Meanwhile the Rail Safety Standards Board (RSSB) has said alcohol will not be banned on rail networks following a number of media reports.

The claims followed a RSSB report that detailed its strategy for addressing alcohol-related incidents, which included "investigation into... banning the sale and consumption of alcohol on trains". In 2008 Boris Johnson banned alcohol on the London Underground, largely considered a successful policy move.

Alcohol was identified as a factor in 21 of 32 rail passenger fatalities over the past decade. RSSB safety figures also show a rise in alcohol or drug related assaults on staff over the last ten years.

'Pre-loading' - not just a challenge for pubs and bars?

Reports relating to both the flight and train incidents both highlight the issue of how attempts to address alcohol-related incidents might be undermined by the rights of passengers to drink before their journeys, albeit that 'drunkenness' is prohibited on flights. Recent attention has been given to premises using breathalysers to reduce alcohol-related violence, but a similar issue presents; to what extent should the supply of alcohol, or the detection of intoxication, be used as policies to reduce such incidents?

Latest IAS Alcohol Alert: February 2015

The latest Institute of Alcohol Studies (IAS) Alcohol Alert: February 2015 is now available (here for PDF version).

• Local Government Association calls for slice of alcohol tax

• Irish Government announces measures to tackle alcohol harm

• Labour to target cheap cider to protect children

• No legal obstacle to MUP in Scotland – Scots QC

• Alcohol Concern renews call for stricter marketing regulations

• Cardiff campaign to cut binge drinking to be piloted across England

• Alcohol Map of Britain shows links between sales, consumption and harm

• End of the road in sight for super-strength products?

• Think Tank calls for ‘penny a unit’ tax to fund alcohol/drug treatment

• Edinburgh alcohol strategy “to balance safe drinking with economic development”

• Alcohol Health Alliance also urges higher alcohol prices to resolve A&E crisis

• David Beckham TV advertisement for whisky approved by Advertising Standards Authority

• British Liver Trust calls for early liver tests to save thousands of lives

• How strong is the link between working long hours and risky alcohol use?

• Alcohol used to take “time out” from daily life, says study

The issue includes a podcast interview with Cllr Jonathan McShane, Chair of Hackney Health & Wellbeing Board on the issues set out in the LGA report.

Breathalyser 'on the door' schemes see further roll-out

A growing number of areas are introducing breathalysers on the door of premises in attempts to reduce alcohol-related problems. The initiatives appear to be gaining momentum following particular successes reported in Norwich and more recently Torquay.

An evaluation of a pilot involving 23 of Torquay’s key nightspots during December 2014 claimed to have reduced violent crime by 39%. Torquay named the initiative #RU2drunk to help promote awareness of the scheme which saw doormen breathalyse over 800 people, over one third of whom were subsequently refused entry. However premises decided on their own criteria and not all opted for a fixed limit for refusing entry.

Police in Norwich were reportedly the first to use the scheme in 2013, which has since been continued 'indefinitely'. The Norwich initiative was reported to have reduced violent crime by 32% and drunk and disorderly arrests by 66%. 

Other similar schemes have been recently reported in Northampton, Mansfield, York, Birmingham, Durham, Liverpool and other areas. In London, the Met police are looking at wider roll-out of the scheme following pilots in Croydon and other boroughs which have used a breath alcohol content reading of 0.70 - twice the legal drink drive limit - as a basis for refusing entry.

All in favour?  

As part of the evaluation of Torquay's scheme, Exeter University found 79% of the public thought it was a good idea, and 70% of licensees thought the scheme should continue.

Some pubs elsewhere however have rejected the scheme, and speaking at the 2015 Pubwatch conference, Norfolk Police licensing Inspector Ed Brown said that he had been named "captain killjoy of the fun police". However he said there had been "a lot of rumour, myth and scaremongering" about the nature of the scheme.

Indeed many of the premises have used breathalysers as an aid to door staff's decision making, rather than universally applying a fixed limit. Exeter University researcher Dr Katherine Boyd said using the breathalyser was welcomed by many door staff as it reduced room for argument about the person's level of drunkenness, thus reducing conflicts.

Changing attitudes to drunkeness and the Night Time Economy?

Last year a report 'One too many?' called for a review of the legislation on 'sales to drunks' - one of the most under enforced laws on the statute books. It highlighted that addressing drunkenness and associated problems is a complex area for which no single initiative is likely to provide a lasting solution. So whilst initiatives such as breathalysing on the door may show positive local results, achieving longer term shifts in attitudes towards pre-loading and drunkenness may require sustainable action on many such fronts.

53% of violent incidents alcohol-related: British Crime Survey 2013/14

Victims perceived the offender(s) to be under the influence of alcohol in 53% of violent incidents according to the latest British Crime Survey figures.

Whilst overall violent crime has been on a downward trend, the proportion of alcohol-related crime appears to have increased slightly from 50% in 2008/09.

Of the estimated 704,000 ‘alcohol-related’ violent incidents in 2013/14, the overall profile for alcohol-related offences remains similar. 70% of all violent incidents occur at the weekend, and 70% of violent incidents occurring in the evening or night, were alcohol-related. Alcohol-related violence was more prevalent amongst strangers at 64% whilst 83% of all alcohol-related violence occurred between 10pm and midnight.

70% of violent incidents which took place in a public space were alcohol-related compared with 40% of incidents that occurred in the home and 43% of incidents around the workplace. Alcohol-related incidents were significantly more likely to result in serious accident or injury, and 43% of assaults on police officers involved alcohol.

Last year the Institute of Alcohol Studies (IAS) released a report exploring the relationship between alcohol, domestic abuse and violence. See coverage of last year's discussion over the fall in violent crime and alcohol's possible role. See here for resources on implementing data-sharing approaches to reduce violence.

See here for Chapter 5 of the BCS and the ONS infographic 5 facts about alcohol-related violence.

Drugscope warn over cuts and pressures to treatment sector

DrugScope’s State of the Sector 2014-15 report has warned over cuts to the drug and alcohol treatment sector and risks posed by 'commissioning churn'. 

The report, State of the Sector 2014 – 15, contains the findings from a survey of 189 adult community, residential and prison drug and alcohol services, from across England’s four Public Health England regions. See the summary report or press release.

Key findings from the report include:

• 53 per cent of respondents reported a reduction in frontline staff and 40 per cent a reduction in back office staff and managers;
• 62 per cent reported an increase in the involvement of volunteer recovery champions and 47 per cent an increase in the use of other volunteers;
• Over half (54 per cent) of community services had been through tendering or contract renegotiation since September 2013; just under half (49 per cent) were expecting this to happen between September 2014 and September 2015;
• The change of funding experienced by respondents was an average net reduction of 16.5 per cent although this masks volatility, with substantial increases and decreases reported;
• Respondents reported that funding changes had a negative effect on service delivery overall, with core services, outreach, education, training and employment support and health services all showing a net deterioration.

Last year Alcohol Concern warned over fears facing alcohol services. A seperate survey by Alcohol Concern also that found that although most key local needs assessment documents recognised alcohol, most did not go far enough to address the full impact of alcohol misuse on the local population.

Alcohol Concern also published a Guide to Alcohol for Councillors to help them address alcohol harm. NICE has a comprehensive set of alcohol guidance and quality standards, including alcohol pathways and further tools. NICE have also released Public Health alcohol guidance for local authorities. 

Young Londoner's drive fall in 'binge drinking': Opinions and Lifestyle Survey 2013

The latest data on adult drinking habits has been released as part of the new Opinions and Lifestyle Survey (OPN). A significant rise since 2005 in the number of young people aged 16 to 24 not drinking was responsible for an overall figure of 21% of adults now reporting as tee-total.

The overall proportion of adults who binged at least once in the previous week also decreased from 18% in 2005 to 15% in 2013, again driven by a significant drop amongst 16 to 24 year olds. However the proportion of adults aged 45-64 and 65 and over binging in the last week actually increased, although less significantly.

Regional factors are also important, with 32% of Londoners not drinking versus just 15% in the South West. London of course is likely to have a higher make of non-drinking young people in part due to non-drinking cultures, but the overall falls amongst young people are likely to be complex.

Perhaps most simply, overall consumption peaked around 2004 following decades on the up. The subsequent recession and slow return to growth is often cited for contributing to the decline in drinking, whilst young people may have been particularly hard hit. Attitudes may change for other reasons, and some academics have suggested younger generations seek to do things differently from their predecessors. Social media, other drugs, or as the ONS bulletin suggests, enforcement of under age sales may also be key factors.

See here for the OPN Statistical bulletin: Drinking Habits Amongst Adults, 2013 (pdf), ONS 5 facts infographic and an exploration by the BBC.

Since 2013 the Office for National Statistics (ONS) 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.

Alcohol-related deaths (2013): ONS highlight socio-economic status 'harm paradox'

The ONS have released the latest Statistical bulletin for alcohol-related deaths in the UK (2013). It shows in 2013 there were 8,416 alcohol-related deaths in the UK, 49 more than in 2012 (8,367).

Although the ONS highlight alcohol-related deaths are at their the lowest since 2000, rates rose rapidly during the 1990s and are therefore still significantly higher than 20 years ago. Scotland is the only country in the UK where death rates have fallen significantly over recent years, but still has the highest death rates in the UK.

A 2012 Lancet piece predicted a longer term rise in alcohol-related deaths for the future. Although it may be too soon to say, alcohol misuse is seen to play a significant role in rising liver disease rates, whilst alcohol-related hospital admissions have also been on an upward trend. Some health experts also believe that consumption, which has been falling since 2004, may start to increase again as the economy recovers.

The alcohol 'harm paradox' 

The ONS also published an analysis looking at socio-economic and gender inequality in alcohol-related deaths among working-age adults (16-64 years).

Alcohol-related death rates were highest for those in routine occupations (e.g. bar staff, cleaners and labourers), despite these groups drinking the least. Conversely managerial and professional roles, who are most likely to regularly drink above the guidelines, experience the lowest death rates.

Last year a report from the Institute of Alcohol Studies (IAS) called for action to address health inequalities as a key issue for alcohol policy. It suggests reasons for the alcohol harm paradox were complex, but likely to be linked to multiple unhealthy behaviours more prevalent amongst lower socio-economic groups.

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.

Findings alcohol bulletins: Scotland's alcohol strategy; MUP would save Welsh lives too; Youth treatment

Recent bulletins from the drug and alcohol bank:

Scotland’s alcohol strategy judged partly successful

Official assessment of Scotland’s national alcohol strategy says changes to licensing laws are unlikely to have affected alcohol-related harm, but that the brief interventions drive and the ban on quantity discounts may have contributed to recent declines in alcohol consumption and harms.

Ending cheap drink would save lives in Wales

After similar analyses for England and Scotland, this simulation of what a minimum unit price for alcohol would do for health, crime and workplace absence in Wales predicts it would substantially save lives and reduce social impact by making (especially poor and heavy) drinkers cut back.

Youth treatment in England improving but contracting

Judged by ‘successful’ completions, this official report documents improved specialist treatment of children with alcohol and drug problems in England. In line with general population trends, patient numbers have fallen, though cannabis bucked the downturns and now dominates the statistics. One concern: do falling numbers also reflect contracting services?

Further questions over lack of action to address alcohol misuse in the military

A BBC report has highlighted further concerns over a lack of action to address high levels of alcohol misuse amongst the armed forces.

Professor Neil Greenberg, lead on military health at the Royal College of Psychiatrists and a former Navy Commander, said the current education based approach was not effective.

Greenberg said that awareness raising of alcohol harms "doesn't really work at all" as the main thrust of current military alcohol 'policy', which might include a briefing informing personnel that "alcohol was bad for them". Calls have previously been made to end subsidising of military bars and do more to reduce alcohol misuse before it becomes a serious health or disciplinary issue.

A heavy drinking culture amongst the armed forces has been documented by various studies, with one survey of 1,559 Royal Navy personnel showing 92% had some level of alcohol misuse based on AUDIT-C scores. Studies have also linked violent offending and mental health issues to alcohol misuse in the military.

In 2011 a defence select committee report called for the Ministry of Defence to conduct an urgent study into the issue of alcohol misuse within the armed forces. The report suggested 13% of military personnel have alcohol dependency, more than twice the prevalence in the general population. The committee said the MoD was "yet to recognise the seriousness of the alcohol problem and must review its policy in this area".

In May 2014 the Independent reported that record levels of alcohol abuse in Britain's armed forces led to more than 1,600 service personnel requiring medical treatment in the past year. The MoD said it had introduced a new system to better record instances of alcohol misuse which was why figures were rising, but Minister Anna Soubry pledged to take action against a culture of "drinking to the point of oblivion" in the armed forces.

According to this week's BBC report the Ministry of Defence said it had introduced extensive policy and guidance for commanders and an alcohol working group had been instigated to "review policy and data to identify what more we can do to tackle alcohol misuse in the armed forces".

See here for a letter in The BMJ's Journal of the Royal Army Medical Corps from the authors of study into AUDIT-C scores and mental health within the military. See here for 'Alcohol use and misuse within the military: A review' [pdf].

News & updates January 2015: alcosynth; health effects; sports sponsorship; policing

Selected media stories since the December round-up:

Policing alcohol misuse

Cliff Mann, head of an A&E doctors' group, wants police to take a “zero tolerance” approach to alcohol-related antisocial behaviour, to stop drunks clogging up emergency wards, reported the Independent. NHS hospitals and surgeries call police 175 times a day - and alcohol is the biggest cause, said the Mail Online.

Police officers are being forced to make “pragmatic decisions” about whether to arrest people for low-level crimes such as drunkenness and minor disorder, according to Inspector Ian Hanson, chairman of Greater Manchester Police Federation - Independent

Health and research in the news

Consuming seven alcoholic drinks over the course of a week could reduce the risk of heart failure, reported the Mirror and others. NHS Choices analysed the research and concluded "it is generally not recommended that people take up drinking alcohol just for any potential heart benefits".

Not long ago research also found one drink a day could be enough to increase the risk of heart disease, a different condition to heart failure. See a related piece in the Independent on 'why are we so obsessed with alcohol health effects?

More than half of the British public are unaware of the link between alcohol consumption and cancer, according to a survey from the Alcohol Health Alliance UK, reported Cancer Research UK.

Alcohol can wreak havoc on your immune system from the moment you start imbibing reported the New Scientist.

Poor sleep in teenage years could be an early warning sign for alcohol problems, illicit drug use and "regretful" sexual behaviour, research suggests. BBC News

Although drinking alcohol before bed can induce drowsiness, it is proven to disrupt the quality of rest and have negative effects on brain function the next day, according to new research reported in the Independent.

Working more than 48 hours a week makes people more likely to drink excessive levels of alcohol, suggests research reported in the Times.

Experts reckon Edinburgh is losing £86 million in economic output through “presenteeism” – when an employee’s performance is weakened by the after-effects of alcohol – as well as absenteeism, drink-related sickness, unemployment and premature death caused by alcohol. Edinburgh Evening News

Policy news

Labour MP Bill Esterson is seeking better labelling of alcoholic beverages to warn pregnant women against drinking alcohol. BBC News

A group of more than 30 health leaders says exposing alcohol sponsorship to children is creating links between drinking brands and sport, calling for a ban on alcohol industry sponsorship of sport, reported Channel 4 News.

Meanwhile Labour has rowed back from banning alcohol brands from sports sponsorship and the party was forced to discard other health policies that were deemed “anti-business”, said the Times whilst Harpers gave a trade perspective.

Alternatives to alcohol

Redemption in Holborn, London - a club and pop-up bar - has opened, offering a bar and restaurant with mocktails on the menu but without a drop of alcohol available. BBC News

Professor David Nutt, in his product 'alcosynth', has cracked a chemical conundrum, which has allowed him to develop new drugs that could wean people off alcohol, while allowing them to enjoy the feeling of being “tipsy”, reported the Telegraph

Trade news

Budweiser brewer AB Inbev has expressed an interest in using alcohol-free beers to win over health-conscious younger drinkers as part of wider efforts to overcome volume declines fuelled by shifts in demographics and consumer preferences. The Drum

Carlsberg’s Special Brew is about to get a makeover and could be watered down to comply with new guidelines designed to stamp out anti-social behaviour, reported the Telegraph.

Drinkers at pubs and clubs in York could face being breathalysed as part of an initiative to reduce drink related disorder. BBC News