Alcohol Policy UK

Events and updates: Alcohol Research UK 72nd symposium & studentships; rolling out brief inteventions in Scotland; last call for New Directions 2012 bursary; Adfam family survey; MA in Comparative Drug and Alcohol studies

Forthcoming events

The 72nd Alcohol Problems Research Symposium is calling for abstracts or other presentation suggestions for the Spring 2012 meeting to take place Stonecross Manor Hotel in Cumbria on the 14th and 15th March. The meeting is part of a long-running series of friendly events in which Alcohol Research UK is helping to organise with Professor Moira Plant, Emerita Professor of Alcohol Studies at the University of the West of England. See here for more information.

Alcohol Research UK have also opened the annual Studentship Scheme. The deadline for the academic year 2012/13 is 10th May 2012. See here for full details.

On Tuesday 27th March 2012, Edinburgh Cyrenians will be holding a one day conference at Murrayfield Stadium: Can Brief Interventions change Scotland's relationship with alcohol? Developing the model for community settings. The event will offer practical support on introducing alcohol brief interventions to new settings and provide opportunities to discuss and share experiences in workshop sessions. For more information see here or contact jenny@cyrenians.org.uk 0131 475 2354.

The New Directions in the Study of Alcohol Group (NDSAG) 2012 conference, exploring '21 years of experience and the future for motivational interviewing' takes place from Thursday 24th May 2012 to Sunday 27th May 2012, in Llandindrod Wells, Wales. The conference will include a keynote from Professor Stephen Rollnick. Submissions for the The Ron McKechnie Prize close this Sunday 29th Feb!

A free workshop on working with 'Frequent Fliers', those with the highest levels of alcohol-related hospital admissions takes place Friday, 23rd March 2012, London. See here for the flyer.  

Further updates:

The Charity Adfam is conducting a short survey for family members affected by problem alcohol use. If you are a family member please complete the short anonymous survey. If you are a practitioner who works with family members please pass the link on: http://www.surveymonkey.com/s/JCDS9LR

Middlesex University has opened a new MA course Comparative Drug and Alcohol Studies. It is designed to develop knowledge and understanding of drugs and alcohol issues, policies and interventions within a comparative context. It is relevant to policy makers and practitioners, and to students and researchers associated with the drug and alcohol field. Full info here.

Lower strength drinks heralded as Stella Artois, Becks and Budweiser switch to 4.8% & 'mid-strength' 2.8% Guinness announced

Brewing giants AB InBev will reduce the strength of popular lagers in the UK from the end of this month to keep line with "evolving UK category trends". The world's largest brewer will reduce the % Alcohol By Volume (ABV) of Stella Artois, Budweiser and Becks from 5% ABV to 4.8% ABV. See Daily Mail report.

The move will reportedly save AB inBev up to £8.6 million a year in duty on off-trade sales alone, but follows an £11.6 million decline in Stella Artois sales. Sales of 'triple filtered' 4% ABV Stella have also suffered after an initial good start. The news comes after the All Party Parliamentary Beer Group recently enjoyed a tasting session of lower strength drinks. But brewers have been suffering from the effects of rising costs, with off-trade beer sales reportedly plummeting faster than on-trade sales for the first time in 15 years.

Daigeo has also just announced a 2.8% mid-strength Guinness to be released for the off-trade. By dropping from the standard 4.1%, the new line will take advantage of the 50% duty discount on beers with an abv of 2.8% or below, introduced in October last year. High-strength beers of 7.5% abv and above must now pay an additional 25% tax. Under the Responsibility Deal, Heineken is expected to reduce the alcohol content of Strongbow by 1% (currently 5.3%) by 2013.

Whether or not such changes in the strength of drinks can have significant impacts on public health, the structure of taxation and pricing levers will remain central to alcohol policy debates. Recently the IFS called for taxation over minimum pricing approaches, and "to tax all alcohols at an equivalent rate per unit" which "would require policy action at the EU level which the Government should pursue."

The British Beer and Pub Association (BBPA) however have continued to speak out against the the alcohol duty escalator after the 2011 budget confirmed the Government would continue with alcohol taxed at 2% above the rate of inflation (RPI). The BBPA highlight duty on beer has increased by 60% since 1995, compared with a 15% increase in duty on spirits, and instead call for a tax system which encourages consumption of lower strength drinks in pubs as supervised environments.

Alcohol research updates - web based reviews: online peer support; web-based self-help; online feedback to students

The role of online peer-support?

A new Insight from Alcohol Research UK has explored the value of alcohol-related online support groups to their users. The Insight Problem Drinking and Peer Support in Cyberspace looked at the experiences and motives in using online support groups. Reasons included dissatisfaction with AA, accessibility & convenience, anonymity and the ability to connect to others. Positives were also cited as ready access to connect with others and find information. However disadvantages were also identified, including misunderstandings, lack of social contact, group dynamics, a lack of response and dis-inhibited behaviour.

Given the growth in online resources and groups, the Insight emphasises the importance of sites maintaining up to date, accurate and reliable information. Moderators play an important role in providing good online peer support, whilst users ought to be made aware of the pros and cons.

Best evidence yet for web-based alcohol self-help

Also highlighted on the Alcohol Research UK blog, the Findings review of the potential effectiveness of web-based self-help resources. Given the rise and rise of the web, it explores the significance and potential effectiveness of online self-help and who may benefit most.

Providing web-based feedback and social norms information to reduce student alcohol intake

A further Insight has explored the feasibility and effectiveness of a web-based intervention including feedback on consumption and social norms. It indicated some small reduction in drinking and concluded that monitoring alone is likely to reduce weekly consumption. However keeping students engaged in online programmes required further work.

Public Health Outcomes Framework released: spend should reflect local needs; alcohol admissions data to be reviewed

The NHS Public Health Outcomes Framework has been published, aiming to tackle public health challenges through moving public health back into local government. It outlines 'a shift away from the focus of process targets' to a framework that describes two 'high level' outcomes: an increase in healthy life expectancy and a reduction in life expectancy gaps across communities.

A DH press release, states:

'Public health will be measured against a framework which sets out 66 health measures so councils and the Government are able to see real improvements being made and take any action needed.

From April next year, councils will be given a ring-fenced budget – a share of around £5.2 billion based on 2012/13 funding – and will be able to choose how they spend it according to the needs of their population. Those who make the most improvements will be rewarded with a cash incentive.'

Investment in alcohol treatment and prevention will be locally determined, and should be reflected in each area's Joint Strategic Needs Assessment and Joint Health and Well-being Strategy.

The 66 indicators will be grouped into four main domains: 'Improving the wider determinants of health'; 'Health Improvement'; 'Health Protection' and lastly, 'Healthcare public health and preventing premature mortality'. Alcohol is addressed within the Health Improvement domain, alongside other lifestyles factors. A set of indicators on premature mortality includes preventable mortality from liver disease.

A specific alcohol indicator will remain for alcohol-related hospital admissions, though the indicator definition is due to be reviewed by NWPHO - 2.18 of the technical specifications states: 'the preferred option is for an indicator based on just alcohol-related primary diagnoses, to minimise the risk of perverse consequences from any changes in coding practice so the indicator rewards local areas for good performance.'

Recently the Health Committee warned over risks to public health budgets within the changes, concerns echoed by the Shadow Health Minister Diane Abbott - see a Press Association release. The Responsibility Deal, a key strand of Lansley's public health strategy, has also been heavily controversial and the 'nudge' focus has been criticised by a Lord's committee.

Last month the DH released a series of factsheets about the new public health system. See news reports in the Daily Mail and Daily Telegraph.

Scientists gleam further insight into alcohol's effect on brain reward system

Further insight into the effect of alcohol on the brain's reward system has been reported in the journal of Science Translational Medicine. It found alcohol effects the orbitofrontal cortex and results in a release of endorphins, previously only proven in animal studies. These naturally produced pain relieving proteins have an action akin to morphine, leading to drinkers experiencing pleasurable feelings.

The study found that heavier drinkers found alcohol more pleasant than non-drinkers. It also describes how the endogenous opioid function in the brains of chronic drinkers appears to change, in a sense 'over-learning' problem drinking behaviours. See reports in the Telegraph and Daily Mail.

The study may help to explain the mechanism by which antagonists such as Naltrexone work successfully, which could lead to the further development of pharmacological treatment approaches. Nonetheless, from the position that environment and learned behaviours also contribute to the development of problem drinking, successful alcohol treatment approaches emphasise the role of psychosocial as well as medical interventions. See here for the review into the effectiveness of alcohol treatment and NICE guidance.

Recently the message of a little but not often came out for preventing the development of alcohol problems. Sir Iain Gilmore, Chair of the Alcohol Health Alliance stated that having at least 2 alcohol free days each week was "a very good indicator of not being addicted". He emphasised the key is not to let regular consumption and rising tolerance end up as daily dependence, as experienced by as many as 1.6 million people in England.

This echoes calls from the Science and Technology Committee of MPs recently to urgently review alcohol guidelines and help the public to understand units better. The Change4Life website now contains public health messages about alcohol use within the context of a healthy lifestyle, and NHS Choices has useful tips for cutting down.

Home Office consultation on late night levy & restriction orders as trade warns of on-trade burden

The Home Office have opened a consultation on new powers due to be brought in under Licensing Act reforms. The consultation is seeking specific responses on the late night levy and Early Morning Restriction Orders (EMROs) as measures to help curb late night drinking problems. See the press release here. 

The consultation asks which types of premises should be covered by Early Morning Restriction Orders, a measure which will allow authorities to restrict the sale of alcohol to any time between midnight and 6am. It also ask which services a licensing authority may fund with the 30 per cent of levy revenue it will retain. The rest of the levy will go to funding police activity.

However BBPA Chief Executive Brigid Simmonds warned the Government against excessive action on the on-trade: “More and more alcohol is drunk at home, yet more and more red tape is heaped on pubs." Concern about the level of regulation being imposed on the pub trade were also raised during pubco debate in the House of Commons last week. 

Health Minister Anne Milton however defended Government action at an event in Parliament where brewers showcased a range of 2.8% ABV beers. Milton said “As a government we do not want to be killjoys but we do have some health problems. We do have a problem with alcohol but it is complicated." Milton said “We are supportive of the pub industry, we are supportive of people having a good time", and expressed hope that the forthcoming alcohol strategy will strike the right balance.

A list of Home Office factsheets on the full licensing changes due are available.

British Liver Trust campaign highlights liver risks of alcohol misuse

The British Liver Trust have a new campaign, www.loveyourliver.org, aiming to promote liver health through good diet and careful alcohol consumption. The British Liver Trust recommend at least two or three alcohol free days in a row each week.

Liver damage is now the 5th largest cause of death in the UK and is on the rise. Many people may not realise drinking above the lower risk guidelines can readily put the liver at risk significant risk - regularly drinking twice the guidelines is said to increase the risk of liver disease by 13 times. In addition, liver damage tends not show any signs or symptoms until later stages.

Chief Executive Andrew Langford stated that new attitudes were needed towards alcohol, and has been critical of Government alcohol policy as not going far enough. Langford also recently caused controversy by suggesting January detoxes won't make a significant improvement to liver health, and are possibly "medically futile". Instead at-risk drinkers should aim to reduce their overall consumption on a more consistent basis.

The British Liver Trust has been running roadshows around the country where the public can have a liver health test and get advice. The website also has video information on reducing the risks to your liver.

A 60% rise in cases of Alcoholic Liver Disease (ALD) in young people over the last seven years was recently reported. See here for a NHS Choices video on liver disease.

Alcohol Policy Comment: The Grocer-isation of Alcohol Brands & policy contradictions

In this guest post, Chris Hackley, a Professor of Marketing at the University of London discusses 'The Grocer-isation of Alcohol Brands and the Contradictions of Alcohol Policy in the UK':

In the UK, the government first issued ‘safe’ alcohol consumption guidelines in 1987. Coincidentally, the 1980s also saw the first UK advertising campaign for alcohol to use imagery previously only seen in pre-school TV programming. The bar-cruising, wise-cracking, girl-chasing Hofmeister Bear (an actor in a trilby-wearing bear suit) became an icon of the times and a symbol of the lager-isation of Britain’s nightlife. Some 24 years later, doctors in the North East recently reported a 400% rise in hospital admissions for advanced liver disease among people in their early thirties, against a UK rise of 61%. 

Coincidence? Clearly, it would be going too far to blame the UK’s alcohol problem on John Webster, advertising agency BMP DDB’s resident creative genius. For Webster, it was simply the case that his Honey Monster sold a lot of Sugar Puffs, so why not do it with beer? What is more, today, the UK advertising regulator, the Advertising Standards Authority, would probably disallow the campaign on the grounds that the imagery appeals to children.

But the juxtaposition of the two events, the Hofmeister Bear campaign and the UK government issuing drinking guidelines, neatly illustrates a contradiction in UK alcohol policy we are yet to resolve. That is, the intensification of alcohol marketing has grown hand-in-hand with the intensification of government-led initiatives to persuade people to drink less. While government convenes committees to ‘look into’ alcohol, children and young people have to negotiate a culture in which alcohol is celebrated as never before. Alcohol brands adorn major sports events and team strips; mixer drinks, which boomed in the 1980s as the notorious ‘alco-pops’, sell 40% proof vodka that tastes like fruit juice; while the country’s leading supermarket chains all treat alcohol brands as if they are normal grocery items, discounting them, promoting them heavily and stacking them in pyramids by the checkouts.     

Alcohol industry lobbyists such as the Portman Group will point to the relatively small numbers of alcohol-related deaths in the UK relative to other countries. As a nation, we do not have a generalised alcohol problem in terms of consumption per capita. But we do have unusual rates of alcohol-related disease and disorder in certain socio-demographic and age groups. The rising numbers and falling age of liver disease victims seems particularly shocking, and hints at worse to come. Under current policy, they bear the whole responsibility for their predicament. They were told to drink ‘sensibly’. They didn’t. They are, in effect, collateral damage in a battle for higher profits from alcohol sales.

Over the past three decades our policy makers have assisted the alcohol industry in shifting the emphasis from steady but unexciting pub on-sales to huge volume, highly profitable, powerfully branded, 24/7, retail off-sales. This grocer-isation of alcohol brands is the elephant in the room in UK alcohol policy debates. The paralysing policy contradiction this creates needs to be acknowledged.

Chris Hackley is Professor Marketing at the School of Management, Royal Holloway University of London. He recently appeared on Channel 4 news discussing the call to review alcohol guidelines. See here for a round up on media and policy engagement in alcohol policy issues and a collection of papers here.

BBC Timeshift explores the social and cultural history of drinking in Britain

BBC Four's Timeshift, a documentary series into Britain's social and cultural history, featured episode 11 on 'The Rules of Drinking' this week and is available for a further 5 days on BBC iplayer.

The Rules of Drinking synopsis:

In the pubs and working men's clubs of the forties and fifties there were strict customs governing who stood where. To be invited to sup at the bar was a rite of passage for many young men, and it took years for women to be accepted into these bastions of masculinity. As the country prospered and foreign travel became widely available, so new drinking habits were introduced as we discovered wine and, even more exotically, cocktails.

People began to drink at home as well as at work, where journalists typified a tradition of the liquid lunch. Advertising played its part as lager was first sold as a woman's drink and then the drink of choice for young men with a bit of disposable income. The rules changed and changed again, but they were always there - unwritten and unspoken, yet underwriting our complicated relationship with drinking.

Another BBC feature 'Inside Out London' also featured alcohol this week - available on iplayer until 16th January. In it Wendy Hurrell goes attempts to 'go dry' in December whilst also talking to people who've experienced alcohol problems - and professionals trying to address alcohol misuse.

Ministers back call for NHS staff to make "every contact count" to improve health

The Health Secretary Andrew Lansley has accepted recommendations for NHS staff to take every opportunity to promote good health. The NHS Future Forum called for action to ensure that "every contact counts" in helping address the impact of alcohol misuse, poor diet, smoking and lack of exercise. See here for the Forum's Public Health report and coverage from the BBC and The Telegraph.

The report warns millions of opportunities to improve patients' health and well-being are missed - every day GPs and practice nurses see over 800,000 people, dentists see over 250,000 and 1.6 million people visit a pharmacy. A recent report by Cancer Research UK suggested 40% of cancers were preventable through lifestyle changes, and over one million  hospital admissions each year are alcohol-related - and rising.

However, Dr Clare Gerada, Chair of the RCGP, expressed concerns suggesting that not every contact is an appropriate time to question lifestyle behaviours. Other concerns have highlighted that helping patients to change does not address the wider causes such as health inequalities, poverty and poor housing.

Making "every contact count" is based on brief intervention principles of behaviour change - motivating an individual to explore the pros and cons of unhealthy behaviours. This often leads to change where an individual further realises the benefits of acting, or the risks of not changing.

Brief interventions for alcohol - or 'Identification and Brief Advice' (IBA) - have been shown to be the most effective health behaviour intervention. However challenges to mainstreaming IBA appear to include staff's fears about raising the subject, although NICE suggests 62% of people will accept alcohol advice when offered it.

North East Lincolnshire have developed an Every Contact Counts website and the West Midlands have developed an E Learning package. Yorkshire and Humber have developed a competence framework to underpin the Every Contact Counts agenda.

MPs call for alcohol guidelines to be reviewed - and emphasise 'alcohol free days'

MPs on the Science and Technology Committee have called for greater efforts to help the public understand alcohol guidelines. It also calls for a further scientific review to build public confidence, although based on the evidence presented the guidelines should not be relaxed. See here for the report chapters or the full report here.

Andrew Miller, MP and Chair of the Committee, said:

"Alcohol guidelines are a crucial tool for Government in its effort to combat excessive and problematic drinking. It is vital that they are up-to date and that people know how to use them."

"While we urge the UK Health Departments to re-evaluate the guidelines more thoroughly, the evidence we received suggests that the guidelines should not be increased and that people should be advised to take at least two drink-free days a week."

In 1987 what was known as "sensible limits" were defined as a weekly consumption figure (14 and 21 units). A review of the guidelines came in the early nineties following scientific evidence that moderate alcohol consumption may reduce Coronary Heart Disease risk. From then the Government somewhat controversially switched from weekly to daily guidelines. Although daily guidelines might prevent people from assuming they could 'save their units up', critics highlighted that they "appeared to endorse daily drinking" and so increased possible interpretation of the advised amount by as much as 50%.

The Committee noted that evidence is still equivocal for health benefits of "little and often" consumption, which appear to apply only to men over 40 and post-menopausal women. Nevertheless, alcohol appears to inhibit the formation of coronary fatty tissues, and thus offer some protective effect. In addition the effect of alcohol in reduction of blood clotting plays a part. There is very little evidence for a protective effect on the development of diabetes or cancers. The health benefits have therefore been cited as much overplayed and there is now ample evidence of the cancer risks.

The Committee notes that public understanding of units and how the guidelines apply to them is still poor. Last year a survey found only 2 in 5 adults could identify the unit content in common drinks.

The Committee concludes that a proper review of the evidence should be conducted to review and build confidence in the guidelines. It should include whether guidance should be widened to include individual drinking episodes, and whether further research is needed for specific groups, such as older people. The Committee feels that there is no reason to change the concept of units, but more efforts should be made to explain them to the general public.

In addition, the public should be encouraged to have at least 2 alcohol free days each week, as is the case in Scotland. The Committee recommends an on-line resource where people can obtain individualised advice on alcohol, to counter concerns amongst the public that generalised information does not apply to them.

It also notes that the co-operation of the drinks industry remains important for achieving the Public Health Responsibility Deal's alcohol pledges, though urges caution as "sensible drinking messages may conflict with the business objectives of drinks companies."

See reports from The Guardian, BBC, and NHS Choices. Recent Alcohol Research UK blogs discussing the limits have explored comparable guidelines and simple messages and are the guidelines 'nannying'?

Working with Older Drinkers: Alcohol Insight warns of growing need to recognise alcohol problems amongst older people

An Alcohol Insight funded by Alcohol Research UK has explored alcohol problems and treatment needs need amongst older adults. The project found that evidence suggests a significant and growing number of older people are at risk of alcohol-related harm: 

• 20% of men and 10% of women aged 65 and over exceed recommended drinking guidelines and 3% of men and 0.6% of women aged 65-74 are alcohol dependent.
• There has been a steady increase in the amount of alcohol consumed by older age groups in recent years.
• Consumption patterns suggest that the ‘baby-boomer’ cohort is likely to have higher levels of alcohol consumption in old age than previous cohorts of older people.

The Insight found alcohol problems are less likely to be detected in older people as a result of complex physical and social problems, including a lack of awareness amongst professionals in recognising alcohol misuse, or barriers for older people to access help. See the full report here.

However older drinkers are just as likely to benefit from intervention as younger drinkers, though approaches should focus on quality of life in addition to issues surrounding alcohol and aim to promote independence and reduce risk. The Insight recommends further understanding amongst health and social care staff and substance misuse practitioners into the complex factors affecting older adults and alcohol misuse. It also suggests further recognition by commissioners and prevention programmes that address risk factors and strengthen protective factors.

Earlier this year 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 separate recommended guidelines should be considered. An Alcohol Concern Wales briefing paper was released earlier this year and presentations from an alcohol and older people event are available here. See here for a RCP leaflet outlining the key alcohol issues and risks for older people.

'Alcohol and sex: a cocktail for poor sexual health' - report highlights missed opportunities within Sexual Health settings

A new report from the Royal College of Physicians (RCP) and British Association for Sexual Health and HIV (BASHH) warns of significant missed opportunities to tackle alcohol misuse in sexual health services - BBC report.

Download Alcohol and sex: a cocktail for poor sexual health 

It says more than one million young people attend sexual health clinics each year, presenting a unique opportunity to communicate key messages alcohol messages and the delivery of brief interventions (IBA). The report highlights evidence linking alcohol consumption to poor sexual health, particularly in the young:

• 82% of 16-30 year olds report drinking alcohol before sexual activity
• People who drink heavily are more likely to have unprotected sex with multiple partners
• 20% of white 14-15-year-old girls report going ‘further than intended' sexually when drunk.

The report highlights 16-24 year olds make up just 12% of the population, yet they account for nearly half of the sexually transmitted infections diagnosed in sexual health clinics.

Key recommendations from the report include:

• Sexual health services should provide information that highlights the link between alcohol consumption and poor sexual health outcomes and signpost sources of useful advice on drinking sensibly
• All clinicians providing sexual health services should be trained in asking about drinking habits through use of a recognised screening tool
• All sexual health services should develop a robust care pathway to refer patients for further support, including local alcohol services
• New commissioning arrangements should ensure that the service specifications for sexual health in primary care and specialist services include opportunistic alcohol screening and brief interventions for young people.

A resource pack for Delivering IBA in Sexual Health settings was recently released by Sexual Health South West and NHS South of England.

IBA in Sexual Health Settings Resource Pack

A resource pack outlining the case and key resources for delivering 'Identification and Brief Advice' (IBA) in Sexual Health Settings has been released.

Download the Delivering Alcohol Identification and Brief Advice in Sexual Health Settings RESOURCE PACK

The pack was developed to support commissioners of sexual health and/or alcohol services and those delivering alcohol IBA in sexual health settings. It was developed in partnership between NHS South of England and Sexual Health South West.

It coincides with the recent release of Alcohol and sex: a cocktail for poor sexual health, a report highlighting the missed opportunities to respond to alcohol misuse within sexual health settings - see the press release here.

See the South West alcohol pages here or more information on IBA here.

DH streamlines public health social marketing for 2012

The Department of Health (DH) will shortly launch public health communications for 2012, taking a 'linked behaviours' approach. It will tailor social marketing operations to follow the life course, instead of focusing on individual behaviour issues.

The strategy, Changing behaviour, Improving outcomes, was published in April 2011 and aims to increase effective communication of public health issues. It was followed by the Change4Life Three Year Social Marketing Strategy which stated the 'alcohol harm reduction campaign will be brought more fully under the Change4Life umbrella, embracing not only the calorific content of alcohol but also the wider health harms of alcohol for adults in mid-life.'

Operations will be supported by two agencies from this month - Freud Communications will manage creative PR for all public health campaigns and MEC will manage media planning. Freud Communications, who already handle PR for the Change4Life campaign, may prove a controversial choice as they also manage PR for Walkers Crisps and KFC.

There are four strands to the strategy, two of which are directly linked with reducing alcohol related harms. Change4Life will focus on diet and exercise issues concerning families and middle aged adults, and from February 2012 it will also include drinking. The Young People strand will focus on 'binge drinking', smoking and risky sexual behaviours.