The social cost of alcohol abuse has been estimated to be £240 a year for each European, with the annual bill for the NHS alone being £2.7 billion.

A major conference of addiction specialists from across the world is meeting at Newcastle University and organisers have called for England to follow Scotland and set a minimum price per unit.

They have also demanded a ban on advertising alcohol.

Professor Eileen Kaner cited new research which showed one in eight UK deaths of people aged 15 to 64 was caused by alcohol.

In Europe, alcohol consumption is more than twice the global average and it represents the biggest addiction in the UK, greater than any illegal drug or gambling.

The conference has heard that the cost per capita in Europe is around £240 when the bill for health, welfare, crime and reduced output is calculated.

Professor Kaner, who is director of the Institute of Health and Society at Newcastle University, said: “Alcohol costs the UK so much in so many ways, both in financial and social impacts.

“Governments need to have a clear and unbiased view of the most up-to-date research on alcohol problems and be bolder about tackling some of the root causes such as overly cheap alcohol and irresponsible marketing that encourages heavy drinking.

“This conference will hopefully help inform the debate and highlight key measures governments should be taking to improve public health and safety around drinking behaviour.”

She felt there was growing agreement between the public and policy-makers that something must be done.

“I think there is more political will than we have ever known and the public are alive to this debate and receptive to the idea that it is part of the government’s responsibility,” she said.

She believed the most cost-effective way of reducing the harm caused by alcohol would be to reduce demand by banning advertising and implementing a minimum price per unit.

The Scottish Government announced on Monday it would implement a 50p per unit minimum charge.

Professor Peter Anderson, who specialises in alcohol and addiction policies at the universities of Newcastle and Maastricht, said stricter regulations on drink were being discussed by governments across the EU.

He said: “If England really introduces a minimum unit price, other countries will be persuaded to follow. At the moment it is a waiting game.”

He said Finland was in the process of strengthening its advertising laws, while in France, alcohol adverts cannot be shown on television or in the cinema.

The ALICE RAP (Addiction and Lifestyles in Contemporary Europe – Reframing Addictions Project) conference in Newcastle, which involves 150 researchers from across the globe, concludes tomorrow.

It is a 10 million euro project which aims to help shape addiction policy internationally.

via Warning over alcohol-related deaths – Health News – Health & Families – The Independent.

Research by the Youth Alcohol Advertising Council – which is co-ordinated by Alcohol Concern– warns that existing rules are not doing enough.

The group has reported the marketing of three brands to the Advertising Standards Authority: Frosty Jack’s Cider, Smirnoff and Lambrini.

Emily Robinson of Alcohol Concern said:

“If Government is serious about tackling binge drinking, then protecting children through full implementation of the existing codes on alcohol advertising is an obvious place to start.

“If the alcohol industry insists on bending the rules to target young people and irresponsibly sell more of their product then we need more robust regulation that prevents advertisers from creatively sidestepping the rules.”

Under the code, alcohol advertising must not imply drinking alcohol is a key component of social success or that it can contribute to an individual’s popularity or confidence. People shown drinking or playing a significant role in the advertising should not be shown behaving in a juvenile manner.

The group complained that Frosty Jack’s YouTube channel, which had no age-restriction mechanism, contained dozens of videos likely to appeal to young people including a clip of a young person attempting to burn wasps with a deodorant and lighter.

The group objected to the Smirnoff advert set in a nightclub, and a scene in a Lambrini ad in which the message “I am what I am” was displayed within a glass being filled with the drink.

The ASA is still investigating the Frosty Jack’s case but the other two were dismissed in part on the grounds that characters in the ads were not shown drinking.

Gordon Johncox, sales and marketing director at Aston Manor, which makes Frosty Jack’s Cider, said the brand’s website had been taken down after an internal review: “As a responsible business we are clear on the need to review activity and we strictly adhere to both the spirit and letter of current regulation concerning communication via social media channels.”

Case study: ‘They make us believe everyone else is drinking and it’s normal’

Gabi Ohlsen, 17, is a sixth-former at Colyton Grammar School in Devon, and a member of the Youth Alcohol Advertising Council

“Some alcohol advertising is very much aimed at young people. Because of your age you can’t buy alcohol in pubs or restaurants and you want to get the cheapest you can. Pubs are more stringent about checking ID than they used to be and it’s easier to get it from a supermarket.

I don’t drink but my friends who do, buy alcohol at a supermarket or get their parents to buy it for them. They drink it at a friend’s house or a party. A lot of young people just drink to get drunk so it’s more about the cost aspect, rather than mattering too much what they are drinking.

Alcohol advertising has a big impact on young people. Advertising can make us believe that everyone else is drinking and that it’s a completely normal part of life. Advertising has a lot of power to change people’s thinking. I don’t think the rules are being enforced strictly enough”.

via Alcohol adverts ‘target teenagers’ despite strict code – Advertising – Media – The Independent.

“I am committed to phasing that out over a reasonable period of time,” she said in the Dáil. There is “no room for ambivalence in our approach”.

Ms Shortall was responding to Fianna Fáil spokesman on children Charlie McConalogue, who asked if the Government was committed to banning “the advertising of alcohol in conjunction with sports events”.

The Donegal North East TD raised the issue following research published yesterday which found young people who drank to excess were more likely to suffer from severe depression, stress or anxiety. The Headstrong/UCD survey of 14,000 people aged from 12 to 25 found 38 per cent had problematic or harmful drinking behaviour, and 7 per cent of those surveyed showed signs of alcohol dependence.

Mr McConalogue highlighted an incident in his constituency last October when 26 students were checked into Letterkenny General Hospital’s emergency department on one night for alcohol poisoning.

“That came as a result of a 99c drinks promotion.”

Referring to the research, Mr McConalogue said “alcohol abuse has become a cancer in our society in recent years” and he demanded to know the Government’s response to the report and what it would do to address the problem.

Ms Shortall, who has responsibility for primary care, stressed that “we as a society can no longer tolerate the level of alcohol abuse in this country, particularly among young people”.

She said “there is no room for ambivalence in our approach”, adding that the Department of Health was working on “developing an action plan on alcohol based on the recommendations in the substance misuse strategy report”.

Recommendations from the majority report of the National Substance Misuse Steering Group, published in February, included a ban on all alcohol sponsorship of sporting and large outdoor events, as well as a ban on outdoor advertising of alcohol, higher excise duties on some alcohol products and the introduction of minimum pricing.

Ms Shortall noted the steering group’s findings that young people were drinking more than ever and from a younger age, that more than half of Irish 16-year-olds have been drunk, and one in five is a weekly drinker.

The report also said alcohol marketing led to young people starting to drink at a younger age and drinking more. And 16-21-year-olds “list alcohol advertisements as five of their top 10 favourite advertisements”.

Pledging to end alcohol sponsorship of sports events, the Minister said “there are contractual arrangements in place at present, and I am working with the different national sporting bodies to agree a proposal to phase that out over a period of time”.

She added: “We must tackle this on a number of fronts” and she looked forward “to support from all sides of the House on the measures I will shortly be announcing”.

She said the Headstrong/UCD survey showed the period between 15 and 25 years of age was a critical developmental time for young people. If issues could be identified as they emerged research showed

“early and brief intervention prevents people from experiencing lifetimes of pain and lost opportunities”.

Mr McConalogue highlighted the cost of alcohol-related illness in Ireland at €1.2 billion in 2007 and alcohol-related crime cost €1.19 billion that year. Alcohol abuse was responsible for 2,000 hospital beds being occupied every night.

Questioning the Government’s commitment to banning alcohol sponsorship of sports events, he said “we should be promoting sports as an alternative to those who are drinking too much but instead it is intrinsically associated with sporting events”.

via Minister to end alcohol sponsorship of sports – The Irish Times – Thu, May 17, 2012.

Health Secretary Nicola Sturgeon said that, at this level, the price was equivalent to the 45p per unit set in 2010 after taking account of inflation. She also said that setting the price at this level would have significant health and social benefits.

Ms Sturgeon made the announcement during a visit to a gastroenterology ward at Glasgow Royal Infirmary, where 80 per cent of patients are there because of alcohol misuse. She met with Dr Ewan Forrest, a consultant gastroenterologist who specialises in treating alcoholic liver disease.

Ms Sturgeon said:

Cheap alcohol comes at a price and now is the time to tackle the toll that Scotland’s unhealthy relationship with alcohol is taking on our society.

Too many Scots are drinking themselves to death. The problem affects people of all walks of life.

It’s no coincidence that as affordability has increased, alcohol-related hospital admissions have quadrupled, and it is shocking that half of our prisoners now say they were drunk when they committed the offence. It’s time for this to stop.

Introducing a minimum price per unit will enable us to tackle these problems, given the clear link between affordability and consumption.

There is now a groundswell of support for the policy across the medical profession, police forces, alcohol charities and from significant parts of the drinks and licensed trade industry who recognise the benefits minimum pricing can bring – saving lives and reducing crime.

Since 45p was first proposed as the minimum price 18 months ago, we have seen inflation of around five per cent.  A minimum price of 50p takes this into account and will achieve a similar level of public health benefits to what 45p would have achieved in 2010.

The Alcohol (Minimum Pricing) (Scotland) Bill is shortly to start the final stage of the parliamentary process.

The Bill looks to set a minimum price for a unit of alcohol as a condition of licence. It also sets the formula for calculating the minimum price (based on the strength of the alcohol, the volume of the alcohol and a price per unit of alcohol).

According to a minimum pricing modelling study carried out by the University of Sheffield, it is estimated by that in the first year, introducing a minimum price of 50p would see:

• 60 fewer deaths
• 1,600 fewer hospital admissions
• A total value of harm reduction of £64 million
• Around 3,500 fewer crimes per year

After 10 years, benefits would increase to:

• Over 300 fewer deaths annually
• 6,500 fewer hospital admissions
• A cumulative value of harm reduction of £942 million

Chief Medical Officer Sir Harry Burns said:

For too long too many Scots have drunk too much and now it’s time for tough action to address this.

I strongly support minimum pricing, as part of a wider framework of action, as the best chance we have of reducing Scotland’s harmful levels of alcohol consumption.

Alcohol-related disease and violence are costing the NHS millions of pounds every year and this cannot be allowed to continue.

Support for minimum pricing has come from all quarters – the Welsh Government, Northern Ireland Executive, the majority of the health and sport committee, the Scottish Licensed Trade Association, all 17 of Scotland’s public health directors in NHS Scotland, the British Medical Association, the Royal Colleges, ACPOS, Scottish Licensed Trade Association, Church of Scotland, various children’s charities, Tennents and Greene King.

Read more at the Scottish Government’s Website, including a useful table showing how the proposed changes would affect the price to consumers of familiar brands: Minimum price for alcohol.

There is widespread concern about health and social consequences of excessive alcohol consumption among young people. Although young men are more likely than women to binge drink, sex differences are decreasing because more young women are binge drinking. Given this, it is important to better understand how gender attributes and attitudes affect young men’s and women’s alcohol use, and whether different health promotion interventions are required for young men and women.

Alcohol consumption may be particularly important to identity during adolescence and early adulthood, with drinking being a part of socialisation into adult roles. The meaning and importance of alcohol may vary as a function of: age (e.g., whether individuals are above the legal age to purchase alcohol); beliefs about gender; and perceived peer drinking norms and peer pressure. This may create a need for different health promotion interventions for different age groups.

The aim of this study was to expand on our own and others’ recent research into young people and alcohol by examining age and sex differences in young people’s beliefs about alcohol consumption and interventions to combat alcohol misuse.

Data collection was conducted in the South-East of England among 13-25 year olds. We conducted 30 in-depth individual interviews and 6 group interviews which focused on:

• perceptions of cultural expectations related to drinking
• motives for drinking
• personal experiences of alcohol use
• concerns about downsides of excessive alcohol use
• recollections of, and responses to, public health campaigns
• beliefs about how to increase the impact of alcohol-related health promotion

The full report contains detailed analysis of the issues described below, and includes many quotes illustrative from the large body of interviews. Further analysis will be presented in academic journals. Links to such papers will be added to the Alcohol Research UK website.

Drinking motives and experiences

Alcohol consumption was viewed as a commonplace and normative part of British culture. Furthermore, across all age- and sex-groups, excessive alcohol use among young people was viewed as normative. As part of this, young people perceived age- and gender-appropriate patterns of drinking. Young people were aware of many negative aspects of their own and others’ excessive alcohol consumption, but they tended to be ambivalent, and often viewed these downsides as the price one must pay for the perceived personal and social benefits of alcohol use.

Interviewees gave multiple motivations for drinking, with a particular focus on socialisation and fun. Furthermore, some of the downsides of drinking were seen to provide opportunities for social bonding, e.g. suffering together through a hangover. Current and former university students noted that excessive alcohol consumption in the first year was strongly influenced by the centrality of (excessive) alcohol to forming and maintaining social networks. This suggests that there may be a need counter heavy drinking and/or provide more alcohol-free activities in freshers week.

Associations between alcohol consumption, peer pressure and concerns about image (i.e., being seen as “cool” rather than “boring”) were commonly experienced at younger ages. Interviewees in older age groups gave a clear sense of a learning curve. Part of this was about learning personal limits, so that they did not experience the negative consequences of over-indulgence. Many reported that they had managed to “grow out of” socially expected patterns of regular binge drinking, and that they now felt more comfortable with drinking at a personally-determined level. However, they tended to retain a concern about their image and reputation. These image and reputation concerns included shame at embarrassing or undignified behaviour (particularly among women). Another aspect of reputation concerns was wanting to avoid being a burden on friends when drunk and unable to look after oneself.

Although many young people had personal experiences of the downsides of drinking too much, they tended to downplay the health implications and to distance themselves and their peers from “problem” drinkers. In contrast, they expressed concern about how their own safety and pleasure were often hampered by others’ problematic drinking and/or antisocial behaviour.

Across age groups, there was a clear concern for personal safety when drunk and for the safety of friends. Concerns were gender-specific, with greater concern about threats to women’s physical and sexual safety from men, and greater concern about threats to men’s physical safety arising partly from their own risky behaviour, but mainly from the aggressive behaviour of other drunk men. Participants were less concerned about their own and their friends’ drunken behaviour than about the drunken behaviour of people they did not know.

Participants of all ages perceived few real barriers to underage drinking, noting that they could deploy various strategies to circumvent licensing laws. Younger respondents reported that if they or their peers wanted to drink, they could obtain alcohol by: acquiring from within the home; purchasing it with the assistance of older siblings, peers, or strangers; targeting retail outlets known not to ask for identification; and/or pooling limited financial resources. Some older interviewees were skeptical as to the government’s real commitment to reducing alcohol consumption.

Interventions – responses and suggestions

Attitudes toward public health campaigns were most positive among the youngest age group: older experienced drinkers tended to be more cynical or skeptical about the impact of mass media messages about alcohol. The severe risks often focused on in public health campaigns were considered by participants as irrelevant: they were perceived to be unlikely to happen, or at least unlikely to happen to them. Many young people thus failed to see the personal relevance of many health promotion intervention messages. However, among the youngest age group there was some support for shock tactics. Interviewees’ accounts suggested that health promotion campaigns may be more effective at deterring young non-drinkers from drinking rather than changing the behaviour of people with personal experience of alcohol use.

Ambivalence toward, and distancing from, the downsides of alcohol use present serious challenges to efforts to counter excessive alcohol consumption among young people. Rather than developing generic “one size fits all” messages on television, posters, or billboards, better use could be made of targeted advertising and viral marketing via popular internet sites, and social networking sites. Social networking sites could also be key methods for norm-based marketing to change perceptions of acceptable behaviour when drinking and the social and interpersonal consequences of excessive alcohol consumption. Such approaches may be strengthened by focusing on the image, reputation, and safety concerns noted above. It was suggested by older participants that moderate drinking messages in television or internet advertising would be most effective if they were reinforced in drinking contexts, but they also noted that managers and proprietors may not support such approaches.

Rather than attempting to change people’s views of the desirability of drinking per se, a more effective approach may be to work with reputation- and image-related concerns that are already relevant to them. Given the role of alcohol in socialising and the importance of not embarrassing oneself, an effective approach may be to focus on embarrassing drunken behaviour. At a bare minimum, respondents suggested that for campaigns and interventions to be effective, they should be tailored to address the concerns of sub-groups of men and women of different ages. For example, the youngest age group emphasised the need to target peer group mentality, as opposed to gender specific approaches.

Unit-based intake guidelines tended to be considered to be unrealistically low, and were therefore irrelevant. Across all age groups, participants expressed a dislike of feeling that they were being told off or preached at by public health messages. Instead, it was suggested that campaigns should give greater respect to young people: they should provide information and advice, but leave choices about alcohol consumption up to individuals.

School-based education was generally thought of as inadequate. Suggested improvements included making use of case studies which are easy to identify with, and emphasising the physical and interpersonal risks associated with excessive alcohol use, in addition to explaining short- or long-term health effects. There was a general desire for more openness of discussion around alcohol: for drinking to be less of a “hidden” or “undercover” activity. This was suggested as a way to counter the image of teenage drinking as an act of rebellion.

A key finding was the general lack of agreement that any single approach would reduce problematic alcohol consumption among young people, with disagreement regarding actual messages and how they should be presented. Different messages and media may be more effective among different age and sex-groups, indicating a need for multi-faceted, multi-modal approaches that will resonate with young people.

Research Team

Dr Richard de Visser (University of Sussex)
Prof Jonathan Smith (Birkbeck, University of London)
Prof Charles Abraham (Peninsula College of Medicine & Dentistry)

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A survey by charity Alcohol Concern Cymru has shown the Governments proposal for a minimum alcohol unit cost of is backed by 77 per cent of Welsh publicans.

Welsh pub owners would actually back a minimum charge of 50p per unit, above the proposed 40p, according to the survey.

Simon Griffiths, general manager of The Cross Keys in St Mary Street, Swansea, said: “I think it is a good thing. It is a step in the right direction, especially for the pubs, because they are effectively being undermined and driven out of business by supermarkets.

“I think the Government should keep a keen eye on things to keep the community and city pubs, like us, in business.”

Jamie Glover, manager of the Pitcher and Piano in Wind Street, Swansea, said: “Although I could not see this affecting us, I think it will help in supermarkets, because it should help to cut down on people binge drinking.”

Figures from the survey also found 48 per cent of 600 Welsh publicans were struggling following a fall in drink sales, and 94 per cent believed cheap alcohol prices in supermarkets were responsible.

Mark Leyshon, a spokesman for Alcohol Concern Cymru, said: “Landlords are telling us that its unfair that they are blamed for so many of the alcohol-related problems in society, while supermarkets are allowed to continue to sell heavily discounted alcohol.

“There are many well-run pubs in Wales that provide a safe and sociable place to consume alcohol, but who feel they are being driven out of business by irresponsible pricing of alcoholic drinks in the off-trade.”

South Wales Police have also shown their support for the proposed change.

ACPO lead on alcohol and licensing Chief Constable Jon Stoddart said:

“Week in, week out in town centres across the country, the police have to deal with the consequences of cheap alcohol and irresponsible drinking. I welcome any new approach that will help reduce the availability of cheap alcohol, give communities a greater say over licensing in their area and reduce pressure on the police.”

via Pub managers back plans for minimum booze price | This is South Wales.

Alcohol Research UK broadly supports the approach adopted in this very useful policy document. Alcohol is not an ordinary commodity. It is the nation’s favourite drug and must be the focus of strong measures to prevent harm to users, children, families and the wider society. Alcohol has been causally implicated in more than 60 categories of disease, illness and injury, including a variety of cancers, cardiovascular illnesses and traumatic conditions. We welcome the approach adopted by the government’s strategy for England and Wales, especially the emphasis on price, marketing and availability.

This paper comments on the evidence-base underpinning some of the key policy proposals within the Strategy and outlines research funded by Alcohol Research UK relevant to these proposals. It is intended to inform those working in the alcohol field – eg. health and social care workers, voluntary organisations, researchers, policymakers, etc – as well as journalists, programme-makers and interested members of the public.

We will be responding in depth to the Government’s consultations on particular elements of the Strategy in due course.

The paragraph numbers in each section below refer to those in the published Strategy document .

The pricing of alcohol

(Paragraphs 2.5 and 2.9 of the Strategy document)

A comprehensive analysis of 1003 sets of data from 112 studies, including information spanning two centuries and many countries, found a significant negative relationship between alcohol price and drinking (1). On average, the authors estimated that a 10% increase in the retail price of alcohol reduced consumption by 4.4%. Other studies have found larger impacts on rates of liver disease than would be expected given the percentage change in price (2), suggesting that problem drinkers respond relatively more to changes in price than other drinkers. Other evidence shows that increases in alcohol taxes have led to reductions in serious harms, including alcohol-related mortality (3), liver cirrhosis (4) , road accidents (4), youth suicide ( 5) and alcohol dependence (6). It would appear that heavy drinkers are not impervious to changes in the price of their favourite beverage.

Minimum Unit Pricing

(Paragraph 2.8)

It is clear that price increases provide governments with a powerful strategy for reducing both consumption and related harms. The effectiveness of overall price increases, however, can be blunted if drinkers are able to choose cheaper, lower-quality products to compensate. Minimum Unit Pricing (MUP) is a very promising approach that would eliminate to some extent the availability of cheap alcohol beverages. Although it is clear that increasing price is linked to reduced consumption across populations, studies of MUP on individual consumption have only recently been initiated. 

Canada was the first to implement and evaluate MUP. An innovative study from British Columbia (7) reported that minimum pricing effectively reduced consumption. A 10% increase in the minimum prices of all types of alcoholic beverage reduced total consumption by 3.4%.

Alcohol Research UK is currently funding a study of the effects of MUP among patients with severe alcohol damage in Scotland, with baseline data currently being collected.

Marketing by the alcohol industry

(Paragraph 2.12)

Alcohol Research UK funded a systematic review of the evidence from studies which evaluated the relationship between alcohol advertising or marketing and alcohol use in young people at a later point in time .

Seven studies met the review inclusion criteria. Five were conducted in USA, one in Belgium and one in New Zealand. The studies provided data on more than 13,000 young people aged 10 to 26 years old.

All studies demonstrated that exposure to marketing resulted in an increase in consumption as would be expected. These included exposure to direct advertising using broadcast and print media and indirect methods such as in-store promotions and portrayal of alcohol drinking in films, music videos and TV programmes.

In one study those young people who gave a positive response to alcohol adverts at the age of 18 were heavier drinkers and reported more alcohol related aggression at the age of 21.

Availability of alcohol

(Paragraphs 3.7 and 3.18)

Overall, more alcohol is consumed when it is easily available. A natural experiment in Sweden demonstrated this very clearly. The study examined consumption and alcohol-related problems when beer, up to 4.5% alcohol, was allowed to be sold in grocery stores. Eight years later this permission was reversed. When permission was granted total consumption increased by 15% and fell by about the same amount when the decision was reversed (8). There was also a drop in motor cycle accidents and a drop in hospital admissions for alcohol related problems in those under 20 (9)

A number of studies funded by Alcohol Research UK support the government’s multi-component approach. These include the following:

Community Interventions

(Paragaph 3.21)

Alcohol Research UK funded three interventions jointly known as the United Kingdom Community Alcohol Prevention Project (UKCAPP). Community Interventions were initiated in Cardiff, Birmingham and Glasgow. The project demonstrated that British communities can generate the kind of coordinated action which studies in the USA and Sweden have shown can reduce alcohol-related violence and injury, creating substantial cost-savings for society.

The UKCAPP report documents how all three were able to generate activity of the kind they sought.

Alcohol Research UK also funded evaluation of the initial work on the Community Alcohol Partnership (CAP) project in St Neots, Cambridgeshire. This provides a well documented example of a local initiative that has gone on to be adopted and adapted by a diverse range of local areas. It is one of the promising approaches identified in a more recent review funded by alcohol research UK.

Strengthening Families

(Paragraph 5.22)

Alcohol Research UK funded research that brought to light the effectiveness of the ‘Strengthening Families Programme: For Parents and Young People 10–14’ (SFP10–14)’ as an intervention for the primary prevention of alcohol misuse. One of the strong features of this programme is that results actually improve over the four year follow-up period, while gains during the first year of conventional prevention programmes tend to decline in subsequent years. Further information is on the Alcohol Research UK website.

Screening for hazardous drinking

(Paragraph 5.17)

A very widely used screening test for alcohol misuse is the Alcohol Use Disorders Identification Test (AUDIT), which was developed in a World Health Organization collaborative project across six countries. Although AUDIT has been well validated and is turning out to be a very useful screening test, there are some situations, such as busy clinics as well as Accident and Emergency departments, where AUDIT takes too long to administer routinely. Alcohol Research UK funding led to the development of the Fast Alcohol Screening Test (FAST) which is now being used by many doctors’ clinics and A&E departments. It is the screening instrument of choice for nurses and GPs in many areas.

Brief interventions and the “teachable moment”

(Paragraph 5.9)

Maxillo-facial surgeons see a regular stream of young male casualties with alcohol- related facial injuries. The majority of them have been involved in a fight, usually on a Friday or Saturday night. They attend an A&E department, receive appropriate treatment and are given an appointment for a follow-up clinic within the next 10 days. This clinic provides an ideal opportunity to influence the drinking patterns of these young men. Can advice given at this point, when the young men are concerned about their good looks, influence future alcohol consumption? Alcohol Research UK funded a brief intervention study (10) to look at this possibility. The motivational intervention lasted for less than 20 minutes and was given by the nurse as she removed stitches. Even though this intervention was very brief, it resulted in a significant change in alcohol consumption during the following year when compared to treatment as usual. There was a reduction of 55% in the number of young men drinking over the recommended limits compared to a drop of 8% in the comparison group. It is important to note that this brief but effective dialogue with the nurse was completed as part of a routine service without the need for additional resources or additional time.

A&E departments see a large number of patients who misuse alcohol. Alcohol Research UK therefore funded a (11) that has had a significant impact on practice and policy. After screening, those who were referred on to an alcohol health worker were drinking less at follow-up. At six months they were drinking 23 units of alcohol a week less than those given an information leaflet; at twelve months the difference was 14 units. Furthermore, those referred to the alcohol health worker had on average fewer visits to A&E over the following 12 months. Attendance at A&E provides a ‘treatable moment’ in which opportunistic identification of alcohol misuse can potentially help patients develop insight into the consequences of their drinking and promote improved health.

Training in brief interventions for alcohol problems should be an essential element of medical and nursing training.

For more intensive interventions we strongly support the statement that: “Increasing effective treatment for dependent drinkers will offer the most immediate opportunity to reduce alcohol related admissions and to reduce NHS costs. Treating alcohol dependence, where successful, has also been shown to prevent future illnesses” (paragraph 5.21)

The need for good research

Although Alcohol Research UK welcomes many of the measures in the Government’s strategy, one disappointing aspect is the lack of explicit reference to the need for high quality research to evaluate these measures. As has been made clear here, Alcohol Research UK has already funded research that is directly relevant to the strategy and will continue to do so. Although policies may seem promising and be based on what appears to be sound reasoning, it is essential that their effects are carefully evaluated under real-world conditions.

One important example of the need for research concerns the effects of MUP. Although there is good evidence to substantiate the link between price increases and reduced alcohol-related harm in general, there is little specific research on the effects of MUP. As mentioned above, Alcohol Research UK has funded a study to investigate the effects of the policy, when it is introduced in Scotland, on the consumption, health and welfare of patients whose lives have been harmed by their drinking. However, it is also necessary to evaluate other aspects of the policy, including its effects on binge drinking among young people and middle-aged drinkers whose regular consumption puts their health at risk. The Government should be urged to fund independent research into the effects of this and other policies included in the strategy. For its part, Alcohol Research UK will continue to fund and promote research that can lead to a reduction in alcohol-related harm in the UK.

Contacts

Prof. Robin Davidson (Chairman)

Prof. Nick Heather (Trustee), Emeritus Professor of Alcohol & Other Drug Studies, Northumbria University
Tel: 0191 227 4521

Prof. Ray Hodgson (Research Director, Alcohol Research UK)
Tel: 01531 820 849

Prof. Alan Maryon-Davis Hon Professor of Public Health, Kings College London School of Medicine
Tel: 07957 642009

References

1. Wagenaar A. C., Salois M. J., Komro K. A. Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies. Addiction 2009; 104: 179–90.
2. Chaloupka F. J., Grossman M., Saffer H. The effects of price on alcohol consumption and alcohol-related problems. Alcohol Res Health 2002; 26: 22–34.
3. Stockwell T., Chikritzhs T., Hendrie D., Fordham R., Ying F., Phillips M. et al. The public health and safety benefits of the Northern Territory’s Living with Alcohol programme. Drug Alcohol Rev 2001; 20: 167–80.
4. Babor T., Caetano R., Casswell S., Edwards G., Giesbrecht N., Hill L. et al. Alcohol: No Ordinary Commodity—Research and Public Policy. Oxford: Oxford University Press; 2003.
5. Markowitz S., Chatterji P., Kaestner R. Estimating the impact of alcohol policies on youth suicides. J Ment Health Policy Econ 2003; 6: 37–46.
6. Farrell S., Manning W. G., Finch M. D. Alcohol dependence and the price of alcoholic beverages. J Health Econ 2003; 22: 117–47.
7. Stockwell T., Auld M.C., Zhao J.,Martin G. Does minimum pricing reduce alcohol consumption? The experience of a Canadian province Addiction Feb 2012 online
8. Noval S., Nilsson T. The effects of medium beer on consumption levels. In Nilsson T (ed) When the medium beer was withdrawn (p77-93) Universitetet I Linkoping; 1984
9. Ramsted M.,The repeal of medium strength beer in grocery stores in Sweden: the impact on alcohol related hospitalizations in different age groups. In Room R.,(ed) The effects of Nordic alcohol policies: what happens to drinking and harm when control systems change? Publication No. 42, pp 117-31. Helsinki: Nordic Council for Alcohol & Drug Research
10. AJ Smith, RJ Hodgson, K Bridgeman, JP Shepherd, A randomized controlled trial of a brief intervention after alcohol-related facial injury Addiction: 98(1) 2003, pp 43-52.. 
11. Crawford MJ, Patton R, Touquet R, Drummond C. et al. Screening and referral for brief intervention of alcohol misusing patients in an emergency department: a pragmatic randomised controlled trial. Lancet 2004; 364:1334-9.

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Ministers hope the payments would provide an incentive to doctors to monitor the alcohol intake of their patients, to help tackle the spiralling costs of treating disease related to the consumption of drink.

Experts have advised the government to make the move as many drinkers do not come to a doctor citing a problem because they are not aware of the risks. Even couples who share a bottle of wine over dinner most evenings unwittingly increase their chances of cancer and strokes.

From next year, patients over the age of 40 will be questioned on their alcohol intake as part of general health checks which occur every five years. But the government is also looking to encourage GPs to routinely ask patients of all ages about their drinking habits when they come into practices.

Doctors are currently able to increase their practices’ income by carrying out a checklist of services, and spotting illnesses and diseases listed under a system of good practice called the Quality and Outcomes Framework (QOF).

They are currently paid extra for monitoring chronic diseases such as asthma, diabetes and coronary heart disease.

Now the new strategy, says the Department of Health will “look at the data from the recently published Screening and Intervention Programme for Sensible Drinking (Sips) research to see if it can support further action by GPs [on alcohol] via the Quality and Outcomes Framework.”

A standard “alcohol identification” test used by GPs involves a patient being asked a series of questions about their alcohol intake and the impact of drink on their day-to-day life.

Those who show signs of dependency or high use will be given 10 minutes of advice by nurses or referred to a specialist.

Read more: Patients to be quizzed by GPs about drinking under new alcohol strategy | Society | The Observer.

Tuesday 27th March 2012, Murrayfield Stadium, Edinburgh

A one day conference organised by Edinburgh Cyrenians, in association with Create Consultancy, Comic Relief, INEBRIA and Alcohol Research UK.

This event will provide an opportunity to discuss and debate the roll out of alcohol brief interventions in wider settings.
It will be of particular interest to the public and voluntary sector, ADPs, policy makers, commissioners, researchers and anyone with an interest in innovative, robust approaches to brief intervention delivery, whether in Scotland or further afield.

Confirmed Speakers:

• Professor Jonathan Chick - chairperson
• Dr Richard Saitz, Professor of Medicine and Epidemiology, Boston University – “Screening and brief intervention: where the evidence is, and isn’t.”
• Dr Andrew Tannahill - “How do we decide what to do, whatever the evidence?”
• Dr. Josie Williams, Glasgow Caledonian University, & Kate Skellington-Orr, KSO Research – “The complex role of alcohol use within hard-to-reach groups – and what this means for practice.”
• Sarah Currie, ABI Manager, Scottish Government – “Alcohol brief interventions: National Policy Update – what has been achieved so far and what next for Scotland?”
• Professor Niamh Fitzgerald, MRPharmS, PhD, Create Consultancy – “Why training is not enough: successful implementation strategies for ABIs in diverse community settings from around the UK.”
• Amy Hutton, Head of Service, Edinburgh Cyrenian Trust – “The Cyrenians story: alcohol interventions in homelessness services.”
• Clare Beeston, Principal Public Health Adviser: Evaluation NHS Health Scotland – “ABI delivery in Scotland: National checklist for planning and evaluation.”

Workshops

• Alcohol-related harm: What’s gender got to do with it? Dr. Marsha Scott, West Lothian Tobacco, Alcohol and Drug Partnership
• Examining the evidence: Does the web and mobile technology have a role to play in the delivery of brief interventions? Andy Hawley, d2 Digital
• On the frontline: what are the challenges in choosing and using a screening tool in the community setting? Kate Skellington-Orr, KSO Research
• “That’s not my job” – workplace culture and role validity; is overcoming staff reluctance to talk about alcohol the biggest challenge? Eleanor McWhirter, NHS Lothian Lead Alcohol Brief Interventions