alert spring 2009 final - ias alcohol alert2 spring 2009 introduced to alcohol. so i hope the chief...

Alcohol AlertUK

Issue 1Spring 2009

www.ias.org.uk

An Alcohol-free childhood is best -Chief Medical Offi cer

www.ias.org.uk Alcohol Alert Spring 2009

CONTENTS

UK Alcohol Alertincorporating AllianceNews

Issue 1, 2009

issn - 1460-7174

Editor:Andrew McNeill

Alcohol Alert ispublished by theInstitute of Alcohol Studies, a RegisteredCharity

12 Caxton StreetLondonSW1H 0QS

Tel: 020 7222 5880

Fax: 020 7799 2510

Email:[email protected]

Alcohol Alertwelcomes feedbackand contributions. Ifyou’re interested incontributing a guesteditorial or article,please fi rst contact usat:

[email protected]

Cover photograph taken from ‘Bottling it up’ courtesy of

Turning Pointwww.turning-point.co.uk

Printed in England

___________________

4 Do the new licensing laws make things worse for young adults?

___________________

7 NHS needs new approach to tackle nation’s unhealthy lifestyles - King’s Fund

9 New Alcohol Profi les show alcohol-related disease is still increasing in England - Northwest a blackspot

___________________

12 Government calls time on irresponsible drink deals

___________________

11 Reducing alcohol harm - Health Services in England for alcohol misuse

___________________

21 Alcohol Pledge Wales campaign

___________________

15 Alcohol pricing and promotion

1 “No alcohol for under 15s”

___________________

5 No reason to be sanguine about teenage drug use

___________________

18 Book Reviews:

Audrey Lewis on Raising the Bar

K Graham & R Homel

Jonathan Goodliffe on Substance

misuse in psychiatry: a guide for lawyers

Bala Mahendra

Sir Liam Donaldson

Kathy Gyngell

Dr Barry Morgan

Please recyclethis magazine

17 Community pharmacies promote alcohol awareness

www.ias.org.uk Alcohol Alert Spring 2009 1

The advice forms a main

part of the Youth Alcohol

Action Plan, published

in June 2008 by the

Department for Children,

Schools and Families. It is

in the form of a consultation

document, with parents,

health professionals, young

people themselves and all

other interested parties

being invited to comment on

the Chief Medical Officer’s

assessment of the issue

of drinking by children

and adolescents and his

proposals for reducing the

harm associated with it.

A particular feature of the

new advice is guidance in

regard to what counts as

low risk drinking for children

and adolescents, the

generally known guidelines

on low risk or `sensible’

drinking being based on

evidence pertaining to adult

populations. In relation to

this, Sir Liam states that

alcohol consumption during

any stage of childhood

can have a detrimental

effect on development and,

particularly during teenage

years, is related to a wide

range of health and social

problems. Vulnerability to

alcohol-related problems,

Sir Liam says, is greatest

among young people who

begin drinking before the

age of 15. The safest

option, therefore, is for

children not to drink at all

until they are at least 15

and, preferably, 18.

Sir Liam Donaldson

formulated the advice

on the basis of extensive

research and work with

a panel of experts who

reviewed the latest available

medical evidence and data

from across the UK on the

impact of alcohol and young

people. Dr Rachel Seabrook,

Research Manager of the

IAS, was a member of the

expert panel.

Launching the advice,

Sir Liam Donaldson said:

“This guidance aims to

support parents, give

them the confidence to set

boundaries and to help them

engage with young people

about drinking and risks

associated with it.

“More than 10,000 children

end up in hospital every

year due to drinking and

research tells us that 15 per

cent of young people think

it is normal to get drunk at

least once a week. They are

putting themselves at risk of

harm to the liver, depression

and damage to the

developing brain. Resulting

social issues can lead to

children and young people

doing less well at school and

struggling to interact with

friends and family.”

Ed Balls, Secretary of State

for Children, Schools and

Families, said:

“Parents have told us

that they lack the health

information and advice they

need to make decisions

about whether or how

their children should be

“No alcohol for under 15s”

A n alcohol-free childhood is the healthiest option, and if children do drink alcohol, it should not be before they reach the age of

15 years, according to new governmental advice to parents issued by the Chief Medical Officer.

Sir Liam DonaldsonChief Medical Officer


introduced to alcohol. So

I hope the Chief Medical

Officer’s advice will help

them with the tricky task of

deciding the best way of

doing that.

“We want this advice and

information to be a success

and really help families.

That’s why we’re asking

young people, parents and

all those interested for their

views. I think all of us as

parents need to look at this

advice, see whether it’s right

for us and ask whether we

are doing the best thing for

our children.

“Alcohol is a part of our

national culture and if

managed responsibly can

have a positive influence

in social circumstances.

However when it is not

managed responsibly it can

cause real problems.”

Speaking for IAS,

Rachel Seabrook said:

“The Institute of Alcohol

Studies welcomes

these new guidelines

recommending that children

should not start to drink

alcohol before the age of

15 and emphasising the

importance of parental

influence on young people’s

drinking. We know of

no evidence supporting

the idea that introducing

alcohol to children or young

teenagers can protect them

against dangerous drinking

habits, whereas there is

a considerable body of

research showing a link

between starting to drink at

a young age and problems

with alcohol in later life.

Additionally, young people

need to be aware of the

risks of drunkenness. Some

of the dangers are far worse

than vomiting and waking up

on a friend’s sofa.”

The Guidance

The new advice specifically

addresses the key points

requested by Government

in the Youth Alcohol Action

Plan, and it is given in terms

of 5 key points:

Children and their parents

and carers are advised that

an alcohol-free childhood is

a healthy option. However,

if children drink alcohol, it

should not be before they

reach the age of 15 years.

For those aged 15 to

17 years all alcohol

consumption should be with

the guidance of a parent

or carer or in a supervised

environment.

Children aged 15 to 17

years should never exceed

adult recommended daily

maximums. As a general

guide, children aged 15 and

16 years should not usually

drink on more than one day

a week. Children aged 17

should drink on no more

than two days a week.

Parental influences on

children’s alcohol use

should be communicated

to parents, carers and

professionals. Parents and

carers require advice on

how to respond to alcohol

use and misuse by children.

Support services must be

available for children and

young people who have

alcohol-related problems

and their parents.

The CMO’s advice and the

consultation document

are accompanied by new

reviews of the evidence

in regard to alcohol

consumption by children

and adolescents which

provide the scientific basis

of the new advice. In regard

to the advice that young

people should delay the age

they start drinking alcohol,

this is because the evidence

suggests that:

children who begin drinking

at a young age drink more

frequently and in greater

quantities than those who

Chief Medical Officer

38% increase in children’s hospital admissions

for alcohol

Between 2002/3 and 2006/7 the number

of alcohol-related admissions for 11 to 18

year olds in England increased by over one

third. The figures were provided by Public

Health Minister, Dawn Primarolo, in answer to a

parliamentary question by Simon Burns MP.

The figures are:

www.ias.org.uk Alcohol Alert Spring 2009

behaviour

it is more likely to lead to

binge drinking and alcohol

dependence in young

adulthood

it leads to a higher

likelihood of involvement

in illegal drug use, crime,

and lower educational

attainment

The importance of

parents

In regard to the role

of parents, the CMO

recognises that they face a

difficult task, and that many

may feel ill-equipped to deal

with their children’s current

or future drinking. His

advice to them is to:

set limits and determine the

consequences for drinking

behaviour

negotiate boundaries

and rules for appropriate

behaviour in relation to

alcohol; and

show disapproval of alcohol

misuse, such as getting

drunk, drinking when they

have been told not to or

getting into trouble after

drinking

This advice is based on

the evidence that :

a permissive approach by

3

general guide children aged

15 and 16 years should not

usually drink on more than

one day a week. Children

aged 17 should drink on

no more than two days a

week.”

The CMO explains that

children and young people

who drink frequently and

binge drink are more likely

to suffer alcohol-related

consequences. While

individuals vary in the

way that they react to the

consumption of alcohol,

young people may have

a greater vulnerability to

certain harmful effects of

alcohol use than adults.

Young people also lack

drinking experience and

decision-making skills

about amount, strength and

speed of drinking. Brain

development continues

throughout adolescence and

into young adulthood, and

drunkenness, binge drinking

or exceeding recommended

maximum alcohol limits for

adults should always be

avoided.

The CMO advice is that

frequent or excessive

drinking by children and

young people is particularly

dangerous because:

it presents particular

risks in terms of health,

unplanned and unprotected

sexual activity and violent

delay drinking. They are

also more likely to drink to

get drunk

the earlier they start

drinking alcohol, the more

they are at risk of alcohol-

related injuries, involvement

in violent behaviour and

suicide attempts, having

more sexual partners and

a greater risk of pregnancy,

using illegal drugs and

experiencing employment

problems and driving

accidents

heavy drinking during

adolescence may affect

normal brain functioning

during adulthood.

Furthermore, young people

who drink heavily may also

develop problems with liver,

bone, growth and endocrine

development; and

the earlier they start

drinking alcohol the more

likely they are to develop

alcohol abuse problems or

dependence in adolescence

and adulthood

In regard to levels of

consumption, the Chief

Medical Officer recommends

that :

“Children aged 15 to 17

years should never exceed

adult recommended daily

maximums (of 2-3 units for

women and 3-4 units for

men on any single day). As a

parents to the use of alcohol

by their children often leads

to heavy and binge drinking

in adolescence

family standards and

rules, as well as parental

monitoring, delay the age

at which young people first

drink

frequent or excessive

drinking by parents

increases the likelihood that

children will also consume

more alcohol and be at

greater risk of harm; and

warm and supportive

parent–adolescent

relationships lead to lower

levels of adolescent alcohol

use and misuse

Further details can be

found at:

www.dcsf.gov.uk/consultations

The closing date for the

consultation is 23 April 2009

Chief Medical Officer


Do the new licensing laws make things worse for young adults?

“Pre-drinking” or “pre-

gaming” involves planned

heavy drinking, usually

at someone’s home,

before going to a social

event, typically a bar or

nightclub. As defined by

young people themselves,

pre-drinking is “[the] act

of drinking alcohol before

you go out to the club to

maximise your fun at the

club while spending the

least amount on extremely

overpriced alcoholic

beverages”.

Culture of Intoxication

Drawing on scientific

evidence from various

countries as well as

information from media

and popular internet

vehicles, the authors

suggest that pre-drinking

is symptomatic of a “new

culture of intoxication”

whereby young people are

drinking with the primary

motive of getting drunk.

Recent research suggests

that a large proportion of

young people pre-drink

and that pre-drinkers

are more likely to drink

heavily and to experience

negative consequences

as compared to non-pre-

drinkers. Pre-drinking

often involves the rapid

consumption of large

quantities of alcohol

which may increase

the risk of blackouts,

hangovers and even

alcohol poisoning. It may

also encourage the use of

other recreational drugs

such as cannabis and

cocaine as drinkers are

socialising in unsupervised

environments.

The authors argue that

the policy of banning

drink promotions or

specials such as “happy

hour” in bars and clubs

may have the unintended

consequence of

encouraging young people

to drink cheaper alcohol

in private settings before

going out, especially

when alcohol is offered

at much lower prices in

off-premise outlets. The

authors also point out that

while later closing times

have been justified as a

way of reducing problems

associated with large

numbers of young people

being on the street after

bars and clubs close, they

may encourage private

drinking to precede rather

than follow public drinking,

producing different social

dynamics and possibly

increasing the potential for

violence and other alcohol-

related problems.

To discourage or reduce

pre-drinking, the authors

suggest a comprehensive

strategy including:

Developing policies

that reduce large

imbalances between

on and off premise

alcohol pricing

Attracting young

people of legal drinking

age back to the bar for

early drinking, where

alcohol consumption is

monitored by serving

staff and drinks are

served in standard

sizes

Addressing young

people’s motivations

for pre-drinking,

including being able to

socialize with friends

and saving money – for

example, bars might

expand their social

function and create an

attractive atmosphere

for more intimate

socializing

I n a new “for debate” piece published

in the scientif ic journal Addiction,

researchers question whether current

l icensing policies have contributed to a

r ise in the phenomenon of “pre-drinking”

amongst young people.

Between 2004/5, before the Licensing Act came into force, and 2006/7, two years after its introduction, the number of alcohol-related admissions to hospitals in England rose from 644,185 to 799,120, an increase of 24 per cent. Whilst this increase cannot of course be attributed to the Licensing Act, it does suggest that the effects of the Act in promoting ‘responsible drinking’ have been limited. The admissions fi gures were provided by Public Health Minister Dawn Primarolo, in answer to a parliamentary question on 16 December 2008.


Do the new licensing laws make things worse for young adults?

Forming effective

strategies to reduce

planned intoxication –

for example, policy and

programming could

be aimed at changing

drinking norms and

promoting moderation

Lead author, Dr. Samantha

Wells, a researcher at the

Centre for Addiction and

Mental Health (CAMH)

in Canada says, “Many

young bar-goers have

found a way to avoid

paying high alcohol prices

in bars: they pre-drink.

And we have begun to

see that this intense and

ritualized activity among

young adults may result

in harmful consequences.

Therefore, we need to look

closely at the combined

impact of various policies

affecting bars and young

people’s drinking and

come up with a more

comprehensive strategy

that will reduce these

harmful styles of drinking

among young people.”

Wells S., Graham

K., Purcell J. Policy

implications of the

widespread practice

of “predrinking” or

“pregaming” before

going to public drinking

establishments – are

current prevention

strategies backfiring?

Addiction 2009; 104: 4-9

No Reason to Be Sanguine about Teenage Drug Use

Kathy Gyngell - Research Fellow at the Centre for Policy

Studies - comments on the National Treatment Agency’s

report ‘Getting to grips with substance misuse among

young people: the data for 2007/08’

Last week the NTA

published the staggering

fi gure of nearly 25,000

young people under 18

getting treatment for their drugs

and alcohol problems.(1) Up

some 8,000 on just a year

and a half ago, this, they

insist, is not a refl ection of

a growing problem but just

one of expanding services.

This does not, however,

leave me feeling much

happier. Ten years ago

the thought of so many

young teenagers using

drugs to this degree was

unimaginable. Yet the

evidence of the continuing

catastrophic levels of school

age drug use suggests that

should ‘services’ go on to

double or treble, demand

will take that up too.

The sad fact is that, despite

ten years of a drug strategy

purportedly designed

to reduce use by young

people, there are thousands

of children beginning their

lives so damaged by drugs

that they need treatment.

Whatever the spin put

on these fi gures, this is a

major social problem that

can neither be denied nor

brushed under the carpet.

What teenagers do today

determines the scale of the

drugs problem tomorrow.

But, as ever in the rose

tinted world of British drugs

policy, we are told by the

great and the good that

there is nothing much for us

to worry about.

Drugscope’s sanguine

response to the fi gures was

that, “Public and media

perceptions of the numbers

of young people misusing

drugs and alcohol can be

distorted. Yet the picture

painted by prevalence data

……. all suggest that the

numbers of young people

using drugs and alcohol are

falling”.(2)

However, the national school

age statistics on drugs use,

which Drugscope portrays

as revealing this good news,

still show that a staggering

25% of the UK’s school

age children (11 – 15) have

tried drugs - fi gures that

are way higher than the

European average - and

that 10% of them are using

drugs regularly.(3) The last

comparable survey fi gures

for European school children

under 15 also showed UK

to have 13% of our under

13s having tried cannabis

against a European average

of 4%.(4) It is also the

case that, while the trend

for schoolchildren’s drug

use remained stable across

Europe between 1999 and

2005, in the UK it doubled.

Although UK school

childrens’ drug of choice,

cannabis, appears to have

now stabilised, their cocaine

consumption has been rising

– unheard of elsewhere in

Europe.

But it is also likely that

levels of teenage cannabis

use are higher than the

published statistics state,

as the Advisory Council on

the Misuse of Drugs recently

acknowledged. In their view

young people: the data for 2007/08’


Young people

the British Crime Survey is

likely for a range of reasons

to underestimate it. Even so,

these estimates show that

some 12% of 16 -19 year

olds are regular users and

that 20% of them have used

it in the last year.(5)

A percentage point decline

in cannabis use in official

statistics is small comfort

for parents or for schools.

Hospital admissions show

that this small gain has

been wiped out by the rising

strength of cannabis and

by the fact that children

are moving earlier to Class

A drugs. In fact with

the UK cannabis market

dominated by high THC

skunk, which, according

to a former head of the

Dutch Police Narcotics

Division, should now count

as a ‘hard drug’, what we

are witnessing is an ever

earlier and disturbing shift to

hard drug use. To dismiss

such concerns as distorted

perceptions is really not on.

As any ‘in touch’ parent of a

teenager in central London

knows, regular cannabis-

using kids are moving to

cocaine, ketamine and

ecstasy by the time they are

16 or 17. Many teenagers

appear to be immune

to drug dangers despite

the endless compulsory

personal health and social

education classes that they

are subjected to at school.

Nor has the government’s

mixed message about drugs

helped – namely their explicit

policy statements about

the non harmful nature of

‘recreational’ and casual

drug use; no more helpful

is their confused ‘informed

choice’ approach to drugs

education.

The appalling truth, as far

as adults are concerned,

is that we seem to have

surrendered to a sense of

‘inevitability’ about children’s

drug use.

While drugs services and

drugs advisors have no

more urgent need than to

highlight “the problems

faced by young people when

they reach 18 and are no

longer eligible for specialist

services” and “to ease their

transition to adult services”,

the outlook is dire indeed.

The NTA’s tables reveal that

1600 teenagers are receiving

treatment for heroin, cocaine

and crack addiction and

that 29% - some 6000 in

all of those in treatment

- are now receiving ‘harm

reduction’ interventions –

usually understood to be a

euphemism for prescribing

an opiate substitute like

subutex or methadone. As

Professor Neil McKeganey,

a leading expert in drugs

misuse has said: ‘The

idea of starting someone

under 18 on a methadone

prescription with an implicit

expectation that they may

be on that drug for the

next ten or more years is

appalling. We need services

to think beyond the chemical

inducement into therapy.’(6)

The desperate fact though,

is that there is still only one

small dedicated residential

rehabilitation centre with

statutory funding for no

more than 12 children/

teenagers at a time in the

country. Last year Mike

Trace, Chief Executive of

RAPT – the Rehabilitation

of Addicted Prisoners Trust

– spoke of the urgent need

for residential treatment for

young, under 18, addicts.(7)

Young addicts, he said, were

unlikely to get better within

the environment in which

they had grown up and that

had fed their problems. Any

parent of a young addict

knows just how truly he

spoke.

But how much of the

National Treatment Agency’s

dedicated funding of £25

million is being spent on

this? How many teenagers

are emerging drug free

from their encounters

with services? How

effective are the disparate

psychosocial interventions,

pharmacological prescribing

interventions, specialist

harm reduction, and family

interventions on offer? It

is simply not enough for

the NTA to tell us that

the proportion of young

people who ‘complete an

intervention according to

the goals set out in their

care plans’ is 57%. Unless

we know what the goals

of their care plans are in

the first place and what

the aspirations are for the

young people in question,

it is a pretty meaningless

statement. As we already

know from adult services

‘completing treatment’ may

be a measure of virtually

nothing.

(1) Getting to Grips with substance misuse amongst young people: data for 2007/8. NTA January 22nd 2008

(2) Drugscope Press Release 22nd January 2008

(3) Drug Use, Smoking and drinking among young people in England 2007, NHS, The Information Centre

(4) EMCDDA Drug use and related problems among very young people (under 15 years old), 2007

(5) Cannabis classification and public health, ACMD 2008

(6) Addictions, Vol 4, Breakthrough Britain

(7) BBC News 20.09.08

NHS needs new approach to tack le na t ion ’s unhea l thy l i f es ty les - The K ing ’s Fund


That is one of the

conclusions of a year-

long investigation into

the effectiveness of

different types of public

health programmes to

tackle smoking, alcohol

misuse, poor diet and

lack of exercise published

by The King’s Fund, the

independent think tank

specializing in health issues.

The report finds that these

behaviours are deep-

rooted social habits that

are not easily changed

by one-off, short-lived

measures. The report

also adds that many

NHS staff lack the

necessary skills and

incentives to help

people effectively

to choose and

maintain healthier

lifestyles.

The King’s

Fund Director

of Policy

and report

co-author, Dr Anna Dixon,

said:

‘The health service needs to

be more innovative in how it

tackles unhealthy behaviour.

Obesity and the health

problems associated with

smoking and excessive

alcohol are the

biggest challenges facing

the 21st-century NHS.

‘The methods used to

promote public health

need to be more modern,

using the most advanced

techniques and

technologies.

‘The reasons people persist

with unhealthy habits are

complex. It’s often about

changing deep-rooted social

habits that can become

addictive, rather than

just helping people make

better choices as

individuals.

‘Financial

incentives and

information

campaigns can

be useful but are

far more likely to

lead to real and

long-term changes

in people’s behaviour

when paired with

other interventions like

tailored information and

personalised support.

‘But at the moment

there simply isn’t enough

reliable data on what works

and what doesn’t, to help

health service managers

plan appropriate behaviour

change programmes to

meet their local needs. This

lack of evidence has to

be urgently addressed so

more money isn’t wasted on

ineffective interventions.’

Commissioning and

behaviour change:

Kicking Bad Habits final

The NHS will fail to tackle the rising tide of obesity and tobacco-related illnesses unless

it adopts more sophisticated techniques including those employed by commercial

advertisers to help people to live healthier lifestyles.


King’s Fund

report makes a series of

recommendations:

The NHS needs to make

better use of social

marketing techniques

and data analysis tools

like geodemographics

to identify, target

and effectively

communicate

messages and

motivate people to

change how they live.

Public health

programmes should

not rely on just one

approach – such as

information campaigns

or financial incentives –

as the evidence shows

the most effective

behaviour change

interventions employ a

variety of tactics.

A robust evaluation

– of short- and long-

term changes in

behaviour and health

outcomes – should be

made a requirement

of all public health

programmes in order

to build an evidence

base for the future.

Frontline staff should

be more proactive

in promoting healthy

habits to the patients

they see every day

and for contracts and

incentives to be used

to encourage such

behaviour.

Government

departments and local

agencies involved in

tackling unhealthy

behaviours must better

co-ordinate their

efforts and ensure that

targets are agreed to

support their shared

objectives.

Dr Dixon added:

‘Encouraging healthier

lifestyles is the job of all

staff working within the

health service, not just

those working specifically

in public health. GPs,

pharmacists and hospital

staff, the people that

interact with patients every

day, need to be trained

in behaviour change

techniques to give them

the confidence to start

conversations about

people’s unhealthy habits

and to be effective in

influencing their lifestyles.

‘For the NHS to truly

change from a service

treating illness to one

promoting good health, all

government bodies and

local health agencies need

to work together. The

responsibility to promote

good health, as well as

Commissioning and behaviour change - Kicking bad habits

final report is available to download at:

http://www.kingsfund.org.uk/media/kicking_bad_habits.html

treat sickness, needs

to be fully embedded in

national policies, Primary

Care Trusts’ priorities, care

providers’ standards and

performance indicators,

and staff and service

contracts.”

Dr Anna DixonDirector of Policy

King’s Fund


New Alcohol Profi les show alcohol-related disease is still increasing in England - North West a blackspot

Seven of the ten areas in England with the greatest level of alcohol related harms are in the North West region:

Manchester, Salford, Liverpool, Rochdale,

Halton, Tameside and Oldham

The latest Local

Alcohol Profi les for

England (LAPE)

show there were around

800,000 alcohol-related

admissions to hospital in

England in 2006/07, a 9%

increase from the previous

year or an additional 174

alcohol-related admissions

every day. The 800,000

admissions were accounted

for by 530,000 individuals,

as some people had more

than one stay in hospital

during the year.

The fi gures were compiled

by the North West Public

Health Observatory at the

Centre for Public Health.

The profi les contain 23

measures of the burden

that alcohol has on local

communities. They

include the Government’s

national indicator – hospital

admissions for alcohol

related harm (NI 39) – as

well as other measures such

as alcohol-related deaths,

crime and incapacity benefi t

claimants.

Dr Karen Tocque, Director of

Science and Strategy for the

North West Public Health

Observatory and lead for the

development of the alcohol

profi les, said “For the fi rst

time, local communities can

see the effect that alcohol

has been having over a four

or fi ve year period and these

trends may come as a bit

of a surprise. No area of

England can escape the fact

that alcohol is having some

negative infl uence on their

residents. Each year, people

living in each community

become a victim of a crime,

are unable to work, are

admitted to hospital or may

even die – all because of

alcohol.”

Professor Mark Bellis,

Director of the North West

Public Health Observatory

added:


Key findings from the profiles:

New figures for the National Alcohol Indicator (NI 39) – hospital admissions for alcohol related harm

Numbers of people being admitted to hospital each year continue to climb – up 7% or 34,000 more people admitted since 2005/06 On a national basis, deaths from chronic liver disease increased in the last year by 7% for women and 5% for men Claims for Incapacity Benefit and Severe Disablement Allowance due to alcoholism remain static at around 41,000 (for November 2007) whilst transport accident deaths attributable to alcohol have decreased by 10% since 2003 to 2,900 in 2007

While there are variations in trends between Local Authority areas, 63% showed an increase in hospital admissions in the last year, 31% had less than 5% change and only 6% showed a decrease

In general, those areas of the country high for one measure of alcohol problem are high for others and therefore, a single measure of harm was created to compare areas. This measure includes alcohol-related ill health, death, crime and poor drinking behaviours. With the exception of Middlesbrough, Hammersmith and Fulham, and Kingston upon Hull, seven of the ten areas in England with the greatest level of alcohol related harms are in the North West region: Manchester, Salford, Liverpool, Rochdale, Halton, Tameside and Oldham

The local areas least affected by alcohol are mostly in the South East or Eastern regions of the country: Wokingham, Mid Bedfordshire, Three Rivers, Castle Point, North Kesteven, South Northamptonshire, Sevenoaks, East Dorset, Broadland and South Norfolk

Children and young people (under 18 years of age) being admitted to hospital because of alcohol have risen nationally by around 5% a year since 2003/04 to nearly 8,000 in 2006/07. However, the areas with the highest rates are not the same places where adult admissions are highest but, instead, are often more rural and isolated areas and include: Copeland, Isle of Wight, Darlington, Redditch, Rossendale, Wirral, Halton, Sunderland, Kingston upon Hull and Wear Valley.

The alcohol profiles can be

accessed on the web at

www.nwph.net/alcohol/lape

“Rises in alcohol-related

health problems reflect not

only weekend binge drinking

but also how use of alcohol

on a nightly basis continues

to erode our health. Further

increases in alcohol

problems are in store if

we continue to focus on

the symptoms of alcohol

misuse, like night life

violence and ill health, but

ignore the causes such as

cheap alcohol and a lack of

recognition that alcohol is a

dangerous drug.”

Alcohol Profiles


Reducing Alcohol Harm:

Health services in England for alcohol misuse

Alcohol related ill-health is an

increasing burden for the National

Health Service, and alcohol harm

costs the health service in the order of £2.7

billion a year, but efforts to address it locally

are not in general well planned, according to

the National Audit Office (NAO).

The National Audit

Office report ‘Reducing alcohol harm: health services in

England for alcohol misuse can be downloaded at:

http://www.nao.org.uk/publications/0708/reducing_alcohol_

harm.aspx

In a report published in

October 2008, the NAO

examined the NHS response

to the rising levels of

alcohol-related disease.

Hospital admissions for the

three main alcohol specific

conditions (alcohol-related

liver disease, mental health

disorders linked to alcohol,

and acute intoxication) have

doubled in the last 11 years.

There were also twice as

many deaths from alcohol-

related causes in the UK in

2006 as there were 15 years

before, increasing from

4,100 to 8,800.

The Department of Health

is raising the profile of

alcohol misuse by providing

information and guidance

to underpin local action,

centred on encouraging

Primary Care Trusts (PCTs)

to gauge their performance

against the rate of alcohol-

related hospital admissions.

However, the NAO found

their response to be patchy.

Primary Care Trusts are

responsible for setting local

health priorities. But around

a quarter of PCTs surveyed

by the NAO had not fully

assessed alcohol problems

in their areas. Many PCTs

do not have a clear picture

of their spending on services

to address alcohol misuse

and its effects on health.

PCTs have often looked to

their local Drug and Alcohol

Action Teams to take the

lead, but these bodies

focus primarily on specialist

services for dependent users

of illegal drugs and alcohol.

The NOA concluded that

there is scope for the

Department of Health to

provide greater leadership

to PCTs on alcohol misuse,

and the NAO report

recommends a number of

specific measures to that

end, such as guidance to

help PCTs assess causes

and to forecast trends in the

level of alcohol harm in their

localities.

There is evidence that ‘brief

advice’ by GPs and health

workers, can reduce alcohol

consumption and help to

prevent longer term damage

to health and there are

some good local examples

of this. From September

2008 the Department has

provided an additional £8

million in support for such

services. For people who

have developed severe

alcohol problems, there

are considerable variations

between different localities

in access to specialist

treatment services, and

scope for better integration

of hospital treatment with

follow on services such as

psychiatry.

The Department has recently

undertaken a series of

new publicity campaigns

to encourage `sensible

drinking’. Research

has shown that

consumers tend to

underestimate the

amount of alcohol

their drinks contain

and are not clear

about what is meant

by a ‘unit’ of alcohol.

Department of

Health funding for

such work was tripled to £6

million in 2008/09.

Tim Burr, head of the

National Audit Office, said:

“Alcohol misuse constitutes

a heavy and increasing

burden on the NHS. If

services to tackle alcohol

misuse are going to

make a bigger difference,

Primary Care Trusts need

to understand better the

scale of the problem in their

local communities. With

its increased focus on the

prevention of lifestyle-related

illness, the Department of

Health could, for example,

do more to convince Trusts

about the value of timely

advice to help people

develop safer drinking

patterns.”

Government calls time on irresponsible drink deals

www.ias.org.uk Spring 2009 Alcohol Alert 12

A ban on ‘all you can

drink’ promotions

in pubs and bars

was among a range of new

measures announced by

Home Secretary Jacqui

Smith and Health Secretary

Alan Johnson, supported

by a new £4.5 million

crackdown on alcohol

fuelled crime and disorder.

The measures will form part

of the legislative programme

announced in the Queen’s

Speech in November 2007.

Following an independent

review, which found that

many retailers were not

abiding by their own

voluntary standards for

responsible selling and

marketing of alcohol, the

Government now intends to

introduce a new mandatory

code of practice to target

“the most irresponsible”

retail practices. The code

will set out compulsory

licensing conditions for all

alcohol retailers, and will

give licensing authorities

new powers to clamp down

on specific problems in their

areas. Licensing authorities

will also be able to impose

these new powers on

several premises at once.

The mandatory code will

be enforced through the

current licensing regime and

will apply to all premises

licensed to sell alcohol –

including private members

clubs. Any breaches of

these conditions

will lead to a

review of the

licence (and

possible loss

of licence) or,

on summary

conviction,

a maximum

£20,000 fine and/

or six months

imprisonment.

The Government

announced that

it would consult

interested parties

on a range of compulsory

conditions including:

banning offers like ‘all

you can drink for £10’

outlawing pubs and bars

offering promotions to

certain groups, such as

women only

ensuring that customers

in supermarkets are

not required to buy

very large amounts

of a product to take

advantage of price

discounts

ensuring staff selling

alcohol are properly

trained

requiring that

consumers are able to

see unit content of all

alcohol when they buy

it; and

requiring bars and pubs

to have the minimum

sized glasses available

for customers who want

them.

The Government also

announced that Crime

and Disorder Reduction

Partnerships are being

awarded a £3 million

cash injection to target

enforcement activities on

Government calls time on irresponsible drink deals

www.ias.org.uk 13 Alcohol Alert Spring 2009

specific alcohol-related

problems in 190 areas

across all police forces. In

addition, £1.5 million will be

given to a number of priority

areas to strengthen their

ability to tackle underage

sales, confiscate alcohol

from under 18s and run

communications campaigns

to tell people what action

is being taken to reduce

alcohol-related crime and

disorder successfully in their

local area.

Home Secretary Jacqui

Smith said:

“I don’t want to stop the

vast majority of people

who enjoy alcohol and

drink responsibly from

doing so but we all face

a cost from alcohol-

related disorder and I

have a duty to crack

down on irresponsible

promotions that can fuel

excessive drinking and

lead people into crime

and disorder. That’s

why I will impose new

standards on the alcohol

industry that everyone

will have to meet with

tough penalties if they

break the rules.

“There is no simple

solution to tackling this

problem - we all have a

responsibility to tackle

the binge drinking

culture. I look forward to

Home Affairs Committee calls for ban on all booze promotions, saying police are

overstretched by alcohol-fuelled crime made worse by longer drinking hours

Earlier, the House of Commons Home Affairs committee had called for a ban on

alcohol ‘loss-leaders’ in shops and an end to pub and club drink promotions. The

Committee took evidence from police and other stakeholders that alcohol-related

crime places a heavy burden on police resources, diverting officers away from

dealing with other types of crime. The Committee concluded that “There is limited

evidence of the effect of the Licensing Act 2003 on the total number of alcohol-

related offences, but there is certainly a strong perception amongst police forces

that alcohol-related violence is on the increase. What is clear is that forces now

deploy resources to deal with alcohol-related crime and disorder for longer periods

of time, as a result of longer opening hours, and in larger areas, as late night

drinking is no longer confined to city centres”.

The Committee identified cheap drink promotions as a particular cause of increased

problems. It said the alcohol trade’s voluntary standards needed to be made

compulsory with a more effective inspection regime and penalties for breaches.

The Committee was concerned that, as one force put it, “the whole focus of officer

shift patterns is to deploy sufficient resources at weekends to cope with alcohol-

fuelled disorder, and football violence”, and fully 45% of victims of violence descibe

their assailant as under the influence of alcohol. The Committee noted that, in

2007, alcohol was 69% more affordable in the United Kingdom than it was in 1980.

Chairman of the Committee, Keith Vaz MP, said

“Policing is about how we feel about the neighbourhoods we live in, yet for

many of us our only direct encounter with the police will be at the worst, most

harrowing times of our lives. That is why it is so

crucial that police are able to respond to local

priorities, respond to the needs of victims and

make the best use of their resources. We

cannot have on the one hand a world of alcohol

promotions for profit that fuels surges of crime and

disorder, and on the other the police diverting all

their resources to cope with it.”

Spring 2009 www.ias.org.uk Alcohol Alert 14

The Government also intends to

increase the maximum fine which can be issued for consuming alcohol in a designated public place from a level two fine (£500) to a level four fine (£2,500).

introduce a new offence of persistently possessing alcohol in a public place. Young people under 18 can be prosecuted for this offence if they are caught with alcohol in a public place three times within a 12 month period, without reasonable excuse

toughen the offence of persistently selling alcohol to children from three strikes within three months, to two strikes within three months

strengthen the police’s power to confiscate alcohol from young people in a public place so that they no longer need to prove that the individual ‘intended’ to consume that alcohol

extend the police’s powers to issue Directions to Leave so that they can be issued to persons aged 10-15 to break up groups of young drinkers

undertake further work based on the ScHARR review’s findings to understand better the impact of policies affecting the price of alcohol; and

commission shortly a second independent survey of industry compliance with its voluntary agreement on labelling and unit and health information.

Irresponsible drink deals

seeing the results of our

£4.5 million crackdown

on alcohol fuelled crime

and disorder.”

The Government undertook

a public consultation on

a mandatory code in July

this year. Over 90 per cent

of approximately 2,000

respondents supported a

mandatory code.

Mike Craik, Association

of Chief Police Officers

(ACPO) lead for Alcohol

Licensing, welcomed the

measures. He said:

“For too long, some

retailers have been

putting profits before

responsibility and

cutting the price of

alcohol until it is cheaper

than water.

“There is no doubt

that irresponsible

drinking leads to

alcohol-fuelled violence

and suggestions that

enforcement alone

can provide an answer

ignore the obvious. Last

year, nearly one fifth of

all violent incidents took

place in or around pubs

and clubs at a cost of

£7.3 billion to the UK.

While there are many

who trade responsibly,

there are also, as the

KPMG study released

earlier this year showed,

a great many who do

not. So the industry has

an important part to play

in helping to reduce the

excessive drinking that

leads to alcohol-fuelled

disorder on our streets.

“ACPO has consistently

called for end-to-end

solutions bringing

together the police, local

authorities, industry,

parents and all those

in each neighbourhood

who share an interest in

tackling alcohol-related

crime and disorder. We

look forward to working

with Government and

partners on proposals to

meet this aim.”

David Poley, chief executive

of the Portman Group,

the social responsibility

organisation for drinks

producers, also welcomed

the proposed mandatory

code as a method of

strengthening the existing

licensing laws while allowing

effective producer self-

regulation to flourish. The

code would “stamp out

irresponsible promotions

without making everyone

pay more for a drink”.


Alcohol Pricing and promotion

To assist policy making, and as foreshadowed in the National Alcohol Harm Reduction

Strategy, the Government tendered for a research report on the effects of alcohol

pricing and promotion. In the event, the contract was awarded to a research team at

Sheffi eld University, and the report was published in two parts.

The fi rst part provided a

systematic review of the

international evidence on the

link between the price and

promotion of alcohol on the

one hand and patterns of

consumption and alcohol-

related harm on the other, as

well as the effectiveness of

related policy interventions.

In particular, the review

indicated how the promotion

and pricing of alcohol affects

total alcohol intake, and

patterns of consumption in

groups identifi ed as priorities

by government, namely

underage drinkers, young

adult binge drinkers, heavy

drinkers, and those on low

incomes.

The second part modeled

the potential implications of

changes to current policies

on alcohol taxation and

promotion, especially the

impact on health, crime, and

employment.

The researchers found

that the exact size of the

impact of price measures

varied between countries

and a major limitation of

the evidence base is that

most studies examining

the impact of such policies

have been conducted

in the United States.

Nevertheless, they say there

is very strong evidence for

the effectiveness of alcohol

taxes in targeting young

people, heavy drinkers

and the harmful effects of

alcohol.

The second part of the

University of Sheffi eld report

amplifi es the fi nding that

alcohol pricing policies are

effective in reducing alcohol-

related health, crime and

social costs, and it analyses

over 40 separate policy

scenarios, including setting

minimum prices per unit of

alcohol at different levels

and bans on price-based

promotions in off licenses

and supermarkets.

The results of the research

show that targeting price

increases at cheaper types

of alcohol would affect

harmful and hazardous

drinkers far more than

moderate drinkers. Heavier

drinkers, by defi nition,

buy more alcohol, but

detailed analysis of data

on purchasing patterns

also shows that they

tend to buy more of the

cheaper beers, wines and

spirits. The effects of price

increases may incidentally

be advantageous for alcohol

retailers (both in off-trade

and on-trade) because the

estimated decrease in sales

volume is more than offset

by the unit price increase,

leading to overall increases

in revenue.

The detailed fi ndings of the

research are:

Across the board price

increases can have a

substantial impact on

reducing consumption,

and consequently, harm.

Such price increases mean

that there is less incentive

for switching between

different types of alcohol

or drinking venues (for

example by going to the

pub if supermarket alcohol

is getting more expensive)

than in policies targeting

price increases at certain

products or market sectors.

Pubs and supermarkets

are equally affected by a

general price increase,

although it has been argued

that supermarkets may

be less likely than pubs to

pass on such price rises to

consumers.

Across-the-board price

increases (covering all

products in the on-trade

Dr Petra Meier “This is the fi rst study to integrate

data on alcohol pricing and purchasing patterns,

consumption and harm, to answer the question of

what would happen if government were to introduce

different alcohol pricing policies. The

results suggest that policies

which increase the price

of alcohol can bring

signifi cant health and

social benefi ts and

lead to considerable

fi nancial savings in

the NHS, criminal

justice system and

in the workplace. “

what would happen if government were to introduce

different alcohol pricing policies. The

results suggest that policies

which increase the price

of alcohol can bring

signifi cant health and

social benefi ts and

The main conclusion of the study, overall, was that pricing

policies can be effective in reducing health, crime and

employment harm. Pricing policies can be targeted, so

that those who drink within recommended limits are hardly

affected and so that very heavy drinkers, who cause by far

the most alcohol-related harm, pay the most. Minimum

unit pricing and bans on alcohol discounting could save

hundreds of millions of pounds every year in NHS, crime

and employment costs. If policy makers wish to see the

greatest impact in terms of crime and accident prevention,

through reducing the consumption of 18-24 year old binge

drinkers, they need to consider policies that increase the

prices of cheaper drinks available in pubs and clubs as

well as supermarkets.


and off-trade) tend to lead

to relatively larger reductions

in mean consumption for

the population, compared to

other pricing options.

Policies targeting price

changes specifically on

low-priced products or

certain product categories

lead to smaller changes in

consumption, as they only

cover a part of the market.

Minimum pricing is a policy

which sets a minimum price

at which a unit of alcohol

can be sold. Price increases

are targeted at alcohol that

is sold cheaply. Cheaper

alcohol tends to be bought

more by harmful drinkers

than moderate drinkers and

studies show that it is also

attractive to young people.

So a minimum price policy

might be seen as beneficial

in that it targets the drinkers

causing the most harm to

both themselves and society

whilst having little effect

on the spending of adult

moderate drinkers.

Approximately 27% of off-

trade alcohol consumption is

purchased for less than 30p

per unit, compared to 9%

in the on-trade. 59% of off-

trade consumption and 14%

of on-trade consumption is

purchased for less than 40p

per unit.

Increasing levels of minimum

pricing show very steep

increases in effectiveness.

Overall reductions in

consumption for 20p,

30p, 40p, 50p, 60p, 70p

are: 0.1%, 0.6%, 2.6%,

6.9%, 12.8% and 18.6%.

Minimum prices targeted at

particular beverages are less

effective than all-product

minimum prices. Differential

minimum pricing for on-

trade and off-trade leads to

more substantial reductions

in consumption and harm

(for example, pairing a 30p

minimum price in the off-

trade with an 80p on-trade

minimum price gives a

reduction in consumption of

2.1% compared to 0.6% for

off-trade alone.

In relation to off-trade

promotions and discounts

(such as buy one get one

free offers), just over 50%

of all alcohol purchased

from supermarkets is sold

on promotion, although

many of the discounts are

quite small. Only quite tight

restrictions on the level of

discount offered would have

noticeable policy impacts.

For example, banning only

buy-one get-one free offers

has very little effect on

consumption and harm.

Bans on discounts only for

lower-priced alcohol (less

than 30p per unit) are also

not effective in reducing

consumption. A ban on

discounts of greater than

20% (which would prohibit

buy-one-get-one-free, buy-

two-get-one-free and buy-

three-get-one-free) leads

to overall harm reductions

similar to a 30p minimum

price.

A total ban on off-trade

discounting is estimated

to reduce consumption

by 2.8%, although this

may only prove effective if

retailers were also prevented

from responding by

simply lowering their non-

promotional prices.

In regard to alcohol

advertising, it is unclear

whether advertising

restrictions can be expected

to have an immediate

effect on consumption.

The international evidence

suggests that effects

of advertising may be

cumulative over time,

and may work through

influencing attitudes and

drinking intentions rather

than consumption directly.

In regard to the savings for

each policy the review has

looked at relating to health

harm, the general pattern is

that the more restrictive the

policy, the greater the harm

reduction.

Higher minimum prices lead

to greater harm reductions,

and this goes up steeply

– for example, there is

relatively little effect for a

20p minimum price, but

30p, 40p, 50p and 60p have

increasing effects. Similarly,

a ban on just BOGOFs

(buy-one-get-one-free)

does not affect health harm

very much, but banning

discounts larger than 10%,

or even a total ban on sales

Alcohol pricing and promotion

Spring 2009 Alcohol Alert www.ias.org.uk 17

promotions in the off-trade

lead to substantial estimated

harm reductions.

For example: A 40p

minimum price gives an

estimated reduction of

around 41,000 hospital

admissions per annum.

A minimum price of 30p is

estimated to reduce total

crimes by around 3,800

per annum whereas a 40p

minimum price is estimated

to reduce crimes by 16,000

per annum and a 30p off-

trade paired with an 80p

on-trade minimum price

by 68,000 per annum. An

off-trade discount ban

would lead to an estimated

prevention of 14,000 crimes

per annum, of which 4,000

are violent offences.

Crime harms are estimated

to reduce particularly for

11-18 year-olds as they

are disproportionately

involved in alcohol-related

crime and are affected

significantly by targeting

price rises at low-priced

products. Crime costs are

also estimated to reduce

as prices increase. A 30p,

40p and 30p(off-trade)/80p

(on-trade) minimum price is

estimated to lead to direct

cost savings of around

£4m, £17m and £65m

per annum respectively,

whereas the value of gains

in quality of life associated

with decreased crime is

estimated at £4m, £21m

and £88m per annum

respectively.

A ban on price promotions

in the off-trade decreases

direct crime costs by £18m

per annum and the cost of

quality of life lost by £25m

per annum. It is important

to note that different policies

emerge as effective when

compared to health harms:

discount bans, targeting

cheap off-trade alcohol

and low minimum pricing

options, which influence only

the off-trade sector, are all

less effective in reducing

crime when compared to

policies that also affect

the on-trade sector. This

is because many of the

offenders are young males

who purchase just over

75% of their alcohol in the

on-trade.

The Independent Review

report can be downloaded

at:

http://www.dh.gov.

uk/en/Publichealth/

Healthimprovement/

Alcoholmisuse/DH_4001740

Community Pharmacies promote alcohol awareness

Community pharmacies are

being mobilized to promote

alcohol awareness as part

of the `Know Your Limits’

campaign. Dr Keith Ridge,

the Chief Pharmaceutical

Officer, has written to

pharmacists urging them

to participate and a special

campaign pack has been

distributed to help

them.

Community

pharmacies

and staff

are

regarded

as key

to

ensuring that the

national campaign messages

are communicated to the

general public. In

England, most people’s

first – and sometimes

only – contact with a

pharmacist is through their

local community pharmacy.

Approximately 1.6m people

walk into pharmacies

everyday and 1.2m walk in

for health-related reasons.

In the past six months

three-quarters of people

have visited a community

pharmacy.

Community pharmacists are,

therefore, particularly well

placed to deliver health

messages to the public. The

activity pack is designed to

support pharmacists and

their staff in

promoting

awareness

of the

alcohol units

messages. The pack

gives ideas and guidance on

how the awkward subject of

alcohol can be approached

with customers and on how

pharmacies can work with

the local media and health

professionals to promote the

message.


Raising the Bar:preventing aggression in and around bars, pubs and clubsBy Kathryn Graham & Ross Homel Reviewed by Audrey Lewis, Chair of Licensing Committee, Westminster City Council

The world explored is almost

entirely English speaking.

Australia predominates,

reflecting the nationality of

one of the authors; the other

author being Canadian,

there is much examination

of attempts there to examine

the causes of the violence

there and in the US.

There are reports carried

out of the work reported by

British authors, particularly

Philip Hadfield. A few

references to Iceland and

Sweden. My reaction is not

that the authors have done

a sloppy job in being so

restrictive in their coverage

but that it accurately

represents the parts of the

world where you might

expect to see alcohol-related

violence around bars. I am

not suggesting that there

isn’t excessive drinking in

Russia and North Germany

and perhaps Holland but I

can’t recall hearing it being

associated much with

violence.

The Metropolitan Police

kindly asked me to meet

one of the authors two

years ago and I mentioned

to him, over dinner at

Scotland Yard, the study

done by Hall and Winlow,

‘Violent Nights’ 2006, which

tried to understand why

alcohol is so associated with

violence in this country. No

reference is made to it in

this but I kept thinking back

to ‘Violent Nights’ as I read

‘Raising the Bar’.

Why is it that there is so

strong an association

with violence and alcohol

in some countries? Hall

and Winlow’s thesis was

that a section of English

people choose to establish

their role in society by the

way in which they handle

themselves in these licensed

premises – these were

sought out arenas, selected

with the expectation of an

opportunity to pick a fight

with a stranger.

It seems generally accepted

that the first result of

drinking alcohol is a

lessening of inhibition. Why

does that lead to animated

conversation and laughter

in so many countries and to

mindless violence among

certain English speaking (on

the whole) men?

Raising the Bar can be

thoroughly recommended

to anyone responsible

for stopping violence in a

particular place. e.g.: Don’t

give the opportunity for

people to bump into people

or furniture, train not only

the door staff but all the

other staff - servers, security,

shot dispensing girls and

DJs to create an ordered

environment in which people

do not get excessively drunk

and in which good-order

obviously reigns. Know

how to get rid of the people

who are not prepared to

accept this.

H ow many readers of this publication are responsible for managing large pubs, bars or nightclubs, I wonder? Not many perhaps, which would be a pity

so far as their getting to hear about “Raising the Bar” is concerned. This is a detailed, thorough, academic study of the attempts that have been made to reduce alcohol-related violence in or just outside bars and nightclubs. Just that. No wonder as to how the people found themselves to be in those bars, the worst for drink.

Audrey LewisChair of Licensing CommitteeWestminster City Council


Raising the BarPreventing aggression in and around bars, pubs and clubs

Kathryn Graham (Centre for addiction and Mental Health, OntarioRoss Homel (Griffith University)

Willan Publishing – Crime Science SeriesISBN-10: 1-843923-18-1ISBN-13: 978-1-84392-318-3Published September 2008

New PublicationRaising the Bar:preventing aggression in and around bars, pubs and clubsBy Kathryn Graham & Ross Homel Reviewed by Audrey Lewis, Chair of Licensing Committee, Westminster City Council

But what happens when

they get outside? What,

indeed, would happen

if every alcohol-led

establishment was closed?

(There is an interesting

question posed here about

the closing of skid row

types of bars and pubs

where getting drunk was

generally accepted. Did

their patrons stop drinking

when the premises got shut

down or did they, as both

I and the authors believe,

become the street-drinkers

who now dominate so much

of the expressed concern

of people living in crowded

cities. I am inclined to

agree that they were safer

and less trouble in their

original environment.)

In my work as Licensing

Chairman in an inner city,

‘Raising the Bar’ gives me

the confidence to insist that

bars and clubs must find

ways to deter violence as

there are detailed accounts

of what has proved

successful. Of course, I

know I’m really just saying

‘don’t come to Westminster

if you want to behave like

that’. However, I am

also currently involved in

helping the City develop its

second edition of its Alcohol

Strategy, working across

partnership with a wide set

of agencies, particularly

the social services and the

Primary Care Trust. Does

‘Raising the Bar’ help me to

do that? Well, I’m grateful

for its confirmation that

relying on spotting who

is getting drunk in large

premises is so incredibly

difficult, particularly in areas

like my own where residents

are outnumbered four to

one, that it’s hardly worth

attempting. So much of

popular expectation is built

round models based on the

Bull and the Vic. The reality

is dark, very noisy places

where you can’t speak to

your friends and you have

to keep drinking because

there’s nowhere to put your

glass down.

The book didn’t mention

smoking. The smoking

ban, together with job

losses and the cheap price

of supermarket alcohol

fuel reports of diminishing

attendance in clubs and

pubs and may contribute

to a lessening of nuisance

for city residents. I can

only hope that they won’t

lead to a transfer of alcohol-

related violence and the

establishment of macho

values being even more

common in people’s homes.

Just think of the extra extent

by which children would be

exposed…..


This is not, however, just a

book for lawyers. It is as

good an introduction and

overview as I have ever seen

to the subject of substance

misuse, with more

emphasis than usual on the

relationship between misuse

The author of this book is a

consultant psychiatrist who is

also qualified as a barrister. He

regularly contributes to legal as well as

medical journals and acts as an expert

witness. This excellent book covers wide

ranging medical and substance misuse

issues. In legal terms the emphasis

is on family and criminal law, although

other subject areas such as contract and

employment law are also considered.

Substance misuse in psychiatry:A guide for lawyersReviewed by Jonathan Goodliffe, Solicitor

and psychiatric disorders.

There is a detailed

general introduction and

a glossary for diffi cult

expressions. There are then

separate chapters on the

leading drugs (other than

nicotine) covering clinical,

behavioural, assessment,

management and

prognosis issues, as

well as medico-legal

considerations.

The longest chapter

(40 pages) is on

alcohol. It contains,

among other things, a

balanced consideration

of confl icting

theories.

The style of this book

makes for interesting and

stimulating reading. This is

partly because it challenges

the lay reader to understand

the clinical issues and how

they relate to the behavioural

side of substance misuse. It

also considers, in layman’s

language, some of the fi ner

points which arise in the law.

One of the reasons I fi nd

it valuable is because my

own interest in the subject

has tended to be focused

on alcohol. I am conscious

that the study of problems

relating to alcohol should

recognise the wider drug

context and that people are

increasingly misusing more

than one substance.

There are many insights and

throw away lines in this book

that have a wider interest.

For instance the author

refers to a Court of Appeal

judgment (R v Mental Health

Act Commission ex parte X

(1988) 9 BMLR 77) on the

Mental Health Act 1983. It

may also be relevant to the

interpretation of substance

misuse exclusion clauses in

insurance policies.

On the subject of cocaine,

the author remarks:

‘It has been suggested –

with little by way of any hard

evidence emerging – that

upheavals which are a

periodic feature in fi nancial

markets are occasionally

due to a single trader or a

group of these who have

been emboldened in undue

risk-taking by the intake

of illicit substances, in

particular cocaine, rumoured

to be the substance of

choice in the City of London

and other fi nancial centres.’

Could the lack of hard

evidence relate to the

diffi culty of investigating the

subject and the fact that it

has not been a suffi ciently

popular focus of evidence

based research? Or should

the lack of evidence be

taken to suggest that the

proposition is unfounded?

If one were to expand the

area of enquiry from fi nancial

markets strictly speaking

into banking and insurance,

would cocaine rather than

alcohol really emerge as

the primary substance

of choice? The fi nancial

downfall of Robert Maxwell,

for instance, as well as his

ultimate death, may have

had at least something to do

with his very heavy drinking.

‘Substance misuse in

psychiatry - A guide for

lawyers’

ISBN13: 9781846611476

Published by Jordan

Publishing Ltd, £50

(discounted to £47.50 on

Amazon).

By Bala Mahendra

JonathanGoodliffe

nicotine) covering clinical,

behavioural, assessment,

management and

prognosis issues, as

well as medico-legal

considerations.

The longest chapter

(40 pages) is on

alcohol. It contains,

among other things, a

balanced consideration

of confl icting

The Archbishop of Wales

with the six other Welsh

Bishops and the four Chief

Constables of Wales lead

the campaign which is

supported by a wide range

of other organizations. It is

aimed to tackle the range

of problems associated

with excessive drinking,

from out-of-control

revellers in city centres on

a Saturday night to people

regularly consuming too

many bottles of wine at

home on weekday

evenings.

As part of the

campaign,

people

concerned

about

how

much

they

drink

are

invited to

take a “Pledge” to cut

down the amount they

drink and to stop before

they have had too much.

Drinkers can sign up to the

Pledge online and carry

a card to remind them of

their commitment and give

them support against peer

pressure.

Posters and leaflets are

being circulated to remind

people of the

damaging

effects of binge drinking

and the huge cost it has

on themselves, their

families and friends and

society as a whole.

The campaign supports

the Welsh Assembly

Government’s Substance

Misuse Strategy.

Launching the campaign,

the Archbishop of

Wales, Dr Barry Morgan

emphasised that the

challenge of today’s

Pledge was not to give up

alcohol altogether but to

give up binge drinking:

“Alcohol isn’t the problem

– it is our attitude to it

that counts. Drinking

can be an enjoyable

part of our social life

but not when we abuse

it – harming ourselves and

others. The challenge

is to change our own

thinking and the prevailing

culture and attitude in

Wales which equates a

good night out, or even a

good night in, with drinking

to excess.

“This is what needs

challenging and this is why

we are saying Enough is

Enough.”

Those interested can sign

up for the pledge at:

www.alcoholpledge.co.uk

Alcohol Pledge Wales Campaign

Spring 2009 Alcohol Alert 21www.ias.org.uk

The most senior churchmen and police officers in Wales have joined forces in a

campaign to tackle the culture of binge drinking by spreading the message that

“Enough is Enough”. The centerpiece of the campaign is a pledge that drinkers

are invited to sign in which they commit themselves not to `binge’ drink.

Dr Barry MorganArchbishop of Wales

regularly consuming too

many bottles of wine at

home on weekday

evenings.

As part of the

campaign,

people

concerned

about

how

much

they

drink

are

invited to

people of the

damaging

Wales, Dr Barry Morgan

emphasised that the

challenge of today’s

Pledge was not to give up

alcohol altogether but to

give up binge drinking:

“Alcohol isn’t the problem

– it is our attitude to it

that counts. Drinking

can be an enjoyable

part of our social life

but not when we abuse

it – harming ourselves and

others. The challenge

is to change our own

Phot

ogra

ph:

Geo

rge

Cong

er

Alcohol Alert is published byThe Institute of Alcohol Studies

a Registered Charity12 Caxton Street

LondonSW1H 0QS

Telephone: 020 7222 5880

Fax: 020 7799 2510

Email: [email protected]

alert spring 2009 final - ias alcohol alert2 spring 2009 introduced to alcohol. so i hope the chief...

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