Keith HumphreysProfessor of Psychiatry, Stanford University School of

MedicineVisiting Professor of Psychiatry, King’s College London

Alcohol Research UK Conference 12 March 2013

What is the Role of Science in Public Policy Formation?Can identify emerging problems of policy concern

Can determine whether policies are delivering their promised impacts

Can suggest new policies that could be tried

BUT cannot tell us what we care about as a society

Why Be Explicit About the Values Basis of Public Health?

Being a scientist does not convey the right or ability to rule

It’s undemocratic and potentially dangerous for scientists to represent their values as proven facts

Public trust may be gained by values-based appeals

Three Evidence-Informed Alcohol Policies That Will Promote Public Health and Public Safety

Mandatory sobriety for alcohol-involved violent offenders

Expansion of treatment and recovery for alcohol dependent people

Minimum unit pricing of alcohol

Mandatory Sobriety for Repeat Drink Drivers in South Dakota

All offenders orientated to programme rules

Twice-daily breath testing or alcohol-sensing bracelet

Alcohol use or no show results in prompt arrest and certain, modest punishment (1 night in jail)

Domestic Violence and Mandatory SobrietyImpact on arrests evaluated quasi-

experimentally as program was rolled out over South Dakota

Counties with the programme experienced a 12% reduction in repeat drink driving arrests

Counties with the programme also experienced a 9% reduction in domestic violence arrests

Kilmer, B. et al (2013). American Journal of Public Health. Jan;103(1):e37-43

Current Status in the UK

Already in operation in Scotland

Programmes legally established in England and Wales as of 1 May 2012

But implementation has been slow

Expanding Access to Alcohol TreatmentWell-validated psychosocial and

pharmacological treatments for alcohol use disorders are now available

Prior UK policy funded drug treatment disproportionately

Creation of Public Health England is an excellent opportunity to expand access to alcohol treatment

UK Treatment Professionals Under-Refer to Recovery GroupsMultiple randomized clinical trials show

positive clinical benefit from facilitated access to 12-step groups

Yet many UK professionals are convinced that 12-step groups are rarely or never valuable

Professionals have a responsibility to educate themselves about the science and also to personally investigate (i.e., visit some open meetings)

Timko RCT on AA/NA referral 345 VA outpatients randomized to standard or

intensive 12-step group referral

Higher rates of 12-step involvement in intensive condition at 6 month follow-up (82% located)

Over 60% greater improvement in ASI alcohol and drug composite scores in intensive referral condition

Source: Timko, C. (2006). Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes. Addiction, 101, 678-688.

The Logic of Minimum Unit PricingHeavy drinkers spend about 80% less per

unit of alcohol than light drinkers

Consumption of high-strength, low-cost beverages is associated with health and safety damage from alcohol

MUP thus may generate health and safety gains despite applying to a small minority of beverages

Sheffield Group Modeling of Annual Impact of a 50p MUP in England2930 fewer deaths

92,200 fewer hospital admissions

274 million GBP lower spendSource: Purshouse, R.C., Meier, P.S. et al. (2010). The Lancet, 375, 1355-1364

Direct Evidence from CanadaBritish Columbia studied from 2002-2009

A 10% increase in average minimum price for all alcoholic beverages was associated with a 31.7% reduction in wholly alcohol-attributable deaths

The impact was evident despite concurrent expansion of private liquor stores in the provinceSource: Zhao, J., Stockwell, T., et al., (2013). Addiction. DOI: 10/1111/add.12139

Other MUP issues in UK

Already the law in Scotland

“Save the pubs, support minimum pricing of alcohol”

MUP should be indexed to inflation

EU regulatory questions

SummaryScience can help us make more public health-oriented

alcohol policy iff we openly choose that value framework

Mandatory abstinence programmes are now in the law of England and Wales and should be implemented

PHE should enhance access to alcohol treatment and encourage knowledge and respect for recovery organisations

A minimum unit price for alcohol would reduce the public health and safety damage of heavy drinking