Review of Alcohol Treatment Services

recovery partnership



Review of Alcohol Treatment Services

Alcohol Concern undertook a project on behalf of the Recovery Partnership to review the current state of alcohol treatment in England. Alcohol Concern conducted three national surveys, 46 interviews, and 14 workshops to find out how recent changes in health and social care have impacted on the service user journey through services,  commissioning, the training cof staff and the needs of specific groups, especially carers.

The review identified four key findings:

  • The enthusiasm of the alcohol field for being involved in a debate about its future;
  • the gap in meeting the needs of people with ‘dual diagnosis’;
  • managing change resistant drinkers with chaotic patterns of behaviour;
  • the problems being experienced in the residential rehabilitation sector.

Read the full report here (pdf).

Further detail regarding dual diagnosis:
The most powerful of these was the failure to meet the needs of the dually diagnosed. The view was that this ongoing problem may be worsening because budgets have been cut in mental health services and they are now commissioned by a separate body (CCGs) from alcohol services (Public Health). This represents a real blockage in the pathway of care for problem drinkers. Moreover it is not one that can easily be resolved at the local level
And regarding physical health:
A widely held view was that the physical health of alcohol service users is worsening. This links to national concerns about the rising rate of alcohol related liver disease. This raised questions about professional training and whether the pressure to reduce costs is reducing knowledge about physical ill-health.
It’s a 75 page report and I have chosen to highlight these these two paragraphs.  Why?
Because I’m a general nurse, with alcoholic liver disease experience, who having worked for a psychologist, knows that these are the two biggest issues – mental and physical well-being.  Yet alcohol remains a law and order issue for the UK govt ……..

Kenyan ‘killer brew’ addicts losing both alcohol and private parts

This was a news feature on the BBC website in July looking at the issue of drinking in Kenya.  Locally in Kenya it is called ‘killer brew’ because of it’s potency as a home-brew.

kenya's killer brew




Authorities in Kenya are cracking down on illicitly brewed alcohol following a recent spate of deaths.

Homemade alcohol, sometimes called “killer brew”, is popular among poorer Kenyans in central parts of the country.

Addiction is having a devastating impact on many communities and, as BBC Pop Up discovered, some wives have been driven to desperate measures.

Produced by the BBC’s Christian Parkinson

Local communities are being destroyed by the men’s addiction to this cheap and potent illegal home brew which the govt are tracking down and destroying.  In desperation Kenyan wives are resorting to cutting off their husbands genitalia because of their drinking induced impotence.  A Kenyan businessman has responded to this by producing metal protective belts for men to wear that resemble a chastity belt.

This may seem like a joke but for these communities alcohol is causing devastation and this is how they have responded.  The Kenyan women just want alcohol gone and celebrate at its destruction when burned.

Kenyan authorities have now stepped in to try to resolve the growing problem and the BBC reports that:

There has been a massive crackdown on the sale and consumption of illegal alcohol in Kenya over the past month.

For the thousands who struggle with alcohol abuse, they can now receive help at central Kenya’s football stadium, which has been converted into a rehab centre.

The BBC’s Emmanuel Igunza has been along – some of the names in his report have been changed to protect people’s identities.

Kenya football stadium tackles alcohol abuse


What it’s like to be a recovering alcoholic in an office where booze is everywhere

A great blog on Vox recently talked about what it’s like to be a recovering alcoholic in an office where booze is everywhere.

booze and work






I am 16 months out of an intensely abusive relationship with alcohol. At home, my wife helps me stay sober by supporting me and encouraging me to drink flavored seltzer water instead of the craft beers I used to down at every opportunity. But for the majority of my waking hours, I am constantly tempted to drink — at work, where alcohol is everywhere.

I work at a digital design firm. There’s a stereotype that all design and tech firms have a keg on tap at the office. My office one-upped the keg and went with an Arkeg: basically what happens when a video game arcade and a keg make a baby. There is also a refrigerator stocked with beer that employees have access to at any time.

What I’ve experienced isn’t unique to the tech field, though: Most industries have their own issues with alcohol. Here’s what it’s like to be an alcohol abuser in a hard-drinking workplace — and what offices like mine can do to create a healthier environment for people who struggle with alcohol.

How work made it easy for me to drink too much

Before I got sober, I would often grab a beer or two at noon, then have another beer or two just before leaving for the day. I might drink a couple extra on Friday just to make sure I was heading into the weekend on a positive note. I had survived another week in the rat race, so I deserved these drinks. We all deserve all the drinks, right?

The office beer refrigerator wasn’t the only way to drink at work. I would also attend after-hours client meetings, which included drinks before, during, and possibly after a meal. If we were up for it, the drinking might continue at additional venues. This behavior makes a lot of sense from a business perspective — clients and potential clients get chattier, happier, and potentially a lot looser with their money when lubricated with alcohol.

I had one goal at these events — get drunk and go unnoticed. I learned to find the beer with the highest ABV (alcohol by volume, listed conveniently next to each drink on the menu) and order it. Ask the waiter to keep them coming if they saw my glass empty. I knew the bill would come out and unfold like an ancient scroll, and my drinks would blend right in with everything else the group had ordered.

And then there was traveling for work. I had a ritual — I’d show up at the airport and grab a couple drinks. Then I’d hope I’d get upgraded to first class and have a few free drinks on the plane. Then I’d land, check in at the hotel, and hit the hotel bar; nothing to do anyway until the next day. Depending on what I was traveling for, I’d spend the next day with clients and the next evening drinking with them. If I wasn’t going out with clients in the evening, I’d drink myself into a stupor in the hotel bar again, or whatever restaurant I chose.

Coming home, I’d repeat the airport ritual. Eventually I knew all the bars at the airports I’d visit most frequently. It felt familiar, like something to look forward to when traveling away from my loved ones. The airport bar — a little piece of home away from home.

I usually wasn’t the one footing the bill for my drinks when I traveled for work, which made it easier to overindulge — put it on the company card!

It seemed like all my co-workers were as in love with alcohol as I was. We talked craft beer, downloaded apps to track the beers we drank, discussed when a limited release was coming out and what bars carried what on tap.

I also assumed I was the only one having any real issue with drinking and its consequences. I didn’t want to talk about it and ruin the mood. I worried that if people found out about my issues there would be no room for me at the table.

How things changed after I quit drinking

I got sober because I wanted my life back. I needed a lot of support, which I received through paid counseling, support group meetings, and from family and friends.

Adjusting to work has been a long, difficult process. I’ve gone through four stages over the past 16 months of sobriety.

Stage 1: Hiding

At first, I avoided drinking-focused work situations. I felt so vulnerable to failing at sobriety, I had to hide from opportunities to drink. I attended Alcoholics Anonymous meetings at lunch. I worked from home whenever possible. I removed myself from the conversation whenever it turned to grabbing drinks.

I didn’t want anyone to know I’d stopped drinking. When our office got a shiny new kegerator, I posted a picture of it to Facebook the day it arrived; I wanted to show the crew I was still a part of things.

Some of my peers noticed I wasn’t going out as much, so I told them I was “taking a break from drinking.” I spun this more as a challenge to myself than as a problem I was trying to solve. “I just feel more energy in the morning when I haven’t been drinking the night before,” I said. I told one colleague I had traveled with on numerous occasions, “I’m just staying away from drinking for now.” “There are so many calories in the beers I drink,” I told another.

Despite my cheery exterior, I felt mopey and sad. I felt disconnected from my colleagues. I had no reference point for what not drinking at my work looked like. Sure, there must have been people not drinking — but nobody openly stated they were refraining from drinking and would support the efforts of anyone else not drinking. I felt like a child. “I can’t do things like the big kids,” I would only half-kid my fiancée, telling her I skipped out on a work happy hour. “I can’t be a responsible adult,” I said. “I’m broken.”

Stage 2: Being angry

My attitude eventually switched from sadness to resentment at how easy it was to drink at work. Now I was mad I couldn’t drink; mad that others could. I’d get revenge. They’ll all see, I’d think, I’ll sober up and then get drunk as fuck because I can. You know, because after I’m sober long enough, I’ll be able to get drunk again. Duh.

I still avoided most situations where drinking was the norm, but it was impossible to stay away from after-hours client meetings. I was the guy who ordered seltzer, tonic, or mineral water. This was embarrassing to me in front of my colleagues. I would tell them, almost apologetically, that I was staying away from drinking. The reasons would change as often as the days of the week: Sometimes I’d say I was honoring my pregnant wife who was also abstaining, sometimes I’d use my more-energy-in-the-morning spiel, and other times I’d say I wrote better when I didn’t drink. I’d started experiencing great success at writing by then, so the excuse worked. I’d say anything except, “I have a problem, and I think it is better for me not to drink.”

Stage 3: Accepting that drinking isn’t for me

I realized I’d shifted from anger to acceptance when it came time for our holiday beer swap. I’d initially signed up for it because I didn’t want to stick out for not participating. But then I decided I didn’t want to spend time or money looking for a craft beer for my colleagues — I wouldn’t benefit from getting the beer, and I didn’t want to stand around and watch everyone exchanging the beer.

Much to my surprise, I felt confident in my decision not to participate in the beer exchange. I was experiencing so much success with writing and work-related projects, and I wanted to keep the momentum going — I wouldn’t drink, I wouldn’t care what others did.

I poured my energy into writing, publishing a dozen articles and getting a book deal. My confidence in refraining from drinking grew with the success I was experiencing professionally. I’d always written, and I’d usually been rejected when attempting to publish. This all started to change as I reached my stride in sobriety. One article would be accepted, then another, then five more. Each article opened another door; each article was another building block for my confidence. Who was going to tell me sobriety wasn’t working for me? No one, but I still didn’t bring it up in conversation, except to occasionally reiterate that I had more energy, more focus for writing, when I stayed sober.

Stage 4: Determined to make a change

I began to feel drastically different as my sobriety approached a year. I became reflective. I understood, statistically, that there were at least three or four people at my work and dozens more I interact with professionally outside the office who experience issues with alcohol abuse.

I wanted to speak up to help others — but I had no idea how. Then I realized, “I’m getting published everywhere I try in industry-related publications. My industry has a drinking problem. Why don’t I put together an article that gives my colleagues some insight into the issue from a personal perspective, along with real ideas for change?” So I wrote an essay for Model View Culture, an online journal aimed at the tech and design community.

I never considered having a conversation with my colleagues as a group or one on one — not without having something published to fall back on. I have always been more comfortable thinking and expressing myself through writing or presenting to large groups. Small groups and one-on-one encounters are too intimate for me; I really need to be comfortable to feel exposed like that.

A week before the article was to be published, I sat down with one of the owners of the firm where I work. He was floored to hear I struggled with alcohol; how could he not have seen it with me working so close to him, he mused. I told him I was very private, that I had wanted it to be a secret — both when I was drinking and as I was sobering up — but now it was time for me to give back to those in need. He agreed and gave the full support of the company in me sharing my story. In sharing my story with colleagues, I have invited them to have the one-on-one conversation with me that I felt unable to have when I was first experiencing sobriety. I know making myself available could be critical to someone who might be searching for support.

What employers can do to decrease alcohol abuse

Here are five concrete steps, regardless of industry, to make workplaces more accepting of sobriety and supportive of those who struggle with alcohol abuse:

Let people know that not drinking is okay

When I first stopped drinking, I felt alone at work. I needed a model for sober behavior. I needed to know that it was okay to be sober, even at company events that might involve drinking.

How can workplaces do this? They can literally tell people it is okay to abstain from drinking. They can provide nonalcoholic options that don’t seem like they come from the Island of Misfit Toys. Here are some other tips from Kara Sowles.

Acknowledge that some people struggle with alcohol abuse

These people are real; they are your colleagues, their parents, and their siblings. They might be your parents or siblings.

Talk about it in the company newsletter, post about it on the company message board, and offer an ear if a colleague does want to discuss an alcohol-related issue. Remove yourself from the situation if you feel you will become judgmental or biased against the person.

Send the message that alcohol abuse isn’t funny

Let’s not have every joke center on how funny it is to go out drinking and cause trouble. Let’s not assume drinking to excess is fun, or the reason to attend an event. We can tell people drinking is fine, and that getting out of hand will lead to getting uninvited to future events. Getting out of hand will result in losing access to the kegerator.

Stop offering free alcohol

Shifting the cultural expectation to BYO or cash bar is a better standard than providing an open bar for staff for an evening of socializing. Sure, free alcohol seems like a nice thing to offer, but it has a real and potentially deadly unseen cost for those prone to alcohol abuse. I think attaching a monetary cost to drinking will reduce the amount of drinking done at work events.

Support people who are struggling

Support is the key — and potentially only meaningful — factor in recovery. If you think you have staff with a drinking problem, you need to give them access to support. This can include counseling covered by health insurance, employee assistance plans, and time to attend support group meetings. Large employers can create an alcohol abuse support group. For an alcohol abuser, nothing compares to the support provided by people who have walked a similar path.

This is a conversation worth having: How are we promoting alcohol abuse, and how can we support recovery? I will do my part to continue the conversation, and I hope you can join me.

Whole Person Recovery

This is a brilliant blog from the RSA website and looks at Whole Person Recovery “the one thing every person wants is to belong somewhere”.  In nursing parlance we would call this holistic care.

whole person recovery







A ‘recovery agenda’ has shifted our focus on support for people with drug and alcohol problems in recent years, but how much recovery still equates to treatment, and how far do we understand the parts the happen next; the parts that so far, remain largely unmeasured and undefined?

As we come to the conclusion of our Whole Person Recovery project, where we’re trialling interventions in drug and alcohol rehabilitation for long-term recovery, we ran a workshop pooling the knowledge of experts, partners, service users and Fellows to discuss the emerging project findings, share learning with others in the field, and explore the priorities we want to see in future policy and deliver. 

The discussion was incredibly useful and very wide-ranging, and the discussion broadly focused on some key themes:

Systems should place more trust in the community. We heard about one recovery centre, where service users ran a daily drop-in session, complementing the structured treatment. Putting that level of trust in service users requires a shift in the way we understand a service user’s journey – giving them the reins not only for their own recovery, but also for those around them. However, there’s a fine line between enabling communities and institutionalising the community, and services should be wary of that.

We often miss a service user’s recovery ‘eureka’ moments. Seizing their positive energy can contribute to their recovery, and set them up as prime candidates to inspire the next group of people going into a recovery programme. Having the space to explore and understand oneself better in recovery is also a key chance to identify what makes that person tick – but often we haven’t got the structures in place to support that.

Measuring effective recovery services is challenging. Commissioned services require measurements and performance indicators. But how can you develop an effective transactional contract for a human journey? Also, recovery is a journey, not a fixed moment in time. 

“If you design a service with fixed, rigid outcome targets you’re probably not going to hit them.”

Recovery uses loaded language: “Relapsing” implies you’re not past your addiction – but it’s an important part of the journey you go through – and in using language like abstinence, relapsing, and lapsing, we fall into a trap of definition rather than functionality. As a service provider, asking questions like “Are you doing alright at the moment?” may not be quantifiable, but gives you answers.

Recovery is a long process, and the structured treatment is only one part. Language can be used for good though – through encouraging community participation and creating a ‘recovery community’, we can help people realise that they are more than a “person in recovery” and are actively part of their local community – be it recovery, locality or interest.

“The one thing everybody wants is to belong somewhere”: What people are recovering from is often conflated with substance misuse – but it’s more than that, it’s about a disconnect from ourselves and others. In one survey that was mentioned, 75% of service users said they wanted to volunteer within their recovery community, but not necessarily within the recovery service. (This dropped to 25% who said they wanted volunteer in the wider community.)

There are still assumptions and stereotypes in place that need talking about: “There’s a weird perception that because I’ve done drugs I’m stupid, and because people’s lives have been a metaphorical car crash, they’re not capable. In fact, they may have picked up skills that make them the most phenomenal staff.”

Put the person, not the service, first: Recovery services work in silos – with competitive commissioning different services are reluctant to share information and mistakes. How can we share learning across different services and peer support groups when you’re constantly competing? And in a Payment by Results model, what is the scope to ensure services are personalised, and owned by the service user rather than the commissioner or the services?

And put the person, not the illness, first: When you take the condition out of the equation – be it drug and alcohol addiction recovery, cancer, depression or Alzheimer’s – you have the same issues: housing, stress, family relationships, and finance. If, structurally, we can’t undo the fragmented system we’ve created, should we be looking at stronger links between care teams and services, to focus on the individual rather than the condition?

If you’re interested in this side of the story, do explore the work of Making Every Adult Matter (MEAM), a coalition of charities fighting so that people experiencing multiple needs are supported by effective, coordinated services, and empowered to tackle their problems, reach their full potential and contribute to their communities.

We should shape systems to focus on people who use them, not on the services and structures – so that people can recognise their individual power and creativity, and can thrive.

A huge thank you to the speakers from the RSA, CRI, aspire2be and MEAM, and attendees who came and contributed their views, stories and experiences at the workshop. The final report will be launched in November – in the meantime, contact me to find out more.

Whole Person Recovery project

Engage with our research

It’s about a disconnect from ourselves and others.  Bingo – that’s it in a nutshell for me.  You?

Parents influence their children’s drinking

Ipsos MORI was commissioned by alcohol education charity Drinkaware to undertake a survey of young people aged 10-17 living in the UK, to provide a picture of their drinking attitudes and behaviours and the report was released in July.

observational learning




This is what the Drinkaware website says:

In November 2014 we carried out a survey on the drinking habits of young people and adults across the UK.

By separately interviewing young people and their parents we are able not only to investigate the drinking habits of young people but also to show how these relate to the attitudes, behaviours and consumption of their parents.

The full Young People Monitor can be downloaded here.

The Executive Summary can be downloaded here.

I was particularly interested in the impact of parental thoughts, feelings and behaviours around their children and whether these influence their children’s drinking.  Instinctively I felt the answer was ‘yes’ because of the evidence around things like Bandura’s social role modelling theory in psychology.  This report provided the evidence to support this feeling.

Parents influence their children’s drinking

There is a clear link between young people’s drinking, drunkenness and harmful drinking and their parental attitudes and whether or not they supervise their child’s drinking. 

  • 15% of those with parents who think 13 or younger is an acceptable age for a first drink say they have felt encouraged to drink by their mum or dad, compared to just two per cent whose parents say 16 or older is the youngest acceptable age to drink alcohol
  • 75% of those whose parents think 13 is an acceptable age to drink have had a drink; only 32% of those whose parents thing 16/17 is an acceptable age

1. Parental drinking was measured in two ways:

  1. Weekly unit consumption, giving categories of lower-risk, increasing risk and higher risk
  2. And AUDIT, giving categories of Low risk (Zone 1), Hazardous (Zone 2), Harmful (Zone 3) and Dependent (Zone 4)
  • 34% of children of lower-risk parents have had a drink; 62% of high risk drinkers
  • 35% of children of AUDIT Zone 1 parents have had a drink; 61% of children of AUDIT Zone 3 or 4 parents
  • Parents who drink above guidelines or who score highly on AUDIT are more likely to think  it’s OK for kids to drink at 13

2. Parental supervision matters:

  • 62% who had first alcoholic drink unsupervised have been drunk, vs 25% who were supervised
  • Unsupervised drinkers are more likely to experience harms (39% vs 8% of those who have never drunk unsupervised).
  • Unsupervised drinkers are more likely to say drinking gives them confidence to meet new friends


Overall, underage drinking is declining. However there remains a group of young people (19% of those who drink) who drink at least once a week. 12% of  10-17 year-olds who drink  have suffered a serious harm as a result (hospitalisation, being in a fight, trouble with the police or being a victim of crime).

There are a range of factors associated with underage drinking, and with harm from underage drinking. These include: parental acceptance of underage drinking; drinking to cope; low mental wellbeing; drinking to feel confident meeting new people; drinking unsupervised; and parental drinking patterns.

So there we have it.  What we do around our children regarding our drinking impacts what they do.  Observational learning applies here just like most other situations ……

Post traumatic growth

This post was triggered by a superb TED talk given by Jane McGonigal that has been watched over 5 million times that Tim Ferriss recommended and it is so good!






Here’s the synposis:

When game designer Jane McGonigal found herself bedridden and suicidal following a severe concussion, she had a fascinating idea for how to get better. She dove into the scientific research and created the healing game, SuperBetter. In this moving talk, McGonigal explains how a game can boost resilience — and promises to add 7.5 minutes to your life.

A bit about SuperBetterSuperBetter helps you achieve your health goals — or recover from an illness or injury — by increasing your personal resilience. Resilience means staying curious, optimistic and motivated even in the face of the toughest challenges. 

She found it being used by others “facing challenges like cancer and chronic pain, depression and Crohn’s disease. Even people were playing it for terminal diagnoses like ALS. And I could tell from their messages and their videos that the game was helping them in the same ways that it helped me. They talked about feeling stronger and braver. They talked about feeling better understood by their friends and family. And they even talked about feeling happier, even though they were in pain, even though they were tackling the toughest challenge of their lives.”

The reason I was so struck by this TED talk is so much of it applied to sobriety.  She talked about post traumatic growth.  Now I’m not saying that getting sober is comparable to the challenges of cancer or chronic pain or a traumatic event (although it can be for some depending on your circumstances of needing to stop).  But for me definitely my slide into alcohol dependence was driven by traumatic life experiences both personally and professionally.

She talks eloquently about post traumatic growth and the 4 factors that support it:

  1. Physical resilience
  2. Mental resilience
  3. Emotional resilience
  4. Social resilience

And what I was hit by was that my sobriety involved implementing all of those things as part of my growth and recovery.

  1. Physical resilience – I took up running before I stopped and have maintained that I think it was a critical shift that started the ball rolling.
  2. Mental resilience – I did a course of CBT in the first year of my sobriety and in the second year took up mindfulness meditation.  TBH reading sober blogs is a way to support mental resilience :)
  3. Emotional resilience –  gratitude practice and positive newsletter services! Quoting Jane here: Here’s a secret from the scientific literature for you. If you can manage to experience three positive emotions for every one negative emotion over the course of an hour, a day, a week, you dramatically improve your health and your ability to successfully tackle any problem you’re facing. And this is called the three-to-one positive emotion ratio. It’s my favorite SuperBetter trick, so keep it up.
  4. Social resilience – the power of sober communities, whether online like here or Soberistas or Club Soda or Living Sober, or in real life such as AA.

And to think that by doing all of these things you can add an extra 7.68 minutes of life a day which cumulatively adds up to 10 years extra!

So to all those people who say that giving up drinking won’t add years to your life but it’ll just feel like it I say b*ll*cks.  Those extra 10 years are going to be the happiest and most resilient of my life 😉

PS Further to last Fridays sober jukebox and all of your lovely feedback I’m going to start winding back the amount of blog posts I write starting with not posting twice on a Friday and we’ll go from there :)

Alcohol pricing and purchasing among heavy drinkers in Edinburgh and Glasgow

More important research from Alcohol Research UK looking at alcohol pricing and purchasing among heavy drinkers in Edinburgh and Glasgow.

cider and vodkaIn Scotland adult sales of pure alcohol are one fifth higher than in England and Wales, with this difference being ascribed particularly to sales of cheaper sprits such as vodka. In 2011 alcohol-related death rates amongst Scottish men were 1.8 times those of their counterparts in England, for women the ratio was 1.75 (Beeston et al., 2013). In 2006 alcohol-related death rates amongst Scottish women actually exceeded those of men in England and Wales (Beeston et al., 2012).

The purpose of this study was to describe the purchasing patterns and consumption behaviour of heavy-drinking individuals who had been harmed by their alcohol intake.


The baseline sample had a mean age of 45.6 years. 72% were male, 28% female. Levels of alcohol consumption among participants were very high, with a median weekly consumption of 185 units. Weekly consumption among men (median=196 units) was significantly higher than among women (median=158 units).

Participants generally bought alcohol cheaply, paying a median price of 40p per unit. 95% of all purchases were made in off-licences and the median weekly expenditure was £70. The three most popular drinks were vodka (27% of all units purchased), white cider (24%), and beer (20%). Vodka accounted for the greatest proportion of alcohol purchased by women (41%); for men this drink was white cider (26%). Whisky, a spirit drink traditionally associated with Scotland, accounted for only 5% of purchases.

Off-sales accounted for 95% of purchases, of which 85% of units were purchased at a price of less than 50p per unit. 34% of all units were purchased from supermarkets, 49% from corner shops, 9% from off-licences and 3% other outlets e.g. petrol stations.

Comparison with pilot data collected in 2008/09 showed that a fall in the affordability of alcohol had been off-set by this type of heavy drinkers switching to cheaper products. White cider was an important buffer: its cheap unit price (average 17p per unit) allowed it to be used as a fallback drink when finances were restricted. It is already recognised that very heavy drinkers tend to buy alcohol cheaply; our findings demonstrate that, as long as very cheap alcohol is available, falling affordability is cushioned by trading down.

Among the general population of Scotland in 2012-13, most alcohol purchased in the off-trade was sold at 35-44.9p per unit (Beeston et al., 2013). In contrast, our participants purchased the largest proportions of their drinks within the 15-19.9p and 35-39.9p per unit price bands.

Despite the economic downturn and recent changes to the welfare system, usually resulting in reduced income, most participants were still able to maintain their level of consumption. This was especially the case for those drinking cheaper products such as white cider and vodka. However, consequences of increased expenditure on alcohol included a reduction in food purchasing and heating, and falling into – or increasing – debt. Some participants coped by pooling or sharing resources, either money or alcohol, with other drinkers. There was little evidence of substituting other substances for alcohol or consumption of illicit alcohol in our sample.

Men drank significantly more than women in deprivation quintiles 1, 2 and 4, but not in quintiles 3 and 5 (5 being least deprived). Among women, the association between alcohol consumption and harm was influenced by two key factors: increased deprivation and being recruited in Glasgow rather than Edinburgh. In this, the study findings reflected a phenomenon sometimes referred to as the ‘Glasgow effect’, in which health outcomes across a wide range of measures are worse for people living in Glasgow than elsewhere (Gray and Leyland, 2008).

In the 639 patients, 161 (25%) reported consuming white cider in their most recent or ‘typical’ week of drinking. Of these, 72 participants drank white cider exclusively. White cider drinkers consumed significantly more alcohol (median=249 units) than the no white cider group (median=174 units). Women were half as likely as men to be a white cider drinker. Those in the least deprived group were one-fifth as likely to drink white cider as those in the most deprived group. While men consumed significantly more alcohol than women overall, among white cider drinkers men and women consumed similar numbers of units.

All white cider was purchased exclusively at off-sales outlets: 77% of white cider units were purchased at independent licenced grocers, 13% from supermarkets and 10% from other off-licences (drinks retailers, garages and newsagents). When asked to state their reasons for purchasing white cider, the majority (83%) reported that it was chosen because of its cheapness. One participant advised that it was cheaper than heroin while others alluded to its role as a ‘buffer’ that was used as a fallback drink when funds were low.

No evidence was identified confirming anecdotal reports in the literaure suggesting an enhanced health harm associated with white cider consumption in particular. Increased health risks are more likely to be associated with the high levels of ethanol consumption among white cider drinkers (which were significantly higher than non-white cider drinkers). The health risk of the alcohol intake reported by participants (equivalent to 4-5 times the UK definition of harmful consumption) is likely to be compounded by smoking (70% of participants smoked).

Interviews with participants revealed a limited understanding of the predicted effects of MUP, but also a concern that removal of cheap alcohol would compromise the budgets of addicted drinkers. The majority of participants lived from day to day, sometimes from hour to hour, and were generally not able to plan ahead, let alone take account of legislation that might not be implemented for years, if at all. Their attitude was that they would deal with any issues if and when MUP (to them merely a vague and obscure concept) was in place. However, for the majority of people we interviewed, who have a high frequency and volume of purchasing, we anticipate that the impact of MUP could be immediate, particularly for the white cider and cheap vodka drinkers. Systems would need to be in place to address possible short-term consequences within this population, such as medical complications associated with alcohol-withdrawal.

Our participants tended to believe that any existing or proposed alcohol policy would not help them reduce their consumption, but that the introduction of, for example, MUP, might reduce the likelihood of younger people developing the same drinking patterns and harms that they had suffered.

Again I find this research valuable as it gives an insight into the reality of the issues of alcohol.  Their median age is horribly young at 45.6 (so younger than me).  Their consumption amount wasn’t a shock at almost 200 units for men and over 150 units for women as this is what I typically saw on the ward.  I’m embarrassed to say I have been known to drink K cider and had no idea it had an ABV of 8.4%!!  This and vodka seemed to be the drink of choice, not Scottish whisky.  White cider has a horrifyingly low price per unit of 17p hence its popularity.  White cider drinkers consumed significantly more alcohol (median=249 units) than the no white cider group (median=174 units).  While men consumed significantly more alcohol than women overall, among white cider drinkers men and women consumed similar numbers of units.  The most shocking revelation was: One participant advised that it (white cider) was cheaper than heroin while others alluded to its role as a ‘buffer’ that was used as a fallback drink when funds were low.

Cheaper than heroin.  I simply don’t know what else to say ……..

Extending alcohol treatment could save 12,000 lives a year in EU

This was a research article on Findings Effectiveness Bank looking at how many deaths would be prevented by extending effective treatment to up to 40% of dependent drinkers across the European Union.

This many people
This many people






Modeling the impact of alcohol dependence on mortality burden and the effect of available treatment interventions in the European Union.

Summary The featured analysis estimated the proportions of deaths among 15–64-year-old residents of the European Union due to drinking, heavy drinking and alcohol dependence, then how many of these deaths would be averted by if varying proportions of dependent drinkers (from 10% to 40%) were engaged in different types of treatments or brief interventions. The results give an indication of the lives which might be saved if treatment was extended to more of the dependent population. The interventions considered were: among alcohol treatment caseloads, prescribing acamprosate or opioid antagonists like naltrexone, motivational interviewing, or cognitive-behavioural therapy; and among hospital inpatients identified as heavy drinkers while being treated for other conditions, brief interventions.

Dependent drinkers entering treatment were assumed to be among the heaviest drinkers in each country. Their consumption was estimated to fall as a result of treatment by amounts indicated in major reviews of treatment evaluation research. In turn this was estimated to reduce their risk of death due or partly due to alcohol. For the year 2004, the difference between the number of deaths due to untreated drinking versus the number expected if 10% to 40% of the heaviest and dependent drinkers were treated was the basis for calculating the proportion and number of alcohol-related deaths saved by treatment.

Main findings

Across the European Union it was calculated that about 86% of adults were drinkers, 9.4% heavy drinkers, and 3.5% dependent. After taking in to account health benefits of moderate drinking on diabetes and cardiovascular disease, in 2004 1 in 7 of all deaths in men and 1 in 13 among women were estimated to have been due to drinking. Nearly 8 in 10 of these deaths were due to heavy drinking and 7 in 10 due to dependent drinking.

Deaths were calculated to be most effectively averted by prescribing acamprosate or naltrexone and by brief interventions in hospitals. Compared to treatment being unavailable, had 40% of the heaviest and dependent drinkers been treated in these ways, it was estimated that in 2004 there would have been 13% fewer alcohol-related deaths among men and 9% fewer among women. These proportions equate to about 10,000 fewer deaths among men due to either treatment, 1700 fewer among women prescribed acamprosate or naltrexone, and 1500 fewer among women who participated in brief interventions in hospitals – in total, nearly 12,000 averted deaths. If just 10% were treated the corresponding figures would fall respectively to about 2500 for men, and for women just below 420 and about 370. In the longer term the number of deaths averted would be greater.

The authors’ conclusions

Mainly due to dependent drinking, alcohol causes a substantial degree of premature mortality in the European Union, but over 10% these deaths could be averted in a year by increasing alcohol dependence treatment capacity and coverage to 4 in 10 of the heaviest dependent drinkers.

I find these research studies fascinating because they give us hard numbers.  So in 2004, and yes I appreciate this is over 10 years ago now, 1 in 7 of all deaths in men and 1 in 13 in women were estimated to be due to drinking.  I find that a staggering number and if those kind of numbers appeared in another health condition there would be strategies implemented to bring that number down pretty swiftly!

Looking at Johann Hari’s works suggestion of diverting revenue currently used in law and order being used to fund more treatment interventions how much could be saved financially, and this is without even considering the more important human cost and the impact on all of those 12,000 families …….

Edited to add:

PHE launches 2015 survey for providers and commissioners of residential rehab

Public Health England is carrying out its second annual survey of the residential rehabilitation sector. This follows last year’s survey and is being done against a background of continuing high-level interest about how the recent changes to healthcare and commissioning systems impact on the sector. The report based on last year’s survey can be found here

Mortality of harmful drinkers increased after reduction of alcohol prices in northern Finland

This was a piece of research from Findings Effectiveness Bank that was shared recently and the full title of the research is: Mortality of harmful drinkers increased after reduction of alcohol prices in northern Finland: A 10-year follow-up of head trauma subjects.

process of alcoholism





Evidence from Finland that the 2004 decreases in alcohol taxes and increase in availability of cheaper drink from abroad led to an increase in alcohol-related deaths and in deaths overall among harmful drinkers.

Summary The huge annual number of alcohol-related head injuries makes it important to know whether this total is influenced by political decisions. More drinking across a population and particularly more drinking to intoxication will increase alcohol-related harm including head injuries. In turn, consumption may be influenced by the price and availability of alcohol; the cheaper and more available alcohol is, the more is consumed and the more harm results. Alcohol taxation is a key policy lever for reducing harm by reducing consumption.

In Finland reduced taxes in 2004 on many alcoholic beverages and increased access to much cheaper alcohol from neighbouring Estonia offered a ‘natural experiment’ through which to assess the impact of taxation and price on drinking and resultant harm. The changes were followed by a marked and rapid increase in consumption across Finland and in particular in Oulu province, where the featured study took place and where alcohol sales rose the following year by 9.3%. Across Finland, alcohol-related mortality simultaneously increased.

The featured study assessed the impact of the taxation changes on all 827 patients who in 1999 were recorded as having attended the emergency room of Oulu University Hospital, the only hospital with a trauma team and neurosurgical services in the province. At issue was whether among this cohort, which included many heavy drinkers, death trends between the years 2000 and 2009 changed after alcohol became more affordable and accessible in 2004.

Any such changes might be more apparent among those known to have been drinking in a harmful manner. Totalling 101 out of the 827 patients, they were identified on the basis of hospital records which noted a diagnosis of alcohol-related disease or acute intoxication preceding admittance during the follow-up period 2000 to 2009.

Whether alcohol contributed to any the 160 deaths recorded from 2000 to 2009 was identified from its presence being noted on death certificates, or from hospital records if the deceased had been in hospital immediately before their death. These were presumed to have been deaths which occurred under the influence of alcohol.

Main findings

During the follow-up period there were clear indications that overall and among harmful drinkers in particular, deaths increased after the 2004 alcohol policy changes. During 2000–2009 the proportion of all deaths which were presumed to have occurred under the influence of alcohol increased significantly, closely paralleling the increase in per capita alcohol consumption in Oulu province. Up until 2004 harmful drinkers died at about the same rate as the other patients, but after then their death rate markedly increased, and their chance of surviving progressively diverged from that of the remaining patients. The result was that after other factors had been taken into account, they were over the whole follow-up period two to three times as likely to have died

The authors’ conclusions

The most striking finding was the significantly increased mortality of harmful drinkers directly after the alcohol price reductions in 2004. Until then harmful drinkers had a similar survival rate to other patients. Moreover, the number of deaths under the influence of alcohol significantly increased after the price reductions.

Such findings have important public health implications. While the example of Finland shows that tax and price decreases increase alcohol-related deaths, the example of the former Soviet Union shows that alcohol control polices which feature price rises can have the opposite effect, dramatically reducing deaths. The lesson from these two ‘natural experiments’ is that political decisions may strongly support or counteract attempts to save lives of hazardous drinkers or those dependent on alcohol.

Reading this research reminded me of this clip with Carrie Armstrong from A Royal Hangover:

And her words “we’re facilitating alcoholism, we’re killing our children, we’re killing our young people and it’s fine because for one person to admit they have a problem is for everyone to admit that actually we all have a little bit of a problem.”

That’s why I used the image at the top of this post about the process of alcoholism.  In my mind cheap booze facilitates alcoholism and this research shows that the consequences of low alcohol prices is killing us ……

I used to drink too much. We Brits have an alcohol problem ….

This ‘comment is free’ video appeared in The Guardian in July and garnered quite a lot of interest if the 600 and counting comments is anything to go by!  It would seem that the topic of whether we have an alcohol problem here in the UK garners a fair amount of heat!

I used to drink too muchNot a good look but one I remember well! The booze sodden fag is a give away for how much had already been imbibed!

I used to drink too much. We Brits have an alcohol problem– video

Deborah Coughlin found herself at an alcohol counsellor after drinking 220 units over a birthday weekend. Ten years and some therapy later, she hardly hits the recommended allowance of 14 units weekly for women. She argues that Britons have a big problem with drink, and that many are searching for excuses to stop.

It’s well worth a view at only 3.35 and features Alastair Campbell, Russell Brand in A Royal Hangover plus the Hello Sunday Morning and Soberistas communities! :)

Interestingly the Guardian Pick comment was this one:

never trust a man who doesn’t drink because he’s probably a self-righteous sort, a man who thinks he knows right from wrong all the time. Some of them are good men, but in the name of goodness, they cause most of the suffering in the world. They’re the judges, the meddlers. And, never trust a man who drinks but refuses to get drunk. They’re usually afraid of something deep down inside, either that they’re a coward or a fool or mean and violent. You can’t trust a man who’s afraid of himself. But sometimes, you can trust a man who occasionally kneels before a toilet. The chances are that he is learning something about humility and his natural human foolishness, about how to survive himself. It’s damned hard for a man to take himself too seriously when he’s heaving his guts into a dirty toilet bowl.

― James Crumley
The Wrong Case – 1975

I’d always wondered where the expression ‘never trust a man who doesn’t drink’ came from and now I know!  It’s a 1970’s fictional novel about an American detective.  This was one book reviewers synopsis of the lead character who uttered these words: ‘He’s a boozer from a family of boozers and after his rich father’s death, his mother put his vast estate into a trust that Milo can’t touch until his early fifties because she thought he’d drink himself to death. So Milo hangs around the small Montana city he grew up in and spends most of his time in bars and is on a first name basis with every wino in town.’ So this perceived wisdom that seems to have seeped into the collective cultural consciousness is that of a drunk!  What a surprise, not!

The comments that followed after it were also interesting and I’ve included them below:

  1. Speaking for myself, I don’t drink because I’m an alcoholic.
  2. “ never trust a man who doesn’t drink because he’ll be sober while you are pissed and will win one over on you every time”
  3. “ never trust a man who doesn’t drink” … that was the favourite line of a member of my family (a drunk) who used to abuse everyone around him.
  4. eh, perhaps men who don’t drink much are just looking after their health? Who’s the one with the chip on their shoulder?
  5. Actually the fact that this is a Guardian pick makes me angry. So the people who are morally upright and know right from wrong are somehow the bad guys now.
  6. Not just alcohol supremacist drivel, but drunkard supremacist drivel.

    Anyway I digress – it’s worth a watch and illustrates a growing awakening to the issues of our frenemy booze, which can only be a good thing.  What do you think?