Calling time on missed opportunities: commissioning alcohol services to reduce avoidable harm

This was an interesting supplement that was covered by Guidelines in Practice a best practice online resource and was titled: Calling time on missed opportunities: commissioning alcohol services to reduce avoidable harm.  It carried a big old disclaimer before you even read the piece outlining Lundbeck’s, the pharmaceutical company responsible for Selincro (nalmefene) the new drug recently approved by NICE for use in alcohol harm reduction.

This was the abstract:

A multidisciplinary group of professionals involved in the clinical and societal management of patients with alcohol dependence met in Spring 2014, with the objective of defining themes for future developments in the management of alcohol dependence. Six themes were identified and 40 consensus statements were developed across these themes. The statements were presented as questionnaires, either as paper documents or electronically, and distributed to professionals engaged in the management of alcohol dependence in the UK. Questionnaires were completed by 194 respondents in a variety of roles associated with the management of alcohol dependence. Thirty-one of the 40 statements (77.5%) achieved agreement scores in excess of 66%, and 26 statements achieved very high consensus >90%. Only nine statements failed to achieve consensus agreement of >66%. The responses from the contributors to this consensus process informed the three recommendations put forward by the expert advisory group:

  1. addressing alcohol-related harm must be a commissioning priority
  2. collaborative approaches between clinical commissioning groups and local authorities are needed to develop and fund effective alcohol services
  3. local strategies are needed to increase the number of people accessing services and to engage a wider group of people using alcohol.

And they conclude:

The expert advisory group welcomes the very high levels of agreement from the treatment and commissioning communities on the importance of tackling alcohol problems. However, the responses to statements about the services currently being commissioned and delivered make challenging reading and require a clear and rapid response to drive improvement.

Put simply, the majority of the respondents do not believe that alcohol misuse is appropriately prioritised by CCGs, HWBs, and Local Authorities; the responsibility for addressing alcohol problems is unclear and therefore funding is often insufficient.
The large numbers of drinkers who are at risk of harm are not covered by the current services, and the services that are ultimately delivered are not seen as effective in improving physical or mental health by almost one-half of the respondents.

This must change rapidly to minimise mortality and morbidity and ensure appropriate use of NHS and Local Authority resources. Failure to do so will represent a significant missed
opportunity in addressing this urgent health and public health need.

The full research supplement can be read here.

I agree with all that they say but find myself gnashing my teeth somewhat.  Yes, yes we know all of this but it doesn’t make a blind bit of difference does it?  And why does it take the involvement of the pharma industry to point out the bleeding obvious? <sigh>

What do you think?

Children pay highest price for inaction on alcohol-fuelled violence

This was a national report from Australia that was picked up by the UK press looking at how children pay the highest price for inaction on alcohol-fuelled violence.  The study found that more than a million children are currently harmed by other people’s drinking in Australia.

The hidden harm: Alcohol’s impact on children and families

Funded by the Foundation for Alcohol Research and Education (FARE) and undertaken by the Centre for Alcohol Policy Research (CAPR), The hidden harm: Alcohol’s impact on children and families, reveals the full extent of alcohol-related family and domestic violence in Australia.

The 2015 study examined the prevalence and effects of heavy drinking on families and children, and the extent to which they persisted or changed over time.

It paints a concerning picture of the prevalence of alcohol-related family and domestic violence in Australia, shedding new light on a hidden dimension of alcohol harms that occurs largely behind closed doors.

Key findings

The hidden harm draws on two national surveys of alcohol’s harm to others, service system data and qualitative interviews with families, providing for the first time a detailed and valuable insight into the magnitude of the problem and the large numbers of Australian children who are being put at risk.

  • In 2011 there were 29,684 police-reported incidents of alcohol-related domestic violence in Australia, and that’s just in the four states and territories where this data is available.
  • Children are being verbally abused, left in unsupervised or unsafe situations, physically hurt or exposed to domestic violence because of others’ drinking. Many were also witnessing verbal or physical conflict, drinking or inappropriate behaviour.
  • Over a million children (22 per cent of all Australian children) are estimated to be affected in some way by the drinking of others (2008). 142,582 children were substantially affected (2008), and more than 10,000 Australian children are in the child protection system because of a carers drinking (2006-07).

Further information

The director of the McCusker Centre for Action on Alcohol and Youth, Professor Mike Daube, said given the prime minister, Tony Abbott, had flagged domestic violence to be on the next Council of Australian Governments agenda, alcohol’s contribution should be a key part of that discussion.

He agreed with the report that action was needed politically on alcohol price, access, promotion and education.

If ever a report deserved to be described as a wake-up call, this is it,” Daube said.

“The report shows the massive impacts of alcohol on others – especially children, women and families who are least able to protect themselves.

“The extent of the impacts should come as a shock, from domestic violence to child protection cases. Sadly, the figures provided are probably an underestimate.”

In 2012, a study from the Northern Territory also found high-risk drinking was linked with high rates of physical harm.

Published in the journal Substance Abuse Treatment, Prevention, and Policy, it reported the incidence of alcohol-related trauma among Aboriginal and Torres Strait Islander people in the Northern Territory was the highest in the world.

A separate study published the same year in the journal Addiction found children were the victims of alcohol-related harm in more than one-fifth of Australian households.

The chief executive of Domestic Violence Victoria, Fiona McCormack, said it was a common myth that alcohol was the cause of family violence.

“Just because somebody drinks, it doesn’t mean they’re abusive, and abusive people don’t all abuse alcohol,” she said.

“We’ve got to be very clear that the causes of violence against women and children are primarily about sexist attitudes held by some men, and unequal power relations between men and women.”

However, alcohol was a contributing factor towards family violence, she said.

“It’s a welcome report, and it’s terrific to see so many different sectors working together to address the issue of family violence,” McCormack said.

I sincerely hope in this case that it isn’t an underestimate because 22% – over 1 in 5 of all Australian children – being affected is a truly shocking statistic …..

Students offered alcohol-free flats at St Andrews University

From the BBC News website – more good news from sensible Scotland!  Students are to be offered alcohol free flats at St Andrews University in Fife.

Students who want to live in alcohol-free accommodation are being given the chance at St Andrews University.

It has been introduced to cater for students with religious beliefs or medical conditions that do not allow drinking.

The move from the Fife institution is thought to be the first time alcohol-free student accommodation has been offered in Scotland.

It will be offered at David Russell Apartments in Fife Park from September.

The flats each hold between four to six people.

Students will be asked to tick a box on their accommodation forms giving them the option.

Pat Mathewson, St Andrews Students’ Association, said: “Our residential services have decided they will offer a small section and then see what the uptake is like.

“We’re always in favour of anything that will make our students more comfortable.

“By no means are any students going to be forced into student accommodation they haven’t asked for.”

A St Andrews University spokeswoman said: “The University of St Andrews is committed to creating a safe, healthy, and inclusive campus experience for all of our students.

“We know that not all students drink alcohol.

“What’s more, we believe student learning lasts a lifetime, so reinforcing positive behaviours during this period of development can have a lasting influence.”

She added: “We’re proud that our Students’ Association is working to shape new attitudes towards responsible alcohol consumption and making our student experience more inclusive. We want our students to think about their lifestyle choices, and to support the choices of others.”

Fantastic news for those who want to avoid booze for whatever reason :)

Edited to add: so I’m just back from a run and it’s gloriously sunny and this track spins round in my mp3 player.  So I LOVE this tune – takes me right back to Glastonbury (yes the old me – too much drugs and drink!) but the new me (reminiscing about running the London Marathon which is on Sunday) thinks lets set up a sober Friday jukebox.  I know my blog can be serious and heavy at times so lets lighten it up a bit and who knows maybe we can grow a big ole sober play list for all us runners, and non runners too!  Who doesn’t need more music in their life?  😉  What dya think?  What tunes would you include?

Here goes track one:

And the lyrics are so BLOODY appropriate too!!

I kicked the habit
Shed my skin
This is the new stuff
I go dancing in
Oh won’t you show for me
I will show for you
Show for me, I will show for you


Smoking Makes It Harder to Stop Drinking

This research was picked up by the excellent Castle Craig blog in March and looks at how being a smoker makes it harder to stop drinking.

Researchers at Yale University have found that smoking might be hampering treatment for alcohol abuse. Their research paper (“Tobacco smoking interferes with GABA receptor neuroadaptations during prolonged alcohol withdrawal”) indicates that, contrary to popular belief, continuing to smoke while abstaining from drinking does not make the process of withdrawal  from alcohol any easier to manage – and in fact may be making recovery from alcohol addiction far more difficult than it already is.

An airbag for the nervous system

As part of the study, the brains of the research subjects – made up of a mixture of alcoholic and non-alcoholic volunteers – were scanned to measure the levels of GABA (A). The GABA receptors in the brain control our responses to stressful situations. They can be thought of as acting like a kind of airbag for the nervous system: in situations of stress they slow down brain activity and reduce anxiety, just like the actual airbag in a car, which cushions the force of impact in the event of a crash.

In chemical dependents and alcoholics this cushioning effect is already not functioning at full capacity, and smoking, while no doubt providing an illusion of relaxation to many, could in fact be aggravating the problem.

The results indicated a link between the levels of GABA(A) in the brains of those who continued to smoke while abstaining from alcohol. Levels of alcohol craving among those who continued to smoke during abstinence were also found to be as much as twice as high as among the non-smokers.

Cigarettes, the recovering alcoholic’s best friend?

For some alcoholics in recovery, however, smoking can be one way to ease their withdrawal from drinking, and it is well known that many alcoholics do indeed smoke. Indeed, a cigarette can be someone’s best friend, especially when that person is struggling with alcohol withdrawal.

But, as discussed above, this new research from Yale University shows that this so-called best friend could in fact be acting as an obstacle to recovery from alcoholism. In an ideal world, therefore, recovering alcoholics would do well to give up smoking, too.

The hard reality of withdrawal

That said, curbing two addictions at the same time is something many alcoholics would say is impossible. So while the lessons of this research are quite clear, in the chaotic world of alcoholism it may be a tall order indeed for someone to kick a nicotine habit while also trying to quit drinking, particularly in the early days of recovery.

I completely concur that it’s a big ask in the early days and I stopped smoking on a daily basis a year before I stopped drinking but still had the occasional lapse on a night out.  I haven’t smoked since I stopped drinking though and if I was to relapse on anything now it would probably be a fag rather than a drink ……  What’s your experience?

PS Today should have been the day that I shared Veronica and I’s discussion about Step 9 but we’ve hit a technical glitch.  As you may or may not be aware Veronica is on maternity leave so we’ve decided to continue releasing steps 10 – 12 as planned over the next few weeks and we’ll circle back on step 9 when she’s back.  Apologies :)

Alcohol in the UK key facts and figures

I’ve been meaning to write this kind of post for a while.   I’ve been doing an online course with the Substance Misuse Management in General Practice (SMMGP) that covers all this data so thought I would put it up here now and then it’s done! So here it is – alcohol in the UK key facts and figures.

Let’s start with the key data:

Definitions of alcohol misuse (please click to open document to see definitions)

Prevalence of alcohol use disorders:


So just to underline that data 17.6 million fall into the drinking at increasing risk and above category (although some of those will be occasional binge drinkers only).  In the UK there are 51.2 million people over the age of 16 (ONS, 2011) so that is 34% or 1 in 3 ……

Alcohol and the NHS:

  1. Alcohol is the third highest risk factor for ill health after high blood pressure and tobacco.
  2. One in five adults seeing a GP drink at hazardous or harmful levels
  3. Problem drinkers consult their GP twice as often as average patients
  4. 35% of A&E and ambulance costs are alcohol related

Problem drinking, families and communities:

  1. Almost half of violent assaults are alcohol related
  2. There are strong links between alcohol abuse and domestic violence and marital breakdown
  3. 27% of children serious case reviews mention alcohol abuse
  4. 16% of road fatalities involve alcohol

Annual cost of alcohol related harm:

  1. Total cost to society £21 billion
  2. Crime in England £11 billion
  3. NHS in England £3.5 billion
  4. Lost UK productivity £7 billion

There are effective treatments for the range of alcohol misuse problems and United Kingdom Alcohol Treatment Trials (UKATT) show that for every £1 spent on evidence based treatment the public saves £5.

And having studied the Kings College Understanding Addiction course that figure rises to £8 saved if you tackle addiction within adolescence.

There is so much more we could be doing to help people both sooner in terms of age of onset of problem drinking and also sooner in terms of offering support and help while people are still reachable before physical addiction is triggered.  As Unpickled said – you don’t wait until someone is morbidly obese before you suggest a healthy eating plan so why would you wait until someone is physically addicted to alcohol before you offer assistance to quit?

Edited to add: 13.17 I apologise if you’ve been trying to access the site in the last 4 hours and have been unable to do so.  My website server has been under DDoS attack.  Hopefully full service has now been restored :)


The elderly are society’s new booze baddies

Thanks to Laura at Club Soda for sending me the link to this news piece in The Spectator in February.  It discussed the fact that now that the young are turning tee-total, the best hope for the survival of heavy drinking lies with the old who have become society’s new booze baddies.

The gulf in understanding between the old and the young has widened with the news that the young are beginning to turn teetotal. If there was one thing that the old thought they knew about the young, it was that they drank too much. British youth led the world in its enthusiasm for alcohol. Our cities swarmed with loutish binge drinkers. Yet now, all of a sudden, we learn that abstinence is becoming fashionable. The number of people under 25 who don’t touch a drop has increased by 40 per cent in eight years. More than a quarter of people in this age group now don’t drink anything at all. What is going on?

The conditions for heavy drinking would seem to be perfect: there is economic hardship and a generally gloomy outlook on most fronts. It can seldom have been more tempting to seek oblivion in alcohol. Yet the financial crash of 2008 seems to have had the opposite effect. It is since then that the tide has turned. It is true that times are hard and drinking is much more expensive than it used to be, but cost has never deterred the determined drinker. Nor is it possible to believe that government health campaigns have had much effect; they have never impressed the young. It is true that Muslims and Sikhs tend not to drink, but there are still not enough of them in our midst to have much impact on the statistics. There must be different explanations.

It could be that other addictions have been replacing alcohol. There is little time for group bingeing if one is glued to one’s computer or smart phone, and the digital world has its own numbing effect. Could it be, on the contrary, that the young are imbued with a new energy, optimism and sense of purpose? It would be nice to think so, but this would be really surprising. I am lost in incomprehension. But I have found from my own experience that far more people of all ages now turn down a drink when they are offered one.

The best hope for the survival of heavy drinking now lies with the old. It is to them that the health experts have turned their attention. More and more elderly men and women are now drinking too much, they say, because they don’t know what else to do with their free time. Once they have mown the lawn, or whatever else retired people do to keep themselves busy, they take out the bottle (for most of them the computer is probably no substitute). I can believe this, though how the experts think they know how much old people drink is something of a mystery, since they also say that this is a ‘hidden’ problem and difficult to detect. But this doesn’t stop them campaigning against it, warning of illness and early death and calling for higher alcohol prices in supermarkets, high though they already are.

Whatever the truth, I feel that they should leave us alone. Private drinking by the old may be a problem, but it is a private problem, not a social one. It is not a problem about which ‘something must be done’. Binge drinking among the young needs addressing, because it leads to violence and disorder on the streets. But you never see gangs of elderly drunks rampaging through city centres.

It should also be recognised that many people find it hard to get through life without a bit to drink, and it is often surprising how little it can impair their performance. Winston Churchill might not have withstood the strain of the war without regular doses of brandy, and Margaret Thatcher was dependent on a glass of whisky at bedtime. Even journalists, who are now pretty abstemious, weren’t noticeably worse at their jobs when they were regularly sozzled.

So everything is now topsy-turvy. The old are becoming heavier drinkers than the young, who are edging along the road towards teetotalism. The upshot is that the old are coming to be seen as the baddies in society, which is rather an invigorating change. It may even help us feel young again. So let us relish our new role and do so in peace.

My response to this story was: and this is a bad thing because? …..  The booze industry must really be scared because if they’re relying on the older drinkers when they die where will their new customer base come from?  Maybe the younger generation are just fed up with seeing their parents and grandparents p*ssed and it’s made it ‘not cool’.  What do you think?

Experiencing Recovery

Thanks to Paul over at The Alcoholics Guide to Alcoholism for sharing this video originally.  It’s some footage of a presentation looking at the recovery experience given by William White a Senior Research Consultant in the US who I remember seeing interviewed as part of the documentary film The Anonymous People last year

It was the slide at the end that really struck me.  He had done a review of 415 studies in 2012 and found that 5-15% of all US adults were in remission from substance use disorder (SUD, not including nicotine).  That’s 25 -40 million citizens.  Here in the UK that would be 2.5 – 7.4 million.

And more amazingly the rate of recovery was much higher than any statistics I had heard before.  Since 2000 the recovery rate in community populations was 53.9% and 50.3% in clinical studies. So over half were living in recovery and yet the meme that I have always heard is that it is a chronic relapsing condition and that success rates were small.  As William White says this should ‘in and of itself challenge the public perception and growing pessimism around recovery‘.

As Paul said we need this to be the research focus of the future.  As William White says we need to stop studying the pathology of addiction and start researching and following the recovery experience.  I’ll drink something non-alcoholic to that! 😉



Deaths connected to alcohol rise in North East England

From The Guardian in February they reported that deaths connected to alcohol had risen in the North East of England.

The north east has the second highest rate of alcohol-related deaths in England, latest figures reveal.

New figures by the Office of National Statistics (ONS) show that while death rates in recent years have stabilised, twice as many people in the north east are suffering an alcohol-related death compared to 20 years ago.

There are 22.3 deaths per 100,000 men in the north east, compared to the England average of 17.8 per 100,000.

For women, the average in the north east is 11.6 deaths per 100,000, compared to the England average of 8.7 deaths per 100,000.

Colin Shevills, director of Balance, the North East Alcohol Office, said: “It’s especially saddening that so many people in England die from alcohol-related causes before they have reached the age of 55.

“While this latest data is shocking enough, these statistics are also a relatively conservative estimate, with the true figure likely to be higher.

“It’s no coincidence that as death rates rise, cheap alcohol has continued to be more accessible. Alcohol in the UK is now 61 per cent more affordable than it was in 1980, but the costs to our health and the wider economy are rising.

“To save lives, we must make alcohol less affordable. People are dying because alcohol is far too cheap, it’s available at all hours and it’s far too heavily promoted.

“A minimum unit price of at least 50p will make cheap, strong alcohol less affordable to the vulnerable, younger and heavier drinkers who are more likely to drink it and suffer the consequences.”

Balance North East are doing a fantastic job of supporting those with alcohol dependence and misuse issues and if you live in the North East and would like their help you can visit their website here.


Lung Donors’ Alcohol Habits Affect Recipient Recovery, Study Shows

This is from the Cystic Fibrosis News Today website and reports on a research study that showed that lung donor’ alcohol habits affected the recipients recovery.

A study published in the journal Alcoholism: Clinical and Experimental Research revealed that the heavy drinking habits of lung donors can influence the outcome of lung transplantation in recipient patients. The study is entitled “Heavy Alcohol Use in Lung Donors Increases the Risk for Primary Graft Dysfunction.”

Substantial alcohol consumption is recognized as a contributing factor for a higher risk of acute lung injury and acute respiratory distress syndrome. The reason underlying this phenomenon is linked to a higher generation of reactive oxygen species (ROS) that correspond to free radicals and chemically reactive molecules, which contain oxygen and are natural byproducts of oxygen metabolism. High levels of ROS have the potential to cause several harmful effects, like damage to cell structures.

Lung transplant is considered an effective, last-resort treatment in individuals that suffer from severe lung conditions and who have lost most of their lung function. In the procedure, the diseased lungs of the patient are replaced by healthy lungs, usually from a deceased donor.

In lung transplantation, the health condition of the donor lungs plays an important role. The team’s goal was to evaluate the hypothesis that lung donors with heavy drinking habits could induce a higher susceptibility to lung injury in the recipients after transplantation. For this purpose, a retrospective cohort study was conducted in 192 lung transplant recipients based on the reported history of the donors and the outcome after transplantation. Donors were divided according to their background in three different groups: Heavy Alcohol Use, Moderate Alcohol Use, and No Alcohol Use.

The researchers found that recipients of lungs from Heavy Alcohol Use donors took more time to be weened off of mechanical ventilation after transplantation in comparison with donors who had Moderate Alcohol Use or No Alcohol Use. In addition, the probability of developing severe primary graft dysfunction (PGD) was 8.7 times higher in recipients of lungs from Heavy Alcohol Use donors compared to No Alcohol Use donors. PGD can be caused by several factors and refers to the injury to the transplanted lung; it is responsible for a substantial morbidity and mortality after lung transplantation. In this case, researchers believe that PGD is the result of a poorer gas exchange in lungs from Heavy Alcohol Use donors, which subsequently forced the recipients to be under mechanical ventilation for a longer period of time after the transplant.

The researchers emphasized that it is essential to know the donor’s history concerning alcohol consumption so that the recipients with higher PGD risk can be identified.

So it would seem NO body systems and structures are unaffected by alcohol and if you drink and smoke (which I did) then you have a double whammy of impact on your lungs …..

Head of NHS says that tackling cheap booze is urgent priority

The Telegraph reported that the head of the NHS is calling for increases in the price of cheap alcohol amid warnings that heavy drinking is taking a “huge” toll on Accident & Emergency departments.

Simon Stevens, chief executive of NHS England, signalled that action on alcohol pricing should be an immediate priority for the next Government, as he disclosed that its relative price has halved in three decades.

The head of the health service said the NHS needed to “stand up and be counted” to highlight the impact of alcohol on A&E departments around the country, to increase pressure on the next Government to tackle the issue.

Mr Stevens said heavy drinking and soaring levels of sugar consumption by the British public were now two of the most urgent health problems facing the nation, as he spoke at a King’s Fund event about the challenges facing the NHS.

“Alcohol together with sugar is one of the debates we really need the new Government to address very early in the next Parliament,” he told an event at the Kings Fund.

The head of the NHS is calling for increases in the price of cheap alcohol amid warnings that heavy drinking is taking a “huge” toll on Accident & Emergency departments.

Simon Stevens, chief executive of NHS England, signalled that action on alcohol pricing should be an immediate priority for the next Government, as he disclosed that its relative price has halved in three decades.

The head of the health service said the NHS needed to “stand up and be counted” to highlight the impact of alcohol on A&E departments around the country, to increase pressure on the next Government to tackle the issue.

Mr Stevens said heavy drinking and soaring levels of sugar consumption by the British public were now two of the most urgent health problems facing the nation, as he spoke at a King’s Fund event about the challenges facing the NHS.

“Alcohol together with sugar is one of the debates we really need the new Government to address very early in the next Parliament,” he told an event at the Kings Fund.

“The fact is that the relative price of alcohol has come down by 48 per cent between 1980 and 2010,” he said.

So that is something that we would be wanting the next Government to take a very clear look at and wanting the health service to stand up and be counted, in those debates, recognising the huge impact that alcoholism and alcohol-induced emergency demand has all across the health service.”

He said overuse of alcohol was taking a huge toll on A&E departments and on hospital emergency admissions.

Latest figures show that 20 per cent of A&E attendances are alcohol related, a figure which rises to 80 per cent during peak weekend periods on Friday and Saturday nights.

Each year, more than one million hospital admissions in England are alcohol related, with a 60 per cent rise in such admissions in those aged between 15 and 29 in the last decade.

The Coalition considered plans to introduce a minimum price for alcohol, before putting the plans on hold, saying more evidence is required to see if it would help tackle problem drinking.

Last month senior health professionals called for a 50 pence minimum unit price for alcohol, which they say could help tackle a culture of “excessive consumption”. Such limits would mean that most bottles of wine or four-packs of strong lager could not be sold for less than £4.50.

Doctors have also said more should be done to help A&E units struggling to cope with violent binge drinkers, and abuse from alcoholics.

Dr Cliff Mann, president of the Royal College of Emergency Medicine, which represents A&E doctors, in January provoked controversy with calls for the police to arrest more drunks in order to reduce pressures on casualty units.

The A&E consultant urged the police to adopt a “zero-tolerance” strategy towards binge drinking that would see troublesome drunks arrested, charged and given a criminal record.

During the King’s Fund event yesterday, Mr Stevens singled out a number of current failings by the health service which he said were “not acceptable”.

The NHS chief executive, who took up post last April, said: “We have got to have some righteous anger about how things currently are.”

I am going hoarse with righteous anger repeating the same news stories and calls for a need to act on this issue and yet it continues to fall on deaf ears from the powers that be.  Again I ask – why is that and will the General Election in 3 weeks change things?

If you’re wondering what the main parties manifesto pledges are with regard to alcohol you can read them here:

Main party manifestos quiet on alcohol policy and minimum pricing