Monthly Archives: January 2015

Dying for a drink: alcohol-related deaths and illness cost us dearly

This article entitled ‘Dying for a drink: alcohol-related deaths and illness cost us dearly‘ was featured in The Guardian prior to Christmas.  It discusses how more needs to be done to raise awareness of the damage that alcohol causes to the NHS and wider society and I couldn’t agree more.

Alcohol is a factor in 8-10% of GP consultations in the UK every day. There are more than 10m alcohol-related visits to the NHS a year. Admissions for alcohol misuse are likely to hit 1.5m a year unless the government steps in to tackle the problem.

The impact of alcohol misuse across the rest of the NHS, in hospitals and in our communities is huge. More than 10 million adults in England now drink more than the recommended daily limit, with 2.6 million drinking more than twice that. As a GP for 30 years, I have witnessed first-hand how alcohol destroys lives. I have seen people who had cirrhosis of the liver or another alcohol-related illness, such as heart disease, as well as those who were injured or assaulted while drunk. My colleagues working in accident and emergency departments tell me that every weekend they see children who have been found unconscious through drink on the street and brought to hospital by the police or the ambulance service.

Alcohol has been linked to more than 25% of serious offences and 35% of all violent offences – how many of those end up in A&E and are admitted to hospitals? The effects of excessive drinking on livers, hearts and waistlines are disastrous. We know under the influence of alcohol people are attacked, have road traffic accidents and have unsafe sex.

Alcohol, in anything but very modest quantities, is potentially a destructive and toxic substance. Your first pint of the day may be beneficial, but your second eliminates the benefit of the first and from then on it is harmful. According to the World Health Organisation, alcohol is the leading risk factor for premature death and disability in developed countries after smoking and high blood pressure. It is related to more than 60 medical conditions – and to violent crime and domestic abuse, destroying families.

Over the centuries, alcohol has become the country’s favourite drug. The introduction of round-the-clock licensing in 2005 has prompted concerns that this has led to an increase in violence and alcohol abuse. The 24-hour drinking legislation has undermined clinician and police efforts to get to grips with this problem.

Society needs to stop marketing the myth of alcohol and start telling the truth: too much alcohol causes huge damage; too much alcohol kills. Yet advertisements offering cut-price drinks are everywhere. Alcohol is marketed through increasingly sophisticated advertising and promotional techniques, including sponsoring sporting events and concerts and through social media sites. There has to be legislation for a comprehensive ban on alcohol advertising, and we need to introduce minimum alcohol pricing to curb the binge drinking culture. There should be freedom of debate about alcohol issues, but there is no reason to concede any freedom to persuade people to harm themselves, especially if the persuasion is motivated by commercial gain.

No one should be in any doubt that the heavy marketing and promotion of alcohol, combined with low prices, encourages young people to drink at levels with which the NHS and society are struggling to cope. Alcohol misuse costs the NHS and the justice system about £25bn every year. That figure covers the cost of healthcare, crime, social disorder and lack of productivity at work attributable to alcohol, including the £2.7bn the NHS spends treating the chronic and acute effects of drinking.

Establishing a minimum price and restricting promotions would be the most effective way to reduce the harm alcohol causes. However, that is unlikely to be enough to change the drinking culture. The historical cultural acceptability of alcohol needs be questioned, starting at primary school level. We also need to get to the root causes of what motivates significant numbers of people who think it is acceptable to go out on Friday and Saturday nights, drink to excess and indulge in antisocial behaviour.

Successive governments have been too complacent about the problem of alcohol abuse – particularly among young people. Apart from investing in alcohol health workers in hospitals, A&E units and GP practices, we need to involve schools, parents, police, local authorities and health professionals in providing better information and education about how alcohol can damage health. Alcohol should have a calorie content label, which may help the nation’s waistlines as well as reduce alcohol consumption. But more needs to be done to raise awareness of both the contents and harms of alcohol. How about having a national alcohol free day between Christmas and new year as a starter? It is high time we stopped dying for a drink.

Cracking first comment to the piece too:

And yet we laugh at people who are drunk, we make hangovers a funny story, we swap stories of drunken activities and its all too acceptable to act like an offensive crazy person – because they are drunk.  To change how people think about alcohol, how accepted its use is in the world, does it need more and more people to get sick? Or can we as a people, stop and have the honesty to look at what it’s really doing to us?   It’s really not funny at all.

 

Alcohol Collateral Damage

This was a phrase which was suggested as a replacement for Passive Drinking by Prof Sir Ian Gilmore at the Alcohol Concern conference last November.  It was felt that there needed to be an expression like passive smoking with tobacco harm that indicated the wider impact that alcohol abuse and dependence can have.

And then in December I was contacted by the outreach team at rehabs.com who shared with me this great infographic called Collateral Damage, How Drug Addiction Affects Families and Friends and you can view it here:

http://www.rehabs.com/explore/addiction-impact-loved-ones/

They analyzed the top addiction-related forums to find out how friends and family members were seeking support and interestingly, they noticed that women are the most common posters, broken down by wife, mother, girlfriend, and sister and that alcohol was by far the most common drug mentioned at almost 35%.

In their email to me they also said ‘I read your recent article, Booze aversion therapy, and I think aversion therapy is really a good idea to use is patients with alcohol addiction. Many would benefit if people are informed with this technique and if many doctors are properly trained to do it.’

I thought their work was a fascinating insight into the issue and underlined to me that women were the largest group going on line, not just to find solutions for themselves, but for loved ones within their family or friendship groups.  It also reinforced to me that the expression alcohol collateral damage might be the right expression even though Prof Gilmore at the conference thought it was perhaps too harsh seeing as it’s original meaning is frequently used as a military term where non-combatants are accidentally or unintentionally killed or wounded (wiki).  I’d be really interested to hear what you think too?

Call for ban on alcohol advertising at sport events in New Zealand & UK

Picked this news story up in the run up to Christmas in the New Zealand press:  Call for ban on alcohol advertising at sport events

The Government has been told to end alcohol sponsorship of sports clubs and ban any advertising of beer, wine and spirits during televised matches by a ministerial forum.  The forum, chaired by former rugby league coach and businessman Graham Lowe, concluded after a two-year inquiry that the total cost of alcohol-related harm in this country was “enough to justify further restrictions on alcohol advertising and sponsorship”.

The six-person panel was set up by former Justice Minister Judith Collins as part of alcohol law reforms in 2012.  In its report, the forum said it had found there was no single drinking culture in New Zealand and many people drank responsibly. It acknowledged that alcohol advertising and sponsorship was just one factor in influencing consumption of alcohol.  But it also recognised an association between exposure to alcohol promotions, an earlier age of initiation to drinking alcohol, and increased consumption.

“In addition, we understand there is compelling evidence that early initiation to drinking alcohol and increased consumption are predictive of, and associated with, increased experience of alcohol-related harm.”

The forum made 14 recommendations designed to reduce young peoples’ exposure to alcohol promotions.  These included major changes to liquor companies’ sponsorship of televised and grassroots sports, including a long-term goal of banning alcohol sponsorship from all sports.  It also recommended banning alcohol advertising during streamed and broadcast sporting events, from events at which more than 10 per cent of the audience was under 18, and further restrictions on the hours at which alcohol adverts could be broadcast on radio and television.

The forum’s report said this would threaten the sustainability of many sporting clubs and events and recommended new initiatives to support sporting, cultural and music events that “might have ordinarily had access to alcohol sponsorship funds”.

Justice Minister Amy Adams said further work would be required on the feasibility and the impact of the proposals.  She said the forum was unable to consider the full effect of the proposals. Officials would report back to her again in mid-2015.  The Association of Alcohol Advertisers expressed concern about the recommendations, saying bans on alcohol promotions were “extreme” and not backed by evidence.

Recommendations:

1. Ban alcohol sponsorship of all streamed and broadcast sports
2. Ban alcohol sponsorship of sports [long-term]
3. Ban alcohol sponsorship (naming rights) at all venues
4. Ban alcohol sponsorship of cultural and music events where 10% or more of participants and audiences are younger than 18
5. Introduce a sponsorship replacement funding programme
6. Introduce a targeted programme to reduce reliance on alcohol sponsorship funding
7. Ban alcohol advertising during streamed and broadcast sporting events
8. Ban alcohol advertising where 10% or more of the audience is younger than 18
9. Further restrict the hours for alcohol advertising on broadcast media
10. Continue to offset remaining alcohol advertising by funding positive messaging across all media
11. Introduce additional restrictions on external advertising on licensed venues and outlets
12. Establish an independent authority to monitor and initiate complaints about alcohol advertising and sponsorship
13. Establish a mechanism to identify and act on serious or persistent breaches of advertising standards
14. Establish a multi-stakeholder committee to periodically review and assess Advertising Standards Complaints Board decisions and pre-vetted advertising

Here’s a link to the Ministerial Forum on Alcohol Advertising and Sponsorship and the full report.

Extreme and not backed by evidence?  How about all the evidence that supported the wholesale banning of tobacco advertising to reduce ill-health and deaths through smoking – is that not enough??  I’m interested if any one from New Zealand is reading this and would be happy to comment on what they think, Mrs D are you there?  Me?  I’d ban alcohol advertising entirely like they did with tobacco.  Then there are no rules for them to try to bend or work-around.

Plus there was calls for this in the UK over Christmas too with this news article in The Guardian:

Ban alcohol firms from sponsoring sports clubs and events, doctors urge

Leading doctors are demanding a ban on alcohol firms sponsoring sports clubs and events because they claim that the “outrageous” practice is fuelling underage drinking by children.

The leaders of Britain’s nurses, A&E specialists and hospital doctors are among those urging ministers to outlaw the sort of deals that have seen Everton and Celtic football clubs agree multimillion pound tie-ups to advertise beer and cider brands on the front of their players’ shirts.

In a letter to the Guardian, a group of medical leaders, public health campaigners and health charities are calling for the action because alcohol sponsorship of sport has become “as commonplace as advertising for cereal or soap powder”.

The letter says: “Shouldn’t our national sports be inspiring our children to lead healthy and positive lifestyles? It would be considered outrageous if high-profile teams like Everton or Celtic were to become brand ambassadors for tobacco, and so why is it acceptable for alcohol?”

The letter claims: “Self-regulation of alcohol advertising isn’t working when it allows drink brands to dominate sporting events that attract children and adults, creating automatic associations between alcohol brands and sport that are cumulative, unconscious and built up over years.”

The signatories also bolster their plea to ministers by adding: “Importantly, evidence shows that exposure to alcohol advertising leads young people to drink more and to drink at an earlier age.”

The letter’s signatories include Professor Jane Dacre, president of the Royal College of Physicians, which represents hospital doctors; Dr Peter Carter, chief executive of the Royal College of Nursing; Dr Mark Porter, chair of council at the British Medical Association; and Dr Clifford Mann, president of the College of Emergency Medicine, which speaks on behalf of A&E doctors.

They want the government to intervene, and claim that public opinion supports introducing a ban on alcohol advertising of sport. “Let’s take action to protect our children by ensuring that the sports we watch promote healthy lifestyles and inspire participation, not a drinking culture. Let’s make alcohol sports sponsorship a thing of the past,” they say.

“Evidence from the UK and abroad shows exposure to alcohol sports sponsorship leads schoolchildren and sportspeople to drink more. Given the hundreds of thousands of pounds channelled into sponsorship deals, it’s not surprising they boost sales,” said Katherine Brown, director of the Institute of Alcohol Studies, an independent thinktank.

“It’s obvious that children growing up idolising sporting heroes with beer brands blazoned across their chests will develop deep-rooted positive attitudes towards drinking. It’s also obvious that high profile alcohol advertising via sponsorship deals work to normalise what is in fact an unnatural association between drinking and sport,” Brown added.

HEAR HEAR!!

 

Alcohol industry “can’t be trusted” to promote moderate drinking

National charity Alcohol Concern is calling for the regulation of alcohol marketing to be statutory and independent of the alcohol industry. This comes after a new report has shown how big alcohol companies cannot be trusted to promote moderate drinking.

The report ‘Creating customers’ looks at how the major alcohol producers are constantly on the lookout for new ways and places to sell alcohol, and new people to sell it to – in the UK and around the world. It also highlights how the industry undermines it own pledges to encourage the safe use of alcohol.

Examples cited in the report include:

  • Diageo (owners of Guinness and Smirnoff) state that people drinking irresponsibly is “not good for them, for society, or for our reputation”. Yet they also urge publicans “to increase spirit sales in your pub” by encouraging drinkers who order a single measure of spirits to “make it a double”
  • Carlsberg are “committed to…ensuring that our consumers are fully informed when making their choice” but also urged off-licenses to stack up beer “away from the beer fixture to drive impulse purchases”
  • SAB Miller (owners of Peroni and Bulmers, as well as Miller beers) pledge not to “target our marketing to anyone under the legal drinking age”. They also say that since “people have grown up on Pepsi and Coke….the younger generation have a much sweeter palate. We are playing to that”

Alcohol Concern Director, Andrew Misell said: “Given the number of different ways the alcohol industry can now sell their products, the big question is whether the people who make more profits the more alcohol we drink are really the best people to advise us on how to use it safely and healthily.

“Given the obvious conflict between the alcohol industry’s need to sell more alcohol and the need to promote moderate drinking, alcohol producers should have no role in drawing up information or policy on safe drinking.”

The report is being released just weeks after the Lancet Liver Disease report showed that the UK is the only country in western Europe, except Finland, where liver disease has increased over the past 30 years.

Andrew Misell, continued: “Positive portrayals of alcohol, whether in programming, through product placement, or advertising encourage drinking. Where alcohol advertising is permitted, we believe the UK should follow the French example of only allowing factual messages and images that refer to the characteristics of the product: its origin, composition, strength, and means of production. Images that show drinking as part of an attractive lifestyle or social occasion should no longer appear in adverts.”

This is an excellent detailed report of what the big alcohol producers and distributors are doing and you can read Alcohol Concern’s full report here:

Creating customers: Finding new ways and places to sell alcohol, and new people to buy it (PDF)

Interestingly another story in the media in December underlines this fact.

Sweden seeks ban on foreign booze advertising

Both the Swedish Consumer Agency (Konsumentverket) and the Swedish Civil Contingencies Agency (Myndigheten) believe that broadcasters Viasat and SBS are circumventing the ban as they are licensed by Ofcom in the UK. 

While Sweden has long had a total ban on televised alcohol commercials the rules are more lenient in Britain, where adverts for beer and spirits are common and feature prominently during commercial breaks for sports events.

“In Sweden the rules are quite clear. There is a complete ban on all forms of televised alcohol advertising but we have seen over the last few years a lot of adverts for alcohol being directed to the Swedish market on these channels,” Cecilia Norlander, lawyer with the Swedish Consumer Agency, told The Local.

So Sweden has a total ban on alcohol advertising on television but because some channel’s are licensed by Ofcom in the UK these rules are being flouted and worked around.  So not only can the industry not be relied upon to promote moderate drinking they can’t even abide by countries laws banning the advertising of its products on tv ……  Why am I not surprised by this?? <sarcastic rhetorical question> Read the full story here

PS This time next week I will be hosting a Club Soda social at my home city of Cambridge.  If you would like to join me and want further details of venue and time either email me at ahangoverfreelife@gmail.com or check the Club Soda website.  Thanks also to another sober buddy for her support with organising this – you know who you are  😉

Alcohol industry lobbyists are hijacking policy

A report published last month and reported on in The Guardian says that industry lobbyists are hijacking government alcohol policy reform discussions and hampering efforts in Australia and the UK to curb drinking rates, health experts say.

Despite alcohol consumption being the leading cause of death and disability globally, the alcohol industry wields a significant amount of political power, a study published in the journal PLoS Medicine found.

Researchers from the University of Newcastle in Australia and King’s College and the School of Hygiene and Tropical Medicine in London said the influence of the alcohol industry was particularly concerning in Australia, where the government was developing a new national alcohol strategy.

And in Britain, a mix of industry self-regulation, campaigns that targeted only binge drinkers, and school-based education had not reduced alcohol harms there, the study found.

Rates of alcohol-related hospital admissions have almost doubled within a decade. Liver disease deaths have also risen markedly, despite falling in many other western European countries.

Alcohol-related injury epidemiologist and author of the paper, Professor Kypros Kypri, said when he was invited by the Australian department of health in November to attend a meeting about reducing alcohol-related harm, he was shocked to find representatives from the Australian Hotels Association and other alcohol industry bodies there.

“I was invited as an expert to give evidence about the impact of trading hours in Newcastle, and it was framed to me as a discussion that would help inform the national alcohol strategy,” Kypri said. “It never occurred to me to check whether industry people would be there because I thought it would be an obvious conflict of interest.

“I have come to the conclusion that it is no longer useful for us to be engaged in these meetings with government because as health experts, all we are doing is giving their process credibility so they can tell the public they consulted with experts when in fact the so-called experts include industry lobbyists.”

A department spokeswoman said Wednesday that the meeting had not been one to form policy, but there was value in liaising with any organisation that had a role to play in reducing alcohol related harms.

“As the primary purpose of this meeting was to discuss potential ways to reduce alcohol related violence and harms, including in and around licensed premises, on this occasion it was considered appropriate to include industry representatives,” she said.

The researchers also found that by developing and funding their own public health campaigns, such as Drinkwise, the industry was ignoring the most effective evidence for curbing drinking and misleading the public.

By suggesting excessive alcohol consumption was an individual choice rather than being a result of the wide availability and affordability of alcohol, the industry was avoiding focusing on proven strategies to curb alcohol consumption such as placing a volumetric tax on alcohol and reducing alcohol industry trading hours, the study found.

“Civil society must not allow the concept of harm reduction to be defined in ways that serve corporate interests at the expense of public health,” the researchers concluded.

“Advocacy inspired by libertarian ideas is at odds with the evidence on how to reduce alcohol harm in the population.”

The Australian Hotels Association chief executive, Stephen Ferguson, said industry always worked cooperatively with regulators, the police, and organisations and bodies that sought to minimise misuse of alcohol.

“This shared approach ranges from a local liquor accord right up to funding bodies like DrinkWise and other community groups that are seeking to positively change Australia’s drinking culture,” he said.

“The AHA, Drinkwise and wider industry are transparent about being involved in campaigns to minimise misuse of alcohol. Academics and activists are not the font of all knowledge regarding alcohol or any other matter. Good policy draws widely from the insights of all interested or affected parties.”

He said the voice of responsible consumers was not being heard in the alcohol debate.

Data released last month from a national survey by the Australian institute of health and welfare revealed that the number of people who drank alcohol daily declined from 7.2% to 6.5% between 2010 and 2013. However, it also found almost five million Australians aged 14 and over were victims of an alcohol-related incident in 2013.

The director of the McCusker Centre for Action on Alcohol and Youth, Professor Mike Daube, said the legitimate public health concept of “harm reduction” had been hijacked by the alcohol industry.

“Harm reduction has a legitimate role in relation to illicit drugs, where the nature of the problem is vastly different to alcohol and tobacco,” he said. “It does not translate readily into areas like alcohol, where reducing harm is just one part of an overall strategy, where we are dealing with vastly greater numbers, and where the product is actively promoted by a massive and powerful global industry.

“Governments have to choose between supporting public and community health, or working with the alcohol industry. So far, the industry is winning.”

The Foundation for Alcohol and Research Education chief executive, Michael Thorn, said while there was a legitimate argument for working with the alcohol industry, their representatives should “never” be involved in policy discussions. He likened it to inviting big tobacco to advise on smoking reform.

“I think it reveals a sad state of policy-making in Australia and internationally where industries with vested interests can threaten governments and have an impact on the way they behave,” Thorn said.

Hear, hear to this studies research findings.  What is it going to take to stop the alcohol industry juggernaut steam-rolling over our individual health and social well-being and to reverse the obvious corporate capture that has happened to Govt by the drink’s industry??

 

Most people who die from liver disease AREN’T alcoholics

Most people who die from liver disease AREN’T alcoholics – they just drink nearly every day’.  Well that’s a newspaper headline isn’t it?  You can always rely on the Daily Wail for a high drama headline! 😉

The news piece goes on to quote Andrew Langford, chief executive of the British Liver Trust, saying that ‘if we don’t do anything about it by 2025 it will almost certainly be one of the top two, it is a major epidemic.’

‘The majority of people who die of alcohol-related liver disease are not alcoholics. They drink every day or most days – not getting slaughtered, but just drinking that bit too much.    Instead of having a glass of wine or a beer after work they’re having two or three. Just topping up every day and never giving their liver a rest.’

Does that make them alcoholics, heavy drinkers, chronic drinkers or just normal?   We can sit here and split hairs all day, but ultimately my opinion, your opinion, even the finger-wagging of your GP doesn’t matter.   They are not categories your liver recognises. It doesn’t care whether you necked those five pints with a crowd of mates to wet a baby’s head, or whether you drank them alone to numb the pain of an argument. 

‘If you are going to drink, you must take two to three consecutive days off every week to give your liver a chance to rejuvenate – regardless of how much you’re drinking.The important word here is ‘consecutive’
It’s not about judgements, just biology.  And liver disease can develop slowly, but its endgame can be apocalyptic.  It’s not a question of lying in hospital with yellow skin and a glorified tummy ache.  Besides its function of filtering out the toxins from drink and drugs, the organ is also vital for hormone balance, blood clotting, and protecting certain parts of the body from infection. Remove its protection, and things will start going to shit very rapidly.   Believe me, you don’t want to see what happens to brain function when the liver can no longer dispose of bilirubin, a by-product of dead blood cells.

In the last 35 years we’ve allowed alcohol to become a commodity,’ says Mr Langford.

‘In the 70s it would have been fairly unusual for my mum to have had alcohol in her shopping, whereas now a bottle of wine goes into the basket along with the milk, eggs and bread.’

I had to laugh at the timing of this piece as 2 weeks before Christmas it was going to be destined to be ignored by anyone who thinks this was sucking the joy out of life and the festive season!!  Good that the health message is filtering into the mainstream media though 🙂
This comment to the article made me almost spit my tea over the keyboard:

My husband and I are very sociable and drink a fair amount. At this time of the year, especially, our alcohol consumption in a day can go like this: morning coffee with a splash of coffee liqueur, mimosas with brunch, egg nog with a dash of whiskey, glass of wine at dinner, beer or three at football games, etc.  Good god, this is alcohol with breakfast, lunch and dinner ……..

Edited to add 7/11/16 (Alcohol Policy UK):

Scotland’s Alcoholic Liver Disease rates were explored in a Conversation article, warning of the continuing upward trend. The latest figures show 3,788 hospitalisations each year, but explaining why Scots drink more than most other countries is complex, though more could be done around prevention say the authors.

Alcohol and Me: A Message for Young People

Alcohol and Me: A Message for Young People is a new video that was launched last month on Youtube by Alcoholics Anonymous, UK

I really like it and think it’s applicable to anyone really.  Here it is:

It’s also really great to see AA involved in new media and trying to reach young people.  I wrongly often assume because it was founded in the 1930’s, and it’s format hasn’t changed much since then, that they are not keeping up with the changes that are happening in the world around the rooms but this tells me they are 🙂

What do you think?

Young people’s hospital alcohol pathways: Support pack for A&E departments

The spotlight really does seem to have narrowed on the impact of alcohol on young people, I’m happy to say 🙂

Here is another new initiative from Public Health England.  Guidance to improve support for young people in A&E with alcohol related problems has been published. It is aimed at A&E clinicians, hospital managers, substance misuse and young people’s commissioners and includes a set of key questions or prompts for professionals to help them develop care pathways within A&E and into other services for young people.

It looks at the extent of the problem

Up to one third of alcohol-related A&E attendances are for under 18 year olds and local areas vary significantly in how they approach the care of young people in this situation. Health services have a responsibility to ensure this ‘teachable moment’ is used to advise young people about their drinking.
Taken from the government’s alcohol strategy, March 2012
“On average, 26% of adolescents consumed alcohol in the past three months starting with 1% of 10-year olds and increasing steadily to 76% of 17-year olds.”
And there are large geographical variables too:

“14% of adolescents in one London A&E department having drunk alcohol in the last three months compared to 35% in the North East of England.”
And to chime with my own research the guidance says:
“There is also growing concern about the impact of alcohol use on young people’s sexual behaviour.  Some young women have reported that using alcohol may help reduce their anxieties in situations where they feel pressurised into having sex.  Alcohol consumption during adolescence is associated with an increased risk of regretted sexual experience.  It also increases the vulnerability of being a victim of sexual assault and other crimes, particularly assaults.”

And it then key questions for developing pathways which they list as including:

  • Understanding levels of unmet need
  • Initial screening and referral process
  • Information and data sharing
  • Safeguarding
  • Interventions
  • Next steps

It is another joint venture between PHE and Alcohol Concern and I welcome it as it is a conversation that very much needs to be had.

Alcohol misuse and young people: the long-term impact on health

Alcohol misuse and young people: the long-term impact on health research article from the Nursing in Practice online journal:

Alcohol is ranked as the most harmful substance when compared to 20 other commonly used substances in the general population.1 In 2012, 43% of pupils (aged 11-15 years) reported having had an alcoholic drink in their lifetime – this is a marked decline from 2003 when the same survey reported 61% had done so.2 This trend is reflected in a reduction in those pupils who drank alcohol in the last week, which was 25% in 2003, reducing to 10% in 2012.

Further analysis reveals falling consumption particularly for young men and increasing abstinence rates for both genders. However theses overall trends are not mirrored by sub groups of young people who develop a problematic relationship with alcohol and the impact this has on their health and social circumstances.3

Risks

There are three broad groups of young people to be aware of in relation to alcohol: those who drink in a hazardous way, and those who drink in a harmful way, or those who are dependent (see Figure 1). There are specific risks that young people face when consuming alcohol. These risks can differ from those encountered by adults, compounded by a potential naivety in calibrating the amount of alcohol they can consume before becoming intoxicated or finding their judgement is impaired. The most serious and immediate risk is alcohol poisoning which can result in death, mortality rates for young people are higher than those for adults, on average over thirteen thousand children or young people are admitted to hospital with alcohol related problems every year in England.5 More routinely, as decision making is compromised, the potential for engaging in unsafe sex, including sexual exploitation, or becoming involved in anti-social behaviour is elevated.6

In addition to the risks young people face when drinking alcohol, there are 2.6 million children living with parents who drink alcohol in a hazardous way.7 This potentially exposes them to behaviours which role model alcohol use in a negative way and may influence their own relationship with alcohol, such as using alcohol to cope with stress or simply increasing access to alcohol.

Long-term impact on health

Alcohol is associated with more than 60 medical conditions. This, combined with the fact that young people are still developing physically and mentally, mean that there are good reasons to be concerned about the longer term impact alcohol will have on their health. Some health related problems include heart disease, liver cirrhosis, cancer, depression and high blood pressure.

At one time alcohol-related liver disease was considered an older persons issue, however there has been a significant increase in those under the age of 30 admitted to hospital with these problems.

Problematic alcohol use is associated with two common mental health problems, namely anxiety and depression. This is a bi-directional relationship in that anxiety and depression can be brought on by drinking too much alcohol in addition these mental health problems can lead to people using alcohol as a way of coping with the way they feel.8

The phenomenon of ‘discounting’ is a potential factor for young people. Even if they are aware of the health costs associated with alcohol, they might discount the impact of these in favour of the more immediate and desired effects of consuming alcohol in the present, in other words adopting a ‘live for today’ attitude.

A recent study suggests that alcohol use and intoxication before the age of 14 years is linked to problematic use of alcohol as an adult,9 however confounding factors such as mental health problems or social disadvantage can also influence this progression from early adolescence to problematic alcohol use as an adult.

Management and treatment

It can be useful to take an opportunistic approach to engaging young people in a conversation about their alcohol use, particularly when they present with alcohol related injuries, as this can be a catalyst to starting the process of contemplating a change in their drinking behaviour. Techniques known as ‘brief interventions’ have an emerging evidence base in primary care, as the name suggests these can be employed when there is limited time available and have shown to be effective in facilitating behaviour change.10 These interventions include giving advice, discussing risky behaviour, encouraging harm reduction and examining the perceived benefits and negative consequences of alcohol use. These interventions can be delivered in as little as five minutes, which fits well with the time constraints in contemporary primary care consultations. 

It is interesting to note that after years of research in the field of addiction ‘therapist effect’ is the one component that consistently demonstrates improved outcomes irrespective of the type of intervention offered.8

These components include:

  • Being empathic.
  • Demonstrating warmth.
  • Being treated with respect.
  • Displaying genuineness. 
  • Optimism that change is possible. 
  • Show interest in the individual. 
  • Not forming judgements about the person’s lifestyle.

Although these components can be viewed as intrinsic to any healthcare worker, they are less likely to be exhibited if we dislike or disapprove of an individual’s lifestyle including the way they use alcohol. Mirroring these qualities as a parent, by demonstrating warmth and communication, have also been found to be protective against problematic alcohol use in young people in a pan European study.

A range of assessment tools are available to determine the impact of alcohol on a young person. The Alcohol Use Disorders Identification Test (AUDIT) is a screening instrument designed to identify those at risk of problematic or harmful drinking over the last 12 months. This ten item screen has been shown to be both reliable and valid in detecting young people who are at risk.12 A score of eight or more on the AUDIT indicates a problem.

Careful consideration of potential drug interactions between alcohol and prescribed anti-depressants, such as selective serotonin reuptake inhibitors (SSRIs), needs to be taken due to the increased risk of sedation when these two drugs are combined.13 Problematic alcohol use can impair hepatic function therefore affecting the liver’s ability to metabolise drugs generally, so again the quantity and frequency of alcohol use will need to be considered in relation to any other prescribed medication and its likely efficacy.

Challenges

For young people, the fact that alcohol is more widely available, and is now 45% more affordable than it was in 1980, presents an increased opportunity to consume it even if their income is restricted.14

A pragmatic and targeted approach can be employed to screening for problematic alcohol use, for example by screening people who are newly registered or transferring in from another primary care practice. Also consider focusing on high-risk groups such as those who attend with alcohol-related problems. Practice nurses can effectively carry out screening, referring young people who are thought to have a problem based on the results. Referrals can be made to your local child and adolescent mental health (CAMH) team who will have a primary care mental health worker acting as a link between primary and secondary care services.

Some specialist substance use teams offer services specifically for young people however most are designed for adults and would be inappropriate for the assessment and treatment of adolescents. The marked variations in the way these specialist services are provided was recently acknowledged by Public Health England, recognising the specific needs that young people have and the importance of providing services which will encourage this group to make contact and seek help.15 This adds to the important role that primary care workers can take in engaging and treating young people with alcohol problems, particularly as the environment is less threatening, since they are likely to have accessed primary care at some point in their life and find it less stigmatising than a specialist addiction service.

Alcohol and the Developing Adolescent Brain

This report looking at alcohol and the developing adolescent brain and shared from Alcohol Policy UK follows on nicely from my post yesterday about alcohol and sexual health in young people 😉

Earlier this year Scottish Health Action on Alcohol Problems (SHAAP) published a report compiling a number of expert insights into the impact of alcohol on the adolescent brain. The issue is of particular relevance to alcohol policy given evidence that early onset drinking is linked to later life alcohol problems.

Download Alcohol and the Developing Adolescent Brain: Evidence Review [pdf].

The review looks at key areas including how the brain develops during adolescence, what alcohol does to the developing brain, the role of genetics, and further clinical, psychological and cognitive implications of adolescent alcohol use. Many of the articles address the limitations and challenges facing research in the area, but identify a number of serious effects adolescent alcohol use can have on short term brain functioning and for later life.

Based on the themes of the report and round-table discussions, SHAAP make a number of policy recommendations:

  • Protecting young people from alcohol-related harm has to be within the context of a ‘whole population’ approach to reduce overall alcohol consumption.
  • Protecting young people from alcohol-related harm should be embedded in national and local policy.
  • Emerging evidence that the adolescent brain may be especially vulnerable to alcohol harms should inform all health-promoting activities.
  • Emerging evidence that the adolescent brain may be especially vulnerable to alcohol harms should prompt investment in further exploratory research.

Last year an event took place exploring ‘Alcohol consumption in adolescence and early adult life: What are the consequences?’, organised by the Cohorts and Longitudinal Studies Enhancement Resources (CLOSER).

A presentation at this year’s Drinkaware conference also looked at the subject with a presentation on ‘The effects of alcohol on the adolescent brain’, by Sarah-Hayne Blakmore, Professor in Cognitive Neuroscience at UCL. View the factsheet here.

I personally think that a key way to tackle this is to improve alcohol education in schools and if it was combined with Sex and Relationship Education (SRE), which is compulsory, then this would be a big step forward.  Equally there needs to be a change in law around advertising and media to try to manage or stop the drink’s industries targeting of young people online via social media.  RAND have done some excellent research looking at this subject which you can read:

Exposure of Youth to Online Alcohol Marketing

British and Dutch Teens See More Alcohol Ads than Adults Do

Also I think the legal age to drink needs to be revisited as it has been with smoking.  It is now illegal to buy tobacco products if you are under 18 and has been revised upwards from 16.  The same needs to be done to raise the legal age of consumption of alcohol in a public place from 18 to 21, not because I’m some kill joy, but because the larger the buffer we can put between adolescents and alcohol the greater the chance we give their brains to develop without the risk of significant harm being done which is a key coda of child protection.  What do you think?

PS Congrats to my free e-book subscriber no 750 who has been emailed regarding the free place offered on my online Udemy course.  From now, subscriber no 1000 same deal! 😀