Monthly Archives: January 2016

The Public Health (Alcohol) Bill 2015

The Public Health (Alcohol) Bill was approved by the Irish Government on 8th December 2015.

Public-Health-Alcohol-Bill-2015-iconSo now we have Scotland to the north of us and Ireland to the west of us who are acting decisively regarding alcohol and public health …..

The bill aims to reduce alcohol consumption in Ireland to 9.1 litres per person per annum by 2020 and to reduce the harms associated with alcohol.

The Public Health (Alcohol) Bill 2015 (PDF)

The Bill consists of 29 sections and as regards alcohol products are listed in Part Two as:

10. Minimum price of alcohol products
11. Labelling of alcohol products and notices in licensed premises
12. Content of advertisements
13. Prohibition on advertising in certain places
14. Restriction on advertising during events
15. Sponsorship
16. Children’s clothing
17. Advertisements in publications
18. Advertising in cinemas
19. Review of operation of section 12 to 18
20. Structural separation (of alcohol products in mixed trading outlets)
We really are being shown up in the UK now as dragging our heels on this issue & I would so love for this type of Bill to be enacted here.  It addresses many of the key issues that put both adults and our young people at risk with this psychoactive addictive drug.
What will it take for our govt to act?  Well recognising it as a public health issue rather than a law and order departmental concern would be a start.  Diverting all that money used in crime and punishment towards health and well-being instead? A girl can dream and sadly that is all it is right now 🙁
Edited to add: It’s amazing what crosses your desk at just the right moment!  When reading a  Daily Telegraph article about how the Scotch Whisky Association wants the Government to cut the tax on a bottle of whisky by 2pc (I know!) they included this chart looking at alcohol taxes in different European countries
 alcohol taxes tableAs you can see Ireland has the largest alcohol tax take but are now counterbalancing it with legislation to help reduce alcohol consumption.  Ireland and the UK are very similar in that booze contributes massively to the economy but that shouldn’t preclude protecting public health ……

Dutch trial of web-based treatment programme for problem drinking

This was featured on Findings in December and looked at the use of a web-based treatment programme for problem drinking as part of a randomised trial within the Netherlands.

Web-based-addiction-treatment-services-2The trial had included 156 adult problem drinkers who on the project’s web site (now also available in an English-language version) had identified themselves as drinking at least 150g alcohol a week for women and 220g for men (about 19 and 28 UK units respectively), but no more than 670g for women and 990g for men. They were among over 500 who had responded to adverts and other invitations to join the study who said they had not recently been in alcohol treatment and were not suffering a psychiatric disorder. Just over half were women, 82% were employed, and they averaged 45 years of age. About 8 in 10 self-assessed as dependent on alcohol, though 86% had never received professional help. The women averaged 352g alcohol (44 UK units) a week and the men 419g (about 52 UK units).

Half were allocated at random to immediately gain access to a 12-session web-based treatment programme. The other half formed a control group who had to wait three months for access, during which they were kept in touch with through fortnightly email messages from the research project.

The web-based programme involved patients being allocated their own personal therapist with whom they communicated in writing via the project’s web site. Rather than online ‘chatting’ in real time, communication was analogous to email messages, responses following some time after the initial contact. The programme was based on cognitive-behavioural therapy and motivational interviewing. The first part involved assessment, assessment feedback, a drinking diary, and identifying situations which for that individual risked heavy drinking. This part culminated in advice from the therapist on how the patient might change their drinking habits. Part two was the change phase, involving setting a drinking goal and formulating a plan for maintaining the new drinking behaviour.

The authors’ conclusions

Post-therapy improvements in drinking and health and in quality of life were sustained over the next six months. The decrease in alcohol consumption was substantial and clinically meaningful. These results suggest web-based alcohol interventions with intensive personal support from a therapist can help reduce problem drinking. However, support of the kind offered in this trial requires more resources than less intensive web-based interventions such as brief interventions or self-help programmes. Professional therapists available at least twice a week are needed to maintain communication with participants, and technology and security requirements are greater because personal information is sent between clients and therapists. Despite these costs, web-based alcohol interventions of this kind are legitimate additions to the range of treatment modalities as they attract new groups of problem drinkers and extend the accessibility of interventions.

Web-based treatment particularly attracts women and better educated and employed drinkers, groups under-represented in face-to-face therapy. Anonymity means participants no longer need stay away from treatment because of shame, fear of stigmatisation, or other barriers to professional help. Participants are helped in their own environments at times of their choosing, making therapy more accessible and convenient. These are also why email type communications have an advantage over ‘chat’ sessions which require client and therapist to be available at the same, set times. An advantage over self-help is the added value of personal contact with a professional therapist. The main challenge seems to be keeping participants involved until the end of the programme.

As part of my online course 1:1 support is available via email – and as this study shows it can be very successful 🙂

Friday Sober Jukebox – Oddity

david bowieIt seems only right to have a sober jukebox dedicated to the late great David Bowie who had been in recovery since the late 70’s following being given custody for his son.  The track, Space Oddity, is both my favourite of his and also speaks to the disconnect in opinions about the value of Dry January campaigns.  And as we head into the last days of the campaign it seems a good time to reflect.

Here is the BMJ’s Head to Head take on it:

Could campaigns like Dry January do more harm than good?

Lack of evidence that such campaigns work and don’t have unintended consequences, concerns Ian Hamilton. But Ian Gilmore thinks they are likely to help people at least reflect on their drinking

Yes—Ian Hamilton

Two questions should be asked of any public health message about alcohol: is it evidence based and who is the target audience? Now in its fourth year, the Dry January campaign, which uses peer pressure to encourage abstinence from alcohol for the month, is promoted by the charity Alcohol Concern in England and Wales.1 It is supported by Public Health England so in effect has government approval. The campaign estimates that “Last year over 2 million people cut down their drinking for January.”1

But popular doesn’t necessarily mean effective. Alcohol Concern’s ambition is to alter people’s relationship with alcohol by encouraging us to reduce the amount we drink, not just for a month but for life. Unfortunately, this type of campaign has had no rigorous evaluation.

Self selecting participants

It is not clear who Dry January is targeting. Because participants select themselves it could attract the people at lowest risk from health problems related to alcohol. Because they consume less alcohol they are also likely to find a month of abstinence relatively easy, as a recent study indicates.2 The campaign should offer a range of advice and more carefully tailor these messages to match the individual’s use of alcohol.3 For example, one high risk group is people aged over 65. Trying to communicate a message about alcohol to the over 65s at the same time as the under 25s risks the message not being heard, as the way these groups use alcohol is likely to be different.

Many of us can be economical with the truth when it comes to how much we drink. Research comparing self reported alcohol consumption with total alcohol sold found a large disparity.4 It is not clear whether this mass denial affects Dry January. At the very least an appraisal of how much and how often an individual really drinks will influence whether they see a need to test their ability to go without alcohol for a month or simply view the campaign as more nagging and switch off. If people aren’t honest with themselves about their drinking, how can Dry January help?

All or nothing

Dry January also risks sending out a binary, all or nothing, message about alcohol—that is, either participate by abstaining or carry on as you are. Dry January could be adding to the confusion we know exists in communicating messages about alcohol—for example, in public health advice about safe levels of alcohol consumption using recommended maximum daily or weekly units of alcohol. Health professionals lack understanding about units.5 Beyond the problems of misinterpreting the guidance, the advice depends on people keeping a tally of the number of units they consume; only 13% do this.6

Dry January has the potential to compound this muddle. Although not the intention, people may view their 31 days of abstinence as permission to return to hazardous levels of consumption till next New Year’s day. “I’ve had a month off, so now I can drink as much as I did before, ignoring the need for regular breaks from alcohol.”

Heavy drinkers

Most people can stop using alcohol without any immediate harm. However, for some heavy drinkers or people who have experienced withdrawal previously, abrupt abstention from alcohol can induce serious symptoms such as seizures.7 This is not a group of people who should be participating in a do-it-yourself detox such as Dry January. They will need expert help and a supervised detoxification programme to ensure their withdrawal from alcohol is managed safely. If Dry January’s campaign material made this clearer it would go some way to minimise potential harm. Otherwise, the campaign risks setting up dependent drinkers to fail, compounding their inability to gain control of their drinking. We don’t know what effect the additional attention given to alcohol through the promotional activity of Dry January has on this group.

In sum, parched of evidence Dry January could have unintended consequences which would do more harm than good.

No—Ian Gilmore

Although successive Westminster governments may have difficulty in acknowledging the scale and scope of alcohol related harm in the United Kingdom, few readers of The BMJ will fail to make the connection in their daily work (and play) between our increasingly uneasy relationship with our favourite drug and the burden on the NHS and emergency services and harm to others.

Our per capita consumption has doubled over 40 years, we have 1.5 million heavily dependent drinkers in this country, and alcohol has become a central part of most social occasions.6 So what could possibly be wrong with encouraging and supporting the estimated two million or so adults who decide on Dry January8—to take a month off the booze and have time to reflect on their drinking?

Sustained drop in drinking

Maybe it is the “nanny state” and interference with personal choice? Well, it is just a personal choice to take part in this voluntary event instigated by the charity Alcohol Concern, which receives no direct government funding. There has been some support in kind from Public Health England, and its independent evaluation of 2015’s Dry January showed that 67% of participants said they had had a sustained drop in their drinking six months on.8 In an earlier evaluation by the University of Sussex, 79% of participants said they saved money, 62% of participants said they slept better and had more energy, and 49% said they lost weight.9

Indeed, researchers at London’s Royal Free Hospital showed that one month’s abstinence produced quite remarkable changes in such diverse aspects as blood pressure, liver stiffness, γ glutamyltransferase concentrations, insulin resistance, and body mass index.10

Greater wellbeing, better sleep

More studies are needed to see how sustainable some of these benefits are, but the overwhelming experience of those participating is greater wellbeing, better sleep, and a sense of achievement. That and the relief that they are not as dependent on that regular “anxiolytic agent” as they thought; there is a life out there that does not have to revolve around drinking.

There are no “prohibition” or “temperance movement” agendas here, and the majority of people choose to return to drinking, although 8% of those followed up by Public Health England six months later had decided to capitalise on the benefits and stay dry.8

The campaign is aimed at social not dependent drinkers, and heavy drinkers are recommended to see their general practitioner before stopping suddenly and completely. But each year Dry January brings to light some dependent drinkers who need professional help, and services for them are still patchy and inadequate.11 But it can’t be bad that some of the 1.5 million dependent drinkers in this country make the first steps towards help.

Some myths around Dry January need to be addressed. It should not be treated as a money raising sponsoring opportunity, culminating in drunken celebration at the month’s end, nor as an excuse for thinking “job done; body detoxed; I can go straight back to the old ways for the rest of the year.” But evaluations indicate that campaigns like Dry January are being used more as a way of people examining their relationship with alcohol and making longer term changes. Further study is needed, not just of the 50 000 people who sign up with Alcohol Concern1 and get support but also the estimated two million people who simply decide to quit the booze after the Christmas break for a month.

Release of the UK chief medical officers’ guidelines on drinking is timely, with their emphasis on having several alcohol-free days each week—some “dry weekdays.”12 Although it is unlikely that this will have much impact on health measures such as blood pressure and insulin resistance, it should be a focus for further research. Until we know of something better, let’s support growing grassroots movements like Dry January and Dry July in Australia and take a month off.

BMJ 2016;352:i143 (references on link page)

I completely agree with Sir Ian Gilmore as it was that month off and having a chance to reflect on my drinking that started the ball rolling to me stopping for longer.  What are your thoughts?

OK so over to Mr Bowie:

Tommy Rosen 2016PS – Tommy’s 2.0 Recovery Conference is back!
http://recovery2point0conference.com/

 

What alcohol does to your body after the age of 40

This was in The Telegraph in December and thanks to Laura over at Club Soda for bringing it to my attention!  As someone now closer to 50 than 40 it resonated strongly …..

over 40If you’re over 40 and live in Britain, the chances are you like a drink.  As the Chief Medical Officer Dame Sally Davies considers the current NHS drinking guidelines, experts are urging us to spare a thought not only to the short-term effects of alcohol on our brains, but also to the damage our drinking habits are doing to our bodies as we approach middle age.

Alcohol affects just about every system because it’s a small molecule that goes everywhere in the body,’ says Paul Wallace, emeritus professor of public health at University College London and medical director of the charity Drinkaware.  ‘From the gut to the heart, the blood vessels to the skin, its effects are all pervasive.’  But why does it feel like the effects of drinking are so much worse post-40? ‘The organs that metabolise alcohol such as the liver and the stomach shrink as you get older, so alcohol stays in your system longer,’ says Dr Tony Rao, consultant old age psychiatrist at the South london and Maudsley NHS Foundation Trust. This could explain that wretched two-day hangover post-40.  ‘Plus, the total fluid in the body is a lot less – we get more dehydrated as we get older – so because alcohol is distributed in blood which will be more concentrated, it won’t be broken down as quickly as it would in the bloodstream of a 20 year old.’  

Here’s what else alcohol is doing to your body post-40.

Brain

‘Alcohol gets through the blood-brain barrier where it works as a depressant,’ says Professor Wallace. ‘We feel quite excited and stimulated when we drink because it’s having a depressing effect on controlling behaviours such as judgement, self-monitoring, planning and reasoning’, he says. It explains why what seemed like great idea the night before is not so much the morning after. ‘Over time this gives you a higher propensity to mood problems such as anxiety and depression.’  In his NHS clinic specialising in alcohol problems, Dr Rao sees people in their 60s with subtle alcohol related brain damage after a lifetime of casual drinking. ‘I always say to my patients ‘Your brain is affected a lot earlier than your liver’’, he says. ‘Before we see the cirrhosis we see depression and problems with impulse control, moodiness, problems making complex decisions, say with finances and their children or spouses might say ‘Oh that’s just so-and-so being a silly old bugger,’ so the problems are missed.’  Good news is, the damage can be reversed after just six months of not drinking, he says. 

Skin

Alcohol causes a flushing of the skin in those prone, says Professor Nick Lowe, consultant dermatologist and spokesperson for the British Skin Foundation. ‘This can trigger rosacea, a chronic redness in the skin because the blood vessels enlarge and produce more blood flow. Though the redness can go down, over time it can lead to a permanent enlargement of the blood vessels and visible thread veins on skin.’  These can be treated with pulsed right or vascular lasers but are better caught early for best results, he says. And those spots you get after a night out?  Here’s why. ‘Alcohol can make people stressed and anxious and this stress produces the androgen hormones that stimulate acne,’ says Professor Lowe.  And the reason heavy drinkers tend to look a little worse for wear? ‘The skin becomes dehydrated and and the fluid lost can lead to flakiness and puffiness around the eyes,’ he says. ‘Plus, the excess sugars you’re consuming – especially with beer and wine – damage the DNA and collagen in the skin which can lead to more rapid ageing.’

Heart

People who regularly binge drink – that’s classified as drinking double the daily limit of 3-4 units for a man and 2-3 for a woman or more in one session – dramatically increase their risk of stroke, says Professor Wallace. Drinking raises blood pressure both short and long term which increases heart attack and stroke risk. Excessive alcohol also damages the heart’s ability to pump, a condition called cardiomyopathy which increases risk of heart failure, says Dr Mike Knapton, associate medical director of the British Heart Foundation. But surely a glass of red wine a night is good for the heart? Knapton concedes that research does confirm this, ’but the benefits come from less than one glass of red wine a day, so the first glass might do you good but anymore won’t.’

 Liver

Liver disease has risen in the UK by a staggering 400 per cent since the 1970s. ‘Those at risk are not just chronic alcohol abusers, but also middle-aged, professionals who drink a little too much most nights,’ says Dr Debbie Shawcross, consultant hepatologist at King’s College Hospital Liver Unit. ‘The liver may start out a little fatty and then if you continue heavily drinking between say 40 and 55 the fat and inflammation creates scar tissue and the liver shrinks and – for about one in six people -can lead to cirrhosis or liver disease.’ 

The liver has a healthy ability to heal itself and the British Liver Trust suggests aiming to have three consecutive non-drinking days a week, to give it a chance to regenerate – they also have an iPhone app called Spruce that helps you work alcohol free days into your week.

 Cancer risk

 Each year about 13,000 cases of cancer in the UK are attributed to alcohol consumption. ‘In terms of cancer risk, there is no safe level of drinking,’ says Nicola Smith, health information officer for Cancer Research UK.  ‘The cancers most closely linked to alcohol consumption are those of the mouth, oesophagus, bowel, breast and throat,’ she explains.  The more you drink, the higher your risk because ethanol in alcohol is broken down into acetaldehyde which damages DNA and directly impacts cells that cause cancer.  Plus, ‘If you’re smoking and drinking at the same time, you’re increasing your risk of mouth and throat cancer because alcohol makes cells more responsive to the toxins in tobacco smoke,’ she says. This effect is even in casual drinker/smokers, she asserts.

Fertility

A pioneering Danish study of thousands of couples who had discontinued contraception in order to conceive found that tee-totallers got pregnant much sooner than even very light ‘social’ drinkers and they had a lower miscarriage rate. Even where couples resort to IVF, a US study found that moderate drinking (half a bottle of wine a week) was associated with an 18 per reduction in success rates for women. ‘For men, excessive alcohol consumption lowers testosterone levels and reduces sperm quality and quantity,’  says Dr Gillian Lockwood, fertility specialist and medical director of Midland Fertility. The ‘sperm cycle’ is 70 days, so the damaging effect of a serious binge may take a couple of months to improve, a more serious consideration for men over 40 whose sperm is already declining in quality’.

Weight

Alcohol contains seven calories per gram, nearly the same as fat (9 calories per gram) and when you drink the body recognises its by-products as toxins and chooses to break these down first over the nutrients in food, explains nutritionist Robert Hobson, co-author of The Detox Kitchen Bible (Bloomsbury £14.99).  ‘ When the body gets round to metabolising the food, it may no longer require the calories, so they get stored as fat.’  Studies also show that drinking can suppress the hormone leptin, which controls appetite which is why people can over eat when drinking. As a sugar source, alcohol raises insulin and turns on fat storage by increasing fatty deposits in the liver and , in middle age, excess can lead to fat storage around the stomach –  a root cause of the classic ‘beer belly’.

Laura & I will be running our next How to Quit Drinking workshop in 2 days if you’d like to join us? 🙂

The NHS is failing people with mental health and substance use problems

This is not the first time I’ve written about mental health and alcohol dual diagnosis and the failure of the NHS to treat appropriately.  You can read my other posts here.

This is what Professor Liz Hughes had to say in The Guardian in December.

dual diagnosisPeople who have mental health along with substance use problems (known as dual diagnosis) have multiple needs, and yet struggle to find services to help them.

Those with complex needs have often experienced a great deal of adversity in their lives, including childhood abuse and deprivation, loss of close family, and poverty. As an adult, having multiple needs brings consequences such as homelessness, unemployment and exploitation, and there is a high risk of poor physical health, suicide, self-harm and of perpetrating violence. Those with dual diagnosis are also unpopular, partly because of society’s entrenched attitudes to substance use problems, which are perceived as a lifestyle choice rather than a health condition deserving of care and treatment.

Dual diagnosis is one of the biggest challenges facing mental health and substance use services, but after 15 years of a variety of initiatives it’s hard to see how things have changed on the frontline. I still hear about the same challenges that were around in the 90s. Mental health services can often exclude people if their problem is perceived to be substance-related and, conversely, substance use services exclude people if their substance use doesn’t fit their criteria.

One of the solutions put forward is to train staff in mental health and substance use with transferable skills and knowledge. Dual diagnosis is the norm, not the exception, and therefore is everyone’s business. Dual diagnosis training has been rolled out, but though it can improve knowledge and skills, it doesn’t always change perceptions and values.

One particular incident stands out from when I was a dual diagnosis worker. It was a Monday, and I arrived at the local psychiatric inpatient unit to see if there were any referrals for me. The nurse in charge greeted me with a “we’ve got one of yours” and a roll of the eyes. A single utterance speaks so much. It demonstrates an absence of compassion – that nurse did not see this person as deserving of care.

My heart sank. I spent a while chatting to “one of mine” and he told me of the trauma, homelessness, desperation, and hopelessness that had led to his suicide attempt at the weekend. He told me that staff at A&E and the mental health team on the ward had treated him with disdain; he did not feel welcome, and so was unlikely to want to stay in treatment and access the help he needed.

One of the consistent messages from service users I have talked to over the years is that they want people to listen, to be with them “where they are at” (as opposed to pushing their agenda on them), not to judge them for their choices, and to have hope. Engaging patients is critical, as we know that loss of contact with services is typically associated with worse outcomes and in some case, increased risk of suicide, self-harm and violence.

Much of the dual diagnosis development in the noughties was supported by the national dual diagnosis programme at the Department of Health. Since the localism agenda of the coalition government, and now the Conservative government, and the cuts to government central budgets, many of the national programmes have disappeared. This is further complicated by the almost complete transfer of substance use services to the third sector and the absence of mental health staff in these new services. Currently dual diagnosis work is based on postcode lottery, and is piecemeal at best.

Testimony must be paid to Progress, a consortium of consultant nurses in dual diagnosis who work locally and as a collective, for free, to keep a resources and information website going, as well as to lobby for better services at government level through the all party parliamentary group for complex needs.

In addition, there are some fantastic examples of where service providers and users work together to improve provision. Leeds is a particular example. An active service user involvement group (the Zip Group) is able to influence the city services at all levels. A vibrant network of users and service staff meet regularly and a funded lead person coordinates the venture.

We face two clear challenges: changing the perceptions of service providers to recognise the complex needs of people with dual diagnosis (which includes a shift in attitudes to substance use), and being able to provide effective services to people with high needs, in a time of unprecedented crisis in mental health provision and loss of mental health expertise within the substance use sector.

The UK dual diagnosis scene is running on nothing but goodwill by a few enthusiastic champions – how long can anything be sustained on this basis? With the increasing need to provide evidence for commissioning, it’s time to harness the data that we have at our finger tips to lobby service providers and commissioners for new roles and new initiatives.

Hear hear Professor Smith hear hear!

Edited to add: 17th Feb 2016

My friend Veronica also had a guest blog post looking at this issue in the US

Most Common Co-Occurring Disorders among Substance Addicts

Affluent middle class teens twice as likely to drink regularly, study finds

So this was featured by Alcohol Policy UK and picked up by at least two broadsheet nationals, The Independent and The Guardian in December and focusing on teens and drinking as relating to social class and other demographics.  This is what Alcohol Policy UK had to say:

What about Youth 2014A new HSCIC report detailing the health behaviours of 15 year olds provides further insights into young people’s drinking – an alcohol policy area that attracts significant attention.

A decline in young people’s drinking in England has driven an overall downward trend in consumption since 2004, although levels for young people’s drinking reportedly still remain above the European average for prevalence and likelihood of binge drinking. Adolescent drinking poses significant risks to both health and well-being, including a greater risk of alcohol problems in later life.

The ‘What about YOUth’ survey involved over 120,000 fifteen year olds in England. 62% reported that they had previously had a whole alcoholic drink (not just a sip) – a lower figure than the 69% of 15 year olds who reported doing so in the smoking, drinking and drug use survey amongst pupils, but more than the 58% identified in the Drinkaware Monitor survey. CMO guidance recommends children 15 and under do not drink alcohol at all.

Fifteen per cent of all the young people surveyed said they had been drunk at least once within the last 4 weeks, rising to 23% for those who had ever had an alcoholic drink. The report also identifies that 10% of the 15 year olds had their first alcoholic drink under the age of 12. An association between age of first drinking and frequency of drinking was also identified; among those who had first had a drink at less than 10 years, 28% were regular drinkers, versus just 3% of those who had their first drink at 15 being regular drinkers.

Girls were more likely than boys to report having had an alcoholic drink (65% and 60% respectively) and to report having been drunk in the last four weeks (27% of girls and 19% of boys among those who had ever had an alcoholic drink). However 6% of fifteen year old girls were regular drinkers compared with 7% of boys.

Ethnicity was also a strong predictor of drinking behaviours; those from a White background were more likely to have ever had an alcoholic drink (72%) than those from a BME background (27%), and more likely to be regular drinkers (7% White compared with 1% BME).

New insights: ‘middle class’ parents under the spotlight?

The report also identified drinking levels were higher amongst young people from more affluent areas, reflecting a similar picture for adults (although deprived areas experience greater levels of harm). Twenty per cent more fifteen year olds in the most affluent areas had ever drunk alcohol than those in the most deprived areas (70% and 50% respectively).

Mainstream media picked up on this, prompting headlines that ‘Middle class parents more likely to turn the children to alcohol’. The Guardian highlighted warnings that ‘Middle-class parents who introduce their children to alcohol with a glass of wine at family dinners will not protect them from becoming problem drinkers.’

Colin Shevills, Director of Balance North East, said:

These figures are clearly worrying. The Chief Medical Officer clearly states that the best advice is for young people to have an alcohol-free childhood…. Someone who begins drinking as a young teen is four times more likely to develop alcohol dependence than someone who waits until adulthood to use alcohol, so it’s vitally important that something is done to try and further reduce the number of young people turning to alcohol.

However whilst the findings confirm previous reports that children living with people who drink alcohol increased the likelihood of them drinking, Drinkaware’s Monitor study found young people who reported drinking unsupervised were more likely to get drunk and experience harm.

Bullying was also associated with increased rates of drunkenness according to the ‘What about YOUth’ survey. Among those who had ever had an alcoholic drink, 32% of those who said they had bullied someone had been drunk within the past 4 weeks, compared to 22% who hadn’t bullied. 26% of those who had been bullied said they had been drunk within the past 4 weeks, compared to 20 per cent of those who had not.

Regional differences were significant; young people in the south-west were the most likely to have tried an alcoholic drink at 72%, compared with 41% in London. PHE have produced a What About YOUth? local area tool.

Last year SHAAP produced a report reviewing the impact of alcohol on the adolescent brain. Earlier this year a Demos report offered views into why young people were drinking less. However its focus on social factors may give insufficient attention to environmental factors such as price and availability.

The connection between bullying of others and being bullied and drinking I find worrying.  What do you think?

Wine o’clock habits

As Dry January heads into it’s final week-end here is some research that Alcohol Concern shared in December.

The YouGov survey of more than 2,000 GB adults reveals women’s wine o’clock starts after the clock strikes 5pm (93%). However, it’s men who are more likely to drink every day and those that drink also tend to start earlier in the day. The survey results show that when drinking, a number of men are having their first alcoholic drink at lunchtime -12% of men surveyed have their first drink before 4pm with 4% of these starting around 1pm.

Of those surveyed who drink alcohol in an average week:

  • 10% men have their first drink between 1pm-4pm
  • 6% women have their first drink between 1pm-4pm 
  • 71% of men have their first drink between 5pm-8pm 
  • 82% of women have their first drink between 5pm-8pm

Throughout Great Britain, of those that drink alcohol in an average week, one in ten have their first drink around 4pm or earlier.

The survey also revealed the booziest regions, with more people starting wine o’clock at 1pm in London and the South East when drinking. In the East and West Midlands more people start drinking earlier in the day, having their first drink at 4pm or earlier, but it’s the North East who have the booziest evenings with 84% of people who have their first drink between 5pm-8pm.

I wonder if those drinking between 1pm and 4pm are topping up from the previous night, particularly if they’re drinking every day.  Just a thought.

 

Two-thirds of drink-drivers would abstain if limit was lower, survey finds

This was in The Guardian in December following a survey regarding the current drink driving limit in the UK.

police breathylserTwo-thirds of motorists who drive after drinking alcohol would not have drunk at all if the drink-driving limit was reduced, according to a survey.

The Populus survey findings have prompted alcohol and public health campaigners to urge ministers to impose Scotland’s lower limit across the rest of the UK.

The legal blood-alcohol limit in England, Wales and Northern Ireland – 80mg per 100ml – is one of the highest in Europe. Only Malta allows people to have more alcohol in their body when driving.

Scotland last year reduced its limit to 50mg, a move credited with cutting drink-driving offences by 5%. Extending the same policy UK-wide would save lives and lead many drivers to be more responsible, it is claimed.

In the Populus survey, 568 of the 1,833 people who took part said they had driven after drinking alcohol. Of those who had, 66% said they would not drink at all if the limit was lowered. The Royal Society for Public Health (RSPH), which commissioned the survey, said that was because some would be unsure how much it was safe to consume and others would decide it was not worth drinking at all.

“Alcohol-related road fatalities account for around one in seven road traffic deaths. While good progress has been made in cutting the numbers killed or injured through alcohol-related driving incidents we believe that the UK should follow the lead of Scotland and the majority of EU countries and adopt a lower limit”, said Shirley Cramer, the society’s chief executive.

“The evidence is that this will lead to a drop in alcohol-related road traffic accidents and our research would suggest that a further reduction would encourage many motorists just not to take the risk of drink-driving,” Cramer added.

While consuming any alcohol at all increases the chance of having an accident while behind the wheel, research shows that drivers who are just under the current 80mg limit are twice as likely to die in a crash than those just under the 50mg limit campaigners are backing.

In a letter to the Guardian, the RSPH and five other alcohol or public health groups claim the case for a UK-wide 50mg legal limit was overwhelming.

“The adoption of a 50mg driving limit across European countries has reduced alcohol-related driving death rates by 11.5% among young people aged 18-25,” the letter says.

The 5% fall in drink-driving offences in Scotland in the year since it introduced the lower limit shows that “people have changed their behaviour and are drinking less before getting behind the wheel”, it adds.

Populus interviewed a random sample of 1,833 GB adults aged 18 and over online between 20-22 November 2015. Surveys were conducted across the country and the results have been weighted to the profile of all adults.

The drinks industry won’t like this, neither will the Govt, because it puts public health above business and the economy.  Wait for the cries of Nanny state to begin …….

Middle-aged mothers are Britain’s worst ‘hidden drinkers’, experts warn

hidden drinking mothersFinally the spot-light finds my demographic.  The one that I knew was here because it describes me.

45-64 *raises hand*

female *keeps hand up*

parent *yep*

drinking at home *check*

This was in The Telegraph in December:

Middle-aged mothers whose children have left home are becoming the “fastest-growing group of hazardous drinkers”, experts have warned.

Two-fifths admit drinking as much or more than their grown-up children, according to a poll, while a quarter say they have increased their alcohol intake since their children flew the nest.

While young people are drinking less, preferring to binge on weekends than drink every day, their mothers are more likely to consume alcohol on a daily basis at home.

They do not tend to get drunk but, because they drink every day, their weekly intake can far surpass the recommended amount.

Dr Sarah Jarvis, a GP and medical adviser to charity Drinkaware, said that is has become more socially acceptable to drink at home, meaning people drink more than they would if they were out at a bar or pub.

“Whilst many believe it is the 20-somethings who are drinking too much, we are actually seeing an epidemic amongst British women aged 45 to 64,’ she told the Daily Mail.

“This is the fastest-growing group of hazardous drinkers who are putting their health at risk.

“Women in this age group seem to be drinking more alcohol, more regularly – whether at home alone or out socialising.

“Many are unaware that a couple of glasses of wine each day can cause as much, if not more, damage than the binge drinking associated with many university students.”

A YouGov survey of 500 mothers over 45 whose children had left home found that 28 per cent admitted they drank more than their children, while 14 per cent said they drank about as much.

A quarter said they had been drinking more since their children left home. The research was funded by drugs firm Lundbeck, which makes medication that reduces the desire for alcohol.

The findings suggest that the vast majority of middle-aged women do not realise the health implications of their alcohol consumption.

Some 95 per cent of those surveyed said they were not concerned about their level of drinking and did not believe it was impairing their health.

Meanwhile, adults aged 18 to 24 were nearly twice as likely to be worried about the negative effects of drinking on health.

The Organisation for Economic Co-operation and Development this year put educated British women top of global league table of alcohol abuse.

Figures from Public Health England revealed hospital admissions linked to alcohol grew three times quicker among women than men last year.

The number of women over 60 to undergo formal alcohol-dependency programmes has increased 65 per cent in five years, with this age group now making up one in ten female alcoholics.

So okay this research was sponsored by a firm wishing to sell it’s product to help with this ‘problem’ so we have to be wary of the source however that does not change the findings.  If you are reading this and fit that demographic too and would like to cut down or quit please reach out to me on email and I will do my best to help 🙂

Britain on the Booze

alcohol stats Guardian Britain on the BoozeIt’s very rarely that I post twice in one day (apart from Friday Sober Jukebox) but this is so superb and important I’m blogging twice today to make sure you see the coverage.  For those who missed it last night The Guardian did an excellent Society focus on Alcohol and the NHS called Britain on the Booze.

I could have cried with joy when I saw this this morning as it feels like finally a respected broadsheet has picked up in a big way on what we’ve been discussing here on a daily basis for the last two years.  Maybe now there will begin to be some acknowledgement to the size and scale of the issue which we are only too aware of out here in the sobersphere but the rest of the country (and world) seems to want to continue to deny.  Hopefully not anymore …. but I am also aware that today’s news print becomes tomorrow chip paper so my optimism is held in check by a dose of realism.  (As a side note MrHOF saw the start of the coverage last night but I’d just gone to bed and he knew that if he told me I’d have stayed up all night following it so he only told me this morning, and he was right, I would have done so thank you to him for knowing me so well!)

They looked at all aspects which included six reporters in city centres across the country report on one night of British drinking – and its impact on the National Health Service.  There is too much to cover in this blog post so I’m going to supply all the links to their coverage and will pick my edited highlights.

So here goes:

The making of a hangover: the true impact of one night out

Friday night: how it unfolded

Healthcare professionals share their experiences of funding constraints, violent behaviour and drink-related disease and death

I look after a 34-year-old woman who drank three bottles of wine and fell down a flight of stairs. She is visibly intoxicated but starts to become less responsive. Is this due to alcohol or a head injury? One thing I have learned is to never assume someone is just drunk. She falls unconscious and stops breathing. A tube is put down her throat to help her breathe. Scans report various limb fractures, a skull fracture, broken ribs and, more worryingly, a bleed on the brain – a potentially fatal diagnosis.

Staff tell of chaos and abuse, with high volumes of drink-fuelled cases now a daily rather than a Friday night aspect of work

(Exclusive: Firms claim to support responsible drinking, yet data shows those who consume at risky or harmful levels account for 60% of sales in England)

And it’s the same in Australia:

More than 3.8 million Australians average more than four standard drinks of alcohol a day, twice the recommended health guidelines, and these drinkers are targeted by the alcohol industry and branded as ‘super consumers’, according to the Foundation for Alcohol Research and Education.

Although they represent just 20% of Australians aged 14 and above, these excessive drinkers accounted for 74.2% of all the alcohol consumed nationally each year, the report says, making them valuable to the liquor industry (Guardian article)

The great British booze problem: how a few glasses a day has led to an epidemic for the NHS – video

(Alcohol Datablog: Discover how much alcohol people drink, and the burden it places on the NHS)

The Guardian coverage summed it all up beautifully too:

So that just about wraps up our Friday night live. Key conclusions: 1. drink is a problem 24/7 in hospitals, not just in the evenings, 2. for every teenager with a sprained wrist and hiccups there’s a serious recidivist who is on first-name terms with all the triage nurses, and 3. Britain may have its problem drinkers, but it has many great people trying to help them, from the staff in A&E departments to the street volunteers who try to protect people from themselves.

And that’s my view too – this isn’t about demonising drinkers, this is about acknowledging all the people who work behind the scenes to support those who get into trouble because of alcohol.  The public sector workers be they nurses, doctors, police officers, paramedics.  The volunteers be they street angels or street pastors.  All those people who try to keep people safe from themselves and each other when under the influence of this legal, yet highly addictive and toxic, drug which is so normalised in society that we can’t even acknowledge the size of the elephant in the room.  I wrote a piece for The Guardian 2 years ago when I said we needed to change the drinking guidance, which has now recently happened!  Maybe just maybe this is the start of a bigger shift?

Will Self had something similar to say himself last week-end

My Christmas night in A&E accompanying someone on a vodka bender brought home the reality of what we ask of our guardian angel health service

Thank you again to The Guardian for such brave (and detailed) journalism – which it is when you are potentially beholden to the drinks industry for your advertising revenue ……

Edited to add: 24th Jan 2016 and their coverage continues!  Ooh I could kiss you Guardian editors!!

Hepatologists in Southampton are seeing more young, middle-class and female alcoholics – some even in their teens

Most of us who drink alcohol won’t die from liver disease – but it still kills more of us than diabetes and road deaths combined

I find out a 35-year-old client died last week. Her drink of choice was cheap wine. I wonder why advertisers don’t use the people who actually drink their products. The woman I knew looked 70, with dead eyes.

Chris Owen, who developed alcohol-induced epilepsy, tells how the health service picked him up after every injury

The NHS is not perfect, show me an institution that is. I’ll say this though: I’m 100% certain I would not have even got to a place where I could begin to get better without it, and I certainly wouldn’t be walking around today.

And more: 25th Jan 2016

The secret old age psychiatrist’s diary: ‘She’s on a downward spiral with alcohol’

I go to see a patient in her 70s who is drinking at least a quarter of a bottle of spirits a day. Over the last five years, she has developed a neurological problem and can hardly stand as a result. Drinking started off as a habit to pass the time, but she is now dependent on alcohol. She has started to develop an alcohol-related dementia that will progress if she doesn’t cut down, and her liver is somewhere between abnormal and cirrhosis. She’s on a downward spiral. To get through to her, I explain her blood test results and say that her existing memory problems will get worse and threaten her independence. She looks at me in disbelief and agrees to cut down.

Thank you again Guardian – welcome to my world as a nurse ……..

PS The Telegraph also had similar coverage on Friday night with this:

Manchester police live tweeted a night of 999 calls and this is what happened

Officers recorded every drunken fight, row and missing person during an alcohol-fuelled night in and around the city’s nightspots