Monthly Archives: March 2016

The new alcohol guidelines: reflections on reaction and policy implications

april foolsNow I know it’s April Fools’ Day tomorrow not today but this e-card was chosen for it’s sentiment and my cynicism about the fact that the consultation period for the new alcohol guidelines runs until 1st April 2016.  I am awaiting the news that they  have been withdrawn or watered down significantly because of the outcry and hard lobbying by the drinks industry.  I really should be more trusting but the April 1st end day just cries out for suspended belief …..

So the day before the consultation process closes I thought I would feature this excellent reflection and review blog by Alcohol Policy UKHere is a reminder of what the new ‘proposed’ guidelines are.

As the dust begins to settle after the revised alcohol guidelines were announced, we invited a few selected experts  for their reflections on the reaction and policy implications. Indeed a subsequent BMJ comment by Professor Theresa Marteau stating the guidelines ‘may not reduce consumption directly’ sparked further coverage and debate over the role of guidelines beyond informing individual decision making.

James Nicholls, Director of Research and Policy Development, Alcohol Research UK, said:

“The publication of the revised alcohol guidelines has raised a number of interesting and important questions about health advice more broadly. On the one hand, it has triggered some productive discussion about how risk is calculated and communicated – and it would perhaps have been interesting if the consultation included an opportunity to consider the level respondents felt marked an ‘acceptable’ mortality risk. The reaction to the CMO’s call for people to think about cancer every time they approach a drink certainly suggested that risk-tolerance in the general population may be higher than among some public health professionals, for better or worse. On the other hand, questions are starting to emerge about wider knock-on effects.  Although construed as advice for personal decision-making, in reality the guidelines will have important implications for issues such as how population-wide levels of ‘risky’ drinking are calculated and how screening and brief advice works in primary care.  Both have the potential to influence policy and practice, making the guidelines much more than simple advice for healthy living.”

Professor of Marketing, Royal Holloway

“I wrote a piece for The Conversation arguing that the alcohol guidelines have become an annual dramatic media performance of policy, rather than an actual policy. I felt that the reaction to the guidelines, both in direct responses to my article and in general media coverage, supported my thesis. My point was not that the guidelines were misconceived, although I think they are for a number of reasons, but that they reflect a possibly unconscious but powerful tendency in policy to confuse media (and social media) reaction with more substantive outcomes. That the announcement received blanket media coverage would be seen by some as its own justification because putatively it ‘raised awareness’, but this, of course, reflects the logic of public relations rather than that of behavioural epidemiology. More importantly, policy that is inflected by the logic of PR displaces and distracts from more substantive policy measures. The more cynical observer might say substituting PR for policy serves the interests of the alcohol industry.”

Professor Mark Petticrew, Professor of Public Health Evaluation at the London School of Hygiene and Tropical Medicine, who was on the Guidelines Development Group highlights a previously contentious issue:

“One other aspect of alcohol and health that is discussed in the report of the Guidelines Development Group to the CMOs is labelling. The report notes that “Consistent messages (developed and monitored independently from industry) should appear on all alcohol products again at stipulated sizes, colours and positions to ensure that health messages and guidelines are prominent”.

We already know that the provision of health information on labels is poor – the most recent report produced for the Portman Group by Campden BRI showed that many alcohol container labels do not clearly present the three required elements (i.e., the CMOs’ guidelines, the pregnancy warning and the unit alcohol content). This may be of particular relevance to women: wine is much less likely to include these elements; only 52% of wine labels include this information. We also know that the pregnancy logo is smaller on wine (which is more likely to be drunk by women) than on beer containers (more likely to be drunk by men). Current labelling practice therefore may make it more difficult for women to make informed decisions about their drinking.”

William Haydock, Health Programme Advisor for Public Health Dorset & Visiting Fellow at Bournemouth University, openly reflects:

“Much of the commentary on the new drinking guidelines can be seen as a classic example of ‘normative misperception’. If we assume for a moment that many of those commenting on the guidelines are higher risk drinkers – who tend to see their own behaviour as perfectly normal and not worthy of comment – it’s not surprising they might object to being told they’re drinking above recommended limits. And these objections show exactly that misunderstanding of how much most people drink. To note that ‘the drinking habits of the vast majority of Britons are perfectly reasonable’ is true, but misses the point that these guidelines aren’t really aimed at most people, who already drink below both the old and new guidelines. Perhaps this debate is a timely reminder of the importance of behavioural interventions that make people aware of what ‘the norm’ actually is, so they can identify whether or not they’re really part of that ‘vast majority’.  (Disclaimer: I’m a ‘higher risk’ drinker myself.)”

Finally Nick Heather, Emeritus Professor of Alcohol & Other Drug Studies at Northumbria University, considers the rationale for having recommended guidelines despite much of the hostility towards them:

One of the main objections to ‘official’ drinking guidelines, including the recent CMO guidelines and earlier versions, is that drinkers don’t take any notice of them. This objection is frequently encountered in media comments on the guidelines and in general conversation “down the pub”. It has also been expressed in a scientific article in the journal Addiction by Melanie Lovatt and colleagues. Based on focus groups with drinkers in northern England and Scotland, these researchers found that “Current drinking guidelines were perceived as having little relevance to participants’ drinking behaviours and were generally disregarded”.

This is a statement of the blindingly obvious to anyone with any experience of British drinking culture but it entirely misses the one of the main points about the value of drinking guidelines. Some of the heavy drinkers interviewed by Lovatt et al. will eventually decide they want to reduce the harm they experience from drinking or, at least, cut down their risk of harm. When they do, they will need to know what to aim for – in other words, what level and pattern of drinking constitutes low risk. This is an issue of the self-control of behaviour or, in more scientific parlance, self-regulation as explored by Carver& Scheier. We self-regulate in order to bring our behaviour in line with standards, and clear and explicit standards are necessary to guide behaviour change. If one is aiming at total abstinence it is obvious what the standard should be; when reduced drinking is the objective, however, one needs to know exactly what counts as success – what lawyers call ‘bright lines’. To merely try to ‘drink less’, which would be the aim if drinking guidelines did not exist or were ignored, invites uncertainty and back-sliding and lowers the chances of successful behaviour change. This applies equally to formal treatment or brief interventions and to spontaneous attempts by people to cut down risky or harmful drinking on their own – and this, despite the findings of Lovatt et al., happens all the time and in large numbers in our society.

Beyond this justification for drinking guidelines, it should also be obvious that the public has a right to know the latest scientific evidence on the level and pattern of drinking that increases the risk of harm; imagine the outcry if it were discovered that scientists had kept this information to themselves! As this suggests, scientists have a duty to inform the general public about the latest, reliable evidence on alcohol-related harm. If people wish to ignore this evidence, that is up to them – it is (hopefully) still a free country. But if they are affected personally by the evidence and wish to do something about their drinking, clear guidelines will help them lower the risk of damage from it.”

Agree with all views.  Now lets see if the guidelines remain in their current format once the consultation process is complete.  I won’t be holding my breath and would be delighted to be proved wrong!

Edited to add: 27th April 2016 (Hansard source [Citation: HC Deb, 25 April 2016, cW])

To ask the Secretary of State for Health, how many responses were submitted to the Chief Medical Officer‘s consultation on the Alcohol Guidelines Review.

We have received 1,017 responses to the UK Chief Medical Officers’ alcohol guidelines consultation including campaign and general responses.

Cancer deaths fall 10 per cent in a decade – but alcohol fuels rise in liver cases

world cancer daySo February 4th was World Cancer Day and The Telegraph featured an article sharing the reduction in cancer rates except for the anomaly in the case of liver cancer.

Cancer death rates in the UK have fallen by almost 10 per cent in a decade, but those fuelled by alcohol and unhealthy lifestyles are rising sharply, new figures show.

A report by Cancer Research UK shows that overall death rates have fallen steadily, thanks to improvements in diagnosis and treatment.

In total, 284 people in a population of 100,000 died from the disease in 2013 – down from 312 in every 100,000 a decade earlier.

But the figures show a rise in specific cancers which can be fuelled by alcohol, smoking and poor diet, with a 60 per cent rise in deaths from liver cancer, and an eight per cent rise in those from pancreatic cancer.

In total, around one in three cancer cases each year in the UK are linked to unhealthy lifestyles, experts have said.

The figures, released to mark World Cancer Day, show that overall, men have seen a 12 per cent fall in death rates, while for women the fall was about eight per cent.

Sir Harpal Kumar, Cancer Research UK’s chief executive, said: “Today, one in two of all people diagnosed with cancer survive their disease for at least 10 years. Our ambition is to accelerate progress so that three in four survive cancer by 2034.”

Four cancers – lung, bowel, breast and prostate – account for almost half of all deaths from the disease in the UK.

The four saw an 11 per cent drop in death rates over the decade.

The figures show around 4,800 liver cancer deaths in 2013, compared with 2,600 a decade before. There were also around 8,500 pancreatic cancer deaths – a rise from about 7,000 in 2003.

Earlier this week Britain’s most senior doctor sparked controversy in urging other women to “do as I do” and think about the risks of cancer before deciding whether or not to have a drink.

Amid a rising and ageing population, the number of people diagnosed with cancer and the total number of deaths from the disease has increased.

Around 80 per cent of cancer deaths occur in people aged 65 and over, and more than half occur in those aged 75 and older.

Public health minister Jane Ellison said: “Prevention is key. It’s good to see growing awareness in some age groups of the benefits of being a healthy weight, eating a balanced diet and limiting how much alcohol we drink – and it’s never too late to kick start a healthier lifestyle.”

Read the full article here.

Alcohol industry ‘misleads’ the public, says study

drink responsibly 2So as we close out Easter  I thought I’d mention this research picked up by the Irish press and looking at how the alcohol industry misleads the public.  We’re talking about their Orwellian double speak ad campaign strap line – drink responsibly.  They don’t make their profit out of responsible drinkers – they make it out of you and me, those with sensitivity to alcohol addiction where one drink is too many and 1000 not enough.  How can you expect anyone to have self-control over an addictive substance and therefore act responsibly once it has been consumed?  Over to the Irish Examiner:

The industry, it was claimed, was “misleading” the public in asserting it did not target its market at children — with the study saying there was “strong evidence to the contrary”.

Furthermore, drinks companies frequently “shift the blame” from the product, and the marketing of it, to the consumer.

The study, published in the journal Addiction, examined 17 research papers on alcohol marketing worldwide, including four in Europe, one of them in Ireland.

The review states: “The alcohol industry argues against marketing regulation by emphasising industry responsibility and the effectiveness of self-regulation, questioning the effectiveness of statutory regulation, and by focusing on individual responsibility.”

It says the industry primarily conveyed its arguments “through manipulating the evidence base” and by promoting “ineffective” voluntary codes.

The review says the industry adopted voluntary codes as a means of reducing political pressure for formal regulation in the UK, Ireland, and the Netherlands.

“The alcohol industry frequently attempts to shift the blame for alcohol misuse to the consumer and away from their products and marketing,” it states

It adds that the industry argued that population-wide approaches, such as taxation or advertising restrictions, penalises moderate drinkers because of a “few” problem drinkers.

The review says there was “strong contrary evidence” to the following industry claims:

  • That self-regulation worked well;
  • That the industry only markets to those of legal age;
  • That the industry is responsible.

The Alcohol Beverage Federation of Ireland said its members are committed to responsible marketing. “We are already subject to some of the most stringent co-regulatory codes of practice on alcohol marketing and sponsorship anywhere in the world,” the group said.

“We welcome a statutory code of practice for advertising codes. We called for its introduction and welcome tough sanctions on those that fail to abide by these codes. We strongly condemn marketing drinks products at under-18s.”

Conor Cullen of Alcohol Action Ireland said: “Crucially, this review shows that alcohol industry arguments against public health policy are not backed by evidence, but rather, like the tobacco industry, the alcohol industry seeks to distort the evidence, argues for ineffective models of self-regulation, funds front groups that promote ‘awareness’, and place all the blame for our huge burden of alcohol harm with ‘irresponsible’ consumers.”

He said the Public Health (Alcohol) Bill, which contains measures to reduce children’s exposure to alcohol marketing, is now a “prime target”.

As I’ve said repeatedly here on the blog watch not what they say but what they do.  This is what they are saying but they had 40 lobby meetings with the Irish Parliament over a 3 month period primarily relating to the new Public Health (Alcohol) Bill.  You can bet all those meetings were not to say what an excellent idea and we support it, quite the contrary I suspect …….


A letter to….. my dad, the alcoholic

dear-dadAnd finally in this week of booze and how it impacts this was on the website Children of Addicted Parents (COAP) and is an anonymous letter from a son to his dad, an alcoholic.

I don’t even know where to begin. I’ve grieved for you now for 15 years, and you’re still here. Every time I think I’m getting somewhere I end up back in the same place, longing for the man who took such good care of me and my siblings and loved me so much up until my teenage years when yours and my mother’s marriage broke up.
I often wonder if you do still love me and how often you think about me, my brother, and my two sisters. Years of broken promises, and unbearable pain you have caused always makes me wonder whether you feel guilty of that, or whether, in your crazy drunken world, you don’t give us a thought at all. Sometimes I think it would be better if you were dead because I know you will never get better, and that way I can get some closure. As it stands now I can’t get that closure because we still hear of you due to the fact we love and see our Nana, your mother, in her failing health. The Nana who you have crippled financially and ruined her retirement. She is blinded by her love for her son, even to the point where she was more worried about you on the day of my Grandpa’s funeral because you were so drunk you didn’t attend. Something I will never forgive you for. She has funded your drinking for the last 15 years to the point our Aunty has had to take control of her finances after you convinced her to take equity out of her home.
I feel all this anger inside but I cling on to the good memories I have because despite being 6’4 and 15 stone you’re the only person that makes me feel like that lost little boy, who would stand pitch side watching you play rugby, proud as punch. The same rugby club I have played at for ten years because it’s the only place I feel close to you and I don’t want to ever lose those memories. I tell all that are close to me that I hate you, but I don’t, I miss you. Not who you are now but I miss the father you once were, unbelievably so. At the end of last season our rugby team won the county cup, it was a fantastic moment, but I wished you were there to see it. I cried afterwards on my own in the car park when I should have been celebrating.
I have a son now, who you have met once. He’s 5 years old next month, and despite not being with his mother I will never let him go through what we went through. You have a grandson and you don’t even know what he looks like, he has to grow up and I have to tell him one day about what happened to his grandfather. All four of your children suffer in different ways because of your downfall; I have suffered terribly with depression, your other son is in and out of jail, your two daughters fear abandonment or seek to control situations because you took away all of our control. If you were the way you used to be, you would be proud of where we all are in our lives in spite of all the damage you have created.
I could never say any of this to your face of course. Despite being assertive and confident in the rest of my life, with no fear of telling people how I feel, I could never find the words when I see you to tell you how you have made me feel. I haven’t seen you for over a year but that last time it was so close. I had everything I wanted to tell you on the tip of my tongue, but it wouldn’t come out.
I know that you will never change or recover, it’s too far gone, but I hope one day you reflect on what you have left behind and the pain you have caused. It may seem selfish, but when you die from the damage you have done to your body, I think there will be a huge wave of relief that will wash over me, and I will forgive you.
Your eldest son.
Maybe those drinks industry lobbyists should go and read some of the messages left by children on this website’s message board ……..

Friday Sober Jukebox – Slow Emotion Replay

slow emotion replaySo today’s post  falls on Good Friday 🙂  Here’s wishing you all a Happy Easter!

As you know I’ve been studying child and adolescent counselling as a post graduate for the last 18 months and it’s a while since I’ve made any reference to that.  That’s mostly because what I’m exploring in personal therapy and in group isn’t for this space but I’ve had a big aha moment recently that I wanted to share.

We often out here in the sober blogosphere talk about the inner critic – that voice that for me was soul destroying when I was drinking and although it is much less present it is still there.  Well we’ve recently had to video a 30 minute counselling session with a peer and our assignment is to critique our performance!  As you can imagine this is uncomfortable stuff but offers up such valuable insights both personally and in our learning about the therapeutic process.  As part of that I’ve been learning about Kleinian & Rogerian theory.

Melanie Klein was a psychoanalytic therapist and “Klein stresses Freud’s concept of transference, meaning the conscious but also unconscious expression of past and present experiences, relationships, thoughts, phantasies and feelings, both positive and negative, in relation to the analyst.” (source)

She also talked about other psychoanalytic defences such as splitting (splitting a person into good and bad objects) and projective identification and that these can be projective and introjective phantasies operating together.

And Carl Rogers (1902-1987) was a humanistic psychologist who agreed with the main assumptions of Abraham Maslow, but added that for a person to “grow”, they need an environment that provides them with genuineness (openness and self-disclosure), acceptance (being seen with unconditional positive regard), and empathy (being listened to and understood). (source)  Self-actualisation was the title of my 2 year post so ties in nicely 🙂

I am going somewhere with this I promise!  So we can not only project parts of ourselves that we don’t like outwards onto others but we can also internalise them.  And one of the strengths I was complimented on by my tutor during the review of the footage was my therapeutic presence (as indicated by Roger’s above).

So fast forward to some processing going on while running and some of the feedback I’ve had during personal therapy recently and the penny dropped.  For us to heal we have to provide a positive therapeutic presence for ourselves just as we do for others.  We have to internalise the ability to be kind to ourselves and when we are in a place of emotional distress rather than reverting to the introjected bad, & for me punitive position (which is usually the voice of someone else not my own), it’s important to recognise that and acknowledge it and be gentle.  We do this in the early days of getting sober but as time goes on that critical voice finds new outlets and new ways to punish us and we have to see it for that.

So this The The song span round while I was on the same run and felt very appropriate:

In the words of Matt Johnson ‘I don’t even know what’s going in myself’ and ‘You’ve got to find your own salvation’.  I’m working on both of those now …… slow emotion replay indeed.

When Alcohol Intrudes in the Workplace

when alcohol intrudes in the workplaceThis was in The New York Times in January and follows on nicely our week about booze and how it impacts on all elements of life including in the workplace both as a drinker and a non-drinker.

I work at a nonprofit with fewer than 10 employees, where we all need to pull our weight. Recently, there have been several instances of a particular colleague getting so drunk on weeknights that he can’t make it to work until the following afternoon, if at all. I know that he is hung over, not sick, because he has admitted it in emails canceling meetings with me.

This colleague has always been a heavy drinker and has alcoholism in his family; I now wonder if he is transitioning from being a functioning alcoholic to a nonfunctioning one. Should I forward the emails he sent me to the boss so she has evidence of the reason for his absences? Should I bring up alcohol abuse with him?

I would think that our boss is aware of this issue, given how small our office is, and I don’t understand why she hasn’t acted. While I am concerned for my colleague, I am also extremely concerned for our organization. ANONYMOUS

Resolving this tricky situation will depend in part on what your goal is. In some cases (an airline pilot, let’s say), getting an alcohol-impaired worker sidelined immediately is a top priority. But in this case, do you want to get this person fired? That’s what simply handing over those emails may achieve. In most workplaces, clear evidence of lying about missed work, for most any reason, is grounds for dismissal.

As an alternative, you might try approaching your supervisor with a nuanced message, said George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. He suggests wording like “ ‘Joe may have a health problem that’s interfering with his performance.’ ”

“That’s the way we look at it; alcohol-use disorder is a health problem,” Dr. Koob said. If the supervisor presses for details, emphasize relevant specifics of the diminished work performance, so if you do mention that excessive drinking may play a role, it’s framed in terms of workplace benchmarks that affect the organization, rather than focusing on the employee’s personal life.

Raising your concern directly with your colleague risks a defensive or hostile reaction that’s ultimately counterproductive. But a close co-worker might be a different story, said Sarah Allen Benton, a founder of Benton Behavioral Health Consulting and author of “Understanding the High-Functioning Alcoholic.” If you feel you have the right kind of relationship, she said, “express concern and have something to offer” — whether that means researching a company’s employee-assistance program or other resources.

But ultimately, it is management’s responsibility to address this problem, Dr. Koob said — preferably by noting that performance is suffering, exploring why and offering help. That said, there remains a profound stigma around drug and alcohol problems, he said: “A large percentage of the population would still consider it a moral problem,” he said. All the more reason, perhaps, to take care in framing your concerns.

Fending Off Exhortations to Drink

I stopped drinking more than 25 years ago. I’m not an alcoholic, but it’s a family disease. While not drinking is positive in my personal life, it causes me heartburn at work. I work remotely and see my colleagues only on social occasions, such as after training courses or client dinners.

There can be a lot of drinking at these events, and howls of protest rise each time I decline a cocktail or glass of wine. The protests get worse as the evening goes on. They’ll say: “We don’t feel comfortable drinking when you aren’t.” Can you provide any suggestions on how to handle this without lying, revealing too much about my personal life, or alienating my colleagues? J.B.

It is, of course, a shame that anybody has to feel put on the defensive for declining a drink.

All the experts I spoke to suggested that as soon as you arrive in such situations, get a beverage in your hand: say, a sparkling water with a lime in it, or some other ambiguous-looking nonalcoholic drink. This may not eliminate every offer or exhortation, but it should minimize the invitation an empty hand presents.

Next, come up with a single, decisive line to deliver when the issue pops up. I understand the reluctance to lie, but I’d say it’s perfectly fine to offer some mild diversionary fib: an allergy, extreme dislike of the taste, whatever. The goal is some sort of benign reason that cuts things off more than “no, thanks” does. And then, in essentially the same breath, change the subject: “Thanks, I can’t, my body doesn’t react well to alcohol — but I’ve been meaning to ask, how did your Penske presentation go?” Most people are perfectly happy to get to their real favorite subject: themselves.

In addition, have an exit strategy, Ms. Benton said. Decide in advance how long you’ll stay and stick to it. It may help to enlist a trusted colleague, she added.

Finally, remember that at any given party, “the truth is there are other people there who don’t want to drink, either,” Ms. Benton said. Nondrinkers can become overly self-conscious about going against the grain. But often the majority of imbibers are “really concerned more with their own drinking than with our drinking or not,” she said.

Nice to see the second piece discussed in a newspaper 🙂

Alcohol Frequent Attenders (AFAs) in Emergency Departments

A&ESo from drink driving to A&E alcohol frequent attenders (AFAs).  This was research conducted by Society for the Study of Addiction looking at the unexplored patient population of alcohol frequent attendees in A&E.

70% of people attending accident and emergency (A&E) departments at the weekend have alcohol-related issues (40% during the week), and alcohol-related admissions to hospital account for 78% of NHS expenditure on alcohol misuse [1]. Reducing alcohol-related hospital admissions is a key target for Public Health and the NHS in England. Whilst some A&E presentations are a one-off, there exists a patient subgroup who repeatedly present at A&E, known as alcohol frequent attenders (AFA’s). This subgroup are a small proportion of people that account for a disproportionate level of A&E use and associated NHS resources [2]

What is an AFA?

Despite a growing need to address the issue of alcohol in the A&E department, research has been limited and there is no single definition of an ‘AFA’. Researchers have typically defined a ‘frequent attender’ by the number of presentations a patient makes at A&E over a given time period, but this has ranged from 5 to 12 presentations per annum [2-5]. Furthermore, there is no consensus on how best to identify and manage this group [6].

What do we know about AFAs?

A briefing report from the Health Innovation Network (HIN) in March 2015 provided a comprehensive overview of the characteristics and associated issues relating to AFAs:

  • AFAs are a complex client group characterised by poor physical and mental health who have high mortality rates [2].
  • They are often homeless or at risk of being so[4].
  • The majority are male (66%) with an average age of 55 years [7].

This group is typically socially isolated and has high levels of unmet social needs limiting their ability to engage in interventions and manage their  health [7]. AFAs have high but incomplete and sporadic use of a variety of different health services.

Managing AFAs

There has been limited success in efforts to reduce numbers of AFAs, but the most promising evidence suggests a multidisciplinary approach including primary care providers, psychiatric services, social care, chronic pain services, alcohol and drug services and local ambulance services. Assertive outreach and engagement programmes support patients at home and in their community rather than asking them to come to a clinic, hospital or treatment centre. Assertive outreach is well established in mental health services and shows promise for alcohol dependent patients. For example, the assertive community treatment for alcohol dependence (ACTAD) study, using a similar model focusing on frequent community contact, building relationships and managing social, physical and mental health issues, demonstrated reductions in alcohol consumption, A&E and hospital admissions in patients referred from specialist alcohol services [8].  Variations of this model are currently used by a small number of services (for example the Salford alcohol assertive outreach team).

Based on a review of the evidence for these existing projects the HIN Briefing report recommends an assertive outreach model approach for tackling the problem of AFAs including:

  • An assertive and case-managed approach with the input of multiple services
  • A focus on gradual change
  • Priority addressing social needs
  • Address physical and mental health needs
  • Practical support in attending appointments
  • Personalised budgets as an incentive for engagement
  • Engaging with clients at every opportunity
Current projects and moving forward

AFAs are a patient group that have received minimal attention within the alcohol research field and consequently, little is known about their characteristics as a subgroup of patients, nor the best ways to treat them. However, attention is beginning to be paid to the issue, with resources and funding being made available to researchers. For example, the alcohol theme of the CLAHRC in South London is currently in the process of setting up an assertive outreach programme for AFAs and will be evaluating its effectiveness in a randomised controlled trial and well as conducting interviews with both A&E staff and patients identified as AFAs in order to gain insight into the characteristics of this patient group.

Let’s hope some assertive alcohol outreach services get some funding ……

Drink-driving: Doctors’ alliance calls for cut to limit

Drink-drive-3So as outlined yesterday these series of posts will look at different issues related to alcohol – starting with this headline about an alliance of doctors’ lobbying parliament for a cut to the drink drive limit.

Drink-driving: Doctors’ alliance calls for cut to limit

A group of doctors and health experts is urging the House of Lords to support a bill to lower the drink-driving limit across the whole of the UK.

They want England, Wales and Northern Ireland brought in line with Scotland.

The bill proposes amending the 1988 Road Traffic Act to lower the blood-alcohol concentration limit from 80mg alcohol per 100ml of blood to 50mg.

The government said the current limit struck a balance between safety and personal freedom.

The bill, which will be debated in the Lords on Friday, also proposes lowering the limits for alcohol in breath and urine when driving a vehicle.

Because everyone has a different susceptibility to alcohol, health experts say it is difficult to quantify exactly how many units can be drunk before reaching the proposed new limit.

For the average man, it would be just under a pint of beer or a large glass of wine and for women, half a pint of beer or a small glass of wine.

Accident risk

In a letter to the Times, the Alcohol Health Alliance said the move would save lives and improve road safety.

The alliance, which is made up of organisations including the Royal College of Physicians, the British Medical Association and Alcohol Concern, said that at the current limit, drivers are six times more likely to die in a road traffic accident than those who have not drunk any alcohol.

It said a vote in favour of the bill would signal to the government that “now is the time time to lower the drink-driving limit”.

Scotland lowered its drink-driving limit to the proposed new level in December 2014 and police figures show that drink-drive offences there fell by 17% in the first three months of 2015.

Northern Ireland is currently consulting on whether to lower its limit.

At present, England, Wales and Northern Ireland have one of the highest drink-driving limits in Europe.

The World Health Organization recommends a limit of 50mg/100ml.

Prof Sir Ian Gilmore, chair of the Alcohol Health Alliance and honorary professor in clinical science at the University of Liverpool, said the overriding reason for lowering the limit was that “several hundreds of lives could be saved in England each year”.

And he said the scientific evidence for the change was strong.

Driving deterioration

“There is a wealth of published, peer-reviewed, high quality research on the impact of alcohol on psychomotor skills and judgement.

“While even low levels have an effect on these critical functions, the deterioration in performance moving from a blood level of 50 to 80mg per 100ml are striking.”

Prof Gilmore said there was public support for a lowering of the legal drink-drive limit at a time when drink-driving appears to be on the rise.

The Local Government Association recently estimated that lowering the current limit would also save nearly £300m a year by reducing police and ambulance call-outs and hospital admissions.

Personal freedom

A spokesman for the Department for Transport said: “The drink-driving limit for England and Wales strikes an important balance between safety and personal freedom.

“By having our limit, we are not criminalising those who drink a small amount a long time before driving, but our advice remains unchanged: don’t take the risk by driving after you have had a drink.”

People who have served road bans in England and Wales for serious drink-driving offences have to pass a medical examination before they can regain their licence.

Further coverage:

Public calls for lower drink drive limit as Lords debate road safety law

29 January 2016: Research released today shows an overwhelming majority (77%) of the British public support lowering the drink drive legal limit, which would bring England and Wales in line with Scotland and the rest of the EU. The polling data, from the Alcohol Health Alliance UK, is published the same day the House of Lords will debate a Private Members Bill to lower the legal limit | Alcohol Health Alliance UK, UK

Road Traffic Act 1988 (Alcohol Limits) (Amendment) Bill [HL]

Second reading, House of Lords at 10:56 am on 29th January 2016 | They Work For You, UK

Drink drive limit could be cut by third, ministers say

Andrew Jones, a transport minister, says that the drink drive limit could be lowered in England and Wales is there is ‘robust evidence’ that it has improved road safety in Scotland

Which prompts the start of the industry media fightback …..

Rural pubs could close if drink drive limit is lowered

And this interesting ITV documentary that showed earlier this week showcases the difference in driving ability at the  two different levels.


Jonathan Maitland examines how much is too much when it comes to drink.

Edited to add: 11th April 2016

Why drink driving is so dangerous

A bitesized guide to why a couple of drinks might not make your driving worse, but your decision making will be seriously impaired | Guardian, UK

Edited to add: 6th Feb 2017

A Freedom of Information request to the DVLA by the Press Association showed 219,008 people were caught drink-driving more than once in the same period, said the BBC. More than 8,000 motorists have been caught driving over the limit twice in the past five years.

Edited to add: 14th Oct 2017

Drink drive figures: cause for concern in 2017?



Ministers lobbied 40 times in three months on alcohol issues

lobbying of parliamentSo over the next ten days I’m going to present a story that starts here with the 40 times the drinks industry lobbied the Irish govt over a 3 month period and then over the next 10 days we consider the collateral damage to public health as presented to me in a weeks worth of news stories that I read including drink driving, alcohol and A&E, alcohol and the workplace and then alcohol and families.  We’re approaching Easter so it feels like a good time to reflect before we hit the next high days and bank holiday event.

Government Ministers and their officials were lobbied on alcohol-related issues more than 40 times in a three-month period, an analysis of the new register of lobbying shows.

Most of the lobbying concerned the Government’s planned legislation to counter alcohol abuse but other topics included the importance of Irish drink exports and the campaign to allow pubs open on Good Friday.

The Minister for Health was the most frequently lobbied Minister on the alcohol issue, followed by Minister for Sport and Tourism Paschal Donohoe. Taoiseach Enda Kenny was also lobbied in face-to-face meetings on several occasions.

Along with drinks companies and their representative bodies, sports organisations such as the Irish Rugby Football Union and its Munster branch were also active in lobbying against any attempt to ban sports sponsorship by the sector.

Alexandre Ricard, chief executive of drinks multinational Pernod Ricard, met the Taoiseach at an event in Paris, where he impressed on Mr Kenny “the importance of supportive domestic policies as underpinning export success,” according to the register.

Irish Distillers, which is owned by Pernod Ricard, invited Tánaiste Joan Burton to speak at the opening of a micro-distillery in Midleton, Co Cork. Informal discussions took place on the “global success” of Jameson whiskey and the economic impact of the indigenous distilling industry.

Public relations

Among the public relations firms actively lobbying in relation to alcohol issues were Q4 PR, Hume Brophy and MKC Communications.

Industry group Ibec made its views known to a wide variety of Ministers, including the Taoiseach and Ministers Leo Varadkar, Paschal Donohoe, Michael Noonan, Alex White and Simon Coveney.

The IRFU wrote to Mr Varadkar and Mr Donohoe to underline its concerns about the Public Health (Alcohol) Bill and to seek a meeting.

The rugby organisation’s Munster branch appealed in an email to Mr Coveney and Mr Noonan not to change the legislation as it would have “a major adverse impact on our ability to continue as a professional sporting organisation”. A meeting was sought with the Ministers but never took place.

So busy behind the scenes lobbying by the drinks industry as the Irish govt were preparing the Public Health (Alcohol) Bill that I talked about here.  Bit like the behind the scenes discussions that took place here about minimum unit pricing ……..

Happy Hour Without the Booze

Happy hour without the booze LABeing the truly international jet set crowd that us sober warriors are I have to thank one of my lovely readers in the US for sending me this piece courtesy of the front page of The New York Times no less!  It would seem that sober cool is gathering momentum stateside too as this article ‘Happy Hour without the Booze’ describes 🙂

On a recent rainy afternoon over veggie burgers at NeueHouse, the co-working space in the Flatiron district, three Vedic meditators were discussing drink options for a new kind of happy hour they were organizing.

“Tonight would be a good night for tea,” Katia Tallarico, 33, a lanky psychotherapist from Williamsburg, Brooklyn, said to Light Watkins, 42, an organizer from Los Angeles typically partial to a hot lemon-ginger elixir.

“It’s O.K., we have a really great water, from Australia,” said Andrea Praet, 34, a trend strategist from Greenpoint, who also runs an urban retreat series, with Ms. Tallarico, called the Uplift Project.

Around 5 p.m., the three made their way over to set up a “bar” and buffet at General Assembly, a fourth-floor technology school and site of New York City’s inaugural Shine: an inspirational, alcohol-free evening.

Founded by Mr. Watkins, the bimonthly after-work party began in Venice Beach, Calif., where it quickly grew to 200 attendees from 12. On this night, for about the price of a glass of nebbiolo at the NoMad, 90 New Yorkers were submitting to an evening of meditation, “enlightertainment” (including live music and film) and vegan food. “Though meat is an option,” Mr. Watkins said. “We want to be normal.”

And “normal” in Manhattan typically involves booze. “Alcohol is such a part of the city’s culture,” said Ms. Tallarico, who drinks occasionally but said her social life doesn’t revolve around it. “There’s nothing wrong with drinking. But people are looking to evolve. They’re looking to wake up.”

Though malbec has arrived at the movies, and brunch cocktails now go way beyond Bloody Marys, some are seeking social gatherings where alcohol isn’t even a temptation.

A recent 50-person “juice crawl” through SoHo was so enthusiastically received that the organizer, Anna Garcia, said she would be hosting them weekly this year. The year-old Manhattan-based social group Clean Fun Network was so overwhelmed by the initial response, it had to temporarily shut down, said Jimmy Hamm, a founder.

And tickets to the Shine sold out within a week, with a lengthy wait list. “We didn’t even do anything,” said Ms. Tallarico, who donned a shimmery top for the occasion. “It is the Shine,” said Ms. Tallarico, putting on lip gloss.

Ms. Praet, who pumped her shoulders to a silent beat as volunteers unloaded bottles of floral essence water, said, “Fun, fun, fun.”

Ambience, though, was a bit of a concern. “The light is definitely too bright,” Mr. Watkins said.

That’s the thing about alcohol-free events — they tend to be “unsexy,” said Catherine Salway, owner of Redemption, a new “bar” in London’s Notting Hill that opened last August, serving beet-o-tinis, coco-ritas and the like.

“A lot can be done with décor and music,” Ms. Salway said. “It’s not alcohol creating that vibe, it’s the people.” She opened a second location this month in the trendy Shoreditch neighborhood. A former brand director for Virgin, Ms. Salway is also eying New York and (brace yourself) Las Vegas. “If we can convince Londoners to take a night off booze. …” she said, trailing off.

Back above Broadway, doors opened to a disproportionate number of tall, willowy women with flawless skin and a blasé, “I-just-have-more-fun-without-it” attitude toward alcohol.

At the name-tag table, everyone was asked an icebreaker: “What actor would you cast to play you in a movie?”

Elle Fanning. Kate Hudson. Several Natalie Portmans. A man in a blazer scanned his phone, stumped. “You know, in ‘Sex & the City 2’? When they’re in Dubai? That butler?” asked Siddhartha Banthiya, an investment banker.

People lined up for sunchoke salad and kale-pumpkin-seed pesto. “This is truly a breath of fresh air,” said Porl Gordon, a multimedia designer and regular drinker, guzzling a green juice. “Conversations are more solid and rooted than any alcohol-fueled chat.”

Nick DiMattina, 28, an Australian life coach, said that he had come looking for love, and that he prefers to date sans alcohol. “It’s the only way to see the real person,” he said. “I told my friends, this is where you’ll meet a cool girl.”

Likewise, Jennifer Ekeleme, 37, a freelance brand strategist, thought she had decent odds of meeting “a straight, down-to-earth, culturally aware man” — at least better than during her drinking days at an ad agency. “Booze was always flowing, people would just get hammered and start talking about how unhappy they are,” she said. “It was getting too hard to justify the toll alcohol was taking on my body, wallet and spirit.”

At the Shine, though, people were all smiles. “This is the only real happy hour happening in Manhattan right now,” said Mr. Watkins, kicking things off with a human massage chain.

Next, Emily Fletcher, a meditation guide, took the mike and commanded people to close their eyes and plug their right nostril with their thumb, exhale with the left, then alternate.

Meditation Bar in Austin, Tex., offers “Happy Hour” classes, and MNDFL, which opened in November on East Eighth Street, has quickly morphed into more than a place to just sit in silence.

“We dedicated half the space to feel like a living room, with couches and free tea,” said Lodro Rinzler, MNDFL’s co-owner and author of “The Buddha Walks Into a Bar. …” “We have real mugs,” said his partner, Ellie Burrows. They also host MNDFL Taste, a partly silent organic catered dinner, paired with water.

“Today, we had training that ended with a happy hour, but I didn’t go,” said Stephanie DiSturco, 26, a digital media planner who chose to go to MNDFL instead.

At the Shine, as people sipped water, some vowed to start meditating more and many exchanged business cards.

A 40-something woman who works in finance, was glad to have a new kind of night out. “Rarely, do I ever come home from a bar and say, ‘That was really amazing,’” she said.

And Shine gets a mention again in this piece:

It’s Hip to Be Sober

London, New York, Los Angeles ……. the sober wave crests over the world 😉

Edited to add: 23rd April 2016

Sober is the new drunk: why millennials are ditching bar crawls for juice crawls

Is being sober finally trendy? Juice crawls are just one of many booze-free events in the US catering to millennials who are ditching the hooch in favor of clarity | Guardian, UK