Monthly Archives: May 2017

Peers back minimum price per alcohol unit if Scotland scheme works

This was in The Guardian in April: Introduction of 50p base rate should go ahead if it is shown to reduce excessive drinking, says Lords select committee peers.

Minimum unit pricing for alcohol should be introduced across the UK if it proves a success in Scotland, a Lords committee has said.

If the decision to introduce a 50p base rate per unit of alcohol is shown to reduce excessive drinking, it should to be rolled out nationwide, the Lords select committee on the Licensing Act 2003 said.

The plan means a 70cl bottle of whisky would cost a minimum of £14.

In December, the Scotch Whisky Association said it would appeal to the UK supreme court against a Scottish court ruling that plans for a 50p minimum price were compatible with EU law.

The coalition government pledged in March 2012 to bring in minimum unit pricing but made a U-turn in July 2013, earning condemnation from medical organisations and arousing suspicions that it had caved in to alcohol industry lobbying.

A government report released late last year found that alcohol is now the biggest killer of people aged between 15 and 49 in England, accounting for 167,000 years of lost productivity annually and a factor in more than 200 illnesses.

Peers have also called for a major overhaul of how licensing decisions are made after hearing evidence that some councillors were guilty of a “scandalous misuse” of their powers.

In addition, the Lords committee called for the Licensing Act to be redrawn to abolish local authority licensing committees and hand their role to planning watchdogs at councils instead.

The committee’s chairwoman, Lady McIntosh of Pickering, said the act was fundamentally flawed and needed a major overhaul.

“It was a mistake and a missed opportunity to set up new licensing committees when the planning system was already available to regulate the use of land for many different purposes,” she said.

“The planning system is well suited to dealing with licensing applications and appeals, and the interests of residents are always taken into account.”

The committee was shocked by some of the evidence it received on hearings before licensing committees.

“Their decisions have been described as ‘something of a lottery’, ‘lacking formality’, and ‘indifferent’, with some ‘scandalous misuses of the powers of elected local councillors’,” McIntosh said.

Referring to evidence that councillors had refused to listen to arguments at hearings, or to stand down when family members were involved in the situation, the report said: “These are scandalous misuses of the powers of elected local councillors, and they are not the only ones we were told of.

“The Derbyshire police wrote: ‘It has become too political with councils being frightened of making a tough decision for fear of an appeal against them by big brewing companies, etc. On two occasions I have had councillors state that they have agreed with the police, however, sided with the pub company for fear of an appeal.’”

The Lords committee said: “The evidence received against local authority licensing committees was damning and the committee was extremely concerned by what it heard. Planning committees are much more effective, reliable and well-equipped to make licensing decisions.”

McIntosh also called for relevant legislation to apply at airports: “We cannot understand why the government has decided not to apply the Act to sales at airports. This can lead to dangerous situations, and must be changed.”

The committee also warned regulations covering late night opening do not work.

“The night-time economy needs regulating; even in these areas of cities, residents have their rights. The current systems are not being used because they do not work.”

The report also called for establishments to provide a disabled access statement when applying for a licence.

The piece went up at midnight on Tuesday 4th April and by the time I read it at 8:45am it  already had 298 comments – which I found both interesting and telling as did several commenters, included below:

Vagabondo: “The industry PR machine can be observed flooding these comments with misinformation about a measure that has been shown to cut youth alcohol abuse requiring medical intervention in other jurisdictions. This is part of the same sadistic campaign that has been waged to preserve profits at the public expense in the Scottish media and courts, and so far successfully in the UK Parliament.”

Hirpling: “Absolutely amazing how the same false assumptions are just churned out over and over and over on this thread. Or maybe not so much amazing as deliberate…?

1. Its a tax. FALSE. Minimum pricing. Read that bit again.
2. It affects ordinary people drinking ordinary booze. FALSE.
3. It doesn’t cure alcoholics. NOT AIMED AT THEM

The low-grade, low price crap is a recent introduction to the UK market to get kids drinking young and hooked at pocket-money prices.  There was no need for this “differential” as there were already three: it was a new price point to get a new market — a new set of addicts in training.  The kids can go back to buying enough to get drunk on as before, instead of enough to give themselves alcohol-poisoning and (or other people) a trip to A&E.”

Tenthred: “I’d like the SWA to be liable for government legal costs when they finally lose. Disgusted that they’re taking it back to the Supreme Court yet again. And then, if the measure does improve public health, I’d like the SWA to be sue for damages for the public health cost of the years of delay.

They call themselves the Scotch Whisky Association, but they aren’t doing this because of anything to do with Scotch or with consumers in the UK. This is all about their parent companies’ huge global interest in cheap booze.”

Agree completely with each comment.  As I oft say here, watch what they do not what they say …….

Sober Friday Jukebox: STAIR-way to heaven

So it feels like all the reading I’ve done of late has been heading to this point.  I recently received an email from Mind the Brain about Complex PTSD, STAIR and social ecology that you can read here.

STAIR is the acronym for Skills Training in Affective and Interpersonal Regulation.  It’s a training programme that has been developed in the US by psychologist Dr. Marylene Cloitre.  Here’s  how the programme is described on the US Department of Veteran Affairs website:

STAIR is an evidence-based cognitive behavioral therapy (CBT) for individuals suffering from PTSD, including chronic and complicated forms as well as for individuals with PTSD and co-occurring disorders.

Complex PTSD results from repetitive, prolonged trauma involving harm or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic .

“Anger directed against the self or others is always a central problem in the lives of people who have been violated and this is itself a repetitive re-enactment of real events from the past. Compulsive repetition of the trauma usually is an unconscious process that, although it may provide a temporary sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a subjective sense of being bad and out of control. Gaining control over one’s current life, rather than repeating trauma in action, mood, or somatic states, is the goal of healing” (Bessel A. van der Kolk)

Using STAIR will allow you to teach your patients skills in:

  • emotion regulation
  • interpersonal functioning

This online STAIR training consists of 8 modules covering several core treatment components. STAIR can be provided as a standalone therapy or as a complement to trauma-focused therapies.

Goals and Objectives

  • To become informed about the impact of trauma on emotion regulation and social (interpersonal) functioning
  • To be able to identify at least one strategy that increases emotional awareness
  • To be able to identify at least three strategies that improve emotion regulation in PTSD patients
  • To be able to formulate interpersonal schemas related to problematic social and interpersonal functioning
  • To be able to develop and test alternative interpersonal schemas with client
  • To learn at least two strategies for effective assertiveness behaviors
  • To learn at least one strategy for improving flexibility in interpersonal expectations and behaviors

What I found so striking about this is it mirrors the process I’ve been going through as part of my emotional recovery and particularly in my recent discover of the brilliant book The Tao of Fully Feeling by Pete Walker.

Here’s more detail on Session Two: Emotional Awareness:

  • Emotions, emotion regulation, and the impact of trauma on emotion regulation.
  • Why feelings are important, the influence of trauma history on feelings, how to use a feelings wheel to help label feelings.
  • How to use a self- monitoring form to identify the relationships between thoughts, feelings, and behavior.

And Session Three: Emotional Regulation:

  • Recognize that all of their behaviors are efforts to cope with their feelings and environment.
  • Evaluate current coping strategies, their efficacy, and alternative strategies.
  • Learning physiological, cognitive, and behavioral channels of mood regulation

Link to full course content pdf here.

Maybe it’s just my experience and I am generalising wildly but I think many of us boozers struggle with emotions which is part of the reason why we drank how we drank.

There are well researched links between substance misuse and trauma (74% sexual abuse, 52% physical abuse & 72% emotional abuse in this research)  and sources estimate that 25 – 75 percent of people who survive abuse and/or violent trauma develop issues related to alcohol abuse.

All of these skills seem so applicable to a life lived well in sobriety as we learn to deal with all those pesky emotions and renegotiate relationships and learn about boundaries and agency without our crutch.  I’m sharing these resources here in case you would like to research further because to me they feel like a stairway to (emotional) heaven 😉

Alcohol Pricing

An excellent blog post from Alcohol Policy UK discussing the Institute of Alcohol Studies updated fact sheet on alcohol pricing published in March.

Over to James:

The Institute of Alcohol Studies (IAS) have updated its factsheet on alcohol pricing as health groups seek to continue highlighting the importance of price in addressing alcohol harms.

Download ‘The price of alcohol’ [pdf] here or see a collection of pricing documents and research here.

Chapters covered in the report include:

Pricing, policy and the future of MUP?

Of central important to pricing debates is the relationship between price and consumption. Price, or more precisely affordability, influences the level of population consumption as has been shown by a wide literature. In the UK, attention has been on rising affordability and consumption during the second half of the 20th century, followed by the more recent decline since 2004. Rises in consumption over the last two years have indicated a possible return to an upward trend, whilst the price and sales gap between off-trade and on-trade prices has continued to widen. As such, attempts to see Minimum Unit Pricing (MUP) have been central to public health policy calls in England, while Scotland’s passing of MUP legislation in 2012 has yet to overcome industry-led challenges. A final verdict is expected this year.

Undoubtedly there are many complexities, with debates particularly focused on how pricing changes affect drinkers of different incomes and consumption levels. Whilst the well cited Sheffield Alcohol Research Group’s (SARG) various modelling has undoubtedly applied advanced and detailed methodologies, predicting the exact impacts is never possible. Indeed the factsheet acknowledges that ‘lower alcohol consumption generally reduces health risks’ and so there is ‘strong reason to expect that higher alcohol prices should improve health outcomes.’ Indeed the recent PHE evidence review found strong favour for pricing as a key desired policy, albeit complicated by issues such as the alcohol harm paradox and complexities in identifying longer term health impacts of harmful drinking.

Secondary to MUP, public health opportunities for taxation policy arise with each budget, though of course also facing strong opposing calls from some industry groups. Over the last decade duty changes have arguably gone both ways, with positive public health impacts reportedly seen as a result of the 2008-2014 duty escalator, but opponents subsequently seeing its end and cuts on certain drinks. This year’s budget ‘froze’ duty which would rise with inflation, although a tax consultation aimed mainly at ‘white ciders’ – typically one of the cheapest drinks per unit – is currently underway.

Affordability

Pricing debates as such are going nowhere, but the policy decisions are hard to call. The former coalition Government infamously u-turned on its 2012 MUP pledge, largely thwarted by the current Prime Minister as then Home Secretary. It was insisted MUP though was not being ‘ruled out’, rather than waiting for more conclusive evidence. Waiting to see what happens in Scotland arguably makes for sensible politics, albeit health groups argue that dealying MUP comes at the expense of lives. Wales and Ireland are also pursuing MUP, and with Brexit in the mix, the future of alcohol pricing policy is likely to remain uncertain.

Valuable research indeed.

Hi My name is Lou, and I’m a recovering emotophobic

So this was another new word to me that I heard recently – emotophobia meaning to be emotophobic.  Not to be confused with emetophobic, the fear of being sick!

What is emotophobia?  It is the fear of negative emotion; i.e. a fear of expressing anger, frustration or disapproval.

I am a recovering emotophobic because I grew up with the ‘toxic trio’ as it is called in children’s safeguarding.  The term ‘Toxic Trio‘ has been used to describe the issues of domestic abuse, mental ill-health and substance misuse which have been identified as common features of families where harm to children has occurred. They are viewed as indicators of increased risk of harm to children and young people.

As I wrote recentlyIn my household growing up our family ‘didn’t do’ emotions as we were often reminded.  I now understand that we (the children) weren’t allowed to do negative emotions.  I learned very early on to keep my head down, my mouth shut and a smile on my face.  Look happy even if you were dying inside.

As Pete Walker describes “emotional emancipation happens when a person is both abused for emoting and is, at the same time, abused by toxic emotional expression.  This scares us out of our own emotions while simultaneously making us terrified of other people’s feelings ”  He goes on to say that “much of the plethora of loneliness, alienation, and addictive distraction that plagues modern industrial societies is a result of people being taught and forced to reject, pathologise or punish so many of their own and others’ normal feeling states.”

There was so much negative emotion expressed around me that I effectively developed a fear of them and learned very early on to dissociate as a way of coping with the anxiety and stress that it caused within me.  I also learned to self-soothe my anxiety by skin picking (also called dermatillomania).

Even now if someone around me is verbally expressing an aroused and heightened emotional state, and this is personally rather than professionally where I have learned to manage it well due to the nature of my job, I will tend to dissociate as I find it triggers emotional flashbacks to my childhood. And I still struggle with occasional skin-picking although it’s nowhere near as bad as it used to be as I am only too aware of the many scars on my arms and legs that remind me of my past.

This is something I am working hard on as this is according to Braiker’s self-help book,[1] part of the “disease to please”/codependency behaviours I am aware that I struggle with along with these other cluster of traits:

My fear has meant that I have not been good at self-championing which is vital as part of our emotional recovery journey because as Matt at Surviving My Past says:

being our own champion and showing ourselves compassion, erases shame.

For me all of this comes back to shame.  Shame around my childhood and past experiences, shame around my drinking, shame around being me.

A great resource about C-PTSD, toxic shame and recovery from emotophobia is Richard Grannon and in this blog post he gives some great tips for working with toxic shame or in this video on  YouTube he talks about emotional literacy.  I am working my way away from it and towards self-championing one day at a time – a lifelong process.

Friday Sober Jukebox in memory of Robert Miles, RIP

 

 

Cost of DUI & Ignition interlock devices

So serendipitously a news story, a guest content offer and a free infographic sent my way coalesced into a post I’ve been meaning to write about DUI’s and ignition interlock devices, called alcolocks here in Europe.

Here’s the news story from February courtesy of Alcohol Policy UK:

The EU is being urged to legislate for the wide-scale use of alcolocks, or alcohol interlock systems, which are automatic systems that require the driver to blow into a breathalyser fitted inside their car. They can be adjusted to kick in at different limits but generally mean the vehicle can only be started if no alcohol is detected. Independent

Here’s the guest content courtesy of Jerry Nicholson, a private practice lawyer in Orange County, Southern California:

The True Cost Of A DUI

Approximately 28 people die every day because of intoxicated drivers who are under the influence of drugs and alcohol. That is more than 10,000 people every year. These are mothers, fathers, students, and children. These victims died because someone decided to drive an automobile while they were impaired. These statistics are shocking, but they do little to deter intoxicated drivers from repeating their reckless behavior. In response to these staggering numbers, our legal system has implemented strict punishments for offenders who are convicted of DUI.

Fines vary from state to state, but the entire process can cost DUI offenders thousands of dollars in fines, fees, court costs, and restitution. For our example, we will focus on the costs of a DUI conviction in the state of California.

In California, the minimum fine for the defendant’s first offense for DUI is $390, and the maximum fine is $1,000. Typically, the judges in California opt for the minimum fine for a person’s first offense. However, in addition to this fine, the defendant is also charged for “penalties and assessments.” While there does not seem to be a cut and dry answer as to the total cost of the penalties and assessments, you can expect them to be triple your fine or more. So, the defendant convicted of their first offense can expect to pay roughly $1,600, but that is not all.

Whether this is your first offense for DUI, you need help from a criminal defense attorney. Consult an attorney who is experienced in DUI cases. They can keep you from receiving much harsher penalties, and they will represent you in court. Your attorney knows the law and understands the court process. They can also recommend programs or alternative punishments that can keep you from serving jail time. The cost of legal representation is based on the attorney’s expertise and experience, as well as the outcome of the case.

A first-time offender in the state of California has often required the convicted to take a 3-month DUI program which costs $575. They may be required to install an ignition interlock device in their automobile, which usually cost $100 to install, then there is a daily fee for use and calibration. The end cost for five months is just over $300. If your car was towed, you could expect a fee of $400 to get it back. This cost might exceed $400 if the car was impounded and stored on the impound lot.

In California, you could lose your driver’s license if you are convicted of DUI, and you must pay additional costs related to alternate transportation until you can get your license back. To get your license back after a DUI conviction, you must pay $125.

You can expect your automobile insurance to increase significantly. Your insurance premiums can increase for many different reasons, such as age and your driving record. According to the AAA Auto Club, a man who is 25 years old will have his insurance increase by $16,000 over a ten-year period.

These numbers do not include property damage, injury, or the impact that a DUI will have on your personal life. These figures also do not take into account that a DUI often costs people their jobs, especially if they operate company vehicles for a living. A DUI conviction damages your reputation and ruins your career. However, the expense of a DUI, even if it is your first offense, does not compare to the price of someone’s life. Driving under the influence of drugs and alcohol is deadly. There is no excuse for drinking and driving. Today, there are more alternative forms of transportation in California than ever before.

If you are accused of DUI, you need a qualified and experienced criminal defense attorney by your side. In California, you can face harsh penalties if you are convicted of DUI which could ruin your career, relationships, and future. This is one of the most important decisions you will ever make in your life. Do not make it without council. Consult an attorney before moving forward with your DUI case.

Written by Jerry Nicholson of the Law Offices of Jerry Nicholson

And then an infographic looking at the cost of an ignition interlock device in the US:

Credit to Interlock Install: http://www.interlockinstall.com/

Thank you to both Jerry for the legal insight into DUI and Stephanie Santos for the infographic!

 

Repetition Compulsion (Friday Sober Jukebox: I Heard)

So this is something I’ve been reading about in Pete Walker’s Tao of Fully Feeling.  The best description I read was from a blog by Graffiti Girl 2013 and she encapsulates beautifully what repetition compulsion is:

“Repetition compulsion is the repetition of a traumatic event and an attempt at mastery of one’s feelings and experience, in the sense that she unconsciously want to go through the same situation but that it not result negatively as it did in the past. Some people make the same mistakes over and over. The individual unconsciously arranges for variations of an original theme which he has not learned either to overcome or to live with.”

This is what Psych Central had to say about repetition compulsion:

Humans seek comfort in the familiar. Freud called this repetition compulsion, which he famously defined as “the desire to return to an earlier state of things.”

This takes form in simple tasks. Perhaps you watch your favorite movie over and over, or choose the same entrée at your favorite restaurant. More harmful behaviors include repeatedly dating people who might emotionally or physically abuse you, or using drugs (including alcohol) when overcome with negative thoughts. Freud was more interested in the harmful behaviors that people kept revisiting, and believed that it was directly linked to what he termed “the death drive,” or the desire to no longer exist.

But there may be a different reason.

It could be that many of us develop patterns over the years, whether positive or negative, that become ingrained. We each create a subjective world for ourselves and discover what works for us. In times of stress, worry, anger, or another emotional high, we repeat what is familiar and what feels safe. This creates rumination of thoughts as well as negative patterns in reactions and behaviors.

As an example, someone who struggles with insecurities and jealousy will find that when his significant other does not return a call or text immediately, his mind begins to wander to negative and faulty thoughts. The thoughts begin to accumulate and emotionally overwhelm the person, which leads to false accusations and unintentional harm to the relationship.

In spite of not wanting to react this way, the person has created a pattern over years that then becomes familiar to him. To react differently, although more positively, would feel foreign. When someone has done something the same way for years, he or she will continue to do so, even if it causes harm for both herself and others.

This idea also resonates with the concept known as the law of the instrument.  Maslow’s hammer (or gavel), or a golden hammer is an over-reliance on a familiar tool; as Abraham Maslow said in 1966, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.”

People also revert to earlier states if the behavior is in any way rewarding, or if it confirms negative self-beliefs. For someone who inflicts self-harm in a time of emotional distress, it is a behavior that momentarily relieves the pain even if later on the individual feels shame over it. In the example of a person who continuously enters abusive relationships, we might find that he or she is highly insecure and does not believe that he or she is worthy of being cared for.

Cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and rational emotive behavior therapy (REBT) can provide effective treatment routes for reshaping thought patterns that lead to maladaptive behaviors. These types of therapeutic approaches focus on bringing awareness to cognitive distortions, irrational beliefs, and negative thought tracks.

By working on different techniques, one can learn how to recognize when thoughts or actions are more harmful than beneficial, and how to stop them from occurring. The brain’s cognitive processes will be rewired and retrained to develop new patterns that are productive, rational, and positive, which ultimately leads to more adaptive behaviors and choices.

It takes years for people to develop maladaptive patterns, habits, and repetitive choices, and it may also take years to reshape them into something that becomes worth revisiting.

References

Dryden, W. (Ed.). (2012). Cognitive Behaviour Therapies. SAGE Publications Limited.

Inderbitzin, L. B., & Levy, S. T. (1998). Repetition compulsion revisited: implications for technique. The Psychoanalytic Quarterly, 67(1), 32.

I was struck by this psychological theory because it is something I’ve come to learn about only recently and it reverberates through my life in many ways, including my past use of alcohol to psychologically hammer my emotional discomfort.

I recently spent a couple of months working at Focus12 in a nursing consultancy capacity and the Consultant Psychiatrist I was working with there was an eminent and learned fellow.  His parting words to me that summarised his work and life wisdom was:

Sit still and do nothing.

I think much of my repetition compulsion would do well to heed this sage advice!  How about you?

This tune so sums up how this feels for me:

City workers at Lloyd’s of London banned from daytime drinking

So this was in The Telegraph in Feburary about Lloyds of London banning daytime drinking (credit for image: Heathcliff O’Malley).  And it was some of the quoted responses from staff in the article that really struck me.  Over to the article:

Workers at the historic city institution Lloyd’s of London have been banned from drinking during the day after around half of disciplinary cases were found to relate to alcohol.

The ban prohibits the insurance market’s 800 employees from consuming alcohol between 9am and 5pm from Monday to Friday.

Anyone who does not comply with the measure risks facing gross misconduct procedures and could lose their job.

The policy was introduced after “roughly half” of grievance and disciplinary procedures in the past year were reportedly found to relate to the misuse of alcohol.

The ban is included in the Employee Guide, which has been reviewed by HR.

However, staff are unimpressed with the new rule, which will stop them from enjoying a drink at lunchtime. 

Comments from employees on an internal intranet seen by the Evening Standard include complaints that the measure is “heavy handed” and was imposed without consultation.

One worker said: “Did I just wake up from my drunken drug-induced slumber to find we are now living in Orwell’s 1984?”

“Lloyd’s used to be a fun place to work. Now it is the PC capital of the world where you can’t even go out for a lunchtime pint anymore?” Another asked: “Will we be asked to go to bed earlier soon?”

An internal memo circulated to staff said: “The London market historically had a reputation for daytime drinking but that has been changing and Lloyd’s has a duty to be a responsible employer, and provide a healthy working environment. The policy we’ve introduced aligns us with many firms in the market.

“Drinking alcohol affects individuals differently. A zero limit is therefore simpler, more consistent and in line with the modern, global and high performance culture that we want to embrace.”

Lloyd’s was founded in the 17th century, when it was a coffee house that served as a meeting point for sailors, merchants and ship owners to find out shipping news.

A Lloyd’s spokesman said: “Our employee guidance was recently updated and provided clarification on the Corporation’s position on drinking alcohol during the working day, which is prohibited.”

The ban does not affect the brokers and underwriters from other firms who are based in the same building.

Picked up by The Guardian too:

‘Don’t go back to work if you’re half-cut’ – should liquid lunches be banned?
Lloyd’s alcohol ban challenges City of London’s drinking culture

If I turned up to my job having had a drink it would lead to an instant response of disciplinary and suspension which would likely lead to dismissal and being struck off.   Same for MrHOF.  How can anyone complain that not being able to drink at lunchtime and then return to work is somehow reminiscent of Orwells 1984?