Category Archives: Alcohol research findings and media coverage

10 things you only know if you’re teetotal

I normally steer clear of sharing these kind of lists on the blog but this one I read in The Telegraph in May I quite liked ūüôā¬† As the post title suggests it’s shares the insights that we have because we are teetotal (another label I’m not terrifically keen on!)

According to the latest data from the Office of National Statistics, teetotalism is on the rise, with 21 per cent of Brits claiming not to drink at all, and almost half drinking less than they previously did. 

As any teetotaller like myself will tell you, the release of stats such as these are always very encouraging (more sober people to speak to at parties!), but somewhat hard to believe. Twenty one per cent may be a notable increase, but it still places us alcohol-shunners firmly in the minority, marginalised from social norms. 

Here are 10¬†things you only know if you don’t drink.¬†

1. You get tired of explaining your reasons for abstaining

You go out, someone mentions drinks, and offers you a glass of wine. “No thanks, I don’t drink” you say, in the hope that, as a mature adult, they will respect your choice and move on.¬†No such luck. “You don’t drink? What, not at all?” they cry in disbelief. “Why?” Once you reel out your valid, personal reasons for the millionth time they are still unlikely to be satisfied, and you find yourself contending¬†either¬†with knowing smiles and patronising comments such as¬†“Ah, I just need to introduce you to a good red wine” or a glazed look of incomprehension, as if you’ve just revealed that you are in fact part-martian.

2. You end up finding ways to make it look like you’re drinking

Once you realise that choosing not to consume liquor proves too much for many of your acquaintances to handle, it becomes clear that a more peaceful evening can be had if you avoid the subject altogether. So you either ask for¬†tap water because you’re “thirsty” or¬†secretly order virgin cocktails, and hope that everyone will mistake your San Pellegrino¬†with ice and a slice for a G&T. After several rounds, no one else will notice that you’re still sober, anyway.

3. You¬†can remember all of your birthday parties…

…as well as¬†those of your friends¬†and any weddings, christenings or graduations¬†you may have attended. There is no need to check Facebook or text someone¬†to find out what happened last night, because, being alcohol-free, your memory is preserved. Rather than looking back on a haze of vodka-fuelled antics and missing belongings, you’ll¬†remember the details: the conversations, the laughter, and all the fuzzy emotions. No embarrassment, and no need for an early morning walk of shame.¬†

4. You can have productive Saturday and Sunday mornings

The benefits of living without hangovers cannot be underestimated. You can go out for an evening safe in the knowledge that, come the morning, you will be able to go about your business as usual without reaching for sunglasses, paracetamol or the nearest paper bag. Days do not need to be written off in advance for recovery, and you can fill your time with other things you enjoy. 

5. You appreciate deep and meaningful‚Äč late night conversations¬†

All teetotallers know that, once the evening has past a certain point, maintaining any kind of serious conversation with a fellow reveller can become nigh-on impossible, as they segue from discussing Brexit to describing their socks, and complaining about that ex who would always leave toothpaste in the sink. Finding someone at 11pm who is sober enough to have a still have lucid conversation is a source of great joy, and you may end up bonding as a result. 

6. You are sick to death of sparkling water

Although certain bars and brands are taking notice of increasing numbers of non-drinkers, the majority of venues do not offer enticing non-alcoholic options. This means you are faced with over-priced, syrup-laden mocktails, watery fruit juices from concentrate or water. Afraid that by constantly ordering tap water you will appear cheap, a killjoy or just distinctly unimaginative, you are forced to go for the sparkling option, as it appears slightly more grown up, whether or not you actually enjoy it. Sadly, until more bars cotton on to the fact that some of us would be interested in drinking a sophisticated tea or coffee after 7pm, you are forced to endure the abrasive, tasteless bubbles at all social events.   

7. You have extra cash

By choosing not to drink, you are inevitably saving yourself a decent sum of money. A meal out¬†with friends does not automatically mean lining and clearing out the contents of your wallet:¬†not only are you saving on ¬†the hiked-up prices of alcohol in bars, but also the dodgy kebabs, taxi rides, dry-cleaning bills and inevitable¬†Alkaseltzer the following day. As a result, you have extra money to spend on food, clothes¬†and¬†sober activities like going to the cinema¬†or the gym. Crippling rent and bills aside, this makes it less likely that you’ll always be counting down the days til payday and forcing yourself to survive solely on pot noodles.¬†

8. You realise how grimy most bars are

Everyone knows that alcohol allows you to see the world through ros√©-coloured glasses, meaning that those under the influence tend not to notice sticky floors or mouldy walls. A life of sobriety allows you to appreciate all the charming details of the world’s drinking establishments in glorious technicolour, and you quickly understand that many of them are pretty nasty places. From the questionable¬†stains in the toilets to the scum on the drinking glasses, you are forced to notice every unpleasant detail, while your drinking peers gush about how much fun they’re having.¬†

9. You are an expert observer of the stages and types of drunkenness 

Being in a minority, the non-drinker in a group has both the advantage and disadvantage of watching everyone else descend into the various types of drunk: the crier, the giggler, the flirt, the¬†overly-sincere etc. You watch with amusement and/or despair as all your friends transform from rational humans into wide-eyed huggers¬†or laughing maniacs, and spend a lot of time listening to people¬†explain with earnest that¬†Michael Jackson really isn’t dead, and that people should be more considerate to the local dormouse population.¬†Whether you choose to remind them of these conversations the next day remains at your discretion.¬†

10. You appreciate a good evening in 

It is still very possible to maintain a busy social life as a non-drinker, but it’s likely that you are more inclined than most to enjoy the comforts of an evening at home, rather than a crowded bar. You don’t have to spend outrageous money on soft drinks or “bar snacks”, nor do you have to put up with inappropriate fondling from soused acquaintances, force anyone into a taxi, or mop up vomit. You can spend an enjoyable evening catching up with friends (or blissfully alone) on the sofa, cooking up a storm, or gorging on your favourite box set. And you can go to bed when you want. Result.¬†

The only one I would disagree with is the dislike of sparkling water Рwhich is still my go to drink almost 4 years in.  Any you disagree with?  Any you would add?

Statistics on Alcohol England 2017

An excellent blog post as always from Alcohol Policy UK in May looking at the latest statistics on Alcohol England for 2017 & Opinions and Lifestyle Survey (OPN) drinking figures.

Over to James:

The annual Statistics on Alcohol for England 2017 has been released, detailing national data for key alcohol-related indicators and health harms.

Mainly bringing together recent alcohol data releases, the overall trend remains one of falls in drinking amongst younger people, whilst many measures of harm including the latest alcohol-related hospital admissions continue to rise, largely driven by heavier drinking mid and older age adults. See here for Guardian and BBC reports.

Key headlines from the release include:

Hospital admissions ‚Äď broad measure
  • There were 1.1 million estimated admissions related to alcohol consumption in 2015/16. This is 4% more than 2014/15.
  • This represents 7.0% of all hospital admissions which is similar to 2014/15 and 2013/14.
  • Blackpool had the highest rate at 3,540 per 100,000 population. Isle of Wight had the lowest rate at 1,400.

Hospital admissions ‚Äď narrow measure

  • There were 339 thousand estimated admissions related to alcohol consumption in 2015/16. This is 3% higher than 2014/15 and 22% higher than 2005/06.
  • This represents 2.1% of all hospital admissions which has changed little in the last 10 years.

See here for the LAPE statistical commentary [pdf] on the latest alcohol-related hospital admission figures.

Drinking Prevalence

  • 57% of adults reported drinking alcohol in the previous week in 2016 which is a fall from 64% in 2006.
  • This equates to 25.3 million adults in England.
  • Those who drank more than 8/6 units on their heaviest day in the last week fell from 19% to 15%.

Deaths

  • In 2015, there were 6,813 deaths which were related to the consumption of alcohol. This is 1.4% of all deaths.
  • The number of deaths is similar to 2014 but is an increase of 10% on 2005.

[NB Age standardised death rates show a relatively stable trend since 2012].

Prescriptions

  • The number of prescription items dispensed in 2016 was 188 thousand which was 4% lower than 2015 but 63% higher than 2006. This breaks the recent trend of successive year on year increases.
  • The total Net Ingredient Cost (NIC) was ¬£4.87 million. This is 24% higher than in 2015 and more than double the level ten years ago.

Consumption confounders?

The national statistics release includes the latest Opinions and Lifestyle Survey (OPN) data on alcohol consumption, albeit that Heaviest Drinking Day (HDD) in the last week is not well regarded as an accurate indicator of consumption. Health Survey for England (HSE) data may be considered better for consumption trends as it also includes questions on mean weekly or daily consumption.
Recent sets of both data though show similar findings in terms of identified trends and socio-economic or geographical variations. However a small decline in the OPN’s proportion of adult drinkers in Britain to 56.9% based on reported drinking in the last week is the lowest since 2005 when the survey began. This time point has however been described as ‘peak booze’ following several decades of steep increases before the turn of the century. As well as the many important demographic differences behind these overall trends in reported consumption, more detailed research has continued to highlight the ‘rich tapestry’ behind the various drinking groups and the extent of under-estimation in self-report data.
Prescriptions: an unexpected drop?
Whilst the ten year trend for prescriptions to treat alcohol dependency has risen significantly, a 4% drop on 2015 may be notable, though largely due to a significant fall in Disilfiram prescriptions. The release however notes a sharp rise of £22 for the Net Ingredient Cost for Disilfiram giving a likely indication as to why. Also of interest, prescription items for Nalmefene fell by 1,000 from 4,400 in 2015 to 3,400 in 2016 which may reflect the apparent decision by its producers Lundbeck ceasing promotion activity in the UK, but also potentially linked to questions raised over the evidence and licensing process.
Alcohol-related cancers: a further harm measure
The latest LAPE statistical commentary [pdf] also includes estimates of alcohol-related cancer based on the six cancer types which are known to have an alcohol link; mouth, throat, breast, stomach, liver and bowel cancer. The release suggests approximately 19,000 new cancer cases each year attributed to alcohol. Since 2004 these rates have been rising, but a recent small drop in alcohol-related cancer rates for men has not yet been followed by the rates for women.
Looking ahead: sales and pricing?
For those keen on assessing the potential future for harm and consumption trends, interest will no doubt be focused on forthcoming sales data which indicated a return to rising total UK alcohol consumption last year, largely driven by the continued growth in off-sales. As such, health advocates wish to see Minimum Unit Pricing (MUP) to curb the availability of the cheapest alcohol – a final conclusion to Scotland’s long running bid is expected imminently.
There has been a great deal of talk recently about JAM (just about managing) or “squeezed middle” in the UK and this share of expenditure being spent on booze can’t be helping financially or otherwise.

Commons alcohol policy briefings

Thanks once again to Alcohol Policy UK for this information shared in April.¬† A spate of alcohol research briefings produced by the House of Commons Library have recently been released, suggesting continuing Government interest in alcohol’s impact on society.¬† An expectation of the need to tackle alcohol harms now seems further embedded amongst the general population.

The recent House of Commons Library briefings include:

Alcohol: minimum pricing

The recent Minimum Unit Pricing (MUP) briefing [pdf] sets out a brief history of MUP in the UK, highlighting:

‘The Government has said that MUP ‚Äúremains under review pending the outcome of the legal case between the Scotch Whisky Association and the Scottish Government, and the impact of the implementation of this policy in Scotland‚ÄĚ.

The Coalition Government introduced a ban on the sale of alcohol below cost price from 28 May 2014. This is one of the licensing conditions of the mandatory code of practice that applies to licensed premises.

The Coalition Government‚Äôs alcohol strategy (March 2012) had included a commitment to introduce MUP. A consultation (November 2012) on the strategy recommended a price of 45p per unit. The commitment was dropped in July 2013 ‚Äď the then Government claimed that its analysis of consultation responses showed there was not enough ‚Äúconcrete evidence‚ÄĚ that MUP would be effective in reducing the harms associated with problem drinking without penalising responsible drinkers.’

The briefing further review the details of recent policy developments, including the long-running Scottish Government’s effort to implement MUP in face of successive legal challenges and appeals by sections of the alcohol industry. A final conclusion to the saga is expected this year, which should it result in implementation will be likely to increase pressure on any Government in Westminster to make commitments pending¬† positive outcomes. Wales and Ireland meanwhile take the view the evidence is already conclusive enough and are seeking MUP irrespectively.

Alcohol taxation and the pub trade

Often tied in with MUP debates, debates over the potential for taxation as a pricing lever can be equally hard fought. A newly released briefing on taxation and the pub trade [pdf] extensively details some of the key issues including the way alcoholic drinks are taxed, Labour’s introduction of a ‘duty escalator’ in 2008, and reported concerns in the pub trade over the impact of the policy. It further considers the Coalition Government decision to remove the duty escalator in two stages in 2013 and 2014, and the current Government’s approach to the taxation of alcohol.

Indeed the growing price gap between off and on-trade sales has been charged with the shift towards home drinking and continued decline in pubs. Whilst multiple factors are likely to be at play, many are concerned that cheap off-trade sales fuel heavy drinking in unregulated environments and ‘pre-loading’. A current consultation on changes to white cider may have some effect down the line, but will not address many of the broader public health concerns.

Alcohol: mandatory licensing conditions

A briefing on the mandatory licensing conditions [pdf] has also been released, detailing the amendments made to the Licensing Act intended to address ‘irresponsible drinking’. A mandatory condition in 2014 introduced the controversial ‘below cost ban’ – an alternative price floor following the MUP u-turn, but in reality thought to affect few if any drinks on sale to the public.

Existing mandatory conditions introduced in 2010, which too may have been of questionable impact or unknowns over national levels of adherence, include:

  • ban irresponsible promotions
  • ensure free potable water for customers
  • ensure that small measures of beers, wine and spirits are offered and that customers are made aware of them
  • ensure that all those who sell or supply alcohol have an age verification policy in place requiring them to ask anyone who looks under 18 for proof of age

Children in pubs

A new briefing relating to children in pubs [pdf] sets out the various legal and policy considerations for this rather complex area. Whilst the Licensing Act includes the protection of children as one of its four main objectives, children can attend most pubs if accompanied by an adult and within certain hours. However certain other laws and circumstances exist, as well as important considerations around age checks, employment and other issues.

Alcohol: drinking in the street

A recent briefing on issues pertaining to street drinking highlights that whilst consuming alcohol in public places is not illegal per se, a range of legislation and controlled zones exist which can authorise confiscation or arrest related to public space consumption. Since their introduction, powers of confiscation, dispersals or penalty notices have been significantly utilised and are likely to have contributed to falls in arrests for drunk and disorderly or being drunk in a public place. Street drinking however remains a concern in many areas; a toolkit for ‘Tackling street drinking’ was released last year, intended to help ‘reduce the incidents of, and burden from, street drinking and to improve the interventions provided to street drinkers themselves.’

Let’s see if what they said is followed up with actions ….

Friday Sober Insight: The Addiction Game

So continuing on reading John Bradshaw he discusses Transactional Analysis and mentioned a Life Script I’d not heard of: the ‘no feel’ (addiction) script also described as Joyless.¬† In deeper exploration I found further talk of the addiction game.¬† The image to the right explains the script types further and this excerpt below from the core Transactional Analysis text explains the Addiction Game:

The drama triangle can be illustrated with the Addiction Game. (I’ve discussed the Karpman Drama Triangle before here.)¬† In the¬†Addiction Game, the addict playing the role of the Victim of addiction, humiliation, prejudice, medical¬†neglect and even police brutality seeks and finds a Rescuer. The Rescuer plays the role by trying to¬†generously and selflessly help the addict without making sure that the addict is invested in the¬†process of giving up drug abuse. After a certain amount of frustrating failure the Rescuer gets angry¬†and switches into the Persecuting role by accusing, insulting, neglecting or punishing the addict. At¬†this point the addict switches from Victim to Persecutor by counterattacking, insulting, becoming¬†violent and creating midnight emergencies. The erstwhile Rescuer is now the Victim in the game. This¬†process of switching goes on endlessly around the Drama Triangle Merry-go-Round.

To avoid the drama triangle in psychotherapy, transactional analysts insist on establishing a contract in which the person specifically states what he/she wants to be cured of. This protects both client and therapist: the therapist knows exactly what the person wants, and the person knows what the therapist is going to work on and when therapy is to be completed. In any case, the best way to avoid the Drama Triangle is to avoid the roles of Rescuer, Persecutor or Victim by staying in the Adult ego state.

SCRIPTS: Transactional analysts believe that most people are basically OK and in difficulty only because their parents (or other grown ups and influential young people) have exposed them to powerful injunctions and attributions with long-term harmful effects.

People, early in their lives come to the conclusion that their lives will unfold in a predictable way; short, long, healthy, unhealthy, happy, unhappy depressed or angry, successful or failed, active or passive. When the conclusion is that life will be bad or self damaging this is seen as a life script.

The script matrix is a diagram used to clarify people’s scripts. In it we see two parents and their¬†offspring and we can diagram the transactional messages–injunctions and attributions–which caused the young person¬†to abandon their original OK position and replace it with a serf-damaging not OK position.

When life is guided by a script there are always periods in which the person appears to be evading his or¬†her unhappy fate. This seemingly normal period of the script, is called the counterscript. The¬†counterscript is active when the person’s unhappy life plan gives way to a happier period. This is,¬†however, only temporary and invariably collapses, giving way to the original scripting. For an alcoholic,¬†this may be a period of sobriety; for a depressed person with a suicide script it may be a brief period of¬†happiness which inevitably ends when the script’s injunctions take over.

In the Script Matrix of Joseph, a drug addict we see that the script injunction “Don’t think, drink instead.” goes to Joseph’s Child¬†from his father’s Child. This powerful message influences Joseph’s life dramatically, when he follows his father‚Äôs injunction with drugs instead of alcohol causing him repeated¬†drug abuse episodes through his young life and adulthood. The counterscript message “You should not¬†¬†drink to excess,” motivates him to make repeated but ineffectual efforts to cut down on drug abuse and it goes to Joseph’s Parent¬†from his mother and father’s Parent.

The Script message: “don’t think, drink instead” delivered from Child-to-Child-is more influential¬†than the Parent-to-Parent counterscript message to abuse moderately: that is why the script messages will usually¬†prevail unless the person changes his or her script. When scripts are not changed they are passed down the generations, like ‚Äúhot potatoes,‚ÄĚ from grown ups to children in an uninterrupted chain of maladaptive, toxic behavior patterns.

You can read more about TEN CONCEPTS IN TREATING ALCOHOLICS WITH TA written by Stephen Karpman:

10Alc

I’ve been wondering to myself whether the “hot potato” of the no-feel script, leading to addiction issues, is present in the UK because of our cultural tendency to a “stiff upper life” approach to life.

From Wiki:

One who has a stiff upper lip displays fortitude in the face of adversity, or exercises great self-restraint in the expression of emotion.[1][2] The phrase is most commonly heard as part of the idiom “keep a stiff upper lip”, and has traditionally been used to describe an attribute of British people in remaining resolute and unemotional in the face of adversity.[1]

And it’s not just me who’s been questioning the value of our stiff upper lip approach to life recently either:

The stiff upper lip: why the royal health warning matters

Just a thought.

Friday Sober Inspiration: Shame and The Squirrel Cage

So I’ve been reading John Bradshaw’s Healing The Shame That Binds You and oh my goodness when I read the section on Shame as The Core and Fuel of Addiction I almost fell off my chair!¬† It’s called The Squirrel Cage and is so reminiscent of this post I wrote it is spooky …..

I’m going to quote this section from his book but will share a series of Youtube video’s you can watch where he speaks about shame and this book’s premise.¬† There are 5 video’s in total and I’ll link the first one below.

Over to John:

Neurotic shame is the root and fuel of all compulsive/addictive behaviours.¬† My general working definition of compulsive/addictive behaviour is “a pathological relationship to any mood altering experience that has life-damaging consequences.”

The drivenness in any addiction is about the ruptured self, the belief that one is flawed as a person.  The content of the addiction, whether it be an ingestive addiction, or an activity addiction (such as work, shopping or gambling), is an attempt at an intimate relationship.  The workaholic with his work and the alcoholic with his booze are having a love affair.  Each one alters the mood in order to avoid the feeling of loneliness and hurt in the underbelly of shame.  Each addictive acting out creates life-damaging consequences that create more shame.  The new shame fuels the cycle of addiction.

The image at the top of the post is taken from Dr Pat Carne’s work, giving you a visual picture of how internalized shame fuels the addictive process and addictions create more shame, which sets one up to be more shame-based.¬† Addicts call this the squirrel cage.

I used to drink to solve the problems caused by drinking.  The more I drank to relieve my shame-based loneliness and hurt, the more I felt ashamed.  Shame begets shame.

The cycle begins with the false belief system shared by all addicts: that no one could want them or love them as they are.¬† In fact, addicts can’t love themselves.¬† They are an object of scorn to themselves.¬† This deep internalized shame gives rise to distorted thinking.¬† The distorted thinking can be reduced to the belief, “I’ll be okay if I drink, eat, have sex, get more money, work harder, etc.”¬† The shame turns one into what Kellogg has termed a “human doing” rather than a human being.

Worth is measured on the outside, never on the inside.¬† The mental obsession about the specific addictive relationship is the first mood alteration, since thinking takes us out of our emotions.¬† After obsessing for a while, the second mood alteration occurs.¬† This is the “acting out” or ritual stage of the addiction.¬† The ritual may involve drinking with the boys, secretly eating in one’ s favourite hiding place or cruising for sex.¬† The ritual ends in drunkenness, satiation, orgasm, spending all the money or whatever.

What follows is shame over one’s behaviour and life-damaging consequences: the hangover, the infidelity, the demeaning sex, the empty pocketbook.¬† The meta-shame is a displacement of affect, a transforming of the shame of self into the shame of “acting out” and experiencing life-damaging consequences.¬† This meta-shame intensifies the shame-based identity: “I’m no good; there’s something wrong with me,” plays like a broken record.¬† The more it plays, the more one solidifies one’s false belief system.¬† The toxic shame fuels the addiction and regenerates itself …..

I would really recommend the book but if you’re a visual and auditory learner instead watch here:

Changing Scotland’s Relationship to Alcohol

Coverage from Alcohol Policy UK of the new report from Alcohol Focus about changing Scotland’s relationship to alcohol and recommendations for further action.

A new report has been released by Alcohol Focus Scotland (AFS) calling for bold action by the Scottish Government as it prepares to refresh its national alcohol strategy.

Download¬†Changing Scotland’s Relationship with Alcohol: Recommendations for further action¬†(PDF)

The report is intended to inform the next phase of the Scottish Government’s alcohol strategy and was developed with the BMA Scotland, SHAAP and Scottish Families Affected by Alcohol & Drugs. It outlines a comprehensive range of actions that it wishes to see the Government prioritise, including a target to reduce national consumption in Scotland by 10%. It argues the fall in consumption could potentially deliver a 20% reduction in deaths and hospital admissions after 20 years, based on University of Sheffield modelling.

The report’s recommendations include:

  • Implementing a 50p minimum unit price as soon as possible
  • Developing a strategic approach to reducing the availability of alcohol, and improving existing licensing regulation
  • Reducing exposure of children to alcohol advertising and sponsorship
  • Protecting every child‚Äôs right to an alcohol-free childhood
  • Clearer information for consumers about the health risks associated with drinking
  • More investment in alcohol prevention, treatment and support services

The report states that whilst per capita alcohol consumption in Scotland declined by 9% between 2009 and 2013, since 2012 the amount of alcohol sold and number of people dying as a result have increased. In 2015 the amount of litres of pure alcohol sold was 10.8 per adult in Scotland; equivalent to 20.8 units per adult per week. Alcohol misuse is stated to cost £3.56 billion a year in health, social care, crime, productive capacity and wider costs, whilst the cost to the NHS in Scotland is £267 million. The cost of alcohol-related crime in Scotland is £727 million a year, and the total costs to society equate to £900 for every adult in Scotland.

Alison Douglas, Chief Executive of Alcohol Focus Scotland said Scotland was “awash with alcohol” and that “widespread availability, low prices and heavy marketing are having a devastating effect.” Dr Peter Bennie, Chair of BMA Scotland said doctors see “the first-hand the damage that alcohol misuse does to patients and their families” and that the country could not afford the costs of alcohol upon the health service.

Health Secretary Shona Robison welcomed the report and said the government would consider all of the recommendations. Last year the final Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) report was released, indicating the Scottish Government’s alcohol strategy has had a positive impact over the past 5 years despite minimum unit pricing (MUP) not having been implemented.

Scotland: evidence first?

In 2015 a report was released exploring the extent to which alcohol policies across the UK nations were evidence-based. The report rated Scotland as having the strongest approach based on policy detailed in ‘Health First’, an independent alcohol strategy proposed by a coalition of independent health bodies in 2013. Scotland’s main weakness was rated as its involvement of alcohol industry in policy decisions – public health groups argue industry should only be involved as producers, retailers and distributors, and not be permitted to influence policy.

Meanwhile Scotland’s infamous long running effort to implement MUP has been repeatedly challenged by sections of the alcohol industry led by the Scotch Whisky Association. The most recent appeal was described as amounting to ‘delaying tactics’ by AFS and others who remain hopeful that MUP will finally be authorised to commence this year.

Certainly it appears the Scottish Government support an alcohol policy approach that public health groups deem largely evidence based. Many including PHE suggest the same approach is needed in England, albeit that MUP has not technically been ruled out. However given the broader political context, those wishing to influence alcohol policy may feel now may not be the most opportune time. Equally, alcohol and related health policy debates may still be considered relatively high profile and with many MPs now routinely involved in a number of alcohol-related issues.

We are cheering you along from down here Scotland!!

The ‘rich tapestry’ of alcohol consumption: insights into heavy drinking

Oh yes a ‘Wine Decor Tapestry Wall Hanging’ actually does exist! :s¬† So this was an Alcohol Policy UK blog post bringing our attention to a report that was published late last year.

Over to James Morris:

Understanding alcohol consumption trends, especially among heavy drinking groups, is undoubtedly central to alcohol policy debates across the UK, but unveiling the complexity and nature of alcohol use across society is no mean feat. Recent research, however, provides new insights into what and who lies behind recent consumption shifts and how to interpret these in the context of ‘drinking types’ and ‘cultures’.

A new analysis of ‚Äėheavier drinkers‚Äô in Great Britain from 1978-2010, funded by ESRC and published earlier this year, urges against relying on headline consumption data when considering alcohol problems and policy. Rather, we need to recognise the ‘rich tapestry’ of alcohol consumption: the patterns of use and culture that are spread not only across the whole population but within a range of drinking ‘sub-groups’. The research explored ‘typologies and dynamics’ of heavier drinkers, identifying four ‘stable clusters’ during the period, with each group showing characteristics that were distinct from both the other heavy drinking groups and the general population.

Between 1978 and 2010 consumption mainly rose, with what has been described elsewhere as ‘peak booze’ being reached around 2004. This increase in consumption was driven in part by higher levels of wine drinking amongst women, including ‘baby boomers’ born in the 1940s and 50s. ¬†Over this period wine has been increasingly ‘democratised’: drunk in greater quantities not only by women but across a wider range of income groups. Wine sales increased by 184% between 1980 and 2007 in the context of increasing affordability and availability through supermarkets and the off-trade. A later generation of women, reaching early adulthood in the 1990’s, also significantly¬†contributed to rising consumption. However whilst the older ‘baby boomer’ generation of women fall firmly within the ‘wine and spirit cluster’ (the only female dominated drinking group), women’s drink choices have more recently diversified alongside growing choice in the market.

Importantly, the authors suggest that shifts in overall levels of consumption tend not to occur as a result of new distinct groups or styles of drinking, but rather develop within existing drinking cultures. For instance, while the increase in heavy drinking by younger women during the 1990’s and early 2000’s was frequently portrayed in the media as ‘ladette’ culture, this overlooked the still heavier rates of drinking by men whose consumption styles remained largely unchanged. Equally, the much talked about invention of ‘alcopops’ received disproportionate attention in relation to overall rising consumption, which was more substantially driven by increased home drinking across all drink types, particularly women’s wine consumption.

The study’s lead author, Dr Robin Purshouse, said:

‚ÄúOver the last 30 years of social change, the styles of drinking adopted by heavier alcohol users have stayed remarkably consistent. The rise in heavier drinking over the 1990s in the lead up to ‚Äėpeak booze‚Äô was driven by increasing numbers of women and older people adopting these styles. Our findings emphasise the importance of cultural factors, such as drinking styles, as key components in the policy debate surrounding heavy alcohol use.‚ÄĚ

The study overlaps with research exploring drinking cultures published last year (also led by members of the Sheffield Alcohol Research Group), which also described a more complex picture than that often portrayed in the media. That study found nearly half (46 per cent) of all drinking occasions ‘involved moderate, relaxed drinking in the home’, potentially indicating the context in which the majority of ‘low risk drinkers’ do so. Certainly there is relevance to further understanding low risk drinking nuances too, especially when considering how heavier drinkers tend to describe their drinking as in line with the norm. However the SARG findings also support evidence of ‘pre-loading’, and¬†10 per cent of all drinking occasions involved groups of friends moving between home and pub drinking, consuming the average weekly recommended guideline of 14 units on one occasion. Other identified patterns included drinking at home alone (14 per cent of occasions), light drinking at home with family (13 per cent), light drinking at home with a partner (20 per cent) and heavy drinking at home with a partner (nine per cent). See here for Conversation article by SARG researcher John Holmes.

And new insight into under-estimation in national survey data

A recent study has explored to what extent national consumption data based on surveys may under-represent heavier drinkers due to ‘non-response bias’. It has often been shown that heavier drinkers may be less likely to be respond, or may require more extensive efforts to recruit to surveys. The study analysed how the number of contact attempts to reach participants varied by drinking status and socio-demographic characteristics, identifying evidence for a significant ‘non-response bias‚Äô among heavier drinkers. When modelled, it was estimated that accounting for non-response bias may lead to a 12.6% increase in men‚Äôs weekly drinking and 20.5% in women.

Lead author Dr Sadie Boniface said:

“Our recent paper presents one way of looking at the likely impact of non-response bias on survey measures of alcohol consumption, similar to previous studies in New Zealand and Canada. Our findings agree with other studies, finding that people with a more hazardous or harmful drinking pattern are harder to reach for surveys. This study underlines the importance of extended efforts to recruit and follow-up participants in research studies in order to reduce the impact of this bias.”

Looking forward?

Overall, recent findings such as these remind us that while the overall level of consumption across the population is an important indicator of trends, within any society drinking behaviours are varied and diverse. Harmful patterns may emerge among one group, or within one set of drinking environments, while trends may improve elsewhere.

Understanding the contexts and multiple factors at play is therefore important in developing and refining responses to alcohol harm. Individually targeted interventions may be generally considered effective, but still face significant delivery challenges¬†within the current limitations of research, policy and practice. Indeed the paper states that the need for more nuanced understandings and responses does not itself call into question models that suggest a ‘structural relationship between overall population consumption levels and harmful consumption’. Indeed there are many complex questions facing the many levels of alcohol policy and interventions – see here for selected events in 2017 that will be attempting to further answer some of these.

I kept the true nature of my drinking hidden from view, even from my GP, so it stands to reason that when drinking surveys are completed people like me either deny or minimise our drinking or avoid getting involved altogether.  Would you have been honest about your drinking if asked as part of a drinking survey?

A letter to … My wonderful mother, who drank herself to death

This photo is from our time in Australia last summer and shows the HOF family at play on the beach at sunset.¬† It was my sons birthday this week and I read this in The Guardian recently and two thoughts came to mind.¬† I didn’t want to be recalled by my children like the mother detailed in this letter and it also resonated with me about my father and the loving bond we had despite his drinking.

I hate it when people who didn’t know you ask me how you died. As soon as I tell them you were an alcoholic, I know exactly the kinds of thoughts running through their heads. That one word conjures a vivid, stereotypical picture. You were violent. You were neglectful. You weren’t a good mother. I had a horrible childhood. You damaged me.

But that’s not how it was. You were a wonderful mother and I had a golden childhood. You gave me everything a child needs and more. You loved me, supported me, invested your time and money in me and cultivated a deep mother-daughter bond between us. I miss waking up in the middle of the night to find you kneeling by my bed and stroking my hair. I miss the way you took care of me when I was ill. I miss your cuddles and kisses and the strong, heady scent of your expensive perfume.

You really did lead a charmed life. You were married to a good man who provided for you and took care of you. You were never short of money, attention or love. You were the life and soul of the party and people flocked around you. You were strikingly beautiful and unfailingly kind. From the outside, you had it all.

Yet appearances can be deceptive. You weren’t happy and it’s taken a long time for me to understand why. You always said you loved me more than I could ever understand and you would die for me. But then you did die and it wasn’t for me.

When you started drinking, it was a bit funny. ‚ÄúOh, Mum‚Äôs drunk again,‚ÄĚ we would giggle at parties, as you stumbled around talking nonsense. As the years rolled on, it became increasingly less funny. You changed beyond recognition and when you were drunk you became nasty and spat out horrible, unforgivable words. It wasn‚Äôt like you at all. I became accustomed to compartmentalising my feelings ‚Äď the love and respect I had for my mum and the fear and loathing I had of this drunken stranger.

Things progressed badly and the drunken stranger took the steering wheel. My beloved mum gave up the fight. Your marriage fell apart and you lost your home. You were irreparably broken. I was young and selfish and, more importantly, I understood nothing of life or loss.

I’ve spent many years feeling guilty because I didn’t do more to help you. If this happened today, things would be very different. I’m a mother now and used to putting others before myself. I know what I should have done to understand you and help you. If only I could turn back time and be the daughter I should have been, perhaps you would still be alive today. At the time, I did nothing except feel sorry for myself. I blamed you. I was at a loss to understand what you had to be so deeply unhappy about. You had a perfect life and you chucked it all away.

Today, I see you with the compassion of a fellow mother and wife. Life experience has provided me with valuable perspective as to how you really felt. I am able to piece together all the little clues you subconsciously gave me until I can see the whole picture. I have suffered some heart-breaking losses, the first of which was you.

I used to be angry with you for hurting me and then leaving me. I then spent many years feeling guilty and blaming myself for your demise. Finally, I am now able to disentangle myself from all these feelings and treat everyone involved in your story with compassion. If I could have just two minutes with you today, I would take both your hands in mine and say: ‚ÄúI love you and I understand.‚ÄĚ

Over 3 1/2 years sober and I continue to be so grateful for every day since I stopped.

Friday Sober Jukebox:¬† Don’t Look Back In Anger + Tony Walsh’s Manchester poem ‘This is The Place’

 

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 ‚Äúscandalous misuse‚ÄĚ 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.

‚ÄúIt 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,‚ÄĚ she said.

‚ÄúThe planning system is well suited to dealing with licensing applications and appeals, and the interests of residents are always taken into account.‚ÄĚ

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

‚ÄúTheir decisions have been described as ‚Äėsomething of a lottery‚Äô, ‚Äėlacking formality‚Äô, and ‚Äėindifferent‚Äô, with some ‚Äėscandalous misuses of the powers of elected local councillors‚Äô,‚ÄĚ 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.

‚ÄúThe Derbyshire police wrote: ‚ÄėIt 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.‚Äô‚ÄĚ

The Lords committee said: ‚ÄúThe 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.‚ÄĚ

McIntosh also called for relevant legislation to apply at airports: ‚ÄúWe 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.‚ÄĚ

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

‚ÄúThe 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.‚ÄĚ

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 Рwhich 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 Р75 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 ūüėČ