Category Archives: Alcohol research findings and media coverage

Minimum unit pricing to go ahead in Scotland after 5 year legal battle

MUP is a more effective means of reducing socioeconomic inequalities in health than taxation ( Colin Angus‏ @VictimOfMaths)

From Alcohol Policy UK today:

Today the UK Supreme Court delivered the final verdict on Scotland’s long running legal challenge to introducing Minimum Unit Pricing (MUP). The Scottish Government first passed legislaton in 2012 but a number of industry bodies spearheaded by the Scotch Whisky Association (SWA) forced a series of challenges under EU which some public health figures have described as ‘delaying tactics’.

The legal challenge rested on the argument that MUP contravened EU competition law, arguing instead that taxation would be a more appropriate means of achieving its aims. However the Supreme Court disagreed stating health objectives and the free market were “two incomparable values” and declaring MUP a “proportionate means of achieving a legitimate aim”. The court also rejected the appeal’s claim that the Scottish Government should have committed to going further in assessing market impact as unreasonable, acknowledging its commitments to evaluating the impacts and the five year sunset clause. 

Public health groups and academics involved in MUP took to Twitter to express relief and comment on the judgement and next steps. The SWA have issued a brief statement on the decision whilst a Spectator article by veteran ‘anti-nanny state’ commentator Christopher Snowden says MUP ‘won’t end alcoholism’. However James Nicholls suggested this was a ‘straw man’ argument and has written a response to the ruling outlining MUPs aims and key considerations. The news has also been covered by the BBC, Telegraph, The Scotsman and Guardian, with further coverage and comment likely throughout the week.

Absolutely delighted that minimum pricing has been upheld by the Supreme Court. This has been a long road – and no doubt the policy will continue to have its critics – but it is a bold and necessary move to improve public health.

— Nicola Sturgeon (@NicolaSturgeon) November 15, 2017

Where next?

The Scottish Government will no doubt hope to see MUP come into effect as soon as possible; indeed the likely impact (see latest Sheffield modelling here) of the 50 pence per unit floor price will be significantly lower than had it been introduced in 2012, though its level can be addressed as part of the legislation. Wales and Ireland will also be welcoming the ruling having taken their own legislative steps to introduce MUP.

As for England, further pressure will no doubt be placed on the Westminster Government who, after David Cameron’s infamous 2012 u-turn, have committed only to monitoring Scotland’s proceedings. Watch this space.

Absolutely bloody brilliant news!!!

Alcohol Awareness Week 2017, 13-19 November: ‘Alcohol and Families’

Courtesy of Alcohol Policy UK – Alcohol Awareness Week 2017, 13-19 November: ‘Alcohol and Families.’

Alcohol Concern have announced this year’s Alcohol Awareness Week (AAW) will take place from 13-19 of November on the theme of ‘Alcohol and Families’. The charity, which has recently merged with Alcohol Research UK, has partnered with Adfam, a charity that supports families affected by drugs and alcohol.

As with previous years, Alcohol Concern hope AAW will prompt conversations about the impact of alcohol, this year ‘to help break the cycle of silence and stigma that is all too often experienced by families’. This may also help people access services or support either directly or via signposting from professionals.

Alcohol Concern will release a number of online resources that will be free to download, including:

  • Expert factsheets on various issues associated with alcohol and families
  • An easy to understand, visual depiction of the Chief Medical Officers’ guidelines for low-risk drinking for print and social media use
  • A bank of statistics for you to use

To receive this pack directly to your email, please click here. Alcohol Concern will be sharing information, resources and stories throughout the week on Facebook and Twitter using the hashtag #AAW2017. Family members who have been affected by a relative’s drinking and wish to share their story can get in touch with Alcohol Concern at contact@alcoholconcern.org.uk.

Protecting families and children: more to be done?

Earlier this year a manifesto for action to support ‘Children of Alcoholics’ (COAs) called upon the Government to take ten key actions including a targeted national strategy, local funding to support alcohol services, a plan to change attitudes and action on price and availability.

In 2014 a report from the Children’s Commissioner looked at the number of children affected by parental alcohol misuse and at the help available to them, calling for further action by services and local authorities. An Alcohol Hidden Harm Toolkit was also released to support managers, commissioners and practitioners involved in designing, assessing or improving Alcohol Hidden Harm services for children and families. Many will bee hoping AAW 2017 helps not only raise awareness of the issue, but also prompts further attention and resources for prevention and support

Links to all #AAW2017 content

Resources

Case studies

And this valuable research was released recently too:

Drugs for the treatment of alcohol dependence: insufficient evidence?

Plus this was published yesterday – more support for MUP when the Scottish decision is finally announced:

The killer on Britain’s streets – super-strength alcohol 

And an update from Alcohol Policy UK today (14th Nov):

Alcohol Awareness Week 2017 kicks off in week of MUP decision

It’s a big week!

New drug strategy prompts calls for clear national alcohol policy

Another great post from Alcohol Policy UK regarding the Govt’s 2017 Drug Strategy released in July.

The release of a new national drugs strategy for England and Wales has prompted revised calls for a new national alcohol strategy that includes minimum unit pricing (MUP).

The last national alcohol strategy was released in 2012 promising MUP, followed by an infamous U-turn. MUP has of course still yet to be implemented in Scotland, though a final legal ruling is expected this month following a drawn out legal challenge, with Ireland and Wales also committed.

MUP aside, alcohol objectives feature across several other policy domains, including as part of a Modern Crime Prevention Strategy, various PHE guidance and a national CQUIN incentivising brief intervention delivery across hospitals.

The new drugs strategy though refers to drugs and alcohol throughout, thus in the context of treatment for alcohol problems it may be seen as reflecting national alcohol ambitions for treating and preventing all substance dependence. Indeed a section on alcohol states:

While the focus of this Strategy is on drugs, we recognise the importance of joined-up action on alcohol and drugs, and many areas of the Strategy apply to both, particularly our resilience-based approach to preventing misuse and facilitating recovery. Alcohol treatment services should be commissioned to meet the ambitions set out in the Building Recovery chapter that are relevant to them, and in line with the relevant NICE Alcohol Clinical Guidelines. Commissioning of alcohol and drug treatment services should take place in an integrated way, while ensuring an appropriate focus on alcohol or drug specific interventions, locations, referral pathways and need.

In addition, local authority public health teams should take an integrated approach to reducing a range of alcohol related harm, through a combination of universal population level interventions and interventions targeting at risk groups. The Modern Crime Prevention Strategy 2016 highlights alcohol – as with drugs – as a key driver of crime and sets out a range of actions to tackle alcohol-driven crime.

The strategy though is not titled a ‘drug and alcohol strategy’, and some argue that there are many issues with providing alcohol treatment – or indeed strategies – under the same roof. Until April 2019 the ring-fenced but still shrinking Public Health Grant to local authorities will require local authorities to ‘have regard to the need to improve the take up of, and outcomes from, drug and alcohol services’, but not thereafter. The strategy also highlights the UK devolved administrations have ‘their own approaches to tackling drug and alcohol misuse and dependence in areas where responsibility is devolved’. 

Where next for national alcohol policy?

Calls for a single national alcohol strategy seem logical, if not at least to make clear the Government’s ambitions across the wide range of areas where alcohol harm and policy can reach. As well as a national drug strategy, a new tobacco control strategy has also been released, further highlighting an apparent gap. From a political perspective however, a lesson from the 2012 alcohol strategy appears to be not to commit to ambitious policies with powerful opponents; at least not until the path is clearer. Indeed since the MUP U-turn, Ministers have said on MUP they would be waiting to see what happens in Scotland.

Other alcohol policy areas are seemingly in an ongoing state of political bargaining. Marketing and availability are hotly contested areas, with health groups calling for the adoption of key approaches including taxation and effective levers identified in the recent PHE evidence review. Translating such calls into action is of course complex and faced with opposing voices, as debates over licensing policy have recently demonstrated.

The drug strategy though has received some praise for highlighting the need for evidence based approaches to prevention and treatment, and the need for addressing multiple-needs and overlapping issues including mental health. Others have argued it as the ‘same old rhetoric’, particularly when treatment budgets are ever shrinking.

Last year a small drop in the number of people accessing alcohol treatment was seen, though unlikely to be linked to the downturn in overall consumption since 2004. Other alcohol trends present a complex picture yet overall alcohol-related hospital admissions are still rising. Regardless of the various trends, many consider the scale and reach of alcohol problems deserve a single national policy for England and Wales. Given that no alcohol strategy will be universally praised or indeed gain much in voter popularity, some may consider its absence suggests political expediency has come first.

I know I sound like a stuck record about MUP but it’s because I agree with those who keep proposing it!

1500 days!

Well how about this for kismet?  Tomorrow is my belly button birthday and today I hit 1500 days sober!  Thank you Universe for tying that up so neatly 😉

Wow – just wow.  Such a big number and yet day 1 doesn’t feel that long ago.  So much has happened, so many friendships made, so much gratitude.  Who knew that such a small change could make such a big difference to my life and the lives of those around me?

So you may have noticed that my post frequency has reduced again as I enter my fifth year sober to once a week.  The fire in my belly doesn’t burn so fiercely for me now on this issue.  I’ve realised that I can’t change the world of public health and alcohol single handedly – no matter how loud I shout or how many words I expend in effort.  So I’ve contented myself on changing the lives of those who matter to me most – my family and to end the intergenerational transmission of alcohol dependence here.  I have above my desk a note that reads:

A hundred years from now it will not matter what my bank account was, the sort of house I lived in, or the kind of car I drove, but the world may be different because I was important in the life of a child.

That was reason enough for me to stop drinking and remains reason enough to never start again.  And to support that reasoning is new research from the Institute of Alcohol Studies

Download “Like sugar for adults: The effect of non-dependent parental drinking on children & families” [pdf]

and as reported in The Guardian last week reads:

At least 30% of parents admit being “tipsy” or drunk around their children, a study has found, prompting calls for a national conversation about alcohol consumption and the harm that exposure can do to youngsters’ emotional development.

Such behaviour can trigger family rows or leave children anxious, embarrassed, worried or disrupt their bedtime, according to research by the Institute of Alcohol Studies (IAS). The findings include that 15% of children have asked their parents to drink less, and 11 to 12-year-olds think adults drink to “solve their problems”. There are now calls for the government to strengthen official warnings about how much it is OK to drink, and when.

“All parents strive to do what’s best for their children, but this report has highlighted a troubling gap in their knowledge,” said Katherine Brown, the IAS’s chief executive. “Parents who have a glass or two of wine in the evening deserve to understand how this might affect their children and the steps they can take to minimise this impact.”

Alison Douglas, the chief executive of Alcohol Focus Scotland, said: “As well as the negative impacts on children’s wellbeing, seeing how adults drink can have a big influence on our children’s future drinking habits.” Jon Ashworth, the shadow health secretary, who has spoken about his father’s death as a result of drinking, said: “Children are incredibly perceptive of their parents’ drinking habits and this analysis must serve as a wake-up call to the government.”

So news continues to present itself as the battle rages for our hearts and minds on the subject of alcohol and addiction.  We still await the outcome of minimum unit pricing (edited to add: although Wales announced Minimum Unit Pricing today!)

PHE continue to produce resources to support alcohol awareness:

PHE ‘All Our Health’ alcohol resource

The alcohol industry continue to try to subvert the public health message:

Drinkers’ Voice Vs ‘anti-alcohol’? Guidelines, pregnancy & cancer risk messages

Drinkers’ Voice labels itself as a consumer organisation and says ‘the anti-alcohol lobby has dominated the conversation on alcohol and your health, resulting in misleading statistics and scaremongering news headlines’

And so it was ever thus …….

Unbelievably this blog has now had over 500,000 views.  Who’d have guessed that when I started it back in October 2013?  Thank you to all of you for being here, for reading, for commenting, for supporting me in my journey from terrified, reluctant ex-drinker to relaxed, contented ‘not interested even if you paid me’ non-drinker and proud member of the soberocracy! 🙂

Edited to add: Plus an extra 1500 day gift of a mention in Single and Sober My Top 20 Recovery Blogs and Sites

 

MDMA used in world’s first trials to treat alcohol addiction

This was a news piece in The Independent in July looking at MDMA being used in trials to treat alcohol addiction.

In a world first, scientists in Bristol are using the psychoactive drug MDMA as part of a treatment programme for addicts and alcoholics.

The study was created by a research team at Imperial College London, and involves giving doses of MDMA – known by the street names Molly or ecstasy – to help patients battling addiction. They claim this could be more effective than conventional methods. Those on the trial will also be put on a course of psychotherapy.

“We know that MDMA works really well in helping people who have suffered trauma and it helps to build empathy,” said Ben Sessa, a clinical psychiatrist on the trial and senior research fellow at Imperial College London.

On his website, Sessa stated: “3,4-methylenedioxymethamphetamine is a remarkable substance. Forget what you know about the popular use of this compound in the context of the recreational drug ecstasy.

“MDMA is a medical drug that started its life in the clinical setting. It has a unique receptor profile that makes this drug, when combined in a supervised clinical setting with experienced psychotherapists, the perfect tool to enhance trauma-focused psychotherapy.”

Participants on the trial are all heavy consumers of alcohol, typically drinking about five bottles of wine per day. They were chosen through the alcohol services in Bristol and have undergone repeated treatments for alcoholism.

After going through a detox period, those on the trial receive two therapy sessions, followed by a day where they receive a capsule of high-dose MDMA.

The drug has shown promise in treating those with post-traumatic stress disorder (PTSD). At the Psychedelic Science 2017 conference in Oakland, researchers showed that after more than one year after two or three sessions of MDMA-assisted therapy, about 67 per cent of participants no longer had the condition.

However, experts warn that recreational use of the drug can cause harm. “I’ve seen people in my practice who took MDMA at a party and weren’t prepared for the memories that came up, and it was really harmful for them,” Michael Mithoefer, a psychiatrist and a principle investigator in the MDMA trials said in a Nature report.

Alcohol-related deaths have increased by 13 per cent over ten years, according to the report Statistics on Alcohol: England, 2016.

I will be greatly interested in reading the research papers following this trial to see what the outcomes were from this experimental process.

Alcoholism continues long after you stop drinking: my 15 years sober

This exceptional piece of writing comes courtesy of Tanya Gold featured in The Guardian earlier this year.  Beautiful writing about alcoholism and how for many of us it is but the symptom of much deeper issues.

It is easy to get morphine in University College hospital, London, if you are a good liar. It hurts, you tell the midwife, although you can’t feel anything, being so high on morphine already that someone could hit you with a sledgehammer and you would only laugh: what else you got? It was close to midnight on 13 August 2013, and I was on medical-grade opiates; nothing else can make you forget you are about to give birth. Eleven years without alcohol or drugs, and I fell, complete, into the waiting groove. I loved it. I was having a party in the high-risk maternity ward and they didn’t even know it. I lay back on my pillow and gurned with joy: oh, Morpheus, god of dreams.

When the morphine ran out, I had a baby. He was very small and handsome, and he was an imposition. I could say I was frightened, but that would be self-serving. It is possible, even likely, that I was afraid. I was definitely high.

I stared at him and thought: I am more vulnerable than you, even if you are a baby. Then I told the midwife: my husband is trying to kill me. My evidence was that he had brought me a tin of biscuits. This, then, was the comedown, and I was at the bottom of the curve. I must have said that the baby was not important to me, because my husband became angry and I became angry, and I told him I hated him and had never loved him. I considered walking out into the traffic, or throwing myself under a train, and that was our baby’s first night on Earth. We went home and I locked myself in my bedroom, without the baby, and looked at photographs of him on Facebook, and ate a ham.

Strange things can bring you to a crisis, like realising that you cannot read Dickens out of jealousy. Or more obvious ones, like thinking: the baby should live with my sister, she will do this better than me. Or, when he was two months old: when is he going to university? In my history of alcoholism, I have been at my most healthy when I knew that I was ill. If you remind yourself that you are ill, you can do better. Now, in my son’s room, wishing his childhood away because I did not know how to care for him, I knew I was ill. I was not drinking or using drugs, but I was as lonely and frightened as I had ever been. I was back where I had started.

***

Alcoholism is a strange condition. If you survive the drinking stage, and many don’t, it has relatively little to do with alcohol, which is merely the drug with which the alcoholic treats herself. It is, rather, a way of thinking, and continues long after you have stopped drinking. It is a voice in the head: a malevolent voice that wants you to die. I certainly see it that way: it makes it easier to pick my way through the days if I know what, exactly, I am dealing with. Is this the voice speaking, or not? Which one made a decision, and which one doubted it? To discover the true root of any plan can require forensic vigour, and much time. It is perpetual inner warfare.

The party in the maternity ward aside, I have not taken drugs or alcohol for 15 years. You might think I would be better by now, but for the alcoholic there is nothing as prosaic as “better”. There is only a daily remission, based on how you deal with the voice in your head. (“Hello, monster. Where have you been?”)

One morning in early 2002, at perhaps 5am, which is, as all addicts know, when the night breaks, leaving you with mashed lips and mad eyes, I stood in front of the mirror in my mother’s house. I had been drinking alcoholically – that is, without stopping – for almost nine years, and I was very near the end. I pointed at myself – I remember myself as a very attractive drunk, red-lipped and irresistible, but this is the voice again, for I was nothing of the sort – and I said, very clearly, “I hate you and I wish you would die.” I knew then what the voice in my head wanted, and how powerful it was. It made a mistake by being honest and, because it made a mistake, I lived.

I could no longer blame circumstances or others; I would have to do something about it myself. It is frightening, seeing yourself wish death on yourself in a mirror, and – because you are full of cocaine, as well as alcohol – being able to remember it. Alcohol shrouds itself in blackout, and you wake to a queasy blank; but cocaine is very bright, and pointed – it is almost telescopic. I was frightened enough to attempt one year without alcohol.

I was prepared to be conscious (I loved the WH Auden line “But who can live for long/In an euphoric dream?”) but I was under the delusion I was a literary genius, even though the only job I could get at the time was as a freelance reporter for a now defunct Daily Mail showbusiness column called Wicked Whispers. Wicked Whispers was so awful that, occasionally, the subs forgot to put it in the paper and no one would notice. If the celebrities I stalked stared at me, and asked, kindly, about my pitiful excuse for a career, I was stunned. Looking askance at Gillian Anderson when she, clearly and without malice, pities you, is, for me, a definitive act of insanity.

I was too scared to drink alcohol, but I couldn’t do anything else about a condition I barely understood. I went to self-help groups in gloomy church annexes, which seemed as despairing – though less vivid – as what I had left behind, and heard people talk about “spiritual growth”. I missed my near-death, for it had not been boring. I did not know what they were talking about. I could not hear them. I said I was an alcoholic, because I supposed I must be, but I didn’t really know what it meant.

I did know I needed a new soul, the old one having broken, and I chose to build it with ink. I thought that I should be a famous journalist, so I stood outside the Daily Mail building and offered up a prayer, like Salieri: Lord, make me a great short-form showbusiness columnist, and then, if you think it right, Lord, may I progress to features. I got a job on the features desk, a job I called “Idiot Girl”. I was required to report in fancy dress – Saxon peasant, old woman – and I loved it. It was evidence of my survival: she mugs, she pratfalls, she lives! The voice was impressed, and temporarily silenced. (I believe everyone is a secret Daily Mail reader, even the voice.)

I built a career in journalism but I felt, always, that the person in print had nothing to do with me. She looked like me, but she was my ghost, and she was not reliable. I could never stop working, but I could never stay in any job; as soon as I arrived, I yearned to leave. I became marvellous at being fired and learned to soothe, and even thank, the person who was firing me, the better to start again at the beginning. It was a game I played with myself. I would procrastinate over my work to stoke the fear, but I was not lazy. I met a sensitive, clever man and married him, but I worked on my wedding day. I worked on my honeymoon. I worked in the labour ward, until I was offered the morphine. I was terrified of losing things and I would try to lose them so I could be, momentarily, at peace. My husband, at least, knew that, which is probably why I chose him. I am not a complete idiot.

I was, for a while, a columnist, but that was no good, either. To write a good column, I had to work myself into such a state of rage that the week was empty of anything else. I had a schedule of rage, which I followed dutifully; if I wrote on Wednesday, I would be numb on Thursday and would then stoke the rage over the weekend. On Monday, the rage would ebb, to be replaced by terror, which would reach a pitch on Tuesday night, after which I would write what seemed to me not sentences, but tiny, insistent stabs. That is not a job; it is a condition.

I was still at the mercy of the voice, but she had regressed to sludge. She manifested as a cloud of anxiety that travelled with me and occasionally mutated, helpfully, into dread, and then back to anxiety. I was a cartoon character with a personal cloud, Charlie Brown with a mood disorder.

Late summer in 2013, I was sitting in a self-help group. This one was surrounded by a very fine, old graveyard, like a metaphor, with many famous intellectuals in fabulous tombs; we sat calmly with the dead, as if we belonged there. The baby was at home in the cradle. I always said the same thing at this self-help group, and they were very patient with me. If I had published a good article in the previous 24 hours, I was happy because I existed in a form with which I was comfortable, and which other people could recognise and approve of. If not, I moped, and complained that I was not happy. I avoided self-help groups where they talked about their gratitude. I did not believe them.

I listened and thought about how much, then, I hated being an alcoholic. I mourned the lives I could have lived if I had not been cursed with this condition. I could have been an MEP! I could have been a chef! I wondered, in a broad way, what had happened, and what I could do. I became aware, quite suddenly in the quiet by the graveyard, of the constancy of the voice. I had waited, every day for 15 years, to wake up and find she had gone, and that was my error.

I knew then that she has always been there. When I was five, she told me my parents didn’t love me. I remember repeating, very insistently, to my parents that I knew they did not love me, because she had told me so. Evidence doesn’t matter to the voice; she kicks it away. She cherishes a passing piece of thoughtlessness, nurtures a harm. She lives in the small places beneath my conscious mind.

When I was 10, she said I was friendless at a noisy suburban school. When I was 12, and mooching about the dull streets of Kingston upon Thames, she said I was alone, and probably always would be. For the nine years of my active alcoholism, she told me to drink, first because it wouldn’t harm me – and what else was there? – and then because I couldn’t be saved.

She says only what she can get away with. She could never, for instance, convince me that my sister doesn’t love me; instead, she tormented me, when I was drinking, with the possibility that my sister might die. She wants so much to be believed, this voice, and is almost as pitiful as the other me, which is the one that is writing this story: the one that wants to live. I am quite aware how mad this sounds, but it is the truest narrative of my alcoholism that I can offer. Perhaps in 15 years I will have another one.

We coexist uneasily, today, the voice and I; she tells me to procrastinate over my work, to start fights, to give up. If I am unwary, she can plunge me into the deepest despair, and I have learned to construct an obstacle course to thwart her. It is made only of ordinary human love. Nothing else works.

My son helps me. His is three now, and knows what is important. “I must teach you to play, Mummy,” he says, and invites me, without irony, to pretend to be a monster. Then, of course, the voice whispers, “You have made him a parental child”: a creature who will care for me and not himself. I try to ignore her, because I cannot send her away. But I wonder now if it is she who is afraid, and not I.

As so many of the comments said too – thank you Tanya.

Moderate drinking: risk Vs reward?

A brilliant post by my friend Libby Ranzetta for Alcohol Policy UK written back in June about moderate drinking: risk vs reward.

Over to Lib:

A study recently published in the BMJ found that alcohol consumption, even at moderate levels, is associated with adverse brain outcomes. The research also found no support for a protective effect of light consumption on brain structure. The authors, from Oxford University and University College London, concluded:

These results support the recent reduction in alcohol guidance in the UK and question the current limits recommended in the US.

The research may be seen in the context of the much debated J-shaped curve suggesting potential health benefits of alcohol consumption at lower risk levels. Indeed another recent BMJ study found evidence to support the potential protective effects of moderate consumption on cardiovascular disease (CVD), addressing some of the previous question marks over the CVD protective effects research. However expert reactions highlighted several reasons why drinking should not be taken up by abstainers for any potential CVD benefits.

In producing the new UK ‘Low risk drinking guidelines‘ last year, the Chief Medical Officer’s (CMO) group considered the evidence that moderate drinking may reduce risks of death alongside ‘a large body of evidence’ demonstrating that these potential benefits are likely to be overestimated due to the limitations found in most studies of the long-term health consequences of alcohol consumption.

The group also factored in modelling by the University of Sheffield which included protective effects for some health conditions weighed against the alcohol-related risks of mortality from others. The conclusions were:

  1. Any benefit to cardiovascular health for moderate drinkers in the UK is largely cancelled out by their increased risk to health from other diseases, and
  2. Any remaining benefits to health from moderate drinking are small and uncertain. (See here for more details)

The Oxford/UCL study, which scanned for structural brain changes such as hippocampal atrophy, grey matter density, and white matter microstructure in the Whitehall II study cohort, has its limitations too of course, summarised in an NHS Choices explainer as:

  • The participants are all people who were civil servants in the 1980s and were mostly male and more middle class and higher IQ than the general population, meaning results might not be applicable to the UK as a whole.
  • The effect of hippocampal atrophy was found in men and not women which may be down to the lower sample size of women and that few of them drank heavily.
  • The information on alcohol intake was self-reported and therefore might be inaccurately reported by participants.
  • It is difficult to link brain structure with alcohol intake when it might have been down to other confounding factors such as intelligence, cognitive stimulation and other lifestyle factors.
  • The MRI scan only took place once, at the end of the study, so it is difficult to tell if and when any changes in brain structure took place and rule out other influencing factors.

No safe level?

Of course such studies do not intend to suggest that alcohol does not have potential social benefits, rather than the seek to answer the question of the possible health implications of moderate consumption – an issue that seems to generate substantial public and media interest. Back in January 2016 when the revised guidelines were announced, an article in the Telegraph covered a range of responses to the ‘Low risk drinking guidelines’, from health professionals discussing risks to critics of the guidelines calling nanny statism. We also published our own expert reactions on the revised guidelines and media reaction, also followed by an analysis of Twitter reactions.

This latest studies nudge the argument further along the current direction of travel regarding potential health risks and benefits: light drinking probably won’t make you healthier; potential CVD benefits need to be considered against other risks. A somewhat tricky message, but as Matt Field, Professor of Addiction at the University of Liverpool, put it in the Telegraph: 

Any amount of alcohol consumption carries some risk. However, it is important to bear in mind that most activities that people undertake on a daily basis – e.g. driving to work – carry some risk, and people need to make informed choices about the level of risk that they are prepared to accept.

In his APE: Alcohol and Epidemiology blog, John Holmes discusses the difficulties of turning research findings – which posit different levels of risk for different diseases – into simple health promotion messages that are ‘scientifically robust, sufficiently compelling and easily understood’.

He highlights a recent meta-analysis of cancer and alcohol research supports the judgement that ‘alcohol causes cancer of the oropharynx, larynx, oesophagus, liver, colon, rectum and breast’, although the risks are pretty small at low levels of drinking. However, as mentioned above, the CMO’s evidence review considers many other conditions, including ischaemic stroke, ischaemic heart disease and type II diabetes, which show U- and J-shaped relationships, indicating a beneficial effect of alcohol at some levels of consumption and a detrimental effect at others.

While addiction professors and epidemiologists may feel confident in making informed choices from the complex information available, the degree to which the wider public choose whether or not to take notice of the CMO’s headline messages on lower risk drinking will remain a hot topic.

Completely agree Lib!

Thursday Sober Inspiration: 4 years clean and sober! (Straight Sun)

As I celebrate 4 years clean and sober it has prompted renewed reflection. So much has happened between this time last year and now.  Much of it has not been as positive as we would have hoped but then sh*t happens whether you are sober or drinking.  Some of it has been stressful, emotionally overwhelming, and felt downright difficult and unfair but again such is life.  One thing is true through all of this though – at no point has the thought of drinking crossed my mind as a good idea.

So when I wrote last years 3 year soberversary post I hoped that we would now be living in Australia and that isn’t so.  Our plans took a turn for the worse at the end of June when the Australian govt announced that they were reducing the age cap on the permanent residency skilled migrant visa from 50 to 45 effective 1st July.  As I’m 48 that was pretty much the end of the road to our emigration plans.  We may get the opportunity to go over on a temporary work visa for 4 years but it’s highly likely we’d have to return after that. The odds aren’t looking good so we’ve accepted as a family this is most likely the end of the living there dream but we  can still go back on holidays to visit our family whenever we wish.

I hoped that I would have been able to successfully publish my Cambridge research and that isn’t so either.  It is however my writing and so I can publish it here if I so wish, and I do.  So here is my research paper written last year for the University of Cambridge Postgraduate Diploma in Education Studies (Counselling).  This isn’t a true academic piece of writing because it is written in the first person rather than the third.  It uses much of my lived experience (phenomenological approach) so is a mix of qualitative and quantitative research.  That is partly why it isn’t suitable for academic publishing without a great deal of rewriting.  What I would ask is that you are respectful to the personal content contained within it.

What is the link between insecure attachment, alexithymia & addiction

If I had to write a time-frame of what this journey has been like to date I would say this:

  • Year 1 was about escaping the physical & psychological pull of drinking & getting through all the social triggers or big sober milestones (week-ends, weddings, parties, Bank Holidays, birthdays, Xmas & New Year, holidays, seasons).
  • Year 2 was about living sober – having made it through the milestones this year can be harder than the first because it is now ‘normal’ to be a non-drinker rather than a drinker in these social situations.  As Mary Karr writes in Lit: “If you live in the dark a long time and then the sun comes out, you do not cross into it whistling.  There’s an initial uprush of relief at first, then – for me, anyway – a profound dislocation.  My old assumptions about how the world works are buried, yet my new one’s aren’t yet operational.”  Sums it up beautifully 🙂
  • Year 3 was where I started to process the emotional sobriety elements of living in recovery.  It was too soon to start deep diving in to the issues but I started to tentatively explore the work that needed to be done later and build my emotional resilience in preparation.
  • Year 4 has been the mother-load of emotional recovery work for me.  Now I’ve felt emotionally robust enough to deep dive on some of the underlying reasons why I drank and to be resilient enough to sit with those feelings and it not trigger an emotional relapse that is then a risk for a full relapse.  And again in the words of Mary Karr from Lit: “A lot of therapy is looking through a child’s eyes, she says.  This is looking through an adult’s”  Again, absolutely bang on!

This is only my experience of sobriety though and we are all very different in how we experience both drinking and recovery.  Melody Beattie in her book: Beyond Codependency describes the stages of recovery as expressed by Timmen Cermak as: survival/denial -> reidentification -> core issues -> reintegration -> genesis (which beautifully mirrors my years 1-4 so far!).  She goes on to say: “This is the recovery process.  It’s a fluid process, with carryovers and crossovers at different stages.  There isn’t a fixed time frame for moving through these stages ….. Recovery is a healing and a spiritual process.  We travel from self-neglect into self-responsibility, self care and self love.  I’ve learned that self-care isn’t narcissistic or indulgent.  Self care is the one thing I can do that most helps me and others too.

And of the genesis stage which is where I now consider myself:

This isn’t the end.  It’s a new beginning.  We’re no longer carrying around our “imprisoned” selves.  Nor are we indulging in all our whims and desires.  Discipline has found its place in our lives too.  Like butterflies broken loose from a cocoon, our selves are “flying free” …  We’ve found a new way of life – one that works.

I would not have changed any of it and remain certain that my decision to stop was one of the best of my lifetime so far.  My life would have been poorer were it not for the friendships and connections I have made out here on the inter-webs because of that single decision to put down my last drink on the 20th September 2013.

Although drink holds no appeal right now I am under no illusion that like Smaug in Lord of the Rings my addiction is like a sleeping dragon that one drink could awaken.  Because as Tolkien wrote Smaug is “a most specially greedy, strong and wicked wyrm”.  I remain alert and resolute heartened by the knowledge that as I head on towards 5 years sober this time next year, the risk of relapse drops to around 15%.

And to end this post?  The only way I know how to celebrate – with a tune!  Orbital ‘Straight Sun’ and some fantastic timeframe video of the UK 🙂

Tighten alcohol availability to reduce alcohol-related harms

Following last weeks blog post about alcohol availability this feels like the perfect follow on.  As reported by Alcohol Policy UK in June IAS in the UK & FARE in Australia released this report looking at tightening alcohol availability to reduce alcohol-related harms.

A new report has called for tighter restrictions on alcohol availability to help address alcohol-related harms, including pressures on emergency departments, hospitals and the police.

The report Anytime, Anyplace, Anywhere? [pdf] reviews fourteen alcohol licensing policies in Australia and the UK rating them for their effectiveness in reducing harm. It follows recent research identifying the extent of alcohol availability in England, and a recent call from the Lords Licensing Review Committee for a fundamental overhaul of the Act.

Produced jointly by the the UK Institute of Alcohol Studies (IAS) and the Foundation for Alcohol Research and Education (FARE) in Australia, the report makes ten recommendations for reducing alcohol-related harms through existing licensing policy frameworks including:

  • Restricting trade hours of on-licence venues to limit the availability of alcohol in the early hours of the morning
  • Enhancing community involvement, better facilitating the engagement of local residents with licensing systems
  • Adding / prioritising public health and / or harm minimisation objectives in alcohol legislation
  • Restricting the sales of high risk products in areas of concern; and
  • Deprioritising government support for industry voluntary schemes in place of policies supported by evidence.

In the document’s foreword, Professor Robin Room states:

“The availability of alcohol is a crucial element in what happens with consumption trends and with rates of alcohol-related harm. Public policy needs to prioritise evidence-based controls on the availability of alcohol to reduce rates of harm.”

Ahead of the launch of the report, Kypros Kypri, Professor of Public Health at University of Newcastle, Australia said:

“There is strong evidence to show that earlier closing times can make a significant difference to the strain alcohol places on emergency services. In Sydney, bringing forward closing times to 3am was associated with a 25% reduction in alcohol-related presentations to the local hospital.”

UK policy calls – falling on deaf ears?

In 2016 the IAS released an extensive report on the 2003 Licensing Act, which said the interests of the licensed trade have benefited over those of local communities. Despite mounting calls to review licensing legislation in England, including from the subsequent Lord’s licensing committee, there appears no intention to fundamentally change national policy – perhaps not surprising within the immediate political climate.

Currently national policy may be best inferred from the 2016 modern crime prevention strategy which sets out three main alcohol-related crime and disorder objectives, including a pledge on ‘equipping the police and local authorities with the right powers’. Critics of the current Act though have also argued that enforcement powers are not fully utilised, possibly reflected by the falling number of premises being called for review. In addition the crime strategy emphasises building local partnerships through industry led schemes – an approach the latest IAS & FARE report calls to be replaced by those supported by firmer evidence. Indeed questions have been raised over the lack of evidence to support the impact of voluntary partnerships schemes, notably ‘Community Alcohol Partnerships’ (CAPs). In contrast, Cumulative Impact Policies do find overall favour in the latest report, albeit with some limitations.

Read the full report here

Ever present alcohol

This was an excellent guest post for Alcohol Policy UK in May which I am sharing again here about alcohol availability in England – or as I see it ‘ever present’.

In this guest post, Colin Angus, a Research Fellow at the University of Sheffield, explores recent research on alcohol availability in England and considerations for policy.

A recent study from the Sheffield Alcohol Research Group highlights how widely available alcohol is in England, and how this has changed in the last decade. The study explores the availability of alcohol through measuring travel distances to the nearest outlet selling alcohol and counting the number of places where alcohol could be bought within walking distance (1km). Researchers looked at how availability had changed between 2003 and 2013, particularly changes in the type of outlets where alcohol was sold, and how availability was related to socioeconomic deprivation.

The key findings include:

  • The average distance from the centre of each postcode to somewhere selling alcohol was 323m, with 85% of postcodes being within 500m of an alcohol outlet.
  • The average English postcode has 31 outlets selling alcohol within walking distance (1km) of its centre
  • Alcohol is more available in the on-trade (places like pubs and restaurants where alcohol is sold for consumption on the premises) than the off-trade (shops where alcohol is sold for consumption elsewhere) based on numbers of licensed premises
  • The most deprived 20% of postcodes have around 3 times as many outlets selling alcohol within walking distance of their centre as the least deprived 20%
  • A rapid proliferation of convenience stores and metro supermarkets since 2003 has meant that access to pubs and bars has decreased by 8%, while access to off-trade alcohol has increased by over a third.
  • Pub closures have been far more common in deprived areas while pub access has increased slightly in other areas.

There are many possible explanations for these findings. Significant changes to licensing were introduced in the 2003 Licensing Act, which came into force in 2005 and made it substantially easier to apply for new off-trade licenses. It is also likely that the economic pressures of the recession have had a major part to play in the economic viability of many pubs, as well as the effects of the 2007 smoking ban. This may explain the more acute declines in deprived areas where the recession has hit harder and smoking rates are higher.

What does this mean for public health?

The physical availability of alcohol is clearly not a barrier to obtaining alcohol in this country. Whilst there is a strong body of evidence showing that reducing the availability of alcohol reduces alcohol-related harm, this evidence is overwhelmingly from countries such as Australia and the USA where there are substantially fewer places to buy alcohol from in the first place. Although a steady reduction in the number of UK alcohol outlets may yield benefits in the long-term, it seems less likely that the closure of a small number of outlets will result in significant reductions in harm as long as alcohol is still widely available.

Declining availability in the most deprived areas, which suffer the most alcohol-related harm, may be seen as a good thing. However, shop-bought alcohol is generally substantially cheaper than that bought in pubs and bars, and access to shops selling alcohol has increased. Some have also expressed concern that a shift from drinking in pubs to drinking at home may bring increased risks to health; pubs may potentially offer a more controlled drinking environment where bar staff and patrons act as a moderating influence on levels of consumption.   

Two recent studies have found an association between higher levels of licensing activity in local authorities (in terms of challenging license applications and introducing cumulative impact policies) and greater reductions in alcohol-related hospital admissions and crime. Our findings suggest that unless a radical change in levels of availability can be achieved, local licensing boards may be more likely to have a greater impact on harm if they focus on particular problem outlets. Seeking to address other aspects of availability may also be more fruitful, such as opening hours or the selling of high strength low price products, rather than seeking to reduce the overall number of outlets in an area.

The findings also suggest that licensing actions and government legislation over the past decade or so has done little to directly address the shift in availability from on- to off-trade. Indeed, recent cuts to alcohol duty rates, whilst portrayed by some groups as a boost for the pub industry, have increased the relative gap in prices between the on- and off-trades, potentially accelerating this trend. Whatever the underlying causes of this shift may be, cheap alcohol is easier to access now than at any point in recent history.  

This research was part-funded by Alcohol Research UK (R 2014/03).

I find some of those statistics staggering particularly these two: 85% of postcodes being within 500m of an alcohol outlet & the average English postcode has 31 outlets selling alcohol within walking distance (1km) of its centre.

Both shocking and unsurprising to me, how about you?