Category Archives: Alcohol research findings and media coverage

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’s 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 ‘heavier drinkers’ 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:

“Over 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 ‘peak booze’ 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.”

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’ among heavier drinkers. When modelled, it was estimated that accounting for non-response bias may lead to a 12.6% increase in men’s 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. “Oh, Mum’s drunk again,” 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’t like you at all. I became accustomed to compartmentalising my feelings – 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: “I love you and I understand.”

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 “scandalous misuse” of their powers.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sober Friday Jukebox: STAIR-way to heaven

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

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

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

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

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

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

  • emotion regulation
  • interpersonal functioning

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

Goals and Objectives

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

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

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

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

And Session Three: Emotional Regulation:

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

Link to full course content pdf here.

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

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

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

Alcohol Pricing

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

Over to James:

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

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

Chapters covered in the report include:

Pricing, policy and the future of MUP?

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

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

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

Affordability

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

Valuable research indeed.

Cost of DUI & Ignition interlock devices

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

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

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

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

The True Cost Of A DUI

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

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

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

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

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

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

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

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

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

Written by Jerry Nicholson of the Law Offices of Jerry Nicholson

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Picked up by The Guardian too:

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

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

The truth about life as a lapsed alcoholic/Catastrophe

This was in The Telegraph in April about a new book by Professor John Sutherland and his truth as a lapsed alcoholic.

Rob Norris is a ‘problem’ drinker. So was Rob Delaney, his co-creator in Catastrophe, the whip-smart Channel 4 sitcom that recently reached the devastating climax of its third series.

The bar room has a blunter term than ‘problem’: let’s call it urine-artist. It’s easy to be lugubrious about alcoholism – it’s a long-winded affliction, and you can never be sure it’s gone.

Relapse. That lovely word for something very nasty and all too common. In the series just concluded, Rob is drinking again. Furtively. Just coping but on a slippery slope. His life is one of low level moral degradation. Putting the dirty washing in the machine he fishes out a miniature bottle of vodka from the soiled pile and gulps it, hating himself.

What did Hemingway say? “A man does not exist until he’s been drunk”. Papa wasn’t thinking of secret drinkers.

There are three telling moments in the last instalment. One is Carrie Fisher, Rob’s mother, telling him that if he drinks a little he’ll drink a lot, and if he drinks a lot he’ll beat up his wife. Just like his father did (news to Rob). 

The second is Rob, glumly waiting for an AA meeting to start. We see it through his eyes. They are not him, these down and outs. I remember the same feeling. Me? A Doctor of Philosophy and eminent scholar at University College London? In this company of such losers? Never.

Rob is saved by a text message from his friends, inviting him to join them for a Chinese. He leaves the meeting, eats – and drinks. Frightened, he can’t finish his meal. Then the climax. His wife, Sharon gets absolutely blotto. Rob drives to pick her up. There’s a crash. Someone, even more out of their head than Rob, has piled into him, broadside. The police, he whimpers, will breathalyse him and he will fail. Sharon takes him to her breast. It’s hopeless. Or is it?

This last scene wrenches. More so since Delaney has gone on record, admitting it is a direct transcript of what happened to him 15 years ago. Why did he recreate (and, one presumes relive) a scene that bears witness to the lowest event in his life? Confession, in a word. Every recovered alcoholic will know the need for that cathartic act.

I too have had my struggles. In my drinking days I did things that I didn’t know were in me, or any sane human. I was lucky not to be killed on the road. But the main risk was suicide when consciousness and conscience returned. Delaney has also confessed as much.

On January 24, 1983 I woke up surrounded by empty bottles in an empty apartment. My family – a wife of 15 years and child – had wisely “saved themselves”, as the pamphlets advise.

Then mid-forties, my drinking had been excessive, but more or less under control, for a decade – a long time for the human liver. But it was now spinning out of control, initially in the form of after hours or weekend binges (what, for normal married men, would be “family time”).

At my loved ones’ insistence I had previously been “seen” at Maudsley hospital, armed with a letter of introduction from a senior physician friend (I was no common-or-garden drunk, for God’s sake). The letter cut no ice. And the prescription was drastic: I must give up drinking altogether. As well as stop breathing?

A fortnightly one-to-one meeting (hours in the ghoulish waiting room for 40 minutes’ counselling) would keep me to this. The theory was that, if I could stay off the booze for 18 months, the “prognosis” was good for permanent recovery. Perhaps they were right. I never made it to the finishing line.

This was 1980. I manfully went on a year’s white-knuckle ride as a “dry drunk”, as AA jargon puts it. It didn’t last, corroding gradually, like an old dam giving way under the pressure of that vast lake of drink on the other side. I would manage six weeks (a painfully long period for an abstaining alcoholic) before jumping out of the groove – usually for an explosively brief bout, but long enough to smash things up. Remorse would get me back on the wagon, but for a shorter period than the last.

By January 1983, I was on the terrible merry-go-round of what AA calls “periodics”. Sober for weeks, sodden-drunk for days, bitterly remorseful, then sober again.

This is a peculiarly destructive phase. Having lapsed, one drinks to madly toxic levels – making up for lost time, suffused with guilt and apprehensive of the dry weeks to come before the next glorious release. The gross drunkenness shatters the trust others put in you. Usually after the third or fourth such episode they give up on you. I was well past that threshold.

Professionally, I would still be classified as a “high functioning” alcoholic. There were occasional disasters: slurred lectures, student complaints, missed meetings, insulted colleagues, dinner-party faux pas (some of which still make me groan out loud today).

Yet I could just about cope. I was experienced enough, after 20 years, to fly on automatic pilot. It helped that in academic life you largely devise your own schedule. Cannily (alcoholics love to think of themselves as smart operators), I ensured that the bulk of my tutorials were in the hungover but clear-headed morning, before the dangerous fog of the lunchtime session descended. 

But domestically, it was something else. One of the problems about problem drinking is that you tend to be at your drunkest and least civilised at night – when you go home. If your family is still around, “scenes” are inevitable.

Few women nowadays wield the cartoonist’s rolling-pin, or throw crockery at their spouse’s head. But their long-brewed disapproval scalds the alcoholic (who will already be feeling remorse) like molten lead.

What defence do you have? None. Guilt makes the drunk quarrelsome and few alcoholics – when drunk and quarrelsome – are not violent, verbally and (​at their worst) physically. Anger is, late in the game, exacerbated by sexual paranoia (the alcoholic’s impotence translates into jealousy of Othello-like intensity). And, of course, there is the sheer nastiness of the Edward Hyde everyone has inside them. He thrives on booze.

Yet most career alcoholics have what is called a “moment of clarity”. A fork in the road. Take one path and it’s the morgue, locked ward or skid row. The other, harder path is recovery, with relapse an ever-present risk. 

I finally cleaned up with the help of AA in America. They invented the ‘fellowship’ and, in my experience, do it best. My wife and child took the risk of rejoining me there for a new life. I got a second chance. A month’s more drinking, perhaps even a day’s more, would have done for me.

Honesty, of the kind Delaney has given us in Catastrophe, is an integral element of the AA programme and I suspect any form of recovery.

But it’s not easy. In 2001, long after I had returned to UCL as Lord Northcliffe Professor of English Literature, I wrote a “drunkalog”, called Last Drink to LA. One scene in the book involves criminals and utter sexual depravity. There’s no mystery about why I wrote it down; it happened. But it scorches me, even now, to recall the truth. 

So why publish this squalid thing? Firstly, unresolved anger – the unexploded bomb thesis. Unlike Delaney, I am not on medication, nor am I consulting a shrink. Perhaps I should be.

But the stronger reason, I think, is public confession. I want to be forgiven. It’s pathetic – but for me, and I suspect Delaney, irresistible. Most alcoholics, in my experience (and I’ve heard thousands of them talk), want to tell all and covertly hope to receive what clemency – or at least understanding – they can be given. The downside? No one will ever think as well of you as they once did.

But then, no one ever said alcoholism was easy. Even the long dry years. Cheers.

Watch Catastrophe here