Category Archives: Alcohol research findings and media coverage

#alcoholfreekids

This was released by Alcohol Focus Scotland earlier this month.   In the report leading academics and health experts outline how the Scottish Government can reduce the unacceptably high levels of alcohol marketing that children and young people are exposed to. (#alcoholfreekids)

Removing alcohol adverts from streets and public transport, and phasing out alcohol sponsorship in sport are among the steps that should be taken to prevent alcohol companies reaching our children.

Children are very familiar with and influenced by alcohol brands and advertising campaigns, despite codes of practice which are supposed to protect them. There is clear evidence that exposure to alcohol marketing leads children to start drinking at a younger age and to drink more if they are already drinking.

Alcohol Focus Scotland was asked by Ministers to facilitate an international expert group on alcohol marketing to advise on the most effective policy options available and how they might be implemented in Scotland.

The group’s recommendations include:

  • removing alcohol marketing from public spaces such as streets, parks, sports grounds and on public transport
  • ending alcohol sponsorship of sports, music and cultural events
  • pressing the UK Government to introduce restrictions on TV alcohol advertising between 6am and 11pm, and to restrict cinema alcohol advertising to 18-certificate films
  • limiting alcohol advertising in newspapers and magazines to publications aimed at adults
  • restricting alcohol marketing on social networking sites

The report also recommends setting up an independent task force on alcohol marketing to remove the regulatory role of the alcohol industry.

More than 30 organisations, including Children 1st, the Scottish Cancer Prevention Network and the medical Royal Colleges, as well as the majority of MSPs (72), have pledged their support to end alcohol marketing in childhood. This report now outlines specific actions which could be taken to achieve that.

Professor Gerard Hastings, one of the group members and internationally renowned expert on social marketing, said:

“Self-regulation does not work; it will not control dishonest banks, over-claiming MPs – or profit-driven multinational drinks companies. And yet we continue to rely on it to protect our children from alcohol marketing. It is no surprise that study after study has shown that, as a result, children are being put in harm’s way – and that parents want policy makers to be more courageous. Scotland now has a chance to grasp this nettle and show how independent statutory regulation of marketing can provide our young people the protection they deserve. The international community is trusting us to take the same public health lead we took on smoke-free public places and minimum unit pricing; let us show them that we will.”

Alison Douglas, Chief Executive of Alcohol Focus Scotland, said:

“An alcohol-free childhood is the healthiest and best option, yet we allow alcohol companies to reach our children from a young age. They are seeing and hearing positive messages about alcohol when waiting for the school bus, watching the football, at the cinema or using social media. We need to create environments that foster positive choices and support children’s healthy development. We hope Ministers will respond to this report and the groundswell of support for effective alcohol marketing restrictions in Scotland.”

Tam Baillie, Children and Young People’s Commissioner Scotland said:

“I strongly support this report which provides clear evidence on the nature and reach of alcohol marketing and makes welcome and sensible proposals to safeguard our children. All children and young people have the right to good health and that must include the right to grow up free from commercial pressures to drink alcohol. The extent of the actions we take now are a good measure of the value we place on our children for the future.”

Summary (pdf) and full Report (pdf)

Radical ketamine therapy could treat alcohol addiction

This was featured in The Guardian in January whereby a one-off dose of the drug, ketamine could help alcohol addicts reduce their intake by ‘erasing’ drink-related memories, say psychologists testing treatment.

Ketamine is used as an anaesthetic agent and also in terminal care in my professional experience and as a recreational drug in my personal experience.

Here’s what the researchers say:

Scientists believe that a radical treatment involving the tranquilliser ketamine could help overcome alcohol addiction by “erasing” drink-related memories.

Psychologists based at University College London are testing whether a one-off dose of the drug could help hazardous drinkers who are trying to reduce their alcohol intake. Alcohol addiction is notoriously difficult to treat, and there are few effective therapies available.

Using a recreational drug to treat addiction may sound counterintuitive, but the researchers say there is a growing body of research suggesting that ketamine can be used to disrupt harmful patterns of behaviour.

Ravi Das, one of the lead researchers, said: “There is evidence that it could be useful as a treatment for alcoholism.”

Crucially, ketamine can disrupt the formation of memories, and scientists believe that this property could be harnessed to over-write the memories that drive addiction and harmful patterns of behaviour.

“Memories that you form can be hijacked by drugs in some people,” said Das. “If you were an alcoholic you might have a strong memory of being in a certain place and wanting to drink. Those memories get continuously triggered by things in the environment that you can’t avoid.”

For instance, seeing a glass of beer, hearing the clinking of glasses or even arriving home from work may trigger memories of the rewarding sensation of taking a drink – and might prompt a person to follow this urge.

“The main problem is the really high relapse rate after treatment,” said Das. “People can successfully quit using over the short term while they’re being monitored in the hospital … but when they return home they’re exposed to those environmental triggers again.”

There is increasing evidence, however, that memories are less stable than once assumed and may be open to manipulation.

Each time our brain accesses a memory, the neural connections that encode it are temporarily destabilised, meaning that our recollection can be slightly altered before it goes back into storage. This is one reason why, in everyday life, people can recall wildly different versions of the same events.

In the clinic, scientists believe this short period of instability, represents a window of opportunity. Ketamine blocks a brain receptor called NMDA, which is required for the formation of memories. So the logic is that giving someone the drug just as a memory has been destabilised could help weaken the memory, or even erase it.

A similar approach with a different drug was shown to eradicate people’s phobia of spiders. And research in rats that were made to be addicted to cocaine showed that the memories underpinning their addiction could be completely wiped out using a similar strategy (although this involved injecting a chemical into the brain).

In the UCL trial, the scientists will intentionally trigger alcohol-related memories by placing a glass of beer in front of the participants, who are all heavy drinkers. They will then disrupt the memory, by surprising the participant (the team is not disclosing the exact details as this could bias the results).

Participants will then be given either a ketamine infusion, with a concentration equivalent to a high recreational dose, or a placebo. The team will follow up the people for a year and monitor whether their drinking has changed and by how much.

In total the scientists are aiming to include 90 people in the trial and more than 50 have already taken part. It involves people who drink harmful quantities of alcohol, but excludes anyone who meets the clinical criteria for alcoholism. The participants were drinking at least 40 units for men (equivalent to four bottles of strong wine) and 28 units for women, and drinking on at least four days.

Nikki, 31, who works as a consultant in London said she decided to take part in the study when she had some time off between jobs and realised she was drinking more than she wanted to. “It’s just in the culture, that’s what all my friends are like. Everyone drinks to excess,” she said.

She described the experience of being given the ketamine as “overwhelming and intense”, but not unpleasant. “My body felt like it was melting away,” she said. “It was quite psychedelic, I felt untethered from my body.”

In the week after the session, she said, she felt in an “incredibly positive mood” and that since taking part she has been more conscious about deciding whether to have a drink, although said this could also be linked to starting a new job and taking up meditation. “In the past, there were occasions where I would be drinking and I’d be on autopilot ‘Let’s get another drink’,” she said.

If the trial yields promising results, the team hope that the approach could form the basis for therapy sessions targeted at alcoholics and people who are drinking unhealthily. However, they acknowledge that there may be resistance to the use of a recreational drug to treat people with addiction.

“There’s just the general social attitude that everything that’s illegal is terrible. There will obviously be that kind of narrow-sighted pushback,” said Das. “But if it’s safe and effective enough it should be recommended.”

Andrew Misell, a spokesman for Alcohol Concern, said: “The researchers have quite rightly highlighted what a lot of people in recovery from alcohol problems know from experience, namely that cues or triggers like the smell of beer can cause a relapse even after long periods of abstinence. Any work looking at how people can overcome these pitfalls is going to be useful.”

However, he added, no drug-based therapy is risk-free “and that certainly includes ketamine”.

Professor Michael Saladin, of the Medical University of South Carolina, is looking at similar approaches to help people quit smoking. “There is a vast animal research literature that suggests memories can be manipulated following reactivation,” he said. “I am convinced that there is sufficient evidence to believe that memory reconsolidation can be harnessed for clinical purposes.”

The Evening Standard also picked up on the research:

Researchers at University College London are trialling the use of ketamine, a powerful anaesthetic used in the NHS and on animals, to block or dismantle the “alcohol reward” memories that cause cravings and addictions. It is hoped the drug, known as ‘Special K’ on the party scene, will help drinkers “reboot” their brain and get their habit under control.

Well I’m all for research and trying new things if it will potentially help.  Although I’d be slightly concerned about cross-addiction because if it is a very pleasant experience people may wish and seek to repeat it and ketamine is available as a street drug.

NICE guidance on dual diagnosis 2016

This is not the first time that Dual Diagnosis has been discussed on this blog (you can read them all here).  However we now have official guidance from the National Institute of Clinical Excellence (NICE) on the issue.

My lovely friend Libby Ranzetta did an excellent synopsis that garnered praise on Twitter from the NICE guidelines chair themselves no less! 🙂

Over to her summary detailed over at Alcohol Policy UK:

New NICE guidance on dual diagnosis was released in November 2016: Coexisting severe mental illness and substance misuse: community health and social care services.

The guidance and supporting tools and resources sets out how services for those dually diagnosed aged 14 and above should be improved to ‘provide a range of coordinated services that address people’s wider health and social care needs, as well as other issues such as employment and housing.’

NICE has also produced a guideline on coexisting severe mental illness (psychosis) and substance misuse: assessment and management in healthcare settings.

Context and definitions

NICE contextualises the guidance by stating that adults and young people with coexisting severe mental illness and substance misuse have some of the worst health, wellbeing and social outcomes (details here). It is not clear how many people in the UK experience dual diagnosis issues, partly because some people in this group do not use services or get relevant care or treatment (see previous post).

The Department of Health’s Refocusing the Care Programme Approach identifies people with dual diagnosis as one of the groups in need of an enhanced Care Programme Approach. That is because they are not being identified consistently and services are sometimes failing to provide the support they need. The policy highlights the need for a whole systems approach to their care, involving a range of services and organisations working together. This guideline, NICE claims, aims to address this need.

In announcing the guidance, Professor Alan Maryon-Davis, chair of the guideline committee, spoke frankly about the challenges coexisting substance misuse and mental health problems pose for patients and practitioners alike.

“People with dual diagnosis almost always have multiple needs – often with physical health and social issues as well as their dual mental health and substance problem. They are often unemployed or struggling to hold onto a job. They may be in debt, homeless or poorly housed. They could even be in an abusive relationship.

To add to their woes, they are also more likely to be stereotyped and stigmatised. They are often regarded as unreliable, feckless, difficult to engage, aggressive or abusive.

As a result, they tend to get shunted around the various services they need support from with no-one wanting to take responsibility for them. This can all too easily lead to a downward spiral and sooner or later a crisis – perhaps forcing them into A&E, or on the streets. They may even find themselves in the magistrate’s court.

This is why our NICE guideline is so desperately needed.”

For Guideline 58 the age cut-off for young people has been set at 14 to reflect the small numbers affected below this age and the fact that many early intervention services usually start at age 14. ‘Substance misuse’ refers to the use of legal or illicit drugs, including alcohol and medicine, in a way that causes mental or physical damage.

‘Severe mental illness’ includes a clinical diagnosis of:

  • schizophrenia, schizotypal and delusional disorders, or
  • bipolar affective disorder, or
  • severe depressive episodes with or without psychotic episodes.

NICE Recommendations

The guideline is arranged as series of detailed recommendations on the following:

  • first contact with services
  • referral to secondary care mental health services
  • the care plan: multi-agency approach to address physical health, social care, housing and other support needs
  • partnership working between specialist services, health, social care and other support services and commissioners
  • improving service delivery
  • maintaining contact between services and people with coexisting severe mental illness and substance misuse who use them

Drug and Alcohol Findings Bank has provided a summary of the key recommendations here.

Professor Maryon-Davis summed up two main messages from the recommendations:

“First, there has to be much wider recognition that this group of people, despite their complexities, have as much right to dedicated care and support as anyone else. They should not be turned away or left to flounder. Every effort should be made to help them benefit from the services they so badly need. Crucial to this is a non-judgmental, empathetic approach and the building up of mutual respect and trust.

And secondly, good communication is key! Staff working in mental health, substance misuse, primary care, social care, housing, employment, benefits, criminal justice and the voluntary sector need to have strong leadership to ensure that they are all working together as best they can. We recommend that this can be best achieved by having a dedicated care coordinators.”

What happens next

Substance misuse practitioners could be forgiven for saying they have heard these messages before; messages which have not made much difference to the way mental health services respond to dual diagnosis. Last year the Recovery Partnership’s Review of Alcohol Treatment Services found a clear failure of services to meet the needs of people with dual diagnosis, summarising the policy context for such failure as follows:

“National guidance on the management of this [dual diagnosis] group was first published by the Department of Health in 2002. NICE published further guidance on psychosis with coexisting substance misuse in 2011.

However, the… situation has not improved and may be worsening because budgets have been cut in mental health services, and because mental health services are now commissioned by a separate body (Clinical Commissioning Groups) from alcohol services (Public Health). This represents a real blockage in the pathway of care for problem drinkers (and drug users), a blockage that cannot be easily resolved at the local level.”

Other questions may relate to possible missed opportunities to address low level mental health problems and substance misuse. For instance Improving Access to Psychological Therapies (IAPT) services – which exist for those mild to moderate mental health difficulties, such as depression, anxiety and phobias – are not mentioned within the guidance. IAPT though may be considered an ideal setting for brief intervention given the link between alcohol misuse and problems such as anxiety and depression, yet few IAPT services appear to routinely deliver IBA (although guidance was released for IAPT roles in 2012).

In 2014 an analysis suggested cognitive based therapy (CBT) and/or motivational interviewing (MI) for comorbid alcohol use disorder and major depressive disorder produced small but robust beneficial effects on both depression and alcohol consumption – regardless of whether delivered by mental health or subtance misuse roles.

Commissioners and service providers though will now be expected to use Guideline 58 to improve the quality of care given to people with dual diagnosis involving severe mental health problems. The Care Quality Commission (CQC) use NICE guidelines and quality standards as evidence for inspections, to inform the award of good and outstanding ratings. CQC’s inspection regime and associated powers may well provide the impetus needed for real change to happen this time.

Liver Transplantation

So I realised when I read this news story that I hadn’t actually ever detailed the liver and transplantation on the blog!  As reported by Alcohol Policy UK earlier this month: Liver transplants have been highlighted by an Eastenders storyline featuring Phil Mitchell (pictured as played by Steve McFadden) suffering with alcohol-related liver disease, reported the Express. The storyline has been praised by Sally Johnson, Director of Organ Donation and Transplantation for NHS Blood and Transplant, who said it had been portrayed responsibly. The Express followed up with the article Liver disease warning: How much damage are YOU doing to your vital organ?

So firstly lets look at how important the liver is and what function within the body it serves.

Your liver has around 500 different functions.  Importantly it:
  • fights infections and disease (which is why I struggled more with illness when I drank)
  • destroys and deals with poisons and drugs (which alcohol is)
  • filters and cleans the blood
  • controls the amount of cholesterol
  • produces and maintains the balance of hormones (hence why women get an increase in breast cancer rates with drinking and men get gynaecomastia, otherwise known as “man boobs” or “moobs”)
  • produces chemicals – enzymes and other proteins – responsible for most of the chemical reactions in the body, for example , blood clotting and repairing tissue (which is why wound healing is slower)
  • processes food once it has been digested (hence why alcoholics are very often severely malnourished)
  • produces bile to help break down food in the gut (and why jaundice is an early sign of liver distress)
  • stores energy that can be used rapidly when the body needs it most
  • stores sugars, vitamins and minerals, including iron
  • repairs damage and renews itself

So it is a major organ without which we die.

By the time you discover you need a transplant your liver might begin to fail and your quality of life may be very poor. You may have experienced the following symptoms:

  • loss of appetite
  • generally feeling unwell and being tired all the time
  • feeling sick and being sick
  • very itchy skin
  • loss of weight and muscle wasting
  • enlarged and tender liver (you may feel very tender below your right ribs)
  • increased sensitivity to alcohol and drugs (medical and recreational)
  • yellowing of the skin and whites of the eyes (jaundice)
  • swelling of the lower abdomen, or tummy (ascites), or the legs (peripheral oedema)
  • fever with high temperatures and shivers, often caused by an infection
  • vomiting blood
  • dark black tarry stools (faeces) or pale stools, associated with cholestatic disease
  • periods of mental confusion.

What is a liver transplant?

A liver transplant is an operation where your diseased liver is removed and replaced with a healthy donor human liver. Although liver transplants are now quite common, the operation is not undertaken lightly. It is a major operation and the body will always see the ‘new’ liver as a foreign agent and will try to destroy it. This means that if you have a liver transplant you will have to take medication for the rest of your life to stop your body rejecting the donor liver.

If you want to read the award winning leaflet about transplantation you can do so here.
If you want to read how a liver transplant is performed go here.
You will have to abstain from alcohol for at least 6 months prior to transplantation.
You will have to take immuno-suppressant drugs for the rest of your life to stop your body rejecting the new liver and regular blood tests to monitor.  These drugs carry their own risks and side effects such as:
  • kidney damage
  • high blood pressure
  • high cholesterol
  • obesity
  • higher risk of infections

It may restrict your travel options in the future and you will carry a higher risk of skin cancer.

For further information visit: British Liver Trust

And if you want to study the liver further there is a MOOC run by the University of Birmingham you can do free online: Liver Disease: Looking after Your Liver

It is not a miracle cure or the answer to your drinking prayers.  And those alcoholics who drink after receiving a donor liver leave me feeling very conflicted indeed – and yes I have met them ……

 

NICE focuses on improving treatment and diagnosis of liver disease

I have to thank the lovely Prim for forwarding this link to me about NICE and new draft guidance on treatment and diagnosis of liver disease (cue obligatory pictures of liver disease!)

Here’s the NICE report:

People who drink too much should be sent for scans to detect early liver disease, says NICE

Almost 1.9 million harmful drinkers in England could be sent for scans for cirrhosis by their GPs to detect disease early so treatment and lifestyle changes are more effective.

A draft quality standard out for consultation advises GPs to send people for scans for cirrhosis if men are drinking more than 50 units per week or 22 pints and women are drinking more than 35 units per week or 3 ½ bottles of wine.

Access to the two recommended tests, transient elastography and acoustic radiation force impulse imaging is currently varied across England, whilst the first is available in at least 120 UK hospitals, the latter is a newer technology that is not as widespread.

Dr Andrew Fowell, consultant hepatologist at Portsmouth Hospitals NHS Trust and specialist committee member, said: “Identifying people who are at risk of liver disease and offering them non-invasive testing to diagnose cirrhosis is key to ensuring they are given the treatment and support they need early enough to prevent serious complications.”

“Ten years ago diagnosis of cirrhosis would often require a liver biopsy, but now with advances in non-invasive testing it is much easier for patients and health professionals to make a diagnosis.”

Draft guidance also calls for all those diagnosed with non-alcoholic fatty liver disease to be regularly tested for advanced liver fibrosis – so they can manage their condition and prevent it developing into cirrhosis.

Professor Gillian Leng, deputy chief executive of NICE, said: “Many people with liver disease do not show symptoms until it is too late.

“If it is tackled at an early stage, simple lifestyle changes or treatments can be enough for the liver to recover. Early diagnosis is vital, as is action to both prevent and halt the damage that drinking too much alcohol can do.

“This draft quality standard makes a number of important suggestions to improve care for those with liver disease from offering advice to less invasive testing.

NICE is calling for all adults and young people with cirrhosis to go for ultrasound scans every 6 months for hepatocellular carcinoma, in a bid to improve earlier diagnosis.

The draft quality standard also supports improvements in treatment to prevent vein bleeds in some adults and young people with cirrhosis. An estimated 2,687 people could be eligible for treatment each year.

Liver disease is the fifth largest cause of death in England and Wales. It is estimated over 4,000 people die from cirrhosis every year and 700 will need a transplant.

Consultation on the draft quality standard for liver disease is open until 2 February 2017.

I look forward to the new guidelines being published and if you are wanting to find out about liver scans prior to this please go to this blog post.

A retrospective on 2016 (Friday sober jukebox: some riot)

So as I have pared down my blog activity and news sources the one I repeatedly return to is Alcohol Policy UK.  They wrote an excellent retrospective piece about 2016 which you can read here:

 

Alcohol policy in 2016 & what’s in store for 2017?

But what really struck me about this blog were the images featured at the end entitled: Selected alcohol slides from the ‘most interesting things about drugs and alcohol in 2016’ from Andrew Brown:

The top image was the first which highlighted how over half (54%) of strong ciders sold in the off-trade in England and Wales in 2015 were sold at below 20p a unit  <pauses to let that sink in for a minute>  so for less than the cost of a pint of milk! 🙁

Below I share the other three because visual images can be so much more impactful than words.  They all tell a compelling story which as yet is not being addressed by our govt sufficiently to change the trajectory of the graphs.

Association between the experience of physical and sexual abuse in the lives of women and dependence to drugs and alcohol …..

 

 

The number of offences committed pre and post treatment for alcohol use disorders ……

 

 

 

Graphic confirmation that those with the most problems with alcohol are more likely to use the NHS …..

 

 

 

I’ll finish with a haunting performance from Elbow and the BBC Concert Orchestra of Guy Garvey’s ode to a friend lost to alcohol addiction  – some riot.

The impact of alcohol is all too plain to see and hear to those who have eyes and ears.  Shame our govt is looking the other way with its collective fingers in its ears (except perhaps Liam Byrne) …..

PS Yesterday was day 1250!

Risky Drinking

So this premiered on HBO in the US in December 2016.  Luckily for us the documentary Risky Drinking has now appeared on Youtube so we can watch it too 🙂

Here’s a synopsis/review from Esquire:

To qualify as a risky drinker, a woman has to drink more than three drinks in one day, or more than seven drinks in a week. A man must have more than four drinks in one day, or more than 14 in a week. The risk itself from breaching these limits isn’t simply defined; it ranges from increased risk of violence, accidents, and self-injury to increased risk of sexual assault. It means an increased risk that something will happen that will irreversibly change someone’s life.

Or, as the new documentary Risky Drinking from HBO and the National Institute of Alcohol Abuse and Alcoholism shows, risky drinking could have already changed someone’s life. Now, the risk is that their life will spiral completely out of control.

The documentary follows four individuals, each on the spectrum for at-risk drinking, and each on the verge of toppling further into their dependencies. Kenzie is a young professional who parties on weekends; most binge drinkers are in her age group, 18 to 34. She downs shots and dissolves into tears each night out. “We haven’t gotten raped or murdered yet,” says her friend. Then there’s Mike, who is on the verge of domestic violence with his wife, and Noel, whose dependency affects her two daughters. The last is Neal, a grandfather so dependent on alcohol that he thinks he’s going to die (and who violently shakes when off the drink).

Risky Drinking doesn’t finish their stories. All we know is that each tries to get help, whether from medication, support groups, or moderation management, which is a treatment plan that doesn’t require total abstinence. Whether they are successful—whether they can get out of range of “alcohol use disorder,” which makes up one third of the drinking spectrum—is left unanswered. It’s a frustratingly open ending. But then, frustration is what you feel as you watch Kenzie, Mike, Noel, and Neal drink themselves stupid.

As the documentary points out, 70 percent of Americans drink alcohol. It’s worth knowing the risks, even if most Americans aren’t at the disorder stage—at least not yet. Risky Drinking assumes you already know this. It’s just showing you what risky drinking itself looks like for real people, if you care to watch.

Edited because original link to full documentary film on YouTube has now been removed.  Here’s the trailer:

And if you want to watch the full documentary film go here:

http://www.hbo.com/documentaries/risky-drinking

Interestingly in looking for the new link for you to watch I came across this panel interview with the experts featured and this is what they had to say:

“Alcohol is a bigger cost on society than all the rest of the drugs combined.” – George Koob, Ph.D.

“It’s the worst drug of all and it’s hidden in plain sight. – Stephen Ross, M.D.

“People don’t drink because they’re crazy; they drink because it works in some way.” – Carrie Wilkens, Ph.D.

“We do have a large epidemiological study in the field now that is looking at rates of fetal alcohol spectrum disorder and we’re hopeful, but the early evidence is concerning.” – Deidra Roach, M.D.

Here’s the panel discussion in full:

Improve services to address addiction related unemployment (this is not a love song)

So maybe not the sexiest post-Valentine subject matter but important none the less – and an excuse to feature a Banksy which is always a bonus! 😉  This was a report on service provision to address addiction related unemployment featured by Alcohol Policy UK in December.

Over to Alcohol Policy UK:

Dame Carol Black’s review into the effects on employment outcomes of drug or alcohol addiction and obesity has been released by the Department for Work and Pensions.

The review sets out a series of recommendations to improve options and support for those with drug and alcohol dependence, and does not endorse restricting benefits as was speculated in 2015.

Whilst the scope of the report covers also the role of obesity on employment outcomes, it states the issue is ‘different’ to substance addiction and ‘is treated seperately’. Specifically on alcohol, the report states:

‘Alcohol misuse may also be a cause or a consequence of unemployment. It is certainly a predictor both of unemployment and of future job loss, but evidence also suggests that increased alcohol consumption may follow job loss. Unlike dependence on heroin and crack cocaine, alcohol dependence is not strongly associated with lower socioeconomic status although the resultant health harms are. Nevertheless, the employment rate for those who develop problematic dependence is less than half that of the rest of the population’.

Overall the review describes the importance of employment in supporting addiction ‘recovery’, but neither drug and alcohol or job support services are sufficiently meeting the needs of service users. As such it recommends ‘practical interventions, including changes in services, practices, behaviour and attitudes.’

Three main areas where action is needed in relation to drugs, alcohol and employment are identified:

  • Addiction treatment does not, in itself, ensure employment, though it brings other social gains. Work has not hitherto been an integral part of treatment, and it needs to be if progress is to be made.
  • The benefits system, which has a central role in helping people enter or return to work, requires significant change. The system is hampered by a severe lack of information on health conditions, poor incentives for staff to tackle difficult or long-term cases, and a patchy offer of support for those who are reached.
  • Employers are the gatekeepers to employment and, without their co-operation employment for our cohorts is impossible. Employers are understandably reluctant to hire people with addiction and/or criminal records. They have told us that they need Government, quite simply, to de-risk these recruitment decisions for them.

Specific challenges are also identified, including ‘fractured commissioning responsibilities and lines of accountability’ that undermine efforts to develop co-ordinated responses. Whilst recognising low waiting times for alcohol treatment, stakeholders reported that alcohol services were ‘still inadequate to meet need in a number of areas’. The Government’s 2010 Drug Strategy, which listed a series of recovery-focused aims, ‘has yet to be realised’, in part owing to the ‘failure of the benefits systems to identify addiction (and indeed other relevant health conditions)’.

A series of recommendations include ‘the introduction of an expanded recovery measure that includes work and meaningful activity (including volunteering)’ as part of the outcomes monitoring for drug and alcohol treatment. It also proposes to trial discussions with a healthcare professional for welfare claimants to discuss ‘the impact of their health condition on their ability to work’. Initiatives to support employers in actively recruiting those in recovery will need to ‘de-risk’ companies from doing so, as explored in an FT blog.

David Best, Professor of Criminology, commented:

“How to read policy reviews? It correctly identifies a gap in supporting the employment needs of alcohol and drug users in employment, and also identifies two key issues – DBS checks and the ‘benefit trap’. The Black Review correctly identifies gaps in provision and joined up working and makes some interesting suggestions around including employment and volunteering in outcome measurement; suggests the use of peer mentors; and has some interesting ideas about collocating workers. But it all feels a bit tame and safe. There is no real drivers for the inter-agency working and pathway modelling that would be required of each workforce and the idea of partnership seems optimistic. There is also little adequate differentiation of the needs of problem drinkers who will typically have a different work history from problem drug users. Individual examples of good practice and innovation are all very well but what is lacking in the review is suggested mechanisms for making these more than beacons of hope in the darkness. So the review is encouraging in as far as it goes… but that is not very far”

A Collective Voice post said the report was a ‘real opportunity for the alcohol and drug treatment sector which we must seize’. According to LocalGov, the Local Government Association (LGA) welcomed the report but warned it was not ‘radical’ enough. See also reports in the Telegraph and Guardian.

Earlier this year the BMA released an updated briefing for medical and other professionals on addressing alcohol and drug use in the workplace, including guidance on supporting or recruiting employees with histories of substance misuse.

Agree with all of the above and know that Focus12 is supportive of these recommendations both in theory and in practice – says she who was a volunteer for them to help my own recovery 🙂

It feels only right to follow this blog up with this sober jukebox tune 😉

Manifesto for Children of Alcoholics – Launched Today

Another email from Liam Byrne today launching the children of alcoholics – manifesto for change yesterday, so on Valentine’s Day no less ….

Dear Friend

Today the All-Party Group launches the first ever manifesto for children of alcoholics.

Thank you for all your help in putting this together!

The hard-hitting manifesto, published to coincide with International Children of Alcoholics Week, sets out a 10-point plan to help Britain’s 2.6 million innocent victims of drink – the children of hard-drinking parents.

It is co-written by children of alcoholics, policy makers and experts from charities, interest groups and medicine.

You can read it here:

Children of Alcoholics – A Manifesto for Change
 
I’ve also launched a petition calling on the Government to back the manifesto. Please consider adding your signature and sharing with your friends and family.

(Click on the image below to access the petition)

I welcome any feedback

Very best


Liam Byrne MP

I’ve signed the petition and hope you will too 🙂

Edited to add: picked up by The Guardian too!

MPs and peers launch manifesto in support of children of alcoholic parents

Group behind initiative reveal feelings of shame and fear of own childhoods and call on ministers to tackle UK’s ‘secret scandal’

A third Labour MP has spoken of the “secrecy, shame and fear” of living with an alcoholic parent, as she urged more government action to help the children of people with alcohol problems.

Byrne, whose late father, Dermot, had alcohol problem, said the issue was “the biggest, dirtiest secret in Britain”, adding: “The challenge for the children of alcoholics is they fall through the cracks.

“They are on the cusp of these three different systems. Their parents are covered by the adult social care system, they themselves are covered by the children’s social care system, then there is the public health system.”

The manifesto was produced by the all-party parliamentary group on children of alcoholics, supported by the archbishop of Canterbury. It found an absence of strategies to deal with the issue and a lack of funding in many areas.

It also issued 10 demands for government action, including better education for children and professionals, better support or families and action on availability and promotion of alcohol.

Alcohol marketing rules failing to protect our youth

Too much news not enough blog posts!  I’m already writing posts for May so time to squeak in some extra one’s with important news stories.  Thank you marketing week for the image 😉

The top story from the Institute of Alcohol Studies for January was the headline grabbing blog post title that alcohol marketing rules are failing to to protect our youth.  To which I cynically want to respond: no shit sherlock!

Greater exposure raises likelihood of earlier and heavier drinking (10 January)

Young people across the world are over-exposed to extensive alcohol marketing practices, claim leading public health experts, who want governments to renew their efforts to address the problem by strengthening the rules governing alcohol marketing with more effective independent statutory regulations.

Their call coincides with the publication of a series of reports in a special edition of the scientific journal Addiction that presents the latest evidence on alcohol marketing and its impact on children. Key findings from the collection of peer-reviewed manuscripts include:

  • Exposure to alcohol marketing is associated with youth alcohol consumption
  • Analysis of alcohol promotion during the 2014 FIFA World Cup indicates alcohol marketing practices frequently appeared to breach industry voluntary codes of practice’
  • Alcohol industry self-regulatory codes do not sufficiently protect children and adolescents from exposure to alcohol promotions, especially through social media.

The Addiction supplement comprises 14 papers, with research presented from around the world.

Alcohol is the leading cause of death and disability for young males aged 15–24 in nearly every region of the world, and young females of the same age in the wealthy countries and the Americas.

The new systematic review – which identified 12 additional studies – found an association between level of marketing exposure and youth drinking behaviour, and found that exposure to ads was even more strongly associated with progression to binge drinking than with initiation of alcohol use.

“This latest review of the scientific literature adds stronger evidence to the claim that exposure to alcohol marketing among youth is linked to more underage youth drinking and, in particular, binge drinking,” said study leader David Jernigan, PhD, the director of CAMY and an associate professor in the Department of Health, Behavior and Society at the Bloomberg School.

The supplement’s lead editor, Professor Thomas Babor of the University of Connecticut said: “Governments are responsible for the health of their citizens. No other legal product with such potential for harm is as widely promoted and advertised in the world as alcohol. These papers provide a wealth of information to support governments in their efforts to protect children and other vulnerable populations from exposure to alcohol marketing.”

Methods

The researchers relied upon four different medical and scientific databases to identify articles for possible inclusion in the review. Studies were included in the final review if they met a number of criteria, including whether they used original data and included measures of marketing exposure and alcohol consumption for at least 500 underage youth. Studies were included only if they used self-reported and observed actual alcohol use such as binge drinking, as opposed to just measures of intentions to consume alcohol in the future. The studies were conducted in seven countries and involved more than 35,000 participants.

Several of the included studies found that levels of marketing exposure appear to be as high or nearly as high among younger adolescents as they are among older adolescents and young adults, suggesting that current voluntary alcohol industry marketing codes are not protecting kids as young as 10 years old.

Reaction

Alcohol NGOs and health experts welcomed the findings as further evidence of self-regulation’s failure to curb alcohol marketing to young people. Chris Brookes of the UK Health Forum noted that: “Governments have previously approved self-regulatory measures on alcohol advertising; however, we can no longer say that they might work to protect our young people – they don’t. In a literature review of more than 100 studies, none was identified that supported the effectiveness of industry self-regulation programmes.”

However, the advertising industry regulator has criticised the research, claiming that the UK’s regulatory framework has had a positive impact on recent official figures showing under-age drinking at a record low and a decline in binge drinking.

“Alcohol policy is clearly on the right track and alcohol advertising – which protects children and respects adults – is an important part of that,” says Ian Barber, the AA’s director of communications.

In the UK, advertising for alcoholic drinks follows a code enforced by the Advertising Standards Authority, while the packaging and branding of the products is subject to self-regulation. And according to the Guardian, AB Inbev and Diageo, two of the world’s biggest alcoholic drinks makers, have reported ploughing as much of 15% of their annual global sales back into marketing, amounting to £5.75bn and £1.6bn respectively.

Ian Hamilton, lecturer in the Department of Health Sciences at the University of York, whose interests include substance use addiction, told the newspaper the AA’s claim that the UK’s alcohol advertising rules are among the strictest in the world, major operators had nevertheless found ways to evade marketing legislation the UK.

“Some of the messages are quite subtle, but they are persistent,” he said. “So this idea that alcohol is necessary for social success, or is both a stimulant as well as a sedative, that it removes sexual inhibition, that it improves – bizarrely – your sporting and mental abilities.

“Of course, the way they do it is they don’t say go and buy Carlsberg, but they’ll do endorsed interviews with celebrities or they’ll offer free music downloads or notices of events, so they do it in quite subtle and clever ways.”

Solutions

The papers offer guidelines to developing more effective alcohol marketing regulations:

  • The most effective response to alcohol marketing is likely to be a comprehensive ban on alcohol advertising, promotion and sponsorship, in accordance with each country’s constitution or constitutional principles
  • Regulations should be statutory, and enforced by an appropriate public health agency of the local or national government, not by the alcohol industry
  • Regulations should be independent of the alcohol industry, whose primary interest lies in growing its markets and maximising profits
  • A global agreement on the marketing of alcoholic beverages would support country efforts to move towards a comprehensive ban on alcohol advertising, promotion and sponsorship
  • Collaboration with other population-level efforts to restrict marketing of potentially harmful products, such as ultra-processed food, sugary beverages, tobacco, and breast-milk substitutes, should be encouraged and supported.

“It is clear that self-regulation is not working and we welcome calls for greater action from governments to protect children from exposure to alcohol marketing,” said Prof Sir Ian Gilmore, chair of the Alcohol Health Alliance (AHA), an umbrella group of more than 40 UK health NGOs, including the Academy of Medical Royal Colleges.

Hamilton also warned that a blanket ban on alcohol advertising could be seen as “taking a sledgehammer to crack a nut”, with the danger that such a policy could give drinking a kind of outlaw prestige that might increase its appeal to some. But he admitted that a similar policy on tobacco advertising had apparently proved successful in diminishing the appeal of smoking. “I think the state does have some kind of responsibility,” Hamilton said. “We can’t have do-it-yourself regulation by industry whose prime motive is to find the next generation of consumers.”

The Addiction supplement, ‘Alcohol marketing regulation: From research to public policy’, is freely accessible from the Wiley Online Library. You can also listen to David Jernigan talk about the supplement’s findings in greater depth in our Alcohol Alert podcast.

The latest Institute of Alcohol Studies (IAS) Alcohol Alert: January 2017 in its entirety is now available (here for PDF version).

Alcohol Policy UK picked up on the special issue of Addiction also which you can read here.

And Liam Byrne interviews Alaistair Campbell about this very thing!

PS New follower on Twitter:

Looking for volunteers for research studies in alcohol addiction, sobriety, weight loss and weight gain. QMUL Led by

If you’d like to volunteer tweet him 🙂