Category Archives: Alcohol research findings and media coverage

Ever present alcohol

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

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

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

The key findings include:

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

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

What does this mean for public health?

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

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

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

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

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

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

Both shocking and unsurprising to me, how about you?

 

I know how alcohol can ruin your mental health. So why is it so rarely discussed?

This article on alcohol and mental health was in The Guardian in May.

It’s amazing to see the British finally begin to talk about our feelings. But even as we mark this year’s Mental Health Awareness week, there’s still an elephant in the therapist’s waiting room: alcohol.

The physical health risks of drinking are well known. Less discussed are the mental health consequences. These are real and significant, and seem to be getting worse. For instance, the number of people admitted to hospital with alcohol-related behavioural disorders has risen in the last 10 years by 94% for people aged between 15 and 59, and by 150% for people over 60.

Alcohol played a key part in my own problems but it took me years to come out of denial about it.

I never drank in the morning or in parks, just in a British way, bingeing along with, well, everybody else. I didn’t question it because no one else seemed concerned.

Presenting to therapists over the years with anxiety, patterns of self-destructive compulsive behaviour, swinging between thinking I was the most important and the most worthless person on the planet, they barely asked how much I was tipping down my neck. And it was a lot.

The more I drank to medicate my low self-esteem, the worse my anxiety got and the more I drank to dull it. Years passed and I couldn’t see I was stuck right in the classic “cycle of addiction”.

Eventually a friend of mine who had gone into Overeaters Anonymous sheepishly suggested I might have a problem. I resented it hugely. I was successful with a good job. There was no problem.

Eventually, it was a work incident that woke me up. As editor of Attitude magazine, I believed it would be culturally significant to have Harry Potter on the cover of a gay magazine. When Daniel Radcliffe, who played Harry in the film franchise, agreed, the only gap in his schedule for a shoot was early on a Sunday morning, which was annoying. Saturday night was my favourite time to go out. But fine. I could do this.

I decided not to drink the day before. No wine at lunch, nor during the play I went to see, and then straight home. All went well. Just as I was about to go to bed, ready for the shoot the next day, curiosity got the better of me and I logged on to a dating site, just to check my messages.

The next thing I remember was waking up, empty cans everywhere, with a bunch of messages on my phone asking where I was. Daniel and his publicist couldn’t have been nicer when I arrived with my lame excuse, insisting I go home to bed and that the shoot would be OK, and he found time later in the week to do our interview. Disaster was averted but it was the wake-up call I needed.

Since finally giving up alcohol, I’ve learned many things. First, that addiction is everywhere. That it is not about the drinking (or whatever the substance is), but the feelings underneath. Usually there is some kind of childhood trauma that needs to be addressed. I’ve learned that it isn’t about when or where you drink but about whether you can easily stop once you’ve started. I’ve also learned that there is an astonishing lack of understanding about addiction in general, not just from the public but sometimes by professionals who, being human too, often have their own issues to deal with.

The positive news is that despite alcohol being a socially acceptable carnage-causing drug that is pushed on us from an early age, it too is beginning to be talked about less furtively. Brad Pitt spoke in an interview last week about his struggles, Colin Farrell recently spoke on Ellen about being 10 years sober. Daniel Radcliffe himself has spoken about his problem drinking.

Last year I did another interview, with Robbie Williams and singer John Grant talking about their life-saving experiences of recovery from alcohol, drugs and sex addiction – and this time, I wasn’t late for it. Studies continually show a link between alcohol abuse and violence, domestic abuse and suicide, so talking about it is not a luxury, it is a necessity.

The British drink too much. Alcohol must be next on the mental health agenda.

Completely agree Matthew!

Drinking in pregnancy: where next for preventing FASD in the UK?

My son was conceived on a Bank Holiday August week-end.  Ironically I also attended a Hen Do that week-end where as you can guess much alcohol was consumed despite my trying to conceive at the same time.  So this post today seems fitting.  It is courtesy of a guest blog for Alcohol Policy UK that I read in May called Drinking in pregnancy: where next for preventing Fetal Alcohol Spectrum Disorders (FASD) in the UK?

In this guest blog, Kate Fleming, Senior Lecturer, Public Health Institute, Liverpool John Moores University, and Raja Mukherjee, Consultant Psychiatrist, Lead Clinician UK National FASD clinic, Surrey and Borders Partnership NHS Foundation Trust consider the context and future for Fetal Alcohol Spectrum Disorders in the UK.

A recent opinion piece in The Guardian entitled Nothing prepared me for pregnancy- apart from the never ending hangover of my 20s took a, presumably, humorous take on the tiredness, vomiting, dehydration, and secrecy that so many women live through in early pregnancy, likening this to days spent hungover after excessive drinking in the author’s early 20s.

In an article that was entirely about alcohol and pregnancy there was reassuringly no mention of the author consuming alcohol during pregnancy, indeed quite the reverse “I don’t actually want booze in my body”.  But neither was there explicit reference to the harms that alcohol can cause in pregnancy. 

The harms caused by consuming alcohol in pregnancy

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term that encompasses the broad range of conditions that are related to maternal alcohol consumption.  The most severe end of the spectrum is Fetal Alcohol Syndrome (FAS) associated with distinct facial characteristics, growth restriction and permanent brain damage.  However, the spectrum includes conditions displaying mental, behavioural and physical effects on a child which can be difficult to diagnose.  Confusingly, these conditions also go under several other names including Neuro-developmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE) the preferred term by the American Psychiatric Association’s fifth version of its Diagnostic and Statistical Manual (APA DSM-V), alcohol-related birth defects, alcohol-related neuro-developmental disorder, and partial fetal alcohol syndrome.

How common is FASD?

A recent study which brought together information from over 300 studies estimates the prevalence of drinking in pregnancy to be close to 10%, and around 1 in 4 women in Europe drinking during pregnancy. Their estimates of FAS (the most severe end of the spectrum) were 14.6 per 10000 people worldwide or 37.4 per 10000 people in Europe, corresponding to 1 child in every 67 women who drank being born with FAS. 

Given the figure for alcohol consumption in pregnancy is even higher in the UK, with some studies suggesting up to 75% of women drink at some point in their pregnancy, conservatively in the UK we might expect a prevalence of FASD of at least 1%.  We also know that it is highly unlikely that anything close to this number of individuals have formally had a diagnosis.  This lack of knowledge of the prevalence in the UK is hampering efforts to ensure the required multi-sector support for those affected by FASD and their families.  

Current policy

For some time a significant focus of alcohol in pregnancy research was to try and identify a safe threshold of consumption, without demonstrable success.  No evidence of harm at low levels does not however equate to evidence of no harm and as such in 2016 the Chief Medical Officer revised guidance on alcohol consumption in pregnancy to recommend that women should avoid alcohol when trying to conceive or when pregnant.  Though this clarity of guidelines has been well received by the overwhelming majority of health professionals there are barriers to its implementation with few professionals “very prepared to deal with the subject”.  In addition, knowledge of the guideline amongst the general public has yet to be evaluated.    

As part of the 2011 public health responsibility deal a commitment to 80% of products having labels which include warnings about drinking when pregnant forms part of the alcohol pledges. A study in 2014 showed that 90% of all labels did indeed include this information. However, it has also been shown that this form of education is amongst the least effective in terms of alcohol interventions, and the pledge is no longer in effect.

Pregnancy is recognised as a good time for the initiation of behaviour change yet in the context of alcohol consumption it is arguably too late. An estimated half of all pregnancies are unplanned and there remains therefore a window of early pregnancy before a woman is likely to have had contact with a health professional and before the guidelines can be explained during which unintentional damage to her unborn baby could occur.  The same argument can be used when considering the suggestion of banning the sale of alcohol to pregnant women – visible identification of pregnancy tends only to be possible at the very latest stages.

How then to address consumption of alcohol during pregnancy? 

Consumption of alcohol is doubtless shaped by the culture and context of the society in which one is living.  Highest levels of alcohol consumption in pregnancy are, unsurprisingly, seen in countries where the population consumption of alcohol is also highest.  Current UK policy that is directed to reducing population consumption of alcohol will likely have a knock-on effect of reducing alcohol consumption in pregnancy.

Many women will however be familiar with the barrage of questions that they encounter when not drinking on a night out.  From the not-so-subtle “Not drinking, eh… Wonder why that is? <nudge, nudge, wink, wink>” to the more overt “Are you pregnant?”.  The road to conception and pregnancy is littered with enough stumbling blocks and pressures that the additional unintentional announcement of either fact of conception or intention to conceive is an unnecessary cause of potential further anxiety. Until society accepts that not drinking is an acceptable choice, without any need for clarification or explanation, then pregnant women or those hoping to conceive who are adhering to guidelines will continue to identify themselves, perhaps before they want to. 

What next?

The UK’s All Party Parliamentary Group for FASD had its inaugural meeting in June 2015.  This group calls for an increased awareness of FASD particularly regarding looked after children and individuals within the criminal justice system, sectors where the prevalence of FASD is particularly high. Concerted efforts need to be made to identify children with FASD to ensure that the appropriate support pathways are in place. Alongside this, efforts to ensure the best mechanisms for education of the dangers of alcohol consumption in pregnancy need to be increased, including training for midwives, and other health professionals who may be able to offer brief intervention and advice to women both before and after conception.

NOFAS run a national FASD helpline on on 020 8458 5951 as do the FASD Trust on 01608 811 599.

My alcoholic daughter, 26, must leave home – or I will

This was a Guardian Dear Mariella letter in June that garnered almost 600 comments so clearly it is a subject that hit a collective nerve that prompted people to offer advice and share their perspective.  An alcoholic daughter cared for by ageing parents who have had enough and write in asking for help.

The dilemma I’m a 69-year-old retired engineer with two children; one who lives abroad and seems to be doing well, and the other, my 26-year-old alcoholic daughter.

She appears incapable of holding down a job, is a strain on our resources and frequently goes on binges during which she might fall and get bruised.

I am her enemy, it seems. Today she told me she wishes I had died when she was 15. Yesterday the police called because she had gone to the local shop, bought cheap spirits, and was outside in a stupor.

I want her out of my house. I am depressed by the constant arguments between her and her boyfriend (a decent sort of guy), her and her mother, her and me. She behaves like a devious psychopath, manipulating others.

Unfortunately my wife keeps enabling her behaviour. I think I am going to have to leave to preserve my sanity. I hate to seem as if I am attacking my wife, but I can’t see any other way.

Mariella replies How sad. Your daughter is an addict plain and simple, but it’s not just her own life she’s destroying. One of the frustrating aspects of addiction is how useless it can make those around feel, even when they are doing their utmost to be helpful.

Your daughter needs professional help, ideally a clinical stay, but as you’ll be all too aware you can’t force her to seek that out. You can, however, make it less easy for her to dodge the fact that she is making a problem for all of you.

All addicts become adept at manipulation, as deluding others is often their only way of maintaining their habit. Lying becomes their lifeline. It’s easy for me to say this, but you must try – no matter how terrible the things she says – not to confuse your daughter with the creature her addiction makes her.

The day she liberates herself from her dependency on alcohol she will be an altogether different human being, so please don’t abandon hope for the return of the girl you once knew. Insisting, if she’s to remain living with you both, she attend AA meetings would be a step forward, but you would have to be prepared to go through with the alternative of her leaving the house.

Have you tried family counselling? It can be a helpful step towards getting the person to realise that they need to look to themselves instead of attacking those trying to firefight for them. At present she’s casting you as a demon, but that would be much harder if you and your wife built up some solidarity. Parenting in partnership is one of the most constructive things you can do with children generally. Speaking in one voice is one of the toughest collaborations to maintain, but it’s indispensable when dealing with an addict. A united front helps to create a sense of security, offers less chance to indulge manipulative tendencies and presents a clear idea of where the boundaries lie. Your daughter is over-stepping every one of those lines and it may be that things have to get worse before they can improve. What would be really destructive would be allowing your daughter’s behaviour to drive a wedge between you and your wife.

Don’t underestimate the immense strain you are both under, which is clearly having an impact on you both in different ways. Your wife’s enabling of your daughter’s behaviour puts her in a majority. There are very few parents who come around easily to abandoning their child in the hope of them hitting rock bottom – it’s an incredibly hard choice to make.

However, your girl needs to see that there are expectations and consequences, and the life you are all enduring is unsustainable and damaging. If you haven’t tried family counselling it’s worth investigating. There’s no downside to having an honest discussion and there can be surprises for all concerned. No amount of therapy, however, will cure her addiction – she is an alcoholic and needs to understand that whatever is at the root of her problems her addiction to alcohol is only exacerbating it.

Maybe her dependable boyfriend can help convince her of the invaluable support available at her local AA meeting. This is an issue for expert advice, not just an email to an agony aunt, so do ensure you’re in touch with the organisations whose expertise has helped many a family, including Al-Anon Family Groups (020 7403 0888) and adfam.org.uk.

Ultimately, the best I can offer is my certainty that you won’t be able to make changes until you and your wife find common ground. Leaving won’t cure the problem and removing yourself will be a temporary respite at best. Refraining from calling the family home “my house” as you do in your letter is one small correction to your own approach that you might make. The way forward will take compromise and a willingness to accept change from all concerned to dig you out of this dark hole.

I liked her advice and thought it was sound – what did you think?

Being drunk in charge of a child can get you arrested

So this was featured in The Independent in July and was picked up by Alcohol Policy UK.   After a Russian heiress was found guilty of being drunk in charge of a child, the Independent dug out the 1902 licensing act.

The Summer’s social calendar is already in swing events from family barbecues to village fetes already lining up. However, while drinking when in charge of children at family events is common practice, it is also actually a breach of the law.

With even David Cameron leaving his eight-year-old daughter behind at a pub back in 2012, parents drinking while looking after their children is an everyday occurrence. But a century old law forbids the behaviour.

Being drunk while in charge of a child under the age of seven is illegal according to the 1902 licencing act. The law states that a fine or up to a month’s imprisonment would result if “any person is found drunk in any highway or other public place, or on any incensed premises, while having the charge of a child.”

“The threshold would be whether the child was compromised. If you’re having lunch with a couple of glasses of wine, you probably wouldn’t be considered drunk in charge of a child,” solicitor advocate Joy Merriam tells The Sun.

Being alert and capable of safeguarding your child are the key responsibilities that could be compromised by drinking irresponsibly. If parents are unable to look after their children and protect them from physical harm they could be committing the offence.

“There is no fixed amount under the current legislation, but it could certainly be argued that if you are an adult solely responsible for a child, it is better not to drink alcohol at all,” family lawyer Jo Shortland tells The Independent. 

However, Ms Merriam adds that in cases of this type where parents are arrested on suspicion of the offence, prosecutions are infrequent and most commonly passed on to social services.   

“Those responsible for children need to consider their own limitations and take a sensible approach to alcohol consumption,” family lawyer Deborah Heald tells The Independent. 

The charity Drinkaware also released the following advice for parents: “Drink within the low risk alcohol unit guidelines of not regularly drinking more than 14 units per week for both men and women, and spreading them evenly over three days or more. This shows your child that adults can enjoy alcohol in moderation.”

Edited to add: I suspect this includes if you are drunk on a plane!

Revealed: The growing problem of drunk and abusive fliers – and the worst routes for bad behaviour

Panorama: Plane Drunk (BBC One Panorama 8.30 pm tonight)

 

Guest Blog Post: Mindful Drinking Festival & Alcohol Free Drinks In Recovery

So this is a quick plug for my friends over at Club Soda and a guest blog post they have written in support of their upcoming Mindful Drinking Festival (see details to the left)

Over to Jussi:

Alcohol-free beers and wines can be a controversial topic for people in recovery. Many feel that they should be avoided completely. Why keep drinking something that reminds you of alcohol? Won’t they just lead you back to the full-strength stuff eventually? These are all valid points, coming from years of experience by many people.

Club Soda is a Mindful Drinking Movement, which means that we support people whatever their drinking goals are. Some want to quit completely, some want to take a temporary “sober sprint”, some want to cut down in some way. We believe these are all valuable goals – any reduction in alcohol use is good news.

Alcohol-free beers and wines is a topic that comes up regularly in our online community. There are strongly held views both for and against them. It was never our aim to promote any particular drinks. But we have heard from so many of our members how swapping their usual beers and wines to a non-alcoholic or even a lower alcohol version has helped them to dramatically change their habits.

But we also believe that only you can decide for yourself. If you don’t think a non-alcoholic beer is right for you, then absolutely do not try them. We do always say that if you find a drink a “trigger” for alcohol, then it is best to stay away. There are plenty of soft drinks to drink which will not remind you of alcohol.

A further interesting twist to this discussion took place recently on our Facebook Group: how does people’s relationship with AF drinks change over time? This is what Ellen wrote:

“At 8 months sober, I can really take them or leave them. However in early sobriety, especially over Christmas, I TOTALLY depended on them. There was a time I could drink a whole AF wine fairly fast and open another. Now though, I honestly hardly even want a bottle.”

Melanie responded in a similar way:

“I’m at 8 months and like you drink a lot less af drinks now than I first did. A weekend treat or if the girls are over. They have their uses but I guess I’ve now broken the habit!!”

Many others added comments on the same lines: used to drink more or less the same amount of AF drinks as they used to drink alcoholic drinks in the beginning of their sober journey, but have reduced their consumption over time. Many of the people with a few sober months under their belt said they only drank AF drinks on special occasions: most often when out in a pub. Partly to “blend in”, partly to have something “grown up” to drink, rather than a sugary lemonade.

The good news is that there is a real revolution going on in the drinks industry. There are more and more good quality non-alcoholic beers and wines available both in shops and bars. And many other new drinks are also making an appearance, from craft sodas to fermented tea drink kombucha.

Many of the new drinks can still be difficult to find though. That is why Club Soda is organising the UK’s first ever Mindful Drinking Festival – bringing together all the best alcohol-free drinks (0.5% and below) in one place: not just wines and beers, but also soft drinks, kombucha, mocktails, fine teas and much more. The event is free to attend, and lets you taste all the best new drinks, and find some new favourites for every occasion!

The Club Soda Mindful Drinking Festival is on 13th August, from midday to 6pm, at Bermondsey Square, London SE1 3UN. Entry is free, and you can RSVP online at mindfuldrinkingfestival.com.

We would love to see you there and hear your views.

I would love to be there that day but sadly will be working my day job 🙁  If you go do drop me a comment here to tell me what you sampled!

Are alcohol-free alternatives finally coming of age?

This article on alcohol-free alternatives was featured in The Guardian in April.

What to drink when you’re not drinking? Not so long ago, the choice was very limited: tonic without the gin, perhaps? Lime and soda sans vodka? An oversweet fruity number? Or (yawn) another sparkling water? Perhaps it is no wonder that those of us of a certain age tend to be heavier drinkers than the younger generation: alcohol consumption in the UK fell 26% between 2002 and 2012, and the number of people aged 16-25 who drink little or not at all has risen by 40% in a decade. So it’s no great surprise that the marketeers are muscling in with a raft of decent alcohol-free tipples designed to please these sober youngsters and their boozy parents, too.

Most low-alcohol beers are still thin and dull, but Brew Dog’s Nanny State (around £1.25, widely available) is clean and hoppy, with body and balance, and stands up well against its alcoholic craft beer cousins.

When it comes to wine, most with no or low alcohol tend to be fairly grim, too. Torres Natureo Muscat (£5.99, Waitrose) is vinified as wine, then de-alcoholised by distillation and comes out at a healthy 0.5% abv. It’s off-dry, but not too cloying, and would sit well on a springtime supper table, especially if the food is slightly spicy: try it with something Thai.

Seedlip is a non-alcoholic, zero-calorie distilled drink that’s caused a stir even among die-hard drinkers. Treat it as a gin or vodka: I like the savoury freshness of Seedlip Garden (£27.95 The Whisky Exchange, £27.99 Waitrose), flavoured with peas, hay, rosemary and thyme. Drink it with tonic and a cucumber slice. (Seedlip recommends Fever-Tree Elderflower tonic, but it works just as well with good old Schweppes.) For a similar grown-up botanical hit with tonic (and at a fraction of the cost), try a few drops of bitters: classic Angostura (about £10, widely available) with a slice of orange; or the deliciously zingy Fee Brothers Grapefruit Bitters (£8.71 thedrinkshop.com, £9.85 The Whisky Exchange) with a sprig of mint.

If you do like something fruity, try your hand at making shrubs, or “drinking vinegars”, as the hipsters call them. These are fruit cordials made with vinegar, which gives a pleasing, sour tang. Mix 1kg fruit with a litre of cider vinegar and 750g sugar, leave in a covered container for two weeks, then strain and bottle the liquid. To serve, dilute 1:5 with still or fizzy water. Soft fruit seems to work best: raspberries with crushed black peppercorns thrown into the mix, or gooseberries with chopped green chillies, say.

I’m always up for new AF drinks suggestions & must try the Seedlip Garden too!  If you’d like to try some of the new alcohol free drinks now available why not head to the Mindful Drinking Festival in London next month?  Having read this morning’s headline on the Guardian (Heavy drinking will kill 63,000 people over next five years, doctors warn) it feels like Laura & Jussi, the founders of Club Soda, have set this up at just the right time 🙂

10 things you only know if you’re teetotal

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

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

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

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

1. You get tired of explaining your reasons for abstaining

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

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

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

3. You can remember all of your birthday parties…

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

4. You can have productive Saturday and Sunday mornings

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

5. You appreciate deep and meaningful​ late night conversations 

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

6. You are sick to death of sparkling water

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

7. You have extra cash

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

8. You realise how grimy most bars are

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

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

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

10. You appreciate a good evening in 

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

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

Statistics on Alcohol England 2017

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

Over to James:

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

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

Key headlines from the release include:

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

Hospital admissions – narrow measure

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

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

Drinking Prevalence

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

Deaths

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

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

Prescriptions

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

Consumption confounders?

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

Commons alcohol policy briefings

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

The recent House of Commons Library briefings include:

Alcohol: minimum pricing

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

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

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

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

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

Alcohol taxation and the pub trade

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

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

Alcohol: mandatory licensing conditions

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

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

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

Children in pubs

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

Alcohol: drinking in the street

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

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