Monthly Archives: November 2014

Round up of media coverage of Alcohol Awareness Week

Last week UK Alcohol Awareness Week seemed to have two main focuses: the older drinker and the young.  I wrote about the impact on the older generation here.

Media coverage and stories aimed at young people:

Drink and Drugs: My Story – BBC programme

The science of how alcohol and other drugs affect the body is explored through eight real-life stories, highlighting how behaviour can change dramatically as a result of drinking alcohol or taking other drugs on BBC3 and aimed at 14-18 year olds | BBC, UK

Alcohol awareness – BBC iPlayer

Your life, your problems, your loves, your Surgery. Radio 1’s Aled and Dr Radha discuss drinking for Alcohol Awareness Week | BBC iPlayer, UK

Shropshire songwriter’s million-hit anti-alcohol song tours schools

A singer-songwriter from Shropshire who recorded a song about his 29 year elder brother’s death from alcoholism has been touring the track around schools | BBC, UK

Lost Day’s Henry Maybury

All good stuff.  I said before that I would go back to posting every other day but I’ve got content coming out of my ears!  It’s going to take me until the New Year to clear the backlog so it’s going to be daily posts for another month 🙂

PS On Monday it’s Cyber Monday as the Christmas season begins.  My Udemy course will be on offer at half price between now and New Years Day, so for $25 (£15.50).  If you’re looking for a surprise treat for your holiday season sober first aid kit, the brilliant idea from Living Sober (amazeballs Mrs D and SueK!) or would like to forgo a bottle of Christmas spirit this year then this could be for you!!  Click HERE for discounted access to the course or click on the link at the top of the sidebar 🙂


Alcohol and breast cancer


Last week at the Alcohol Awareness Conference Balance North East shared their campaign for this year which you can see above and which I really like.

To coincide with the start of Alcohol Awareness Week, the campaign will launch on the region’s airwaves with a radio advert featuring the North East TV star.
In the advert, Charlie Hardwick says: “I’m a worldly woman and I’d like to think I’ve gained a bit of knowledge in my time. But I’ll tell you something, I didn’t know about the proven links between alcohol and breast cancer. Until now.
“The more you drink the more you increase your risk of developing breast cancer. Now there aren’t many ways we can reduce our risk. But limiting the amount we drink is one. And that made me think twice.
“I just thought, ‘isn’t this something women should know about?’ Which is why I support this message from Breakthrough Breast Cancer and Balance.”
One in eight women develop breast cancer in their lifetime but the individual level of risk varies from person to person depending on a number of factors such as genes, lifestyle and environment. Drinking alcohol is one of the few contributing factors that can be changed to help reduce a woman’s risk of developing the disease.
Studies have shown that: 
  • In a group of 100 women who do not drink, around 11 are likely develop breast cancer during their life. 
  • In a group of 100 women who drink two units a day – which is the equivalent of a standard glass of wine – about 14 will develop breast cancer. 
  • In a group of 100 women who drink four units a day – the equivalent of a large glass of wine and a single measure of spirits – about 16 will develop breast cancer.

The conference also hosted the speaker Professor Linda Bauld who shared research data from Cancer Research UK about breast cancer and alcohol.

She talked about:

  1. How alcohol damages your DNA
  2. Is a solvent for tobacco so increases the risk if you drink and smoke
  3. How alcohol raises the level of oestrogen in the body
  4. Alcohol is a known carcinogenic toxin

Regularly drinking even small amounts of alcohol can increase the risk of breast cancer. A review of the evidence in 2012 concluded that having 1 drink a day (around 1.5 units) could increase the risk of breast cancer by 5%. And the risk increases the more a woman drinks, several studies have found that each additional 10g of alcohol drunk a day increases the risk of breast cancer by about 7 – 12% (10g of alcohol is equivalent to 1.25 units) (research)

The impact of alcohol on our health needs to be more widely discussed otherwise how can we try to protect ourselves against the cancer risk?

Drink Refusal Self Efficacy

So while at the Alcohol Concern conference last week a lecturer, Dr Dom Conroy from Birkbeck University, talked about Drink Refusal Self Efficacy (DRSE).  This was a new expression and phenomenon to me and so I’ve been busy researching.

Here are the initial findings:

Drink Refusal Self Efficacy is a cognitive construct related to our belief in one’s ability to resist drinking in, usually high-risk, situations.  It originates from Bandura’s (1986) concept of efficacy expectations – one’s perceived ability to achieve a desired outcome in a particular situation.  DRSE has been studied in relation to resisting heavy drinking use, resisting urges and confidence in not using and Burling et al (1989) showed a relationship between abstainers and high refusal self-efficacy.

The DRSE questionnaire looks at:

  1. Social pressure
  2. Emotional relief
  3. Opportunistic
  4. Alcohol dependence scale
  5. Alcohol quantity
  6. Drinking frequency

Having high levels of DRSE is unsurprisingly a predictor of success.

DRSE alongside alcohol expectancy, our expectations about the effects of drinking alcohol on one’s behavior and mood,  have consistently been demonstrated to be useful to our understanding of alcohol use and abuse.

What struck me about this research and knowledge is that it is aligned to Bandura’s social learning theory, better known as role-modelling, to you and I.  Two of the 3 factors on the DRSE questionnaire are environmental – social pressure and opportunistic.

I can’t help but wonder if we changed the drinking culture around us so that there was less role-modelling of drinking behaviour we would see a shift in attitudes and levels of drinking.  Look at what’s happened with smoking.  It is role-modelled less so less people are engaging with it.

For me Bandura’s theory of role-modelling is one of the most important as I only have to see what happens to my own children’s behaviour and what ticks of mine they have taken on already to know how critical it is and that is why I’ve stopped.

Were you aware of DRSE and what do you think?

PS My 500th free e-book subscriber has signed up so guess I better extend the offer!  The 600th subscriber gets the next free place! 🙂

Industry adopt tactics of ‘Dr Evil’ in battle against tougher regulation

This was in The Guardian earlier this month and lays out what the tobacco industry is doing to try and save it’s business model.

Britain’s leading cigarette manufacturers are attempting to open a new front in their fight against tougher regulation.  Tobacco companies are backing a new organisation that launches this week to push the message that drinkers and fast food fans will be the next targets of health campaigners if smokers’ freedoms are not respected.

Action on Consumer Choice (ACC) is closely modelled on the Centre for Consumer Freedom (CCF) in the US, a hugely powerful organisation funded by tobacco firms and fast food chains that was the brainchild of Richard Berman, one of Washington’s most successful – and notorious – lobbyists. Berman has argued against an initiative to lower the blood alcohol content limit for US drivers, claiming that stricter limits would punish those who drink responsibly. His various lobbying efforts have earned him the sobriquet “Dr Evil”.

“His principal strategy appears to be: destroy your opponent’s credibility before they destroy yours,” Simon Clark of Freedom of the Right to Enjoy Smoking Tobacco (Forest), the tobacco-funded body behind the ACC, notes on his blog announcing the soft launch of the ACC, crediting Berman as its inspiration. “Consumers who believe in choice and personal responsibility must have a voice,” Clark continues. “With a few tweaks for a UK audience, I can’t think of a better model than Rick Berman’s Centre for Consumer Freedom.”

Berman found himself in the New York Times last week after a speech he gave to the oil and gas industry was secretly recorded and leaked to the paper. According to the NYT, Berman told leading oil and gas executives that they must be “prepared to employ tactics like digging up embarrassing tidbits about environmentalists and liberal celebrities”. He continued: “Think of this as an endless war. And you have to budget for it.”

Interestingly another article with a similar message was published in The Telegraph headlined: Watch out: the anti-smoking fanatics now want to regulate drinking.   The anti-smoking lobby has been offering advice to the House of Lords on how to regulate drinking. Draconian moves could follow.

This is  a snippet of what the article had to say:

The UK Centre For Tobacco and Alcohol Studies is demanding legislation to impose new restraints on marketing alcoholic drinks, an end to sponsorship of sport by drinks companies, and a blanket ban on representatives from the drinks industry attending meetings civil servants.

Meanwhile I remain puzzled that the UK Centre For Tobacco and Alcohol Studies continues to be treated with such respect. This video of Gerard Hastings, the academic who is one of their main protagonists, suggests that he is also something of an anti-capitalist campaigner as well as a public health expert. Yet he is listened to with entranced respect by Parliament and the Department of Health.

To repeat what Rick Berman said again “Think of this as an endless war. And you have to budget for it.”  This business model applies to the drinks industry as much as it does to the tobacco industry, particularly as drinks companies have interests in tobacco too, such as SABMiller discussed here. Their concern is not with public health but with profit and they will employ any tactic or professional advisor to ensure their message gets across and their profitability is maintained …… it’s not just a war but a dirty war.

To end on a more cheery note Happy Thanksgiving Day to all my American friends.  Hope you have a happy, sober relaxing holiday.  As Lori mentioned in the comments Veronica has written a great post today about what a sober alcoholic is thankful for and you can read it here 🙂

Veronica Valli and I (5) discuss ‘recovered’ vs ‘recovering’

Veronica and I met a couple of weeks ago on Skype and during this conversation we discuss how the AA fellowship perceives ‘recovered’ alcoholics as opposed to ‘recovering’ and the difference between the ‘fellowship’ of AA and the ‘programme’ of AA.

As someone who has a copy of the Big Book, which is the ‘programme’, but who has only been to one 12 step meeting, which is the fellowship, I find AA fascinating and over the next 12 sessions we are going to discuss each of the 12 steps.  I am interested to learn how the steps can be used to resolve the ‘spiritual malady’ that AA talks of without necessarily attending a 12 step meeting and Veronica has very kindly agree to be my guide, and because it’s recorded, you can share the journey too 🙂

Look out for the next conversation in the coming weeks or subscribe if you don’t want to miss it!

Veronica Valli is an Addictions Therapist and the author of Why you drink and How to stop:…


2013 How to Stop Cover 960x1280

PS Over 450 of you have subscribed to receive my e-book since it launched and I am so grateful for the support.  You can now buy it on Amazon and it is being well-received there with three 5 star reviews already! Please feel free to go add a review yourself if you’ve read it and benefited from it.  If you are reading this and haven’t subscribed I’m offering a free place on my newly launched Udemy course for the 500th subscriber so go sign up at the top of the page if you haven’t all ready! 🙂

Civil service chief under fire for keeping second job in alcohol industry

John Manzoni waives £100,000-a-year SABMiller salary amid criticism from doctors that his role is incompatible with health goals.  Read the full story hereThis really makes my blood boil ……

John Manzoni, the new chief executive of the civil service, will waive his £100,000-a-year salary from a major drinks company as he comes under fire from more than 70 leading medical professionals and charities over his second job in the alcohol industry.

Challenging the government’s claim that there is no potential for a conflict of interest, the letter to Heywood said: “We write to you as public health professionals to express our deep concerns about the alcohol industry interests held by the newly appointed chief executive of the UK civil service, John Manzoni.

“We find it inexplicable and troubling that Mr Manzoni retains a paid position as non-executive director of one of the world’s largest brewers, SABMiller, while stepping down from two other paid positions in the energy sector. This appears to be only partial fulfilment of the Nolan principles, which require holders of public office to ‘take steps to resolve any conflicts arising in a way that protects the public interest.’”

The signatories, who include Prof Sir Ian Gilmore, special adviser on alcohol to the Royal College of Physicians, Prof Klim McPherson, chairman of the UK Health Forum, Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, and Alison Cox, of Cancer Research UK, list two potential conflicts of interest:

• Manzoni’s remuneration for his post with SABMiller – taken in the form of company shares – means he has a pecuniary interest in growth of the company’s sales and profits and therefore an interest in government policies that may affect this.

The letter says SABMiller has conducted a “well resourced and wide-reaching lobbying campaign against UK government policies aimed at tackling alcohol harm that potentially threaten the interests of the drinks industry, such as minimum unit pricing”.

It adds: “It is problematic that the chief executive of the UK civil service has such clear links to an organisation with strong vested interests on one side of such debates.”

• SABMiller has commercial ties to the tobacco industry through its shareholder Altria. The letter says the Altria group (formerly known as Philip Morris Companies Inc) is the parent company of Philip Morris USA and also a 27% economic and voting interest in SABMiller plc, with representation on its respective board.

The letter says: “We seek clarification on whether Mr Manzoni’s commercial links to the tobacco industry are considered to be compatible with the UK government’s obligations under article 5.3 of the WHO [World health Organisation] framework convention on tobacco control and its implementation guidelines, requiring that public health policies should be protected from commercial and other vested interests of the tobacco industry.”

It goes on to argue that Manzoni’s continued interest in SABMiller “poses a serious threat to the perceived neutrality and integrity in the role of the UK civil service in policy-making” and calls for full disclosure of the details surrounding his appointment.

One of the organisers of the letter, Katherine Brown, director of the Institute of Alcohol Studies, said she found the situation an astonishing example of the revolving door between business and the government.

“In this instance they haven’t even bothered with a smokescreen,” she said. “Having the chief executive of the UK civil service receive private funds from an industry whose impact and activities are so highly contested is seriously problematic. This presents a major risk of conflict of interest and exposes public policy to interference by big business financial goals.”

Oh yes and SABMiller is one of the key leading partner’s in the Public Health Responsibility Deal and you can read their current pledges here:

Words fail me ……..

Alcohol and older people

From Alcohol Policy UK:

A new report explores influences on older adult’s drinking as an area of increasing significance within an ageing population. Researchers from Keele University and University College London aimed to help improve understanding of drinking in later life and to inform possible interventions and guidelines.

The report’s introduction states:

Older people tend to drink less than any other age group. However, in recent years British survey data on alcohol consumption has shown that while younger age groups have experienced a decline in the quantity and frequency of consumption, drinking behaviours among the elderly have not declined in the same way… Yet relatively little is known about the (a) diversity of patterns of drinking in later life; (b) how drinking is associated with key socio-demographic characteristics and health conditions; (c) and how drinking changes over time and which life course events, such as retirement and partnership change, might influence this process.

Main findings include:

  • Older men tend to drink more and to drink more often than women.
  • For both men and women, those in higher income groups and with higher levels of education drink more and drink more frequently.
  • Both the amount that older people drink and how often they drink declines over time, though the rate of decline in quantity and frequency varies according to health and partnership status.
  • Men who are not in a partnership drink more compared to men with a partner, though there is no difference in the frequency of men’s drinking by partnership status. For women loss of a partner is associated with a faster decline in weekly alcohol consumption and with drinking less often.
  • Poorer self-rated health is associated with not drinking. Among drinkers, there is no evidence that a moderate amount of alcohol consumption improves health in later life compared to heavy drinking.
  • Over time older people with poor health and deteriorating health report a steeper decline in the quantity and frequency of alcohol consumed. This finding suggests that older people moderate their drinking in response to health events.
  • Those who stopped drinking at the start of the period of observation and remained in the study were more likely to experience an improvement in health compared to drinkers.

Older people drinking (graphic representation of statistics)

This report coincides with a new initiative being launched in the UK with flagship work taking place in Glasgow, Sheffield, Devon, South Wales and Northern Ireland.  This is to help tackle the issue of drinking in later life and the Big Lottery Fund is investing £25 million into this alcohol-related harm prevention and awareness programme for the over fifties, called ‘Drink Wise, Age Well’, in partnership with support charity Addaction.  Read more here: £25M to help over-fifties enjoy booze without the blues.

Edited to add: further news stories last week about alcohol and the over 60’s can be read here too:

And here:

Liver disease: a preventable killer of young adults

Reblogged from the Public Health Matters, the blog of Public Health England and written by Julia Verne.

Liver disease has changed over the years but my commitment to reducing deaths hasn’t.

I’ve had a fascination and passion for treating and preventing it since I was a medical student, training at the Royal Free School of Medicine under Dame Professor Sheila Sherlock who was the founder of liver disease as a speciality.

As a junior doctor I worked on both medical and surgical liver units, assisting in the first transplant conducted at the Royal Free when liver transplantation in the UK was in its infancy.

I vividly remember the terrible suffering of patients with end stage liver disease, coming in as an emergency, vomiting vast quantities of blood from oesophageal varices or with huge pregnant looking bellies distended with ascites which had to be drained. Patients were restricted to drinking very small quantities of water and eating virtually no salt. Others suffered psychoses or coma and then multiple organ failure resulting from their end stage liver disease.

In those days we didn’t wear gloves because we didn’t want to upset patients and make them feel untouchable. Hepatitis C had not yet been discovered and our options were very limited.

Since then, we know about Hepatitis C, Hepatitis B can be subtyped there are new treatments for both. There are 600-700 transplants per year and liver disease has gone from being a rare disease to one seen frequently in every hospital and general practice.

But though treatments have improved we have to tackle the increase in disease which is mainly preventable. There are also large inequalities in liver disease – it is a no brainer that as a Public Health Physician, I see that we should be making a concerted effort to reverse these trends.

Here are some hard facts:

  • Liver disease is the only major cause of mortality and morbidity which is on the increase in England, whilst it is decreasing among our European neighbours
  • Over a decade the number of people dying with an underlying cause of liver disease in England rose by 40% from 7,841 to 10,948
  • Most liver disease deaths are from cirrhosis (a hardening and scarring of the liver) or its complications – people die from liver disease at a young age with 90% under 70 years old and more than 1 in 10 in their 40s
  • Liver disease is the third biggest cause of premature mortality and lost working life behind ischaemic heart disease and self-harm
  • Most liver disease is preventable – only about 5% of deaths are attributable to autoimmune and genetic disorders – over 90% are due to three main risk factors: alcohol, viral hepatitis and obesity
  • It’s a disease of inequalities. Mortality rates from liver disease in people aged 75 years and under varied significantly by Primary Care Trust. People who live in the most deprived fifth of areas in England are more likely to die from liver disease than those who die in the most affluent fifth.
  • Liver disease, and death from it, is associated with stigma mainly because of the risk factors. This sometimes makes it hard for the patients to access care and hard for the families especially in bereavement
  • 70% of patients with liver disease die in hospital and while one in five of those who die have had five or more admissions to hospital  in the last year of life one in five are admitted only once and die in that first admission and 4% die in A&E without getting admitted to hospital. This reflects the often dramatic complications accompanying death from liver disease

With these statistics in mind it’s unsurprising that liver disease has received a high profile over the past few years. In 2014, The Chief Medical Officer devoted a chapter to liver disease recommending a need for preventative measures involving a combination of public health policy initiatives and increased awareness of liver health and the risk factors for liver disease among the public.

The All Party Parliamentary Hepatology Group Inquiry into Improving Outcomes in Liver Disease produced their report ‘Liver Disease: today’s complacency, tomorrow’s Catastrophe’, earlier this year. The Lancet also launched a commission on Liver Disease which will publish its findings and recommendations this autumn.

Following a meeting between the chairs of the APPG, liver charities and PHE, independently it was agreed that PHE would produce a framework outlining its scope of activities to tackle liver disease. I am leading the co-ordination of this framework which will involve input from colleagues across all PHE departments and directorates, as well as input from the liver charities and Directors of Public Health in local authorities. PHE has extensive programmes of work to tackle all three major risk factors; alcohol, viral hepatitis and obesity.

On the 16th October, PHE will publish Liver Disease Profiles for local authorities in England. These will support the work of Health and Wellbeing Boards and Joint Strategic Health Needs Assessments by providing vital information about liver disease prevalence in their areas.

The challenge will be significant. Liver disease develops silently and obvious signs and symptoms may only appear when changes are irreversible, therefore the identification of people with risk factors for liver disease in primary care is a critical first step in the pathway.

Many patients come from marginalised groups with unstable accommodation, many don’t speak English and many may have difficulty attending or sticking to treatment because of addiction to alcohol and or drugs.

These liver disease profiles did not disappoint in terms of painting a stark picture and I discussed them here. It is not what people say but what they do that is important so let’s see action that matches the words ….


Alcohol Marketing to Children

Following up on the post on the Drinkwise Campaign Launch report discussed before here the section on marketing to children was particularly worrying in terms of statistics.
There is a link between advertising and the amount that young people under-18 drink:
  • Alcohol advertising increases the likelihood that young people will start to consume alcohol
  • If young people already drink, alcohol adverts increase the likelihood they will drink more
  • 96% of 13-year-olds have encountered alcohol advertising in more than five different media
  • 0-15-year-olds view more alcohol adverts on TV than adults aged over 25

And where do they see this marketing?  These statistics taken from a piece of work done looking at awareness of UK 13 year old’s of alcohol marketing showed:

  • 60% special price offers
  • 53% billboard or posters
  • 55% in-store promotions
  • 77% on TV adverts
  • 66% branded clothing other items
  • 61% sponsorship of sports or teams
  • 34% sponsorship of music events/venues
  • 24% mobile logos or screensavers
  • 12% web pages or pop-ups
The industry has switched the focus of its estimated £800 million per annum marketing war chest to focus predominantly on digital marketing. As this is a form of communication heavily used by young people, this is a very worrying development. 67% of 12-15-year-olds have a social media profile and the voluntary safeguards that industry have put in place for television, radio and print advertising are virtually non-existent in the digital world.
“Whether deliberate or not, our results show that children are not protected from online marketing of alcohol”
Professor Theresa Marteau, University of Cambridge


Liver disease profiles highlight the role of alcohol

New liver disease profiles released by Public Health England and covered in a report by Alcohol Policy UK highlights that liver deaths in England increased 40% between 2001 and 2012.

A picture paints a 1000 words as the old adage goes:

liver disease mortality

Alcohol specifically accounts for 37% of all liver disease deaths, although over 90% are due to one of the three main risk factors: alcohol, viral hepatitis and obesity. One in ten people who die in their forties die of liver disease, whilst 90% of people who die from liver disease are under 70 years old.  See reports in the Telegraph, Guardian, and BBC for more about alcohol-related liver disease (ARLD)

In 2009 the Department of Health said it would deliver a National Liver Strategy to combat the rise of liver disease. By 2012, more reports indicated it was soon coming, but never appeared.

Why is that?  It is clear from the above graph that this is a health priority in terms of morbidity and mortality.  Plus campaigns have been launched for all of the other areas highlighted and they are all dropping which suggests that it is a successful strategy.  Even if it was launched looking at reducing deaths from obesity as the leading issue  it leaves me scratching my head as to why this hasn’t happened yet.   Obesity is recognised as a major public health issue in it’s own right and as I said in a previous post I wonder how much of the obesity epidemic is created by alcohol consumption not just food over-consumption?

Why is the Department of Health looking the other way on this issue?  Is it because real longer term outcomes would also depend on action on price, availability and marketing of alcohol and junk food and that is where the conflict of interest lies with our govt?  It would involve reigning in the vested interests of corporations that fund the govt through lobbying and donations and impact on their profitability.  Are the financial interests of the corporations being put before the best interests of the health of our nation?  I have to conclude that the answer is yes.  What do you think?