Another great post from Alcohol Policy UK regarding the Govt’s 2017 Drug Strategy released in July.
The last national alcohol strategy was released in 2012 promising MUP, followed by an infamous U-turn. MUP has of course still yet to be implemented in Scotland, though a final legal ruling is expected this month following a drawn out legal challenge, with Ireland and Wales also committed.
MUP aside, alcohol objectives feature across several other policy domains, including as part of a Modern Crime Prevention Strategy, various PHE guidance and a national CQUIN incentivising brief intervention delivery across hospitals.
The new drugs strategy though refers to drugs and alcohol throughout, thus in the context of treatment for alcohol problems it may be seen as reflecting national alcohol ambitions for treating and preventing all substance dependence. Indeed a section on alcohol states:
While the focus of this Strategy is on drugs, we recognise the importance of joined-up action on alcohol and drugs, and many areas of the Strategy apply to both, particularly our resilience-based approach to preventing misuse and facilitating recovery. Alcohol treatment services should be commissioned to meet the ambitions set out in the Building Recovery chapter that are relevant to them, and in line with the relevant NICE Alcohol Clinical Guidelines. Commissioning of alcohol and drug treatment services should take place in an integrated way, while ensuring an appropriate focus on alcohol or drug specific interventions, locations, referral pathways and need.
In addition, local authority public health teams should take an integrated approach to reducing a range of alcohol related harm, through a combination of universal population level interventions and interventions targeting at risk groups. The Modern Crime Prevention Strategy 2016 highlights alcohol – as with drugs – as a key driver of crime and sets out a range of actions to tackle alcohol-driven crime.
The strategy though is not titled a ‘drug and alcohol strategy’, and some argue that there are many issues with providing alcohol treatment – or indeed strategies – under the same roof. Until April 2019 the ring-fenced but still shrinking Public Health Grant to local authorities will require local authorities to ‘have regard to the need to improve the take up of, and outcomes from, drug and alcohol services’, but not thereafter. The strategy also highlights the UK devolved administrations have ‘their own approaches to tackling drug and alcohol misuse and dependence in areas where responsibility is devolved’.
Where next for national alcohol policy?
Calls for a single national alcohol strategy seem logical, if not at least to make clear the Government’s ambitions across the wide range of areas where alcohol harm and policy can reach. As well as a national drug strategy, a new tobacco control strategy has also been released, further highlighting an apparent gap. From a political perspective however, a lesson from the 2012 alcohol strategy appears to be not to commit to ambitious policies with powerful opponents; at least not until the path is clearer. Indeed since the MUP U-turn, Ministers have said on MUP they would be waiting to see what happens in Scotland.
Other alcohol policy areas are seemingly in an ongoing state of political bargaining. Marketing and availability are hotly contested areas, with health groups calling for the adoption of key approaches including taxation and effective levers identified in the recent PHE evidence review. Translating such calls into action is of course complex and faced with opposing voices, as debates over licensing policy have recently demonstrated.
The drug strategy though has received some praise for highlighting the need for evidence based approaches to prevention and treatment, and the need for addressing multiple-needs and overlapping issues including mental health. Others have argued it as the ‘same old rhetoric’, particularly when treatment budgets are ever shrinking.
Last year a small drop in the number of people accessing alcohol treatment was seen, though unlikely to be linked to the downturn in overall consumption since 2004. Other alcohol trends present a complex picture yet overall alcohol-related hospital admissions are still rising. Regardless of the various trends, many consider the scale and reach of alcohol problems deserve a single national policy for England and Wales. Given that no alcohol strategy will be universally praised or indeed gain much in voter popularity, some may consider its absence suggests political expediency has come first.
I know I sound like a stuck record about MUP but it’s because I agree with those who keep proposing it!