Category Archives: Alcohol research findings and media coverage

MDMA used in world’s first trials to treat alcohol addiction

This was a news piece in The Independent in July looking at MDMA being used in trials to treat alcohol addiction.

In a world first, scientists in Bristol are using the psychoactive drug MDMA as part of a treatment programme for addicts and alcoholics.

The study was created by a research team at Imperial College London, and involves giving doses of MDMA – known by the street names Molly or ecstasy – to help patients battling addiction. They claim this could be more effective than conventional methods. Those on the trial will also be put on a course of psychotherapy.

“We know that MDMA works really well in helping people who have suffered trauma and it helps to build empathy,” said Ben Sessa, a clinical psychiatrist on the trial and senior research fellow at Imperial College London.

On his website, Sessa stated: “3,4-methylenedioxymethamphetamine is a remarkable substance. Forget what you know about the popular use of this compound in the context of the recreational drug ecstasy.

“MDMA is a medical drug that started its life in the clinical setting. It has a unique receptor profile that makes this drug, when combined in a supervised clinical setting with experienced psychotherapists, the perfect tool to enhance trauma-focused psychotherapy.”

Participants on the trial are all heavy consumers of alcohol, typically drinking about five bottles of wine per day. They were chosen through the alcohol services in Bristol and have undergone repeated treatments for alcoholism.

After going through a detox period, those on the trial receive two therapy sessions, followed by a day where they receive a capsule of high-dose MDMA.

The drug has shown promise in treating those with post-traumatic stress disorder (PTSD). At the Psychedelic Science 2017 conference in Oakland, researchers showed that after more than one year after two or three sessions of MDMA-assisted therapy, about 67 per cent of participants no longer had the condition.

However, experts warn that recreational use of the drug can cause harm. “I’ve seen people in my practice who took MDMA at a party and weren’t prepared for the memories that came up, and it was really harmful for them,” Michael Mithoefer, a psychiatrist and a principle investigator in the MDMA trials said in a Nature report.

Alcohol-related deaths have increased by 13 per cent over ten years, according to the report Statistics on Alcohol: England, 2016.

I will be greatly interested in reading the research papers following this trial to see what the outcomes were from this experimental process.

Alcoholism continues long after you stop drinking: my 15 years sober

This exceptional piece of writing comes courtesy of Tanya Gold featured in The Guardian earlier this year.  Beautiful writing about alcoholism and how for many of us it is but the symptom of much deeper issues.

It is easy to get morphine in University College hospital, London, if you are a good liar. It hurts, you tell the midwife, although you can’t feel anything, being so high on morphine already that someone could hit you with a sledgehammer and you would only laugh: what else you got? It was close to midnight on 13 August 2013, and I was on medical-grade opiates; nothing else can make you forget you are about to give birth. Eleven years without alcohol or drugs, and I fell, complete, into the waiting groove. I loved it. I was having a party in the high-risk maternity ward and they didn’t even know it. I lay back on my pillow and gurned with joy: oh, Morpheus, god of dreams.

When the morphine ran out, I had a baby. He was very small and handsome, and he was an imposition. I could say I was frightened, but that would be self-serving. It is possible, even likely, that I was afraid. I was definitely high.

I stared at him and thought: I am more vulnerable than you, even if you are a baby. Then I told the midwife: my husband is trying to kill me. My evidence was that he had brought me a tin of biscuits. This, then, was the comedown, and I was at the bottom of the curve. I must have said that the baby was not important to me, because my husband became angry and I became angry, and I told him I hated him and had never loved him. I considered walking out into the traffic, or throwing myself under a train, and that was our baby’s first night on Earth. We went home and I locked myself in my bedroom, without the baby, and looked at photographs of him on Facebook, and ate a ham.

Strange things can bring you to a crisis, like realising that you cannot read Dickens out of jealousy. Or more obvious ones, like thinking: the baby should live with my sister, she will do this better than me. Or, when he was two months old: when is he going to university? In my history of alcoholism, I have been at my most healthy when I knew that I was ill. If you remind yourself that you are ill, you can do better. Now, in my son’s room, wishing his childhood away because I did not know how to care for him, I knew I was ill. I was not drinking or using drugs, but I was as lonely and frightened as I had ever been. I was back where I had started.

***

Alcoholism is a strange condition. If you survive the drinking stage, and many don’t, it has relatively little to do with alcohol, which is merely the drug with which the alcoholic treats herself. It is, rather, a way of thinking, and continues long after you have stopped drinking. It is a voice in the head: a malevolent voice that wants you to die. I certainly see it that way: it makes it easier to pick my way through the days if I know what, exactly, I am dealing with. Is this the voice speaking, or not? Which one made a decision, and which one doubted it? To discover the true root of any plan can require forensic vigour, and much time. It is perpetual inner warfare.

The party in the maternity ward aside, I have not taken drugs or alcohol for 15 years. You might think I would be better by now, but for the alcoholic there is nothing as prosaic as “better”. There is only a daily remission, based on how you deal with the voice in your head. (“Hello, monster. Where have you been?”)

One morning in early 2002, at perhaps 5am, which is, as all addicts know, when the night breaks, leaving you with mashed lips and mad eyes, I stood in front of the mirror in my mother’s house. I had been drinking alcoholically – that is, without stopping – for almost nine years, and I was very near the end. I pointed at myself – I remember myself as a very attractive drunk, red-lipped and irresistible, but this is the voice again, for I was nothing of the sort – and I said, very clearly, “I hate you and I wish you would die.” I knew then what the voice in my head wanted, and how powerful it was. It made a mistake by being honest and, because it made a mistake, I lived.

I could no longer blame circumstances or others; I would have to do something about it myself. It is frightening, seeing yourself wish death on yourself in a mirror, and – because you are full of cocaine, as well as alcohol – being able to remember it. Alcohol shrouds itself in blackout, and you wake to a queasy blank; but cocaine is very bright, and pointed – it is almost telescopic. I was frightened enough to attempt one year without alcohol.

I was prepared to be conscious (I loved the WH Auden line “But who can live for long/In an euphoric dream?”) but I was under the delusion I was a literary genius, even though the only job I could get at the time was as a freelance reporter for a now defunct Daily Mail showbusiness column called Wicked Whispers. Wicked Whispers was so awful that, occasionally, the subs forgot to put it in the paper and no one would notice. If the celebrities I stalked stared at me, and asked, kindly, about my pitiful excuse for a career, I was stunned. Looking askance at Gillian Anderson when she, clearly and without malice, pities you, is, for me, a definitive act of insanity.

I was too scared to drink alcohol, but I couldn’t do anything else about a condition I barely understood. I went to self-help groups in gloomy church annexes, which seemed as despairing – though less vivid – as what I had left behind, and heard people talk about “spiritual growth”. I missed my near-death, for it had not been boring. I did not know what they were talking about. I could not hear them. I said I was an alcoholic, because I supposed I must be, but I didn’t really know what it meant.

I did know I needed a new soul, the old one having broken, and I chose to build it with ink. I thought that I should be a famous journalist, so I stood outside the Daily Mail building and offered up a prayer, like Salieri: Lord, make me a great short-form showbusiness columnist, and then, if you think it right, Lord, may I progress to features. I got a job on the features desk, a job I called “Idiot Girl”. I was required to report in fancy dress – Saxon peasant, old woman – and I loved it. It was evidence of my survival: she mugs, she pratfalls, she lives! The voice was impressed, and temporarily silenced. (I believe everyone is a secret Daily Mail reader, even the voice.)

I built a career in journalism but I felt, always, that the person in print had nothing to do with me. She looked like me, but she was my ghost, and she was not reliable. I could never stop working, but I could never stay in any job; as soon as I arrived, I yearned to leave. I became marvellous at being fired and learned to soothe, and even thank, the person who was firing me, the better to start again at the beginning. It was a game I played with myself. I would procrastinate over my work to stoke the fear, but I was not lazy. I met a sensitive, clever man and married him, but I worked on my wedding day. I worked on my honeymoon. I worked in the labour ward, until I was offered the morphine. I was terrified of losing things and I would try to lose them so I could be, momentarily, at peace. My husband, at least, knew that, which is probably why I chose him. I am not a complete idiot.

I was, for a while, a columnist, but that was no good, either. To write a good column, I had to work myself into such a state of rage that the week was empty of anything else. I had a schedule of rage, which I followed dutifully; if I wrote on Wednesday, I would be numb on Thursday and would then stoke the rage over the weekend. On Monday, the rage would ebb, to be replaced by terror, which would reach a pitch on Tuesday night, after which I would write what seemed to me not sentences, but tiny, insistent stabs. That is not a job; it is a condition.

I was still at the mercy of the voice, but she had regressed to sludge. She manifested as a cloud of anxiety that travelled with me and occasionally mutated, helpfully, into dread, and then back to anxiety. I was a cartoon character with a personal cloud, Charlie Brown with a mood disorder.

Late summer in 2013, I was sitting in a self-help group. This one was surrounded by a very fine, old graveyard, like a metaphor, with many famous intellectuals in fabulous tombs; we sat calmly with the dead, as if we belonged there. The baby was at home in the cradle. I always said the same thing at this self-help group, and they were very patient with me. If I had published a good article in the previous 24 hours, I was happy because I existed in a form with which I was comfortable, and which other people could recognise and approve of. If not, I moped, and complained that I was not happy. I avoided self-help groups where they talked about their gratitude. I did not believe them.

I listened and thought about how much, then, I hated being an alcoholic. I mourned the lives I could have lived if I had not been cursed with this condition. I could have been an MEP! I could have been a chef! I wondered, in a broad way, what had happened, and what I could do. I became aware, quite suddenly in the quiet by the graveyard, of the constancy of the voice. I had waited, every day for 15 years, to wake up and find she had gone, and that was my error.

I knew then that she has always been there. When I was five, she told me my parents didn’t love me. I remember repeating, very insistently, to my parents that I knew they did not love me, because she had told me so. Evidence doesn’t matter to the voice; she kicks it away. She cherishes a passing piece of thoughtlessness, nurtures a harm. She lives in the small places beneath my conscious mind.

When I was 10, she said I was friendless at a noisy suburban school. When I was 12, and mooching about the dull streets of Kingston upon Thames, she said I was alone, and probably always would be. For the nine years of my active alcoholism, she told me to drink, first because it wouldn’t harm me – and what else was there? – and then because I couldn’t be saved.

She says only what she can get away with. She could never, for instance, convince me that my sister doesn’t love me; instead, she tormented me, when I was drinking, with the possibility that my sister might die. She wants so much to be believed, this voice, and is almost as pitiful as the other me, which is the one that is writing this story: the one that wants to live. I am quite aware how mad this sounds, but it is the truest narrative of my alcoholism that I can offer. Perhaps in 15 years I will have another one.

We coexist uneasily, today, the voice and I; she tells me to procrastinate over my work, to start fights, to give up. If I am unwary, she can plunge me into the deepest despair, and I have learned to construct an obstacle course to thwart her. It is made only of ordinary human love. Nothing else works.

My son helps me. His is three now, and knows what is important. “I must teach you to play, Mummy,” he says, and invites me, without irony, to pretend to be a monster. Then, of course, the voice whispers, “You have made him a parental child”: a creature who will care for me and not himself. I try to ignore her, because I cannot send her away. But I wonder now if it is she who is afraid, and not I.

As so many of the comments said too – thank you Tanya.

Moderate drinking: risk Vs reward?

A brilliant post by my friend Libby Ranzetta for Alcohol Policy UK written back in June about moderate drinking: risk vs reward.

Over to Lib:

A study recently published in the BMJ found that alcohol consumption, even at moderate levels, is associated with adverse brain outcomes. The research also found no support for a protective effect of light consumption on brain structure. The authors, from Oxford University and University College London, concluded:

These results support the recent reduction in alcohol guidance in the UK and question the current limits recommended in the US.

The research may be seen in the context of the much debated J-shaped curve suggesting potential health benefits of alcohol consumption at lower risk levels. Indeed another recent BMJ study found evidence to support the potential protective effects of moderate consumption on cardiovascular disease (CVD), addressing some of the previous question marks over the CVD protective effects research. However expert reactions highlighted several reasons why drinking should not be taken up by abstainers for any potential CVD benefits.

In producing the new UK ‘Low risk drinking guidelines‘ last year, the Chief Medical Officer’s (CMO) group considered the evidence that moderate drinking may reduce risks of death alongside ‘a large body of evidence’ demonstrating that these potential benefits are likely to be overestimated due to the limitations found in most studies of the long-term health consequences of alcohol consumption.

The group also factored in modelling by the University of Sheffield which included protective effects for some health conditions weighed against the alcohol-related risks of mortality from others. The conclusions were:

  1. Any benefit to cardiovascular health for moderate drinkers in the UK is largely cancelled out by their increased risk to health from other diseases, and
  2. Any remaining benefits to health from moderate drinking are small and uncertain. (See here for more details)

The Oxford/UCL study, which scanned for structural brain changes such as hippocampal atrophy, grey matter density, and white matter microstructure in the Whitehall II study cohort, has its limitations too of course, summarised in an NHS Choices explainer as:

  • The participants are all people who were civil servants in the 1980s and were mostly male and more middle class and higher IQ than the general population, meaning results might not be applicable to the UK as a whole.
  • The effect of hippocampal atrophy was found in men and not women which may be down to the lower sample size of women and that few of them drank heavily.
  • The information on alcohol intake was self-reported and therefore might be inaccurately reported by participants.
  • It is difficult to link brain structure with alcohol intake when it might have been down to other confounding factors such as intelligence, cognitive stimulation and other lifestyle factors.
  • The MRI scan only took place once, at the end of the study, so it is difficult to tell if and when any changes in brain structure took place and rule out other influencing factors.

No safe level?

Of course such studies do not intend to suggest that alcohol does not have potential social benefits, rather than the seek to answer the question of the possible health implications of moderate consumption – an issue that seems to generate substantial public and media interest. Back in January 2016 when the revised guidelines were announced, an article in the Telegraph covered a range of responses to the ‘Low risk drinking guidelines’, from health professionals discussing risks to critics of the guidelines calling nanny statism. We also published our own expert reactions on the revised guidelines and media reaction, also followed by an analysis of Twitter reactions.

This latest studies nudge the argument further along the current direction of travel regarding potential health risks and benefits: light drinking probably won’t make you healthier; potential CVD benefits need to be considered against other risks. A somewhat tricky message, but as Matt Field, Professor of Addiction at the University of Liverpool, put it in the Telegraph: 

Any amount of alcohol consumption carries some risk. However, it is important to bear in mind that most activities that people undertake on a daily basis – e.g. driving to work – carry some risk, and people need to make informed choices about the level of risk that they are prepared to accept.

In his APE: Alcohol and Epidemiology blog, John Holmes discusses the difficulties of turning research findings – which posit different levels of risk for different diseases – into simple health promotion messages that are ‘scientifically robust, sufficiently compelling and easily understood’.

He highlights a recent meta-analysis of cancer and alcohol research supports the judgement that ‘alcohol causes cancer of the oropharynx, larynx, oesophagus, liver, colon, rectum and breast’, although the risks are pretty small at low levels of drinking. However, as mentioned above, the CMO’s evidence review considers many other conditions, including ischaemic stroke, ischaemic heart disease and type II diabetes, which show U- and J-shaped relationships, indicating a beneficial effect of alcohol at some levels of consumption and a detrimental effect at others.

While addiction professors and epidemiologists may feel confident in making informed choices from the complex information available, the degree to which the wider public choose whether or not to take notice of the CMO’s headline messages on lower risk drinking will remain a hot topic.

Completely agree Lib!

Thursday Sober Inspiration: 4 years clean and sober! (Straight Sun)

As I celebrate 4 years clean and sober it has prompted renewed reflection. So much has happened between this time last year and now.  Much of it has not been as positive as we would have hoped but then sh*t happens whether you are sober or drinking.  Some of it has been stressful, emotionally overwhelming, and felt downright difficult and unfair but again such is life.  One thing is true through all of this though – at no point has the thought of drinking crossed my mind as a good idea.

So when I wrote last years 3 year soberversary post I hoped that we would now be living in Australia and that isn’t so.  Our plans took a turn for the worse at the end of June when the Australian govt announced that they were reducing the age cap on the permanent residency skilled migrant visa from 50 to 45 effective 1st July.  As I’m 48 that was pretty much the end of the road to our emigration plans.  We may get the opportunity to go over on a temporary work visa for 4 years but it’s highly likely we’d have to return after that. The odds aren’t looking good so we’ve accepted as a family this is most likely the end of the living there dream but we  can still go back on holidays to visit our family whenever we wish.

I hoped that I would have been able to successfully publish my Cambridge research and that isn’t so either.  It is however my writing and so I can publish it here if I so wish, and I do.  So here is my research paper written last year for the University of Cambridge Postgraduate Diploma in Education Studies (Counselling).  This isn’t a true academic piece of writing because it is written in the first person rather than the third.  It uses much of my lived experience (phenomenological approach) so is a mix of qualitative and quantitative research.  That is partly why it isn’t suitable for academic publishing without a great deal of rewriting.  What I would ask is that you are respectful to the personal content contained within it.

What is the link between insecure attachment, alexithymia & addiction

If I had to write a time-frame of what this journey has been like to date I would say this:

  • Year 1 was about escaping the physical & psychological pull of drinking & getting through all the social triggers or big sober milestones (week-ends, weddings, parties, Bank Holidays, birthdays, Xmas & New Year, holidays, seasons).
  • Year 2 was about living sober – having made it through the milestones this year can be harder than the first because it is now ‘normal’ to be a non-drinker rather than a drinker in these social situations.  As Mary Karr writes in Lit: “If you live in the dark a long time and then the sun comes out, you do not cross into it whistling.  There’s an initial uprush of relief at first, then – for me, anyway – a profound dislocation.  My old assumptions about how the world works are buried, yet my new one’s aren’t yet operational.”  Sums it up beautifully 🙂
  • Year 3 was where I started to process the emotional sobriety elements of living in recovery.  It was too soon to start deep diving in to the issues but I started to tentatively explore the work that needed to be done later and build my emotional resilience in preparation.
  • Year 4 has been the mother-load of emotional recovery work for me.  Now I’ve felt emotionally robust enough to deep dive on some of the underlying reasons why I drank and to be resilient enough to sit with those feelings and it not trigger an emotional relapse that is then a risk for a full relapse.  And again in the words of Mary Karr from Lit: “A lot of therapy is looking through a child’s eyes, she says.  This is looking through an adult’s”  Again, absolutely bang on!

This is only my experience of sobriety though and we are all very different in how we experience both drinking and recovery.  Melody Beattie in her book: Beyond Codependency describes the stages of recovery as expressed by Timmen Cermak as: survival/denial -> reidentification -> core issues -> reintegration -> genesis (which beautifully mirrors my years 1-4 so far!).  She goes on to say: “This is the recovery process.  It’s a fluid process, with carryovers and crossovers at different stages.  There isn’t a fixed time frame for moving through these stages ….. Recovery is a healing and a spiritual process.  We travel from self-neglect into self-responsibility, self care and self love.  I’ve learned that self-care isn’t narcissistic or indulgent.  Self care is the one thing I can do that most helps me and others too.

And of the genesis stage which is where I now consider myself:

This isn’t the end.  It’s a new beginning.  We’re no longer carrying around our “imprisoned” selves.  Nor are we indulging in all our whims and desires.  Discipline has found its place in our lives too.  Like butterflies broken loose from a cocoon, our selves are “flying free” …  We’ve found a new way of life – one that works.

I would not have changed any of it and remain certain that my decision to stop was one of the best of my lifetime so far.  My life would have been poorer were it not for the friendships and connections I have made out here on the inter-webs because of that single decision to put down my last drink on the 20th September 2013.

Although drink holds no appeal right now I am under no illusion that like Smaug in Lord of the Rings my addiction is like a sleeping dragon that one drink could awaken.  Because as Tolkien wrote Smaug is “a most specially greedy, strong and wicked wyrm”.  I remain alert and resolute heartened by the knowledge that as I head on towards 5 years sober this time next year, the risk of relapse drops to around 15%.

And to end this post?  The only way I know how to celebrate – with a tune!  Orbital ‘Straight Sun’ and some fantastic timeframe video of the UK 🙂

Tighten alcohol availability to reduce alcohol-related harms

Following last weeks blog post about alcohol availability this feels like the perfect follow on.  As reported by Alcohol Policy UK in June IAS in the UK & FARE in Australia released this report looking at tightening alcohol availability to reduce alcohol-related harms.

A new report has called for tighter restrictions on alcohol availability to help address alcohol-related harms, including pressures on emergency departments, hospitals and the police.

The report Anytime, Anyplace, Anywhere? [pdf] reviews fourteen alcohol licensing policies in Australia and the UK rating them for their effectiveness in reducing harm. It follows recent research identifying the extent of alcohol availability in England, and a recent call from the Lords Licensing Review Committee for a fundamental overhaul of the Act.

Produced jointly by the the UK Institute of Alcohol Studies (IAS) and the Foundation for Alcohol Research and Education (FARE) in Australia, the report makes ten recommendations for reducing alcohol-related harms through existing licensing policy frameworks including:

  • Restricting trade hours of on-licence venues to limit the availability of alcohol in the early hours of the morning
  • Enhancing community involvement, better facilitating the engagement of local residents with licensing systems
  • Adding / prioritising public health and / or harm minimisation objectives in alcohol legislation
  • Restricting the sales of high risk products in areas of concern; and
  • Deprioritising government support for industry voluntary schemes in place of policies supported by evidence.

In the document’s foreword, Professor Robin Room states:

“The availability of alcohol is a crucial element in what happens with consumption trends and with rates of alcohol-related harm. Public policy needs to prioritise evidence-based controls on the availability of alcohol to reduce rates of harm.”

Ahead of the launch of the report, Kypros Kypri, Professor of Public Health at University of Newcastle, Australia said:

“There is strong evidence to show that earlier closing times can make a significant difference to the strain alcohol places on emergency services. In Sydney, bringing forward closing times to 3am was associated with a 25% reduction in alcohol-related presentations to the local hospital.”

UK policy calls – falling on deaf ears?

In 2016 the IAS released an extensive report on the 2003 Licensing Act, which said the interests of the licensed trade have benefited over those of local communities. Despite mounting calls to review licensing legislation in England, including from the subsequent Lord’s licensing committee, there appears no intention to fundamentally change national policy – perhaps not surprising within the immediate political climate.

Currently national policy may be best inferred from the 2016 modern crime prevention strategy which sets out three main alcohol-related crime and disorder objectives, including a pledge on ‘equipping the police and local authorities with the right powers’. Critics of the current Act though have also argued that enforcement powers are not fully utilised, possibly reflected by the falling number of premises being called for review. In addition the crime strategy emphasises building local partnerships through industry led schemes – an approach the latest IAS & FARE report calls to be replaced by those supported by firmer evidence. Indeed questions have been raised over the lack of evidence to support the impact of voluntary partnerships schemes, notably ‘Community Alcohol Partnerships’ (CAPs). In contrast, Cumulative Impact Policies do find overall favour in the latest report, albeit with some limitations.

Read the full report here

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)