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Issue 1 1999

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Duty-free budget

A cheer went up in the House of Commons when, choosing his words carefully, the Chancellor of the Exchequer, Gordon Brown, said that duty on alcohol would not be increased before the Millennium. It seems that the most important thing was not to mar in any way the booze-up planned for the end of the century. The joy expressed by Members of Parliament was regardless of party, as though the wider implications of alcohol tax policy took second place to thecontinuation of cheap drink in the many bars available in the Palace of Westminster.

Chancellors traditionally sip their favourite drink whilst delivering the budget speech. Gladstone preferred egg-nog, Churchill, brandy and soda, Ken Clarke, scotch. As befits a son of the manse, Brown favours mineral water. But there was nothing sober about his measures. The only alcoholic drinks to be subject to any increase are sparkling cider and low-strength sparkling wine - a totally insignificant section of the market. That measure was taken simply to avoid action in the European Court. The sparkling variety comprises 0.5 per cent of total cider sales. Duty on spirits was frozen last year as well (that on beer and wine increased by the rate of inflation on 1st January) and so, of course, they are becoming cheaper as time goes by.

Whilst alcohol escaped extra taxation, tobacco was subject to swingeing increases - 17.5 pence on a packet of cigarettes and 7.5 pence on a pack of 5 small cigars. At the same time the Chancellor promised action against tobacco smuggling, which is said to cost the Treasury £1.5 billion in lost excise duty every year, but was not specific about what this action would be. A spokesman for the Tobacco Manufacturers' Association said: "The Chancellor's misguided cigarette tax policy is simply flushing billions of pounds down the drain. He says he is alarmed at the state of the tobacco smuggling problem but he chooses to ignore the only sensible option to combat it, namely cutting Britain's ludicrously high tobacco tax." At the Dispatch Box, Gordon Brown acknowledged this argument implicitly but said that he could not allow any loss in revenue to undo a policy in place for "good and urgent health reasons."

In a statement on the budget, the Institute of Alcohol Studies said: "The Chancellor's decision to freeze excise duties on alcohol while raising them on tobacco is an exercise in political cynicism. If the problem of smuggling is not to be allowed to undo health policy on tobacco, as the Chancellor asserted, then why is it to be allowed to undermine health policy on alcohol? The argument is exactly the same.

"This is further evidence that the Government has been 'nobbled' by the alcohol industry. The Chancellor's decision, along with other Government proposals bodes ill for the national strategy to reduce alcohol misuse that it is supposed to be drawing up. While having little, if any, effect on smuggling, Gordon Brown's decision indicates that the Government has no serious intention of tackling alcohol misuse. Indeed, it seems set on encouraging it."

The drink industry, by and large, welcomed the budget. The Brewers and Licensed Retailers Association said: "A freeze is very welcome as far as it goes, but as long as the duty differentials between the UK and France remain so high, jobs will go, pubs will close and crime will increase." Presumably, the reference to crime concerns smuggling rather than the violence and disorder increasingly associated with alcohol. Quentin Rappaport of the Wine and Spirits Association was happy with the freeze: "We are particularly pleased that he mentioned that he did not want to spoil the Millennium party."

The Scotch Whisky Association was more churlish. A spokesman said that its members were disappointed not to see taxes on their product cut in order to help reverse falling UK sales. "We are very disappointed because the Chancellor has ignored the problems we are facing," he said. "The Chancellor made a start in reversing the trend last year by freezing tax and we were hopeful there would be a cut this year. Unfortunately, the situation has remained the same,and the cause of the industry's decline - cross-border shopping - has not been tackled." The Association were hoping for a cut of 26p on a bottle.

Any reasons for the freeze on alcohol duty are a matter of surmise since the Chancellor declined to give any, other than the implied disinclination to do anything to temper the millennium booze-up. It may be, in an inexplicable contrast to his action on tobacco, that he hopes to stem the tide of alcoholic drink being brought in from France. If so, the difference in prices on either side of the Channel remain sufficient to make smuggling well worth while. The Government's anxiety not to take any action which might be electorally disadvantageous is another possible explanation for freezing alcohol duties. This is particularly the case in Scotland, where any increase in the duty on whisky would have resulted in scares about exports and unemployment playing into the hands of the SNP which is running neck and neck with the Labour Party as the election to the Scottish parliament approach. "It is a pity, to put it mildly," the IAS said, "that a coherent public health policy is to be sacrificed to these short term interests. How can there be any effective national alcohol strategy when excise policy works in the opposite direction?"

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IAS and Home Office Millennium claim

The Home Office's plans for a mammoth millennium booze-up have been challenged by the Institute of Alcohol Studies. (IAS)

The intention is to allow for 36 hours drinking as the world marks the passing of 2,000 years of the Christian Era and to establish this as the practice on every subsequent New Year's Eve. In its submission to the Home Office, the IAS states that it has no basic objection to extended drinking hours on the eve of the Millennium and subsequent New Year's Eves, "provided civic disruption can be avoided and public services maintained."

The IAS is challenging the Home Secretary, Jack Straw, and the Secretary of State for Health, Frank Dobson, to provide assurances the proposals will not put undue strain on public services.

As they stand, says the IAS, the measures are against the public interest.

The document forcibly points out that "no convincing case has been made out for the present proposals, and that it is unwise to impose all night extensions of drinking hours on local communities." The IAS also argues that the system of restriction orders proposed will prove to be inadequate.

As we reported in (Alert Number 3, 1998), the Home Office's Consultation Paper states that every New Year's Eve tens of thousands of licensees seek extensions to permitted hours, and that for the eve of the new Millennium the expectation is that virtually all licensed outlets will apply for extended hours. The Consultation Paper claims that processing such a large number of applications would place a huge burden on the courts and the police as well as on the licensed trade. In reply to the Home Office, the IAS refutes both of these claims. Firstly, the picture of magistrates' courts brought to a standstill by an avalanche of applications is a false one since "licensing committees can decide policy on late night extensions for Christmas and New Year at the annual licensing meeting. There is nothing to stop them granting all night relaxations if they consider them appropriate. It is true that individual applications for extensions must be made, but we understand that where these conform to an already agreed general policy, processing them is a formality which does not amount to an undue burden... Any burden on the licensed trade is presumably small compared with the benefits of being granted extended hours."

The IAS submission says that "the reasons for the measure given [by the Home Office] are clearly bogus." It argues that the Government's real intention is to deny local licensing committees the discretion to grant all night relaxations. This is no doubt because some committees may not consider them desirable. The IAS calls on the Government to be honest about its apparent wish to deny discretion to licensing committees.

The submission highlights the irony that "it is by no means certain that virtually all licensed outlets will seek all night extensions for Millennium Eve." Some large brewers and other retailers, citing 'crippling staff costs and the threat of damage and violence posed by drunken revellers', have already stated that they may well keep their premises closed on 31st December/1st January, while other premises will close before midnight. If a significant proportion of licensed premises do not open on Millennium Eve, there will be extra pressures on those that do with additional problems on the streets. "It even more important," says the IAS, " that through licensing committees, local communities retain control of the situation."

Moving on to the problem of public order, the IAS argues that "contrary to the mythology presently being constructed by the media, vested interests, and some politicians" there is plenty of evidence that extended or de-regulated night-time drinking hours have inherent dangers. They "tend to increase crime, disorder, and related problems...These problems can be considerably more serious than the 'noise and nuisance' referred to in the Consultation paper." Experience in Scotland, New Zealand, and Perth, Western Australia, supports this view. It was the increasing incidence of social disturbance in Scotland, following de facto de-regulation of closing times, that prompted the Scottish Office to demand better control of extended drinking hours in the late 1980s.

The Institute emphatically states that "no grounds whatever are provided for believing that previous experience in the UK and elsewhere will not be repeated, and that 36 hours continuous drinking hours will not have adverse effects."

The Home Office Consultation Paper ignores the likely impact of extended drinking hours on public services other than passing references to the police whose resources are going to be stretched to the limit on the Eve of the Millennium. Jack Straw himself has stated that "all the problems of policing a typical New Year's Eve are likely to be multiplied several times" and that "New Year's Eve 1999 will test police forces to the full". In this context, it is reported that the Millennium Eve overtime bill for the Metropolitan Police alone is expected to be £12 million. This, presumably, is hugely more than the financial savings derived from not having to deal individually with each application for extended drinking hours.

The same problems apply to the hospital service, especially accident and emergency (see Alert, Number 3, 1998). The burden of alcohol abuse on A & E departments is already large and disruptive in normal circumstances, especially at nights and at weekends. The NHS Executive is worried that any problems caused by the Millennium Bug will occur when the NHS is also struggling to cope with staff shortages and the unprecedented pressures and demand over the millennium celebration period.

The nearest the Consultation Paper gets to discussing these issues is in the proposal to provide a system of restriction orders. "Unfortunately," the IAS says, "the social ills against which restriction orders are seen as a protection are defined far too narrowly in terms of noise and disturbance to local residents...It is possible that restriction orders may help to prevent problems of that kind, but it is difficult to see how they would provide a solution to the broader problems of civic disruption, possibly involving thousands of people milling around town and city centres, including non-residential areas."

The tone of the Consultation Paper implies that the Government is convinced that its proposals will not result in additional disturbances on the streets or seriously ill people not being cared for properly in Accident and Emergency Departments because of drunken revellers putting undue strain on the system. The IAS calls on the Government "to publish the information, evidence, and advice on which it has arrived at these confident conclusions. In view of the possible impact on the health service, this should be done by means of statements by the Secretary of State for Health as well as the Home Secretary."

Even with such assurances, however, the IAS does "not believe that the proposed system of restriction orders will be adequate to control the potential problems...Helping to make proper arrangements for extended drinking hours on New Year's Eves should be one of the tasks of the local partnerships against crime...but which are ignored totally in the present proposals...NHS Health Trusts should be able to have their views taken into account by the licensing justices."

The Institute of Alcohol Studies' submission undermines some of the basic premises of the Home Office's proposals. Unless Jack Straw is able to provide the assurances sought, the Government needs to abandon the idea of its marathon binge to welcome the new Millennium.

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Young drinking more

You would be forgiven for under-standing official Government advice to mean that four units of alcohol a day will do you no harm, but, on the other hand, four units a day will damage your health.

The twenty-ninth edition of Social Trends - the annual publication of the Office for National Statistics - repeats this confusing advice on "sensible drinking" and confirms government policy when it briefly discusses alcohol consumption in the United Kingdom. "The current Department of Health advice on alcohol consumption is that drinking between three and four units a day for men and two to three units a day for women will not accrue significant health risks, but that consistently drinking four units or more a day (three units or more for women) is not advised because of the significant health risk."

The authors also say that "medical advice is that light to moderate drinking of alcohol is unlikely to damage health and may even provide a health benefit for certain groups. However, sustained consumption of alcohol at higher levels is thought to be associated with increased likelihood of social and health problems including high blood pressure, heart disease, cancer, and cirrhosis of the liver." It is significant, given the government's concentration on the medical effects of alcohol, that no example of social problems is given. As it is clear that alcohol-related social problems far outweigh in extent those associated with the drinker's own health, it is important for a publication like Social Trends to provide comprehensive data. One of the recommendations of the EUROCARE/COFACE report, Alcohol Problems in the Family, is that the collection of information about family alcohol problems should be improved and coordinated. Perhaps Her Majesty's Government will take the lead in this and for the Office for National Statistics begin the process in the next edition of Social Trends.

In the small section on alcohol, it is reported that young men and women are most likely to drink beyond the advised maximum level. "In 1996-97, 35 per cent of 16 to 24 year old men in the United Kingdom drank more than 21 units a week and 22 per cent of women of the same age drank more than 14 units of alcohol a week." The proportion of people consuming over these amounts has been growing. This is particularly so among women where the percentage drinking more than 14 units a week has increased from 9 to 14 between 1984 and 1996-97.

In the section on illicit drug, Social Trends tells us unsurprisingly that "young people are more likely to misuse drugs than older people." One area for concern is the finding that under a third of those aged between 16 and 54 who had used drugs in the previous month said they would like to stop using them completely and about 60 per cent said that they saw no need to stop at the moment.

Social Trends 29 (1999 edition) is available from The Publications Centre, PO Box 276, London, SW8 5DT (telephone 0171-873 9090, facsimile 0171 873 8200).

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High-as-a-kite

Air rage has been in the headlines over the last year after a series of high-profile incidents. It is becoming increasingly clear that the safety of the vast majority of passengers is being threatened by others who become violent, usually when drunk. Rob Enock, a former prop forward for his university, had to overpower a 31-year-old Scotsman who went berserk on a transatlantic flight and attempted to kick open an emergency exit. Although locking systems should make it impossible to open doors whilst in flight, the experience was extremely frightening to other passengers. "I thought we were going to die," said Enock. "Everyone on the 'plane was scared."

The case of the 12 members of the same family whose exuberance caused their Jamaica-bound Airtours flight to be diverted to Norfolk, Virginia, featured prominently on national television news and front pages for several days. An Airtours spokesman described the incident as "a mass mid-air brawl", although the Virginia 12, as journalists inevitably dubbed them after they were thrown off the flight in the USA, referred to "a good old Irish sing-song". Of course, there may be no essential difference between the two concepts.

Equally eye-catching was the "Full Monty" routine performed by two policemen, father and son, and their friend, the landlord of their local pub, on a flight from Florida to Manchester. At their recent trial, a witness said that the three men were passing a litre bottle of gin between them. Nonetheless, the cabin crew sold them eight gin and tonics, followed by a further four miniatures of gin and two of whisky. The in-flight film was the highly-successful "Full Monty", a scene from which brought the defendants' participation. Far more offensively, the men were abusive to two elderly female passengers and tried to intimidate them.

The cases go on and on, from the repellent behaviour of Ian Brown, former lead singer of the pop group The Stone Roses, who was gaoled for violently threatening an air hostess, to the drunk who punched a hole in an inner window. They all put considerable pressure on cabin crew, cause distress to other travellers, and often distract the pilots. It is not uncommon for the captain's authority to be required to restore calm. The common factor in all these cases is alcohol.

Whilst not minimising the problem, Superintendent Tim Burgess, whose is responsible for policing Manchester airport, points out that last year 17.5 million people took flights and only 50 were reported to police for drink rela-ted incidents. Nonetheless, it is not the quantity but the nature of incidents of air rage. There is no doubt that the number is increasing but the major worry is that one day a disaster will be caused. However unlikely this seems, it is not impossible and, given the potential for loss of life, has to be addressed. In the meantime, other passengers are abused and terrified and aircrew suffer threats and assaults.

One issue which airlines themselves need to look at very carefully is their policy with regard to serving alcohol. The "Full Monty" drunks had brought their own supply on board but were still served with what many would consider excessive quantities. It has been suggested that one cause of stress among passengers is the prohibition on smoking. Anxiety arising from nicotine deprivation is said to emerge as aggression, especially when fuelled by alcohol. Tightly-packed holiday flights, often with a high level of tension and many inexperienced travellers, some of whom have been drinking before take-off, seem particularly susceptible. The longer the journey, the greater is the likelihood of an incident.

Like othe airlines, Airtours offers plentiful supplies of alcohol.

Greater Manchester Police's Airport Subdivision and the relevant airlines have drawn up a Disruptive Passenger Protocol which sets out their respective responsibilities. This has arisen from the perceived need for a standardisation of response with police, airline, victim, and crew. The protocol outlines the procedure which should be followed by the airline in reporting any incident so that the police are able effectively to pursue any investigation and prosecute offenders. The fact that an incident might occur on the outbound leg of a flight is not necessarily a bar to prosecution, which is why West Sussex Police are investigating the case of the Virginia 12. In the prot-ocol, the Greater Manchester police undertake to co-ordinate all matters concerning any incident, including the often difficult financial implications, such as applying for witnesses expenses and compensation for the airline if divert and landing fees have been involved.

Significant as individual cases are in the accumulation of anecdotal evid-ence and important as are the measures being taken to deal with air rage, a dispassionate examination of its causes has been long needed. Professor Helen Muir and Professor John Moyle, of the College of Aeronautics at Cranfield University, are the authors of a paper written recently called Contributors to Disruptive Behaviour. In this they point out that in 1997 there were 109 reports of disruptive behaviour by passengers to the UK Civil Aviation Authority (as opposed to the 50 per year mentioned by Superintendent Burgess as coming to the notice of police) and that the general belief is that worldwide the number of incidents could be as great as 2,000. However, Professors Muir and Moyle say that we "currently have limited information not only about the frequency of disruptive behaviour, but about the extent to which various factors contribute to the behaviour." Nor is there any information as to which types of behaviour are associated with different groups of people. The authors make a link - logical enough - between the changes in society which have brought about higher levels of aggression and violence on the streets, on football terraces, in the school playground, with similar behaviour on aeroplanes. Similarly, changes in the nature of air travel are perceived as a factor in the spread of air rage. In the early days of civil aviation, flying was seen as a privilege and an adventure, accessible only to the rich, and as more dangerous than other means of transport. Relatively few people could be carried on each flight and these were treated on an individual basis by members of the crew. However, nowadays air travel is available to most members of society, often at cheap prices. There is high density seating and passengers are treated as a whole, eating, drinking, even sleeping as suits the airline operatives.

Muir and Moyle identify "Individual and Pre-flight Factors", including a variety of causes of stress, such as general "life stressors" and the more directly pertinent fear of flying. For many travellers there is immediate stress involved in the very act of catching an aeroplane: the journey to the airport and concern about being on time and the often acute tension arising from delays. They add that "one of the methods some people adopt in an attempt to offset the effect of this stress is to consume alcohol." At the same time the disruption to normal routines associated with flying may lead to lack of sleep and missed meals. The combination of lack of food and alcohol "is almost certain to affect mood and behaviour."

There are, according to Contributors to Disruptive Behaviour, many stress inducing elements in the environment of an aircraft's cabin. Professors Muir and Moyle's list include the following: hypoxia (oxygen deficiency); alcohol; raised carbon dioxide level; noise; crowding; company; catering; 3D motion; and fear.

The combination of a number of these stressors may provide a powerful impulse towards air rage. "In particular the effects of alcohol intake and the mild hypoxia caused by the cruise cabin altitude are likely to potentiate each other as they produce similar symptoms" including aggression, confusion, poor judgement, loss of inhibitions, no insight, and delayed reaction time. "Cruise cabin altitude produces a mild hypoxic state which is perfectly tolerable in the healthy, sober, non-smoking adult but the ability of the blood to transport oxygen is diminished by poor health or high alcohol intake or the carboxyhaemoglobin induced by tobacco smoking." An added problem is that, in the interests of fuel economy, carbon dioxide levels in the cabin are often allowed to rise.

Muir and Moyle conclude by stressing the importance of a systematic investigation of "the influence of alcohol and stress on mood in conditions of oxygen and carbon dioxide concentration." They have therefore set up an experimental programme in which members of the public coming to the test site in groups "to take part in a task for the duration of a typical flight, which will have the potential to cause some of them to become annoyed and even angry." The quantities of alcohol administered will vary from group to group and on some occasions the simulated environment will be that of conditions at sea level altitude.

It is hoped that the results of this experiment will help determine the environment which is least likely to encourage air rage. Beyond doubt, the factor which most engenders disruptive behaviour is alcohol. If this is to be combated then the airlines and airport authorities need to examine their policy of giving alcohol to their customers and, indeed, the criteria by which they prevent people actually joining a flight. The airlines, of course, are concerned at any threat to profits, as the current dispute over the abolition of duty free within the European Union indicates, but will have to consider a ban on the consumption of alcohol during flights.That such a ban would diminish the enjoyment of the majority of passengers hardly compares to the potential danger of the present situation and the unpleasantness of being in an aeroplane with the likes of the Full Monty policemen or the Virginia 12.

If drunken passengers are, on the whole, an extreme irritation, then pilots who have consumed alcohol inappropriately are potential causes of disaster. In February, a written question from Conservative MP Andrew Rowe to Glenda Jackson, the transport minister with responsibility for civil aviation, asked what plans there were to change the regulations governing the flying of civil aircraft while under the influence of drink or drugs. The minister, after pointing out that it is currently an offence for any person to act as a member of an aircraft's crew while under the influence of drink or drug, conceded that "there is no power for the police to require samples from someone suspected of committing an offence. While there is no evidence to suggest that alcohol or drugs abuse by aircraft crew is a problem, it is our long-term intention to introduce legislation to set an alcohol limit for aircraft crew and to give the Police the power to require suspected offenders to provide samples for testing." Miss Jackson did not disclose how long "long-term" might be nor whence she obtained the information that there is no evidence that alcohol and drugs were a problem among air crew.

As long ago as 1993 the journal Aviation, Space, and Environmental Medicine published a paper "Alcoholism and treatment in airline aviators". This was based on the study of one American airline but there is no reason to suppose that their experience is unique. Between 1973 and 1989 nearly 200 United Airlines pilots were advised to seek help for problem drinking through a programme organised by the Company. 87 per cent of these returned to flight duties after treatment. The number of pilots who sought treatment outside the company's programme is unknown. The authors of the paper suggest that, whilst the the prevalence of problem drinking among airline pilots has not been established, it is likely that substantial numbers need treatment but are not getting it. By 1985 in the USA 2 per cent of the pilot population had gone through the process of re-certification after alcohol treatment. The lifetime prevalence rate for problem drinking among the general American population is between 11 and 16 per cent.

The cost of not dealing with this problem can be catastrophic. Twenty years ago a DC8 crashed killing everyone on board. It was subsequently established that the pilot had been three times over the limit for driving.

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National Alcohol Strategy

The government is committed to introducing a national alcohol strategy. It gave the undertaking in Our Healthier Nation, the green paper it issued in 1998. The Department of Health enlisted the help of Alcohol Concern which carried out a far-reaching consultation before formulating a set of proposals for this strategy. This is a document of some 150 pages, covering all aspects of the subject. Some of these - such as the suggestion that promotions such as "happy hours" be banned - have already attracted the attentions of the press.

Given the government's rejection of a strategy to reduce per capita consumption, the first objective in Alcohol Concern's proposals may not be welcomed by ministers. It reads: "Should the annual national consumption of pure alcohol rise to more than 8 litres per head of the population, the highest recorded level since 1965 being 7.8 litres, accompanied by evidence of a rise in alcohol misuse, [the objective will be] to reduce levels of consumption to those rates pertaining when the strategy came into operation." This is a modest aim since the latest figures available show that 7.6 litres of pure alcohol were consumed per head of the entire population (9.4 litres for those aged 15 and over).

Other European countries have taken closer note of the World Health Organisation's aims as set out in the first European Alcohol Action Plan (EEAP) which was to reduce consumption by an ambitious 25 per cent. Whilst this has been met in only three countries, others are taking measures to approach the target, possibly by the end of the second EEAP in 2004. In France the intention is, by the turn of the millennium, to reduce the average consumption of alcohol by people over 15 by 20 per cent. In Spain, the Health Minister recently declared that a reduction in the per capita consumption of alcohol was the "path that we have to follow if we do not wish to pay the high price implied by the scientific evidence. This evidence categorically shows that higher levels of consumption go with higher rates of sickness and mortality."

The Institute of Alcohol Studies made a submission to the Department of Health in support of Alcohol Concern's proposals. Whilst applauding the wide scope of Alcohol Concern's work, the IAS set out to emphasise a number of points:

The nature and scale of the problem and future prospects

It is known that deaths from alcohol-related disease increased by over a third in the 10 years from 1984 to 1994. Deaths from chronic liver disease and cirrhosis increased by two thirds during this period. The increase was especially steep in young adults aged 15-44, in whom the death rate doubled.

Since 1994, the death rate from chronic liver disease and cirrhosis, conven-tionally taken as an indicator of the general extent of alcohol-related health damage, increased in men by over a further 30 per cent, and in women by a further 24 per cent. Liver disease is of course only one example of a wide range of health problems associated with alcohol consumption. These problems affect not just the individual drinkers concerned but also impose a heavy burden on the health service.

However, important though health problems are to individuals and to society, we believe strongly that it is a mistake for national alcohol strategy, and messages about 'sensible drinking', to be dominated by health issues to the exclusion of other considerations and, especially, for these health issues themselves to be limited to chronic problems such as alcoholic liver disease.

In relation to the numbers of people affected and the total burden on society, the problems of acute intoxication are undoubtedly more important than the chronic health conditions, important though these are to those who experience them.

In societies such as ours alcohol is more accurately described as a social problem that can have medical complications than the other way around. For example, the strong associations of alcohol with crime and anti-social behaviour are well known.

One of the disadvantages of an undue focus on the health aspects is that it tends to divert attention away from the ways in which problematic drinking can impair and destroy relationships, and can have highly adverse effects on people other than the drinkers themselves. In our recent report on behalf of EUROCARE to the European Union, we estimated that there are probably around a million children in the UK experiencing often severe problems from parental alcohol consumption.

Crime and family problems associated with alcohol consumption are particularly important examples of social problems which impose huge burdens on individuals and society but which are ignored totally by burden of disease studies designed to ascertain whether the supposed cardioprotective effects of alcohol result in less, as many, or more deaths being prevented as caused by alcohol consumption. Such studies are concerned with only a small part of the total picture. For most people, most of the time, alcohol problems mean problems in their lives, not the causes of their deaths. Moreover, in many cases the person with the problem is someone other than the person doing the drinking. These aspects of the problem were almost entirely ignored in the Report of the Interdepartmental Working Group on Sensible Drinking, which, when it was published, was described as governing national alcohol policy for the foreseeable future.

The aims and terms of reference of a national policy

Our view, contrary to the implicit assumption of the interdepartmental Working Group, is that the need and justification for a national alcohol policy arises not from the fact that drinkers may damage themselves but, from the excessive and inappropriate consumption of alcohol harming other people as well as the drinkers and placing an enormous burden on society at large.

We believe that this should be made explicit in a statement of national policy. The statement should refer in particular to alcohol problems as they affect families.

Trends in alcohol consumption

After a period of relative stability during the early 1990's, per capita alcohol consumption is now rising again to historically high levels. Taking into account the consumption of unrecorded imports of alcohol, legal and illegal, from across the Channel, per capita consumption in 1998 was probably higher than at any time since the turn of the century.

Despite the 'Health of the Nation' targets set by the previous Govern-ment, there is no sign at all of any reduction in the numbers of those exceeding the recommended limits of regular consumption. On the contrary, the proportion of women exceeding the limits has increased by 55 per cent since 1984 and is still rising. The latest available information suggests that the proportion of men exceeding the limits is now also increasing.

Barring an unwanted turn-down in the economy, there is no reason to believe that this growth in average consumption, heavy drinking and in alcohol problems will come to a halt spontaneously, still less go into reverse.

A strategy on alcohol or on alcohol problems?

The alcohol industry expends much time and effort in trying to discredit the scientific consensus that there is a close relationship between per capita alcohol consumption and the level of alcohol-related harm, or more usually simply asserts that this view has already been discredited, which it has not. An equally erroneous argument employed by the industry is that because of the supposedly cardioprotective effects of alcohol, the health of the population could be put at risk by a reduction in the overall level of national alcohol consumption.

The health benefits of alcohol

The argument of the alcohol industry concerning health benefits is invalid. The scientific consensus is that light drinking may have health benefits for some (mainly middle aged and elderly) individuals, although it is of interest that in the one major UK study relevant to these issues, the lowest mortality rate from cardiovascular disease was found in lifetime non-drinkers.

However, at a population level the cardioprotective effects of alcohol 'are essentially cancelled out by increases in other causes of death'. This is exemplified by France, where a particularly low death rate from coronary heart disease coexists with a high overall excess mortality rate in men, largely attributable to alcohol and tobacco.

It is of particular interest that far from the decline in French national alcohol consumption causing any increase in mortality from cardiovascular disease, deaths from this cause have in fact declined as consumption has declined.

The absence of adverse consequences from reduced consumption arises from the fact that, in relation to the cardioprotective effects of alcohol, the optimum level of per capita consumption is estimated to be around 3 litres per annum. There is no valid reason, therefore, to suggest that a reduction from the present UK consumption of more than three times this amount would have any adverse health consequences: on the contrary, any health benefits would remain while the adverse health effects would be reduced.

The whole population model

Despite the statement quoted above, the Interdepartmental Review on Sensible Drinking discounted the whole population theory as `scientifically uncertain and difficult to apply, especially in the UK'. The Review speculated that while the whole population theory might apply to comparisons of one country with another (countries with higher average consumption would probably be found to have more heavy drinkers), it did not necessarily follow that the theory applied within a single country, such as the UK.

Prompted by this challenge, resear-chers analysed information on drinking habits in fourteen regions of England. They found that, exactly as the whole population theory predicted, the regions with the lowest average consumption had the fewest heavy drinkers and vice versa - the regions with the highest average per capita consumption also had the highest proportions of heavy drinkers (defined as those drinking above both the old and the new 'sensible limits') and the highest prevalence of people reporting symptoms of alcohol dependence. This was found for both men and women.

These observations confirm that heavy drinking or 'alcohol abuse' are not purely the result of individual attributes scattered randomly through the population, but are also, and mainly, a reflection of the prevailing drinking culture and the average level of consumption. They also imply that factors encouraging increased average consumption in light to moderate drinkers, - such as longer drinking hours, alcohol becoming cheaper, or, perhaps, governments raising the 'sensible drinking limits' and sending messages about the 'heath benefits' of moderate consumption - are also likely to result in an increase in heavy drinking and alcohol-related problems.

Given these findings, the statement of the Minister of Health that what is required is action against the harm caused by alcohol, not action against alcohol itself needs to be qualified in certain key respects. We share the Minister's distaste for `nannying lectures' but the reality is that for both individuals and whole populations, increased alcohol consumption tends to be accompanied by increased alcohol problems, and reduced alcohol consumption by reduced alcohol problems. It will do no service to the public to base a national alcohol strategy on the absurd delusion that there is no relationship between average consumption and the level of harm, that it is possible to tackle the harm caused by alcohol without tackling alcohol.

Other than in overblown rhetorical declamations, the prospect of depriving millions of moderate drinkers of their alcohol does not, of course, arise. In the real world, the main issue that the national alcohol strategy needs to address is that alcohol consumption and harm are at high levels, are rising and will, presumably, continue to rise unless preventative action is taken. We hope that the Government does not intend systematically to divert attention from this real and pressing issue by conjuring up the entirely bogus threat of prohibition.

We know of no country in which the goal of reduced alcohol-related harm is regarded as compatible with a policy of encouraging increased alcohol consumption. On the contrary, in countries which have formulated national alcohol strategies, the objective, implicit or explicit, is always to reduce or at least stabilise alcohol consumption, this being seen as either the means or the consequence of reduced alcohol-related harm.

In our view, therefore, it would be not just foolish but also dishonest for the Government to base its strategy on the mythology cultivated by the alcohol industry that the level of national consumption is a matter of complete indifference. Measures - the level of excise duties is an obvious example - which affect the drinking population as a whole must necessarily play an important role in an overall strategy.

None of this is to deny the importance of the targeted approach, or that the main need is, to focus on harmful and dangerous patterns of consumption. In our view, the whole population and the targeted approach are complementary: far from its being necessary to make a choice between them, to be fully effective the one requires the other. In the words of a recent, comprehensive international review of the research evidence: `..if the level of alcohol consumption is allowed to run free and go high, more targeted interventions will be rendered null and void.'

A popular strategy based on evidence

Alcohol Concern lists some of the main components of a national strategy.To these we would add public acceptability and an approach based on components are linked.

We agree fully with the Minister's statement that widespread public support is needed successfully to tackle alcohol problems. We would however question the implication of the Minister's statement that public opinion is normally or necessarily hostile to preventative measures. In relation to drinking and driving, for example, it is clear that for several years public opinion has been in favour of rather tougher measures than Governments have been prepared to introduce. It is also clear that a succession of measures has been introduced - and more are being proposed - to weaken the licensing law in defiance of public opinion.

The Government's advice on the need for public support is so obviously sensible and desirable that we can only hope that the Government takes it itself.

We also make the possibly optimistic assumption that public opinion is more likely to support measures which they are convinced are designed to protect or promote the public good and which are based on evidence rather than pre-judice and the demands of vested interests.

Fortunately, there is now a good deal of evidence available on which to base policy decisions. A recent, comprehensive international review summarised what the research evidence shows to be effective policies for reducing alcohol problems :

  • Taxation of alcohol

  • Measures influencing physical access to alcohol

  • Drink driving countermeasures if vigorously enforced and given a high public profile

  • Other situationally directed measures such as control of alcohol at sporting events

  • Treatment of alcohol problems, including simple forms of help given in primary care settings

The review adds that school-based education, public education, warning labels and advertising restrictions can be added to the policy mix, but on the basis of the reasonable hope of long-term pay-off, rather than on evidence of the kind that supports the above group of measures.

The sensible drinking message

As suggested above, the evidence is that public education of this kind has very limited direct effect on actual drinking behaviour. However, it is possible that over a prolonged period such campaigns may effect the general social climate.

We have explained previously our reservations about the `sensible limits' approach to educational programmes aimed at the public at large. We hope that the Government will reconsider this approach, and be alert to the obvious danger of appearing to endorse levels of consumption which are higher than those of the majority of the population.

We do accept that the 'sensible limits' approach may be appropriate in programmes aimed at heavy drinkers and in view of the extensive media pub-licity that these limits receive there is an urgent need to correct the confused and contradictory advice on limits inherited from the previous Government. We hope the Labour Government will emphasise that medical advice is that the daily limits of up to 4 and 3 units for men and women respectively should not result in the old weekly limits of 21 and 14 units being exceeded. In other words, the Government should make it clear that there never was any valid scientific case for raising the drinking limits.

Administrative responsibilities

A feature of the situation that has become very clear over recent years is that statements of good intention and exhortations to do better are not enough. There is a real danger that a national alcohol strategy will founder through a failure to make anyone in particular responsible for its implementation.

We fully support calls for the Interdepartmental Group on Alcohol Misuse to be re-established. We believe that, as before, the Ministerial Group should have the tasks of co-ordinating departmental policies towards the agreed strategic objectives and providing the national leadership required: this includes providing a framework for action for those involved in implementing the strategy at local level.

In regard to local initiatives, we believe that the Government has made a good start with the Crime and Disorder Act by requiring local partnerships to formulate plans to tackle alcohol-related crime. This approach could be further developed.

The Institute of Alcohol Studies' critique of the Government's present attitude highlights the difficulty of establishing a coherent national alcohol strategy when there is a refusal to countenance any reduction of the per capita consumption. The assumption of ministers seems to be that the voting public will not tolerate any measures which limit their opportunity to drink. This is contrary to the evidence of the drink-driving legislation which, over a period of time, won such acceptance that public attitudes are more hard-line than the Government's. The fear of loss of revenue and of restricting a multi-million pound business puts huge power into the hands of the drink industry. Tessa Jowell, the Public Health Minister, is attempting to reconcile the irreconcilable.

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A nation of beer drinkers

Beer remains an Englishman's favourite tipple (and a Scotsman's and Welshman's, for that matter). The traditional view of this as a beer-drinking nation is upheld by the findings of the latest government survey of drinking behaviour.*

Of all the alcohol consumed by men over in Great Britain in 1998, 70 per cent was beer, lager, or cider. Of this 16 per cent was strong versions of these drinks - that is 6%ABV (alcohol by volume) or more. In the male population, consumption of these strong beer, lagers, and ciders outstrips that of spirits which tie with wine at 14 per cent. Among women, wine constitutes 34 per cent of all alcohol consumed and spirits 25 per cent. Although women drink much less than men over all, the difference is made up largely by beer. They drink the same amount of wine and marginally more fortified wine. Their average weekly consumption of spirits is less than one unit smaller than men's.

Beer's dominant position is particularly marked among men under 25, where it makes up four fifths of their alcohol intake. For those over 65 this has sunk to just over half. The decline in strong beer and lager consumption is even more marked (45 per cent of the total alcohol drunk for those under 25 to only 12 per cent for the 65s and over). On the other hand consumption of spirits increases sharply with age: from 11 per cent for those aged 16-24 to 27 per cent for those aged 65 and over.

It is worth noting that alcopops account for a tiny and decreasing section of the market. In 1998 they were only 1 per cent of male consumption and 3 per cent of female (as opposed to 3 and 4 per cent respectively in 1997).

Respondents of the survey were asked how often they had had an alcoholic drink during the previous twelve months. About three out of ten (29 per cent) said that they had drunk on at least three days a week. Just under 11 per cent said that they had drunk alcohol on almost every day last year (14 per cent of men and 9 per cent of women - unchanged since 1997). Those who had not drunk any alcohol at all during the same twelve months were also 11 per cent (8 per cent men and 13 per cent women), down by 2 per cent on the 1997 figures. There was a small but statistically significant increase in the number of people who said that they had consumed alcohol on at least three days a week during the last year.

As far as social class is concerned, those in non-manual employment were much more likely to be frequent drinkers than manual workers. 19 per cent of men in socal class I/II said that they drank every day as opposed to 8 per cent in social class IV/V. Among women the equivalent figures were 14 per cent and 6 per cent.

In the seven days preceding the survey, 77 per cent of men and 61 per cent of women had drunk alcohol. 22 per cent of men had drunk more than 8 units on at least one occasion during that week. The proportion varied considerable according to age from 38 per cent of men aged 16-24 to 4 per cent of those aged 65 and over. Women were much less likely to have drunk heavily. Only 7 per cent of women had drunk more than 6 units on at least one occasion during the preceding week. As with men, the likelihood of having done so was related to age. 20 per cent of 16-24 year old women had drunk more than 6 units but only 0.5 per cent of women over 65 had done so.

Perhaps it is unsurprising that those whose average weekly alcohol consumption was highest also reported the highest incidence of heavy drinking days. 52 per cent of men who consumed more than 21 units, on average, during the week had drunk 8 units on at least one occasion. The same held true with women: 25 per cent of women who had consumed more than 14 units had drunk 6 units on at least one occasion during the previous week.

Respondents were asked about their knowledge of units. 75 per cent admitted having heard of measuring alcohol consumption in this way. This was a fall of 4 per cent on 1997. On in five got it wrong when asked what consisted a unit of beer.

One of the objects of the survey was to establish what proportion and drinkers and types of drinker were likely to buy alcohol from places where unit labelled drinks were available. Unit labelling is being undertaken by a number of the UK's largest drink companies in support of the Governments "sensible drinking" messages. The idea is that drinkers will more readily associate these messages with the actual amount of alcohol they are buying. To begin with the labelling will be used on cans and bottles sold in off-licences and retail outlets.

Just under 70 per cent had bought alcohol from a licensed bar and a similar proportion had done so from supermarket during the year. 57 per cent had bought alcohol with food in a restaurant and around a third from an off-licence, abroad, or a duty-free. It is interesting to note that only a tiny proportion (1 per cent) said they bought alcohol abroad or in duty-free "once or twice a month". No-one - perhaps not surprisingly given the possible implication - admitted to doing this once a week or more. However, well over a quarter (28 per cent) of the adult population bought alcohol abroad or from duty-free "a few times a year".

*Drinking: adults' behaviour and knowledge in 1998. E Goddard and T Thomas Office for National Statistics. 1998.

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Alcohol problems in the family

At least 4.5 million children in the European Union are living in families suffering from the effects of alcohol. The actual figure is almost certainly much higher, possibly as great as 7.7 million.

These deeply worrying conclusions are drawn by the new report Alcohol Problems in the Family, the result of a joint project of Eurocare and Coface (Confederation of Family Associations in the European Union).

The report was launched at a press conference in Brussels in December, 1998, by Padraig Flynn, EU Commissioner. Commissioner Flynn said that he was very pleased with the contents of the report. "It sets out in a very clear and comprehensive manner the serious consequences for the family which result from alcohol abuse. This is a factor which is all too often overlooked in reports on problems associated with alcohol abuse.

"We are all aware of the statistics on road accidents and deaths associated with alcohol abuse. Similarly, we know of the problems associated with violence and crime. But, all too often, we overlook the important consequences for the family resulting from alcohol problems. And this report makes very disturbing reading in this respect."

A cautious estimate for the entire European Union shows that 14 per cent of men and 4 per cent of women report lifetime experience of alcohol abuse or dependence. This gives a figure of 42 million Europeans having experienced alcohol problems for some period of their lives. Even if each of these drinkers adversely affected only one other person, that means that there are 84 million people in Europe either suffering from alcohol problems or afflicted by another's drinking. "In terms of sheer numbers this problem dwarfs the problems arising from illegal drugs," says the report.

The working party consisted of representatives of all Member States of the EU with the addition with Norway. The intention was to assess the scale of the problem and to find out what is being done, or not done, in member countries. Andrew McNeill, of the Institute of Alcohol Studies, said, "It quickly became clear that this was a very difficult job, largely because of the shortage of hard information. It is known that alcohol is involved in a range of social and family problems such as domestic violence, divorce and family break-up, and behavioural problems in children, but the contribution of alcohol to these problems is not normally ascertained or recorded in official statistics."

The report states that more than "one third of problem drinkers receiving treatment cite marital conflict as one of the main problems caused by drinking. In the UK, the divorce rate is twice as high in marriages complicated by alcohol problems as in those without alcohol problems. Marital conflict may take a violent form, and there is much evidence to show that domestic violence and alcohol are often associated. While problem drinking is neither a necessary nor a sufficient cause of domestic violence, high proportions of perpetrators of domestic violence are either problem drinkers or under the influence of alcohol at the time of the assault. Equally, high proportions of victims of violence are also under the influence of alcohol at the time of the assault.

"There also appears to be an association between problematic drinking and child abuse, including incest. The connection between child abuse and alcohol abuse 'may take the form of alcohol abuse in parents or alcohol intoxication at the time of the abuse incident."
In the section on Families as a Cause of Alcohol Problems, the report says: "A UK study found that higher levels of alcohol consumption, heavy drinking and problem drinking were found for those who had experienced parental divorce in childhood. The increased risk became apparent between the ages of 23 and 33. The same effects were not found for later parental divorce or parental death...The potential significance of these findings is clear, given that if present trends continue, almost one in three marriages in the European Union will end in divorce. There are also fewer marriages.

"In the EU, divorce has risen from 11 per cent of marriages in 1970 to 30 per cent in 1995; marriages have fallen from eight per 1,000 inhabitants in the 1970s to 5.1 per 1,000 in 1995... Across the Union, therefore, hundreds of thousands of children now experience parental divorce. In the UK, it is estimated that around 40 per cent of the present generation of children will experience parental divorce or separation before they are 18."

The bulk of the report is concerned with family problems caused by alcohol. It makes the vital point that problematic drinkers can bring suffering not only to themselves but also to everyone around them: spouses, children, parents, and other family members.

In general terms, social life if often severely disrupted: "Activities, particularly recreational activities within the family are likely to be restricted as the drinker becomes unwilling or unable to participate, or the other family members themselves choose to avoid activities out of fear of the behaviour of the drinker.

"The unpredictable, disruptive and often drunken behaviour of the drinker is likely to be regarded by family members as acutely embarrassing and shameful. The tendency is to keep the problem a secret from the outside world. Divulging the nature of the problem to others may be regarded as an act of betrayal or disloyalty. This makes it difficult or impossible to invite others into the family home, or, given the norms of hospitality, to accept invitations from others. The family tends to become increasingly socially isolated. Activities and relationships outside the home may come to be severely restricted. Where family members do still engage in activities and relationships outside the home, these are likely to be kept rigidly segregated from life at home.

"In either case, family members may be unable to explain to others the real reasons for what is happening. A particular feature of this inability is that family members, often the spouse, are put in the position of having to tell lies in order to prevent the truth becoming apparent. For example, it may be the spouse who has to make the excuses for her partner's repeated absences from work. In this way the spouse may unwittingly protect her partner from the consequences of his own behaviour. Many commentators have referred to this tendency to collusion and cover-up and the way in which it may serve to perpetuate the drinking."

The family is put under further stress because "money spent on alcohol is not available for other purposes. An alcohol problem may impair or destroy the drinker's capacity to earn a livelihood. Reduced earnings or unemployment are not infrequent consequences of drinking problems and these, naturally, affect the other members of the family and can have all sorts of repercussions. Holidays may have to be forgotten; it may become impossible for children to be sent on school trips; the rent may not be paid."

More specifically the report goes on to look at individual family members: "The spouse has to cope with the bewildering unpredictability and frequent unpleasantness of life with a problem drinker. The more serious an alcohol problem, the less able a person is likely to be to perform competently, or at all, the various roles and responsibilities of a spouse and parent.

"More than one third of problem drinkers receiving treatment cite marital conflict as one of the main problems caused by drinking. In the UK, the divorce rate is twice as high in marriages complicated by alcohol problems as in those without alcohol problems. Marital conflict may take a violent form, and there is much evidence to show that domestic violence and alcohol are often associated. While problem drinking is neither a necessary nor a sufficient cause of domestic violence, high proportions of perpetrators of domestic violence are either problem drinkers or under the influence of alcohol at the time of the assault."

The reports states that "how badly a child is affected by parental problems is likely to depend, amongst other factors, on the child's age at the time they develop. The child under five is particularly vulnerable to diminished physical care whereas the older child may be more vulnerable to psycho-logical damage. This is not to say, of course, that the younger child does not suffer psychological damage, merely that its situation does not allow it to detach from the abusive parent in the way an older child can do by simply leaving the family home.

"As has been described, in the worst cases the world of the child of a problem drinking parent is likely to be bewildering, unpredictable and threatening.

"The possible adverse effects of a problem drinking parent may be seen in relation to... the importance of trust for the development of a healthy personality: the child must be able to trust the love of the adults who care for him, and he must also be able to trust in the fact that they will continue to be around in the future.

"The child may experience various forms of neglect and feel abandoned by both parents; it may fear that the drinking parent may die, or that the non-drinking parent may leave; it may have a restricted capacity to make or sustain friendships; to be the victim of verbal or physical aggression; to be a witness to conflicts, perhaps violent conflicts, between his or her parents, and may experience the break-up of the family...

"Children may be forced to take on adult roles and responsibilities and in this very real sense be deprived of their childhood. A particular feature that can arise is that the child, like the spouse, comes to believe that he or she may be to blame for the problems the family is experiencing."

The report discusses the psycho-logical, emotional, and behavioural problems faced by children and whether these persist into adult life. In an important section, it looks at what is being done and examples of good practice. Prevention and treatment, as they are approached in the different member countries, is covered.

"It is clear that the problematic consumption of alcohol affects millions of families, and thus millions of children and adults across the European Union, causing harm and misery on a scale which dwarfs the problems associated with illegal drugs. Despite this, national governments often devote more resources to campaigns against illegal drugs. Likewise, combating illegal drugs is written into the Treaty of Rome but there is no special EU campaign against the far larger problem of alcohol misuse.

"It is worth noting at this point that Eastern European countries, including those seeking membership of the European Union have high levels of alcohol consumption and harm. In most of these countries the situation appears to be worsening. The entry of Eastern European countries into the European Union will thus result in additional millions of EU citizens affected by alcohol problems.

"For a substantial minority of the affected children, the problems continue into their adult lives and, indeed, some children of problem drinking parents themselves become transmitters of the problems to the next generation.

"The difficulties experienced by family members go beyond indiv-idual unhappiness to health and social problems that affect, and are an economic burden upon the whole society. Unknown but necessarily large amounts of public money are expended in all member states each year on health and social services in dealing with the consequences of alcohol problems in families.

"And yet, in no Member State do family alcohol problems appear to be accorded the importance that they actually deserve. All Member States promote often very high profile public awareness programmes on the dangers of drunken driving: none promotes any remotely similar awareness programme about the dangers of drunken parenting.

"Across the Union there are some treatment and helping services for family members but provision is patchy and, undoubtedly, there are many people, particularly children, who currently have no real access to help or support.

"A particular problem identified is that alcohol treatment services may not be prepared or equipped to deal with the family aspects of the problem, while family treatment services may not be prepared or equipped to deal with alcohol problems.

"However, while more and better helping services are a priority, crisis intervention alone is of limited value to society however much it may benefit individuals. The main task is to prevent problems reaching crisis point or, preferably, from occurring at all. There is also the question of how and by whom helping services should be funded.

"Partly because of lack of information, it has not been possible to explore in this report the question of the economic costs of family alcohol problems to society. The issue of funding treatment services should be seen in this context and, as suggested above large sums of public money are already being expended on dealing with the consequences of family alcohol problems. It makes sense therefore to allocate some resources to addressing and treating the problems that produce the consequences. New money is likely to be required. An obvious source is revenue from alcohol sales. In member states where alcohol taxes are low it is unlikely that they are sufficient to cover the economic costs of alcohol problems including family problems. As well as raising excise duties a special levy could be placed on alcohol sales to fund treatment and prevention services.

"In some Member States family alcohol problems are at least on the public policy agenda, although occupying only a relatively minor place. In most Member States, however, we have been unable to find any explicit reference to the family aspects of the problem in national policy or any authoritative statement by government ministers recognising the existence of the problems and the need to do something about them.

"It is not surprising, therefore, that there is much that is not known. As has been made clear in this report, lack of information makes difficult even a rudimentary estimate of the size of the problem. In a number of Member States there appears to be a lack of statistical information about the involvement of alcohol in cases of child abuse and related social problems. Earlier in this report, this lack of knowledge was described in terms of the `ostrich response' and it does not require an excess of cynicism to believe that a lack of information can on occasion be extremely useful and convenient: so long as the true scale of a problem remains unknown it has no real existence in relation to public policy, and Governments and others are spared the unwelcome necessity of having to do something about it.

"Children and the non-drinking parent may here be paying the price of the clear difference in public attitudes towards problems associated with alcohol and those associated with the illegal drugs. When problems occur with illegal drugs, the tendency is to blame the drugs; when problems occur with alcohol, the tendency is to blame the drinker. As one of the quotations at the beginning of this report illustrates, the drinkers family are likely to experience the problem of guilt by association. Blaming the individual drinker diverts attention from the social and economic factors that encourage the problematic consumption of alcohol.

"In reality, alcohol problems in families are affected by the same factors as affect alcohol problems in general: at both the individual and the population level, the likelihood of experiencing such problems increases with the amount of alcohol consumed and with the frequency of intoxication. Policies that increase alcohol consumption are thus likely to increase family alcohol problems, problems that can impair and destroy families.

"Equally, family conflict and family break-up can increase the likelihood of alcohol and other substance abuse problems in both adults and children. For these reasons, policies that reduce alcohol problems are likely to strengthen and support families, and policies that strengthen and support families are likely to reduce alcohol problems.

In regard to substance abuse by children and teenagers, it is becoming increasingly clear that, in the words of a recent report, 'If society intends to provide young people with an environment which helps them not to take illicit drugs (or abuse volatile substances), or to reduce the harms which they do, the climate of awareness and belief on alcohol and tobacco must be seen as part of that context.'"

The report forcefully brings out, not only the problems alcohol can cause to the family, but also the vastness of its scale to the attention of the European Union and makes recommendations to national governments, the European Commission, and to non-governmental organisations. Among these are that governments should encourage research and monitoring to obtain more complete and reliable information about the contribution of alcohol to divorce, family break-up, child neglect and abuse; that national policies should make explicit reference to family alcohol problems; require local health and social service authorities to draw up plans for tackling alcohol problems and, in particular, for meeting the needs of family members including children; and that national alcohol education programmes should provide information not just about alcohol and health but also about alcohol as a potential social problem.

The report recommends that the Commission should encourage Member States to improve the collection of information in regard to family alcohol problems and coordinate these investigations; that it should use the existing Health Promotion Programme to disseminate information about alcohol in general and family alcohol problems in particular; cont-inue to promote workplace alcohol policies and anti-drink driving campaigns, the latter paying particular attention to the management of the 'high risk offender'; ensure that the Union's other policies, particularly those on taxation and the single market do not undermine efforts to reduce alcohol problems; and, in view of the fact that for many young people, alcohol, tobacco and illicit drugs are all part of the same domain, extend drug awareness campaigns to include alcohol and tobacco.

In the case of non-governmental organisations, the report suggests that specialist alcohol agencies should designate a member of staff to be responsible for family and children's services; that the agencies should also ensure that adequate training is provided to staff in relation to child development and the family aspects of alcohol problems; COFACE and EUROCARE should cooperate in the field of alcohol problems in the family by setting up a joint working party at European level which would meet on a regular basis to take stock of developments and decide on and carry out joint initiatives; and that the same organisations should encourage their members at national, regional and local community level to seek cooperation with each other to develop a network of appropriate information, support and counselling services for families suffering from alcohol problems.

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Drink drive stoppers

Members of the public were offered up to £500 for informing on drinkers who use their cars during the Christmas holiday period - an extension of an initiative on the part of a police officer with a mission to combat drink driving.

The scheme, when it was piloted in Lancashire, brought 80 calls from the public resulting in 29 convictions. It has now been adopted by the Lancashire and Cumbria forces. Financial inducement related only to Christmas and New Year - there was no reward involved in the trial or in the wider application off the scheme.

A spokesman said, "We believe that people might think twice about drinking and driving if they are aware that someone may notice them and report them."

The idea originated with PC Robert Beeston, stationed at Chorley. He had extensive experience with drink drivers and had noticed that the pattern of arrest had changed over time. "Ten years ago," he said, "arresting a drink driver was relatively easy. All I had to do was park near a public house from 11.30 pm onwards and stop a few vehicles. It was almost guaranteed to produce results." There are far fewer drinkers in those pubs nowadays, according to PC Beeston, but there were still a high number of drink-related accidents. "I found that I was arresting people for drinking and driving in the afternoon and early evening rather than late at night."

A number of incidents, including the arrest, for the third time, of a middle-aged woman who was found to be considerably over the limit, driving through the town centre during the afternoon, prompted PC Beeston to come up with a scheme to reduce road accidents and prevent death and injury. He set up Drink Line, a confidential answer phone service where members of the public could leave information about drink drivers. The main targets were persistent drink drivers who are often difficult to detect unless they are involved in an accident. Through the local press and radio, PC Beeston made sure that the public were aware of the scheme. The information received was of a high quality. Suspects were allocated to particular officers who had special responsibility for targeting them. Only a very few of those who were stopped under the scheme were found not to have consumed alcohol. Those who registered amber on the breath testing equipment and therefore were not over the limit on that particular occasion despite having drunk alcohol, will be stopped at some future date and tested again.

Some of those stopped under the scheme proved to have very high readings. One was a repeat offender who subsequently received a custodial sentence. Another was a taxi driver who had been injecting heroin whilst working.

PC Beeston's Drink Line has now been handed over to Crime Stoppers and extends over all of Lancashire and, in a modified form, Cumbria. As Crime Stoppers is a national number (0800 555 111), the scheme could be extended to the whole country, depending on the attitudes of the Chief Constables.

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What's in a name

Andrew Varley on the philistine brewers

The brewers, especially the large chains, have never shown themselves great preservers of the national heritage. They own a huge number of historic buildings and are the custodians of a significant portion of living social history but, as ever, are not letting such trivialities as these stand in the way of making a quick buck.

Attention at the moment is focused on the way breweries are playing fast and loose with pub names. You do not have to be a regular at your local, or even a member of CAMRA with a taste for atonal folk music, to be angry about this. Everyone with an attachment to the preservation of our heritage and with a concern for tradition should support the private members bill being introduced by Anne Winterton, the spirited Tory member for Congleton. Her aim is to prevent pubs which have been known for generations as The Royal Oak or The Red Lion transforming into The Wig and Pistle, The Brahms and Liszt, or whatever tiresome piece of jocularity appeals to the appropriate department of the brewery concerned.

The brewers want to fill their pubs and believe that one way to appeal to the part of the market under 25-years of age - the men among whom are the heaviest drinking section of the population is to abandon tradition or rely on "theming". It is perfectly understandable to want to develop redundant pubs in areas where the customers have moved on or the clientele has changed such as outside closed shipyards or in city centres with no resident population to speak of. It is quite another to make gratuitous changes to well-known locals or ancient inns. It is to change their essential nature for a short term gain.

With the same purblind arrogance which in the sixties led them to foist bland keg-bitter on the public in the belief that beer needed to taste uniformly nasty everywhere in the country, the brewers now regard their customers as so stupid that they cannot cope with a pub unless it has the same name as its exact replica in Bolton or was christened by some buffoon of an executive with the delusion that he has the same talent for whimsy as the Monty Python script writers. No doubt somewhere drinkers are propping up the bar in The Dead Parrot.

I live in an ancient town in rural Suffolk. For some reason, Scottish and Newcastle bought a pub there which since the mid-sixteenth century has been called The One Bull, a reference to the papal document rather than the animal. It was a run-down, unappealing establishment and its new owners wanted to brighten its image and fill it with young drinkers. They decided to rename it Ye Olde Cloisters. I know, I know. It beggars belief. The town had a mighty abbey in happier days and its ruins are still a major feature but its cloisters were nowhere near this particular pub. Nor is it easy to understand how monastic reference is believed by Scottish and Newcastle marketing people to be especially attractive to lager-swilling youth. The intended name change was so offensive to everyone in the town that it was abandoned after vociferous protest. People rightly saw a brewery which had no connection with the area unilaterally obliterating a small section of its heritage. (The poor things at Scottish and Newcastle are a bit vague about names: one of their pubs in Sunderland has been called The Wolseley since the time of the eponymous Victorian hero, Sir Garnet "I am the very model of a modern Major-General" Wolseley. A few years ago, the brewery decided that a new sign would be effective and so there appeared a passable copy of Holbein's portrait of Cardinal Wolsey.)

A similar hazy view of history was shown in Nottingham in 1996 when The Turf, succinct and to the point, became The Samuel Morley Victorian Ale House, prolix and anachronistic. The pub had originally been named in honour of Lord George Bentinck, political ally of Disraeli, high-living grandee, and author of the laws of racing. Samuel Morley, on the other hand, whilst undoubtedly a local worthy, was a proselytising abstainer and so possibly less suitable for commemoration in a licensed premises than the sporting Lord George.

Mike Ripley, a spokesman for the The Brewers' and Licensed Retailers' Association, clearly out of his depth, attempts some ill-informed historical justification for changes of name:  "Pub names do change - if they didn't they'd all still be called the St Peter or the Virgin Mary, because before the Reformation, they were owned by the Catholic Church. The beer was brewed in local monasteries. Henry VIII came along and did away with the Catholic Church so landlords were faced with a choice - change the name or lose your head. That's why so many pubs are called the Red Lion - his coat of arms - or the King's Head." Of course, Mr Ripley is not paid to know about history or heraldry, which is just as well.

It is very easy to mock the industry's stupidity and ignorance, but there is an important point here. The overriding concern is to sell as much drink as possible. The most profitable market is perceived to be young people. Therefore, pubs are themed and renamed to appeal to them. Two undesirable things are happening: local sensibilities and traditions are being outraged and young people are being encouraged to drink even more than they are at the moment outside the constraints of the community pub.

None of us, even if we only use our local pub for an occasional coffee, want The Bull or The Rover's Return to emerge from "restoration" as The Happy Hooker or The Gorilla and Air Hostess.

Whatever did happen to Watney's Red Barrel?

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Brewers lose beer battle

UK beer will continue to be taxed at its present rate after independent brewers Shepherd Neame lost a long-running court case against the government (see Alert, number 2, 1997 and number 1, 1998). The brewer, which is one of the oldest in the country, had taken the action after the Chancellor increased beer duties by a penny a pint in his 1998 budget. The legal argument was that this was a breach of European Union rules on tax harmonisation.

Whilst deciding against Shepherd Neame, the three Court of Appeal judges said they were "sympathetic" to the brewery and others fighting for lower beer taxes. However, they went on to say that there was "no legal obligation on the UK to abstain" from raising the tax on beer.

True to the spirit shown so far, the Kentish brewer has vowed to fight on. After the court refused to refer the matter to the European Court of Justice, Shepherd Neame declared that they will appeal to the House of Lords. A director of the company, Jonathan Neame, said: "We are obviously disappointed but the judgement was favourable to us in many ways. This may be just the loss of one battle in a long war to remove unfair taxes." Shepherd Neame and other independent brewers had argued that high beer taxes in the UK were driving them out of business, because more and more people were importing large amounts of cheap beer from France.

Beer sold in the UK carries taxes eight times higher than those in France - 32 pence a pint compared to 4. As a result, it is claimed, thousands of Britons cross the Channel for a day trip to France, where they stock up on beer, wine and other cheap goods. However it is argued that, contrary to the brewers' claims, much if not most of the price differential on beer between Britain and France is not due to higher British excise duties but to the higher prices set by the brewers and the retailers themselves. Also it is by no means clear that the beer purchased in France simply replaces that which would have been bought in UK pubs. Drinking patterns have been changing for some while, with a move away from the traditional pint in the local, and a significant proportion of beer bought in the hypermarkets of Pas de Calais represent additional consumption. Of course, the supplies brought in by smugglers are distributed throughout the country and presumably affect Shepherd Neame no more than any other brewer.

Nevertheless, Shepherd Neame blames the flood of cheap beer for the closure of 50 of its pubs since 1993. The company believes that one in three pints of beer drunk in Kent are now coming from across the Channel. Because of those changing patterns, this probably damages off-licence trade at least as much as that of pubs. The Court of Appeal decision was welcomed by Her Majesty's Customs and Excise, where Barbara Roche is financial secretary. She said their lordships had upheld "the important principle that Parliament can legitimately set excise duties in the UK, subject to minimum rates agreed with our EU partners".

Shepherd Neame began its court action in 1997 and has spent an estimated £300,00 in legal costs so far

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Epater-le-bourgeois

Andrew Varley reviews A Man's Place: Masculinity and the Middle-Class Home in Victorian England, John Tosh, Yale University Press.

John Tosh has written an elegant and perceptive examination of the Victorian middle-class male and his relationship to the domestic environment. The subject is one worth serious analysis, not least because the Victorian home and all the attitudes which informed its ethos have entered popular mythology and still affect our conduct. The literature and art of the time, the pronouncements of public men, the sermons of clergymen (seized on by inexplicably enthusiastic and apparently undiscriminating publishers), the "home life of our own dear Queen" all seemed to conspire in the propagation of the domestic Ideal. But the Victorian home was not a moral construct. Certainly, it reflected an outlook on life and was in many ways a showpiece for a particular - perhaps a peculiar - set of values, but its origins, as Professor Tosh convincingly argues, lay in economic forces which had been at work during the reign of George III and the young Queen's far from "Victorian" uncles.

Professor Tosh shows how the separation of home and work led to the development of a new kind of household and, perhaps with greater significance, a new rôle for women. Wives changed from help-meets to homemakers. The home became a refuge from work rather than a central part of an economic unit. The more successful elements of the middle-classes removed themselves geographically from the sources of their wealth. Suburbs burgeoned, villas proliferated, and front-doors closed. There were psychological costs: no sooner had the Victorian male withdrawn into his domestic fastness than he wanted to escape. Of course, there were thousands of men in the period who did live out an idyll within their homes, all sorts of Pooters who sincerely believed in the saccharine sentiments of "Home Sweet Home" samplers. Nevertheless, there were clearly plenty more who failed to conform to the claustrophobic mores of the hearth, or else why was it necessary for so many writers to inveigh against profligate gadding about? As early as 1828, with the reprobate George IV still on the throne, John Angel James felt the need to lament that "it is a sad reflection upon a man when he is fond of spending his evenings abroad. It implies something bad, and it predicts something worse." The bad was drunkenness, the worse, presumably, sexual debauch. To Victorian moralists, abuse of alcohol led to further degradation. There was no political divide in this viewpoint. The radical William Cobbett regretted the habit of men frequenting ale-houses (and coffee-houses, for that matter): it was "a profligate abandonment of their homes."

It was acute sensitivity to the distinctions of class which drove the respectable bourgeois man away from taverns some time before the temperance movement sprang up. The family which had risen from the lower orders to the rapidly expanding middle-classes, says Professor Tosh, was primarily concerned with maintaining and emphasising its often precarious position. One means was the physical appearance and display of the home itself, another was the "public re-moralisation of men's leisure." Taverns were associated with crude manners and "lowness" and so avoided. The common sight of groups of thirsty tourists looking for a watering-hole in Belgravia or Bloomsbury is an enduring testimony to the absence of pubs from the newly-developed residential areas of Victorian London. Not until the growth of of the grander music halls at the end of the nineteenth century was it possible for the middle-classes to drink in public. Professor Tosh makes the point that until then consumption of alcohol was confined to the home or had to be abandoned altogether. The latter course was given considerable impetus by the growth of Nonconformity.

The antithesis of the home was the gentleman's club. There the married man, surfeited with domestic bliss, could revert to bachelor ways. The clubs grew out of drinking and dining fraternities. The grander, aristocratic institutions, such as White's and Brook's in St James Street, were raffish places for deep drinking and profligate gambling and maintain something of that atmosphere to this day. More middle-class establishments, like the Reform or the Travellers, catered for City merchants, lawyers, men-of-letters, the higher clergy. They might not be so louche but they performed the same essential service: they excluded wives and let members enjoy exclusively male company over a convivial decanter. London clubs were replicated in the provinces. Manchester, Sheffield, and Leeds all had their own versions, usually with carefully graded social distinctions. Professor Tosh perhaps lays too little emphasis on the importance of drink. In his club a gentleman could soak in a way which at home was inappropriate. Indeed, for the middle-class man, it was one way of laying claim to gentle status. "As drunk as a lord" was an ambition not a warning. In the Sheffield Club, a captain of industry might have to be better behaved than a marquess in White's but it was only a matter of degree. It was equally comforting to stand in the window, glass of claret in hand, and "watch the damned people get wet."

Professor Tosh's is a considerable achievement. Historians, of course, have a duty to shatter the myths their predecessors have erected and replace them with something more realistic. An historian who has complete command of his material and who is also an accomplished writer frequently provokes in his readers the exclamation, "Of course, how obvious, now I come to think of it!" Almost every page of A Man's Place elicits this response. Professor Tosh allows us to see our Victorian grandfathers, not as stern, emotionally stultified patriarchs, but as men. Whilst throwing invaluable light on domestic life in the last century, he has moved that vogue subject, the history of masculinity, towards its proper respectability. He shows just what the Victorian middle-class man got away with and we, stranded on a more rational shore, can only sigh.

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