November 2019

Editorial – November 2019

Welcome to the November 2019 edition of Alcohol Alert, the Institute of Alcohol Studies newsletter, covering the latest updates on UK alcohol policy matters.

This month, an IAS report finds that one in three children report negative outcomes from their parents drinking, at any level.
Other articles include: Brits still drinking above the OECD average, Ireland phases in parts of its alcohol legislation to do with curbing marketing, and SALSUS stats suggest underage drinking is on the rise again.

Please click on the article titles to read them. We hope you enjoy this edition.

 

COVER STORY – One in three children report negative outcomes from parents’ drinking

Even moderate drinking by parents may impact kids

04 November 2019 – Research published in the Alcohol & Alcoholism journal suggests that children experience negative outcomes as a result of their parents’ alcohol use, even amongst moderate drinkers. In a survey of almost 1,000 UK parents and their children aged 10-17, more than a third (35%) of children reported at least one adverse consequence as a result of their parents’ drinking.

In the survey, children were presented with a range of negative outcomes that they could attribute to their parents’ drinking: 12% reported parents giving them less attention than usual, 11% reported being put to bed later than usual, and 8% reported thinking that parents argue more than normal. In the survey parents were asked not only how much they drank, but how often they drank for a range of reasons, including both positive and negative. While 95% of parents reported instances of drinking because it is relaxing or makes them feel happier, around three in five claimed to have consumed alcohol to help them cope with feelings of depression and to escape problems (60% and 59% respectively).

Children of parents drinking for predominantly negative reasons were more likely to report experiencing at least one negative outcome. This research also confirmed findings from a previous grey literature publication that the more parents drink (beginning from only moderate levels) the more likely children were to report one of these negative outcomes, and that children who had witnessed their parents tipsy or drunk were more likely to report experiencing negative outcomes following their parent’s drinking – irrespective of how much their parent drank overall.

Eric Appleby, chair of the Alcohol and Families Alliance (a cross-sector alliance of more than 40 organisations including the NSPCC, Nacoa, and Adfam), welcomed the research:

‘The finding that a third of children have experienced a negative outcome from their parents’ drinking should trouble the government. The resources and support available to parents who want to learn more about or address their drinking are inadequate.

‘We need evidence-based support for families affected by alcohol and evidence-based guidance on parental and family member drinking and its effect on children, including at low levels – calls the Alcohol and Families Alliance have been making for some time.’

Lead author of the paper, IAS Research & Policy Officer Lucy Bryant told Reuters: ‘We needed to understand the effect this drinking could have on children,’ adding that further research is needed to find out why the impact of parents’ drinking seemed lower in 14- to 17-year-olds.

‘It is possible the older age-group truly experience less harm, but it is also likely some of the negative outcomes we presented, for example, playing less, might not have resonated with them,’ Bryant said.

Bryant also called for the official guidance on alcohol focused on children and young people to be updated so parents could make ‘informed decisions’.

You can listen to the study’s lead author (Lucy Bryant) talk about the research findings in our Alcohol Alert podcast.

Majority of alcohol treatment service patients middle-aged

New data repeat the same old story

05 November 2019 – Just over a quarter of all adults receiving substance misuse treatment do so for alcohol only, and seven out of every ten of those patients are over the age of 40, according to Public Health England (PHE).

Data collected by PHE’s National Drug Treatment Monitoring System (NDTMS) found that in 2018/19, the number of clients receiving treatment for alcohol misuse changed little on the last year, and by extension a decade ago.

Overall, there were 268,251 adults in contact with drug and alcohol services between April 2018 and March 2019, very similar to last year (268,390). The number of adults entering treatment increased by 4% on the previous year (127,307 to 132,210), the first increase in the number of people coming to treatment since 2013/14, while those in treatment for alcohol alone remained stable, (75,787 to 75,555). The increase therefore likely reflects recent increases in the prevalence of illicit drug use.

However, clients receiving alcohol only treatment represented three-fifths of all those receiving some form of alcohol treatment (129,809), who themselves represented almost half (48%) of all those in contact with drug and alcohol services in 2018/19. This comes to 27% of all clients.

Almost 70% of people in contact with alcohol treatment services only are over the age of 40 (illustrated) – the median age of the alcohol only group is 46, significantly older than among other substance use groups.

The vast majority of people in contact with alcohol treatment services only are over the age of 40

 

Among new presentation to treatment centres, those accessing alcohol services only represented two-thirds (52,393) of all those receiving some form of alcohol treatment (79,196), and those receiving some form of alcohol treatment made up 60% of all new presentations to drug and alcohol services in 2018/19.

Silver lining

The good news was that those seeking alcohol services only were more likely to refer themselves to treatment centres (66%) and more often able to complete treatment successfully compared with other substance misuse clients – 60% compared with a fifth of clients seeking treatment for opiate use (illustrated).

Those seeking treatment for alcohol only were most likely to complete it in 2018/19

 

OECD: Brits still above-average boozers

Adults drink nearly a whole litre of pure average more per head

07 November 2019 – The average British drinker still drinks above the OECD-average, despite falls in alcohol consumption in the last decade, according to the latest Organisation for Economic Cooperation and Development (OECD) figures.

Statistics published in the Health at a Glance 2019 report show that Britons over the age of 15 consumed 9.7 litres of pure alcohol each in 2017, equal to 108 bottles of 12% ABV wine or 342 pints of 5% strength lager, and 0.9l above the OECD average of 8.9l. In 2007, they drank 11.1l compared with the average of 9.9l.

Recorded alcohol consumption among adults, 2007 and 2017 (or nearest year)

 

The OECD is an international organisation with 36 member states, which studies the economies and populations of developed countries, and its biennial Health at a Glance release compares how many litres of pure alcohol are drunk by people in 44 countries around the world.

It revealed that after Lithuania, Austria, France, the Czech Republic, Luxembourg and Ireland were the heaviest drinking nations, while Turkey, Israel, India, Costa Rica, Mexico and Colombia made up the bottom of the table, all drinking fewer than five litres each.

Commenting on the findings, IAS Head of Policy Richard Fernandez said: ‘It’s time for the government to take this seriously, with a strategy that includes minimum unit pricing.’

Bit-by-bit: Ireland phases in parts of its alcohol legislation

Study: Alcohol advertising restrictions become law – minimum unit pricing and more to follow

12 November 2019 – The Minister for Health, Simon Harris TD and Minister of State, Catherine Byrne TD have welcomed the coming into operation of three sections of the Public Health (Alcohol) Act 2018.

From 12 November:

• alcohol advertising in or on public service vehicles, at public transport stops or stations and within 200 metres of a school, a crèche or a local authority playground will be prohibited
• alcohol advertising in a cinema will be prohibited except around films with an 18 classification or in a licensed premises in a cinema
• children’s clothing that promotes alcohol will be prohibited
• in mixed retail units, alcohol is to be confined to an area separated from other products by at least a 1.2-metre high barrier. Alcohol products can be contained but not be visible in a unit behind the counter.

The provisions are among 23 sections of the Public Health (Alcohol) Act, which was passed by the Oireachtas after almost three years going through the Seanad and Dáil.

Commenting on the move, the health minister said: ‘Studies report consistently that exposure to alcohol advertising is associated with an increased likelihood that children will start to drink or will drink greater quantities if they already do. These measures aim to change that situation in Ireland and to remove alcohol advertising from the day-to-day lives of our children.’

Harris is also expected to seek cabinet approval before the end of the year for the introduction of minimum unit pricing on alcohol by the end of the year. Restrictions on the visibility of alcohol sales in supermarkets are to follow next year.

Drinks Ireland, a body representing alcoholic drinks manufacturers and suppliers in Ireland, welcomed the advertising measures, while maintaining their opposition to the proposed pricing measure.

Fighting talk

Harris also attacked the drinks industry role in educating schoolchildren about alcohol, calling their involvement ‘completely and utterly bizarre’ at the launch of a new national resource for teachers aimed at highlighting the risks associated with alcohol and drugs to students.

The Irish Times reports that the health minister told the audience: ‘It’s completely and utterly bizarre that you’d have a body funded by the drinks industry educating our kids about the dangers of alcohol… I mean it’s ridiculous. I’ve never been a fan of self-regulation.’

‘Know the Score’ has been developed by public health and education professionals and Harris says that the programme will help to ensure that there will be ‘no room for alcohol in Irish childhoods’.

‘It is not appropriate that schools use any materials or resources developed by organisations funded by the alcohol industry.’

Minister for Education Joe McHugh said the involvement of teachers in developing will is essential if we are to make a success of helping young people to become better informed of the risks associated with substance use.

‘I would encourage teachers to take up the offer of specialist training to support them in the delivery of what can be a complex topic area.’

Welsh Assembly approves MUP

Legislators set March 2020 date

13 November 2019 – Welsh Assembly members have approved the Welsh Government’s plans to introduce a minimum unit price for alcohol of 50p from March 2020.

The Public Health (Minimum Price for Alcohol) (Wales) Act 2018 will mean that it will be an offence for alcohol to be supplied below that price in Wales.

The new law supports the Welsh Government’s comprehensive work to tackle harmful and hazardous drinking by tackling the availability and affordability of cheap, strong alcohol, which is part of wider efforts to improve and protect the health of the population of Wales.

In Wales there are 60,000 admissions to hospital every year, because of alcohol. Alcohol costs the NHS £159 million annually. In 2018, there were 535 alcohol-related deaths in Wales. Research estimates that introducing a 50p minimum unit price (MUP) would:

• result in 66 fewer deaths and 1,281 fewer hospital admissions in Wales per year
• save the Welsh NHS more than £90 million over 20 years, in direct healthcare costs
• reduce workplace absence, which is estimated to fall by up to 9,800 days per year
• contribute £783 million to the Welsh economy over the next 20 years, in terms of the reduction in alcohol-related illness, crime and workplace absence.

The Welsh Government describes alcohol as a ‘major public health issue’, which leads to more than 500 deaths a year, and has impacts on ‘the NHS, the economy and families’.

Health Minister Vaughan Gething said: ‘There is a very real and clear link between levels of excessive drinking and the availability of cheap alcohol. We believe the introduction of a minimum unit price will help reduce alcohol related harm and support people to drink responsibly.’

‘Scotland has seen a decline in the amount of alcohol that is consumed since the introduction of MUP and I hope that we will see similar results in Wales’, he added.

Alcohol and me

Theme of Alcohol Awareness Week gets nation thinking about drinking

17 November 2019 – Thousands of public health teams, workplaces, GP surgeries, pharmacies, hospitals, charities and other community groups across the country participated a week of awareness-raising, campaigning for change, and more, coordinated by Alcohol Change UK.

This year’s Alcohol Awareness Week (November 11–17), centred around the theme of people focusing on their own drinking habits, encouraging them to test their knowledge around the drinking guidelines and health impacts associated with drinking.

Activities included the a quiz, and an interactive body map to improve understanding and motivate participants to think about the ways in which we drink, and to consider changing habits.

Alcohol Change UK also sought to encourage people to get talking about alcohol, in order to begin breaking down the shame and stigma surrounding those who have alcohol problems. This involved the publication of blogs written by people recounting their relationship with alcohol.

Scotland: No change in alcohol-related hospital stays

Middle-aged drinkers most frequent visitors

20 November 2019 – The number of alcohol-related hospital admissions to general acute and psychiatric hospitals in Scotland remained unchanged in 2018/19, compared with the previous year.

NHS Scotland’s latest Alcohol-related Hospital Statistics dataset showed that in 2018/19, there were 38,370 alcohol-related hospital admissions (stays) in general acute and psychiatric hospitals in Scotland, similar to the previous year (38,199).

Nine in ten admissions (93%) were to general acute hospitals (35,685), with a further 2,685 to psychiatric hospitals. The 35,685 admissions to general acute hospitals relate to 23,751 patients, some of whom had multiple admissions to hospital. Around half of them (12,033) were admitted for the first time for alcohol-related conditions.

Trend wise, since 1981/82, there was a steep and sustained increase in general acute alcohol-related hospital admissions until 2007/08, when they reached a rate of 855 admissions per 100,000 population; this has now fallen to 669 per 100,000 population.

Alcohol-related hospitalisation rates for general acute hospitals in Scotland, trend graph

 

Over the same time period, the average number of alcohol-related hospital admissions per patient in each year increased from 1.1 in 1981/82 to 1.5 in 2006/7 and has remained at 1.5 since then.

Historically, the rate of alcohol-related general acute hospital stays has been dominated by middle-aged people over the last twenty years – that is, women aged 45-54 years, and the 55-64 / 45-54 age groups for males. Men were also 2.5 times more likely than women to be admitted to general acute hospitals for alcohol-related conditions (971 per 100,000 population compared to 377).

The socioeconomic picture also remained largely unchanged. People in the most deprived areas were six times more likely to be admitted to general acute hospitals for an alcohol-related condition than those in the least deprived areas (1,059 per 100,000 population compared to 167).

NHS hospital Alcohol Care Team guidance released

Abridged from Alcohol Policy UK

26 November 2019 – A set of resources relating to the delivery of hospital-based Alcohol Care Teams (ACTs) has been released.

The guidance, co-produced with Public Health England (PHE), follows a commitment in the NHS Long Term Plan (LTP) earlier this year to establish ACTs in hospitals with the highest rate of alcohol dependence-related admissions.

A summary document sets out the role of ACTs as part of an effective local area alcohol treatment system, also supported by a core service descriptor, a case study example, and a checklist for commissioners.

The guidance states admission to hospital is ‘often the first time alcohol dependence is identified and diagnosed as an underlying or primary condition, so hospital admission provides an ideal opportunity for early intervention and access to more comprehensive alcohol treatment.’

For the full article, please visit the Alcohol Policy UK website.

Underage drinking on the rise in Scotland again?

Drunkenness is ‘okay’ still common attitude among children

26 November 2019 – New survey data from Scotland indicates an increase in underage drinking in Scotland.

The 2018 edition of Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) for 2018, interviewed just over 21,000 13-year-old and 15-year-old pupils from nearly 200 secondary schools in Scotland.

Although the vast majority (four-fifths) of 15-year-olds did not identify as regular drinkers, the figures still revealed a reversal of the trend of decline (since 2004) in the numbers of 13- and 15-year-olds who had tried alcohol.

When split by sex, girls were more likely than boys to have ever been drunk. As a result of drinking, boys were more likely to get in a fight and/or receive treatment from a medical professional, whereas girls were more likely to have an argument and/or do or say things that they might later regret.

The normalisation of drinking and drunkenness as a ‘thing that is acceptable to do’ is still embedded in children’s attitudes towards alcohol. The proportion of pupils who think it is ‘ok’ to try drinking has shown a marked increase between 2015 and 2018, and has the proportion of pupils who thought it was ok to get drunk. (illustrated).

Source: SALSUS 2018, figure 16

 

Alcohol remains the most popular substance consumed by children. SALSUS found that in 2018, pupils were more likely ‘by some margin’ to think that it is ‘ok’ to try drinking than to smoke or take drugs.

Disposable income played a role in this. In 2018, the more money a pupil had a week to spend, the more likely they were to have used substances, a relationship that was ‘particularly strong’ for alcohol: those with more than £30 a week to spend were twice as likely to have drunk in the last week than those with nothing.

SALSUS is the Scottish Government’s main source of information on alcohol, drug and tobacco use among Scotland’s young people. It helps to inform progress towards Scottish Government policies to reduce the harms from smoking, drinking and drug use among children and young people.

SALSUS is also designed to inform policy and practice by providing information on patterns of behaviour in relation to smoking, drinking and drug use; sources of cigarettes, alcohol and drugs; pupils’ attitudes and the attitudes of families and friends to substance use; and contextual information on the relationship between substance use and other lifestyle, health and social factors.

In response to the survey results, Alison Douglas, chief executive of Alcohol Focus Scotland, said:

‘After a number of years in which we saw reductions in children and young people’s drinking it is disappointing to see increases in the number of 13 and 15 year olds who report ever having drunk alcohol and the number of those who have been drunk in 2018, compared with 2015.

‘The attitudes and behaviours of our young people are a symptom of a wider issue – our children are growing up in an environment saturated with positive messages about alcohol and drinking has become a normal part of our everyday lives. Recent work from Alcohol Focus Scotland and Children’s Parliament shows that children come into contact with alcohol throughout their day including at home, the community, on the streets, in shops, on public transport, and at sports games and events.

‘We need to do more to protect our children and young people.’

ALCOHOL SNAPSHOT — How global drinking preferences have come together

It is common to classify countries according to their preference for different beverage types. For example, Northern European countries, such as the UK and Germany are described as ‘beer drinking cultures’. Mediterranean countries such as France and Italy as ‘wine drinking cultures’ and Eastern European countries as ‘spirits drinking cultures’. Yet a new piece of analysis by the University of Sheffield’s Colin Angus demonstrates that countries’ drinking preferences are far more malleable than that might suggest, showing that they have shifted dramatically over the past 50 years. Moreover, it suggests that international drinking cultures may be in the process of converging.

Angus took data from the World Health Organization’s Global Information System on Alcohol and Health, which collates international statistics on alcohol consumption. He then colour-coded countries according to the proportion of their total alcohol consumption that comes from different drinks types. On his schema, yellow represents a higher share from beer, light blue (cyan) a higher share from spirits and pink (magenta) a higher share from wine.

 

 

The charts above show how drinks preferences changed between 1965 and 2015 (you can see a dynamic version of the same chart here). Notice how the bright vivid colours of the 1965 chart become a duller, sludgy grey-green in several of the countries by 2015. That reflects a shift away from the extremes of strongly preferring one drink over the others. For example, the clear pink of Italy and Argentina in 1965 giving way to purply brown reflects a move away from a drinking culture dominated by wine to one which includes more beer and spirits. Similarly, Russia and China have moved from blue to green as spirits have given way to beer and wine.

According to Angus, this may be the product of globalisation, leading to an increasingly shared common drinking culture – ‘As the world gets smaller are we all behaving more like each other?’ Given the not inconsiderable differences that remain between countries, both in terms of the level of alcohol consumption and the drinks they prefer, that may be a while off. However, it will be interesting to see whether the trend in that direction continues.