Welcome to SHAAP’s (Scottish Health Action on Alcohol Problems) weekly media monitoring service.

25 August  2016


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This briefing aims to provide a ‘snap shot’ of latest news on alcohol and health policy. The inclusion of an article in the briefing should not imply that SHAAP approves or condones the content.

SHAAP provides a coordinated, coherent and authoritative medical and clinical voice on the need to reduce the impact of alcohol related harm on the health and wellbeing of the people in Scotland. SHAAP was set up by the Scottish Medical Royal Colleges, through their Scottish Intercollegiate Group (SIGA) and is governed by an Executive Committee made up of members of the Royal Colleges.

Emergency service workers punched, threatened and spat on by drunks

Scotland's emergency services have united to demand an end to alcohol-related abuse against their workers - as figures suggest drink is linked to half of all 999 call-outs.

Police officers, paramedics and firefighters said they have been punched, threatened and spat on while trying to do their job on the front line in emergencies.

A staff survey across the three blue light services found alcohol misuse is a contributory factor in around half of the incidents 999 workers responded to.

One in three workers said they were subjected to physical abuse while attending an alcohol-related incident over the four weeks the survey looked at.

Two-thirds said they have experienced verbal abuse from drinkers, while a similar proportion said they had faced difficulties in securing urgent information because of victims or callers being drunk.

The three services are now campaigning for an end to such "unacceptable" behaviour.

Scottish Fire and Rescue Service (SFRS) assistant chief officer David McGown said: "The public will be shocked to hear our front-line firefighters and control officers are often abused and obstructed by people under the influence of alcohol.

"They are all working to save lives and protect property. Being drunk is absolutely no excuse for impeding emergency responders or directing abuse at them.

"We are determined to get the message across - this is reckless, criminal behaviour that risks lives and it can never be tolerated."

Anonymous responses to the survey shed light on what the services called the "sad reality" faced by those on the front line.

One firefighter said: "I was in breathing apparatus at a house fire and I found a man lying in his bed. He had tried to cook after coming back from a night out but he was drunk and fell asleep.

"The smoke alarm was blaring but he only woke up when I shook him to see if he was alive. He punched me in the face."

An ambulance crew member told the survey: "I have been assaulted, spat at and verbally abused too many times to mention."

The study also revealed that an ambulance on its way to a life-threatening emergency was delayed by drunks who danced in front of the vehicle.

Police Scotland Assistant Chief Constable Mark Williams said: "The demands being placed on the emergency services by people who are drunk are huge.

"On many occasions, it delays police officers, firefighters and paramedics from getting to members of the public who really do need our protection and help."

Daren Mochrie, director of service delivery for the Scottish Ambulance Service (SAS), said: "Our front-line staff should not have to fear for their own safety when treating patients, but alcohol is a key factor in most assaults.

"They respond to patients in all weathers and situations and deserve the public's respect for the high-quality care that they provide.

"However, at times they are verbally abused and have to put up with being pushed and spat on, as well as being kicked, punched, and in some extreme cases assaulted with a variety of weapons.

"Instances of this kind of behaviour would fall dramatically if people learned to drink responsibly."

Source: Herald Scotland, 24th August

Children's Commissioner Tam Baillie rejects plans to extend Stop and Search

It is hard to imagine any other context in which a tactic with a failure rate of more than 90 per cent would be extended more widely.

That is exactly what is currently being considered under proposals to extend the police power to stop and search children and young people for alcohol.

I have frequently voiced my opposition to non-statutory – so-called "consensual"– stop and search by police officers on children and young people.

Children and young people have been disproportionately targeted by ‘consensual’ stop and search, and, because of the outcry, these types of searches are due to end this year, when a new code of practice comes into force, limiting the police to searches only where they have the legal power to conduct them.

However, a decision has yet to be made by the Scottish Government about whether to create a new statutory power to allow the police to stop and search under-18s for alcohol.

Everyone is agreed that under-age drinking is not to be overlooked or condoned, but searching children and young people for alcohol is a disputed area.

Police Scotland has previously asserted that the loss of non-statutory stop and search will leave a gap in powers to seize alcohol from children and young people.

However, the statistics simply do not prove this hypothesis.

Fewer than one in every 10 of all stop and searches actually results in the finding of alcohol.

And where they do, it has been found through research published by Her Majesty's Inspectorate of Constabulary in Scotland ( HMICS ) that many of these "searches" were in fact using existing powers of alcohol seizure.

Since then, recording has improved and it is clear that it is the existing power of alcohol seizure, which is key to keeping children and communities safe from the effects of under-age drinking.

My office played a key role in the Stop and Search Advisory Group, chaired by John Scott, QC.

In my consultation response to the Scottish Government, I made it clear that I believe the creation of a new, statutory power is not necessary.

I believe the new proposals for a statutory power to stop and search under-18s for alcohol is a retrograde step that is neither desirable nor proportionate: it would be discriminatory and could lead to more unnecessary searches of children and young people.

In recent months, the UN Committee on the Rights of the Child raised concerns about the use of stop and search on children and young people in the UK, recommending that non-statutory searches be stopped and that the use statutory stop and search be proportionate and non-discriminatory.

Any measures put in place to prevent harm need to be balanced carefully against the rights of children and young people to go about their lives without undue interference.

They should be able to meet with friends in the park, for example, without the concern that they will be subject to stop and search on a regular basis.

We need to get the balance right between protecting the public – and the health of children and young people – and the rights of individuals to go about their daily lives without suspicion or fear.

The existing police power of "seizure", which allows the police to remove and dispose of alcohol in the possession of children and young people, is sufficient.

There is no need to add another power.

To do so will run the risk of making legislation which is unnecessary, with a return to the concerns around the disproportionate targeting of children and young people and failing to honour our international duties through the UNCRC.

Source: Herald Scotland, 18th August

'Drinking is as safe as driving' Theresa May waters down anti-alcohol guidelines

The Prime Minister has rejected strict warnings by chief medical officer Dame Sally Davies, who said there was no safe level of alcohol.

The controversial Dame also called for people to consider the risk of getting cancer every time they wanted a drink.

But now Mrs May is making it clear that moderate drinking is fine.

New Government guidelines on alcohol are stricter than those presently in force and have not changed since they were published in draft form by Dame Sally, but the rhetoric is less harsh.

The recommended weekly limit for men will be reduced from 21 units a week to 14 – the same as women and equivalent to six or seven glasses of wine.

Pregnant women or those trying to conceive will be warned they should not drink at all.

However, Health Secretary Jeremy Hunt is expected to highlight a section of the guidance stressing that risks from drinking within recommended limits are comparable to those from “regular or routine activities, such as driving”.

Mrs May has reportedly told aides to tone down the earlier “hysterical” message.

A source told the Sun on Sunday: “We acknowledge a pint after work at the end of the week is unlikely to do any harm.”

The Sunday Times reported that papers seen by the drinks industry show that ministers have accepted that while there is no totally safe limit, the guidance ‘will give context about not preventing people enjoying a drink’.

A Government source said: “We think the new guidelines are based on good science. Up to the limits we’re advising, the level of risk is probably something people would accept.”

Dame Sally told the Commons Science and Technology Committee in February: “I would like people to take their choice knowing the issues and do as I do when I reach for my glass of wine and think, ‘Do I want my glass of wine or do I want to raise my risk of breast cancer?’”

“I take a decision each time I have a glass."

Research shows that a daily glass of wine can increase a woman’s risk of breast cancer by 13 per cent.

The tough guidelines will anger drinks firms who wanted the “no safe level” claim to be rebuked, complaining that the Government promotes their products abroad while calling them a health risk at home.

Source: Daily Express, 22nd August

Key policy issues still fought as white cider back under fire

White ciders and 'super strength' drinks have been a regular feature in alcohol policy debates over the years. This month a letter published in Clinical Medicine reminded readers of research that found all cheap strong cider drinkers in Scotland are 'dependent, and possibly ill' - or 'alcoholics' as some of the media seemed to prefer.

The existence of such drinks are therefore highly contested and interplay with key alcohol policy areas including price, availability and industry led 'responsibility' action. In 2011 a report released by Alcohol Concern called for action to stop 'irresponsible profiteering from the high-alcohol low-cost drinks' whillst the Observer ran a feature 'White cider is becoming like heroin among alcoholics'.

Price and taxation: time for change?

An Alcohol Research UK comment piece responding to the recent letter highlighted Scotland's minimum unit pricing (MUP) legal battle is currently going through the final stages, with a decision expected soon - albeit likely to be subject to further legal appeal. However the precise impact of MUP on white cider drinkers is unknown. Whilst some arguments have been made that MUP is an 'almost perfect policy' precisely because it will force the heaviest drinkers to cut down, questions over what alternative drinks might be sought instead by the most severely dependent, and the possible impact on others, have also been raised.

MUP though would also impact a much wider range of 'harmful' drinkers given the volume of off-trade units that are sold below 50 pence a unit, and as such public health epidemiologists might counter that smaller reductions in a larger group are more significant in terms of the intended gains. It is often cited that '40% of all alcohol is consumed by 10% of the drinkers', yet only a small proportion will access treatment services or seek formal help.

Tax has also been much discussed as an issue, though under the current system unrealistic tax hikes would be required to see the equivalent price effects of MUP. Added complications include how some producers might absorb tax rises on certain drinks, price shift onto different products, or the effects on groups such as the craft cider industry. The Institute for Fiscal Studies' repeated calls for the re-structuring alcohol taxation have support from some health groups as an additional measure to MUP, and may be more likely following Brexit.

RIP Responsibility Deal?

What of industry-led action? The greatest claimed success of the now expired responsibility deal was to have removed more than a billion units from the market, though subsequently questioned. However public health groups are unlikely to be concerned that there appear to be no signs of revitalising the former alcohol pledges.

Despite this, there may be scope for further pressure on producers to reduce strength, serving sizes or even de-list 'super strength' products. In 2009 White Lightening was de-listed by its owners Heineken to 'reinforce its stance on responsible drinking', but what value was such a move if other products such as Frosty Jacks have merely filled the gap in the market?

More recently, local 'reducing the strength' type initiatives appeared to have risen in popularity. Some positive impacts have been reported, but opposition from some industry groups and questions over sustainability and actual impact may warrant further attention. 

For Scotland, an eventual MUP victory would certainly be celebrated by many health groups, and cheap ciders could be the most obvious scalp from the off-trade shop floor. To what extent wider 'harmful drinking' population effects would mitigate possible potential negative impacts on those at the heavier end of the spectrum would be closely monitored by supporters and opponents alike.

Source: Alcohol Policy UK, 17th August

Half of parents with children under the age of 14 allow them to drink alcohol at home, research by Churchill home insurance has found.

It also found that 34% of parents with children under 14 used alcohol as a bribe to encourage good behaviour, while 11% of parents with children aged five to seven allowed them to drink at home. A quarter of those surveyed who let their children drink said they saw nothing wrong with it.

While it is not illegal for children aged five to 16 to have alcohol at home, the Chief Medical Officer’s report states that children under 14 who drink have increased health risks – including suicide attempts, involvement in violence and alcohol-related injuries.

Almost a third of parents said that allowing their children to drink at home let them monitor their child’s alcohol consumption. The research also suggested that one in five parents would allow minors who are not family members to have alcohol in their house.

Martin Scott, head of Churchill home insurance said: “The relationship between children and alcohol in Britain always seems more fraught than for our continental cousins. Many parents want their children to have a responsible attitude to drinking and introduce alcohol in a safe, controlled environment.

“The challenge any parent will recognise is how to prevent excessive drinking, especially amongst teenagers ... Whenever people are drinking in the home, there is a greater risk of injury or property damage as alcohol has a significant impact on co-ordination.”

Joanna Simons, chief executive at Alcohol Concern, said: “We know that many parents start from the best intentions when they introduce children to alcohol at home, but all the research indicates that the younger that children start drinking, the more likely they are to have problems with alcohol in later life.

“Parents are really important role models for their children and the more that they can keep an eye on the number of units they’re drinking, and have a few days off drinking each week, the more that their children’s attitude to alcohol will be shaped in a safer way.

“The Chief Medical Officer advises that an alcohol-free childhood is the safest option and that those under 15-years-old, ideally, should not drink at all.”

Rosanna O’Connor, director of alcohol, drugs and tobacco at Public Health England, said: “Advice from the Chief Medical Officer for England is that an alcohol-free childhood is the healthiest option.

“Most parents are aware of the dangers of children and young people consuming alcohol from an early age and evidence points to the fact that starting to drink alcohol before the age of 15 can affect their health and wellbeing in the future.”

Source: The Guardian, 19th August

Childhood ADHD and Adulthood Alcohol Problems: The Role of Emotional Impulsivity

According to CDC, attention deficit hyperactivity disorder (ADHD) is one of the most prevalent developmental disorders, and approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD in 2011. The average age of ADHD diagnosis is 7 years of age, and boys are more likely than girls (13% vs. 6%) to receive the diagnosis. In the present study, average age at diagnosis of ADHD was 9.40 years (SD=2.27), with a range of 5 to 16 years of age. Also, 90% of participants were between 5 and 12 years of age.

Investigators affiliated with the University of Pittsburgh, University of Houston-Clear Lake, Chatham University in Pittsburgh, and Florida International University, showed that elevated levels of emotional impulsivity among children diagnosed with ADHD are associated with an increased risk for alcohol problems such as alcohol use disorder (AUD) in adulthood. Their findings from a longitudinal study of individuals with (n=170; 88 male) and without (n=119; 89 male) childhood ADHD [an average of 15.25 years (SD=2.5) from childhood into adulthood] were reported in the journal Addiction, which is published by the Society for the Study of Addiction.

“The current study examines associations between childhood ADHD, five components of impulsivity (lack of planning, lack of perseverance, negative urgency, positive urgency, and sensation seeking) and alcohol problems in adulthood,” researchers wrote in their publication.

Researchers used a modified version of the Young Adult Alcohol Problems Screening Test (YAAPST) to assess alcohol problems in adulthood among participants with [29.02 years of age (SD=3.39)] and without [28.15 years of age (SD=3.32)] childhood ADHD. With regard to impulsivity, they used the UPPs-P impulsive behavior scale. Investigators included the following covariates in their analyses: gender, age at adult assessment, race, frequency of alcohol use, and conduct disorder diagnosis (assessed at the same time as childhood ADHD).

Findings indicate that childhood ADHD significantly predicted a higher number of alcohol problems in adulthood, as well as higher levels of 4 out of 5 impulsivity facets in adulthood. More specifically, childhood ADHD did not predict sensation-seeking behavior, but it did significantly predict lack of planning, lack of perseverance, negative urgency, and positive urgency.

The association between ADHD and number of alcohol problems in adulthood was mediated significantly by both negative and positive urgency, was mediated marginally by lack of perseverance, and was not mediated significantly by lack of planning.

These findings are important, as CDC rank alcohol-attributable mortality as the third leading cause of preventable death in the United States. And, on average, almost 70% of substance use disorders involve alcohol only (ie, alcohol use disorders).

“The current study addresses several existing gaps in the literature,” and “is the first to demonstrate that impulsive tendencies, in the context of strong positive or negative mood, are related significantly to alcohol problems in adulthood for individuals who had ADHD in childhood,” the authors concluded.

Source: Psychiatry Advisor, 24th August

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