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.
Offlicence News - 19th March
Advertising regulators are planning to take action to prevent children being exposed to alcohol marketing on social media.
The Advertising Standards Authority said it was responding to concerns about age-gating on websites and ease of access to accounts on services such as Twitter and Instagram.
Shahriar Coupal, director of advertising policy and practice at the ASA, told a Westminster Social Policy Forum: “We’ll very shortly be introducing measures that will better limit children’s exposure to alcohol ads on social media.”
Coupal revealed that the ASA had received only around 10 complaints per year about social media campaigns for alcohol, but researchers say the higher use of some social media among young people makes them vulnerable to this content.
Eleanor Winpenny, analyst at market researcher RAND, said that time spent on the internet now surpassed that spent watching TV among 12-15-year-olds.
Seven out of 10 of that age group have a social media profile or accounts, with Facebook, Instagram and Twitter the most popular. While Facebook blocks access to alcohol advertising for those who declare their age to be under 18, others, including Twitter and Youtube do not.
The issue has come into the spotlight this month after Diageo’s Ciroc vodka announced that it would be the first alcohol brand to run paid for advertising on Instagram.
Smirnoff and Stella Artois have both used Instagram campaigns and Heineken has publicised music festival content through Snapchat.
Winpanney said: “Social media is blurring the lines betweens user-generated content and brand marketing.
“There is a need for better regulation of children’s exposure to alcohol marketing online.”
The ASA received 236 complaints about 123 alcohol campaigns across all types of media in 2014, down from 445 notifications about 164 drinks campaigns in 2012. Approximately half related to TV ads and less than 10% to the internet, cinema or outdoor.
But Elaine Hindal, chief executive of Drinkaware, said digital media had a positive role to play in disseminating information about responsible consumption.
“It is an increasingly important way of engaging with consumers when they are on the bus or train on the way home form work,” she said. “There is a consumer appetite for information.”
Drinkaware carried out research among 49,000 users of its smartphone app
Hindal said that after four weeks, users were drinking an average of two to three units less alcohol per week, and after 12 weeks the average was 12 to 13 units.
The Publicans Morning Advertiser - 19th March
Smirnoff vodka and Guinness beer owner, Diageo, will become the first drinks company to provide drinkers with information on both nutritional information and alcohol content per typical serve, it announced today.
BBC - 18th March
Beer duty cut by 1p a pint and cider by 2p. 2% cut in excise duty on scotch whisky and other spirits while wine duty frozen
BBC - 18th March
Beer duty is being cut by 1p a pint for the third year running, Chancellor George Osborne announced.
The last two years' penny-a-pint cuts helped create 16,000 jobs in the brewing industry, he said.
Duty on cider and spirits such as Scotch whisky will be cut by 2%, "to back one of the UK's biggest exports", he said.
Reacting to the reduction in beer duty, Brigid Simmonds, chief executive of the British Beer & Pub Association, said: "The chancellor really is a 'hat-trick hero'. His third, successive beer tax cut shows he has listened to consumers, publicans and brewers.
"Beer tax is now ten pence lower than it would have been under the beer duty escalator, which he abolished."
The cut would help create 3,800 jobs this year and "put £180m in the pockets of beer drinkers and pubgoers," she said.
The move was also welcomed by the Society of Independent Brewers.
"This is a great day for British independent brewers, pubs and consumers," said managing director Mike Benner.
Andy Fyffe, leisure expert at consultancy EY, said: "Following the reductions in 2013 and 2014, volumes of beer sold in the UK increased year on year for the first time in a decade, helping to alleviate margin pressures experienced in recent years, boosting profits and ultimately protecting and growing employment.
"We expect that this latest beer duty cut will have a similar impact on the sector."
But Alcohol Concern said the government had "once again cast aside the health of the nation to protect the interests of 'big alcohol".
Alcohol misuse costs the nation £21bn a year, said chief executive Jackie Ballard.
"Instead of taking serious, evidence-based action - like implementing a minimum unit price - the chancellor has given the alcohol industry the go-ahead to make even bigger profits at all of our expense.
"Until we treat alcohol misuse as the huge public health issue it is, like smoking, we will all continue to pay billions to deal with it."
The Guardian - 18th March
George Osborne announced a penny off a pint for the third year running as he cut duty on beer and cider.
Brewers and pub companies welcomed the move and said the chancellor’s tax reductions had helped to support the UK’s ailing pub trade.
Osborne said that, from 23 March, duty rates on general beer and lower strength cider would be cut by 2%. A typical pint of beer will be a penny cheaper than now and 9p less than under the previous government’s plans.
Tim Martin, chairman of pub chain JD Wetherspoon, has campaigned for a better deal for pubs competing with cheap alcohol sold by retailers. He said: “The pub trade needs tax equality with supermarkets. We haven’t got that but what we have got [from Osborne] is welcome.”
According to the Campaign for Real Ale, 31 pubs closed each week in the first six months of last year. Beer sales have fallen sharply since 2000 but sales of beer in pubs rose in 2014 for the first time in a decade.
Britain is in the middle of a craft beer boom. Last year 14 breweries opened each month, taking the number to almost 1,300 – the most since the 1940s, according to the Campaign for Real Ale.
Matthew Howgate, head brewer at Marbles brewery in Manchester, said: “Duty going down allowed us to keep our prices steady when a lot of the ingredients we were purchasing, particularly hops, were going up in price. That helps the customer and it helps us because it means people can afford to drink more.
The beer duty cut will create 3,800 jobs this year alone and attract new capital investment, the British Beer and Pub Association (BBPA) predicted.
Brigid Simmonds, chief executive of the BBPA, said: “Cutting beer duty supports a great British industry which contributes £22bn to GDP and supports almost 900,000 jobs.”
GP Online - 19th March
The lack of mention of the NHS from the Budget statement is a worrying sign. We know all parts of the health service are struggling to meet demand and maintain quality under the financial strain of the last five years.
This Budget does not give patients and NHS staff any certainty about wider funding plans up to 2020. Yet that is the timescale on which NHS England, rightly, thinks spending must be committed in order to drive improvement and maintain quality.
There was some extra funding announced - but unfortunately it is mostly likely to go not to the NHS but rather to the growing number of companies and social enterprises feeding off it.
Impact of alcohol misuse is huge
For me, the most damaging announcement in the budget for the NHS was the proposed cut of duty on beer for third year in a row with another penny coming off the pint. Cider duty will be reduced by 2% as will the duty on whisky and other spirits. Wine duty is frozen.
The impact of alcohol misuse across the rest of the NHS, in hospitals and in our communities is huge. More than 10m adults in England now drink more than the recommended daily limit, with 2.6m drinking more than twice that. As a GP for 30 years, I have witnessed first-hand how alcohol destroys lives. I have seen people who had cirrhosis of the liver or another alcohol-related illness, such as heart disease, as well as those who were injured or assaulted while drunk.
My colleagues working in A&E departments tell me that every weekend they see children who have been found unconscious through drink on the street and brought to hospital by the police or the ambulance service.
Alcohol misuse costs the NHS and the justice system about £25bn every year. That figure covers the cost of healthcare, crime, social disorder and lack of productivity at work attributable to alcohol, including the £2.7bn the NHS spends treating the chronic and acute effects of drinking. The total number of alcohol-related NHS admissions hit almost 10m in England during 2012/13 with almost 600,000 in Greater Manchester.
Successive governments have been too complacent about the problem of alcohol abuse, particularly among young people. The WHO says that Europe has the highest proportion in the world of total ill health and premature death due to alcohol. More than one in five people across the whole of Europe admits to heavy drinking at least once a week.
The cost of tax giveaways to the alcohol industry in the last three budgets now totals £690m annually. While, in real term the NHS budget been squeezed every year. Reducing duty on beer, cider, spirits and wine would do nothing to address the economic and health impacts caused by alcohol abuse. Is the government not concerned to tackle alcohol-related harm and its implications for the cost and workload on the NHS? Politicians may have been tapping into populist sentiments of a booze-loving nation, but they are also playing with lives. Once again, the government in England is bowing down to big business. Ministers now are doing what ministers in the past have done with these public health measures – kicking them into the long grass.
The short-term revenue gains from alcohol advertising do not tell the full story of how much social, financial and medical misery alcohol abuse causes.
The New York Times - 16th March
As my children, and my friends’ children, are getting older, a question that comes up again and again from friends is this: Which would I rather my children use — alcohol or marijuana?
The immediate answer, of course, is “neither.” But no parent accepts that. It’s assumed, and not incorrectly, that the vast majority of adolescents will try one or the other, especially when they go to college. So they press me further.
The easy answer is to demonize marijuana. It’s illegal, after all. Moreover, its potential downsides are well known. Scans show that marijuana use is associated with potential changes in the brain. It’s associated with increases in the risk of psychosis. It may be associated with changes in lung function or long-term cancer risk, even though a growing body of evidence says that seems unlikely. It can harm memory, it’s associated with lower academic achievement, and its use is linked to less success later in life.
But these are all associations, not known causal pathways. It may be, for instance, that people predisposed to psychosis are more likely to use pot. We don’t know. Moreover, all of these potential dangers seem scary only when viewed in isolation. Put them next to alcohol, and everything looks different.
Because marijuana is illegal, the first thing I think about before answering is crime. In many states, being caught with marijuana is much worse than being caught with alcohol while underage. But ignoring the relationship between alcohol and crime is a big mistake. The National Council on Alcoholism and Drug Dependence reports that alcohol use is a factor in 40 percent of all violent crimes in the United States, including 37 percent of rapes and 27 percent of aggravated assaults.
No such association has been found among marijuana users. Although there are studies that can link marijuana to crime, it’s almost all centered on its illegal distribution. People who are high are not committing violence.
People will argue that casual use isn’t the issue; it’s abuse that’s worrisome for crime. They’re right — but for alcohol. A recent study in Pediatrics investigated the factors associated with death in delinquent youth. Researchers found that about 19 percent of delinquent males and 11 percent of delinquent females had an alcohol use disorder. Further, they found that even five years after detention, those with an alcohol use disorder had a 4.7 times greater risk of death from external causes, like homicide, than those without an alcohol disorder.
When I’m debating my answer, I think about health as well. Once again, there’s no comparison. Binge drinking accounted for about half of the more than 80,000 alcohol-related deaths in the United States in 2010, according to a 2012 report by the Centers for Disease Control and Prevention. The economic costs associated with excessive alcohol consumption in the United States were estimated to be about $225 billion. Binge drinking, defined as four or more drinks for women and five or more drinks for men on a single occasion, isn’t rare either. More than 17 percent of all people in the United States are binge drinkers, and more than 28 percent of people age 18 to 24.
Binge drinking is more common among people with a household income of at least $75,000. This is a solid middle-class problem.
Marijuana, on the other hand, kills almost no one. The number of deaths attributed to marijuana use is pretty much zero. A study that tracked more than 45,000 Swedes for 15 years found no increase in mortality in those who used marijuana, after controlling for other factors. Another study published in the American Journal of Public Health followed more than 65,000 people in the United States and found that marijuana use had no effect at all on mortality in healthy men and women.
I think about which is more dangerous when driving. A 2013 case-control study found that marijuana use increased the odds of being in a fatal crash by 83 percent. But adding alcohol to drug use increased the odds of a fatal crash by more than 2,200 percent. A more recent study found that, after controlling for various factors, a detectable amount of THC, the active ingredient in pot, in the blood did not increase the risk of accidents at all. Having a blood alcohol level of at least 0.05 percent, though, increased the odds of being in a crash by 575 percent.
I think about which substance might put young people at risk for being hurt by others. That’s where things become even more stark. In 1995 alone, college students reported more than 460,000 alcohol-related incidents of violence in the United States. A 2011 prospective study found that mental and physical dating abuse were more common on drinking days among college students. On the other hand, a 2014 study looking at marijuana use and intimate partner violence in the first nine years of marriage found that those who used marijuana had lower rates of such violence. Indeed, the men who used marijuana the most were the least likely to commit violence against a partner.
Most people come out of college not dependent on the substances they experimented with there. But some do. So I also consider which of the two might lead to abuse. Even there, alcohol fares poorly compared with marijuana. While 9 percent of pot users eventually become dependent, more than 20 percent of alcohol users do.
An often-quoted, although hotly debated, study in the Lancet ranked many drugs according to their harm score, both to users and to others. Alcohol was clearly in the lead. One could make a case, though, that heroin, crack cocaine and methamphetamine would be worse if they were legal and more commonly used. But it’s hard to see how pot could overtake alcohol even if it were universally legal. Use of marijuana is not rare, even now when it’s widely illegal to buy and use. It’s estimated that almost half of Americans age 18 to 20 have tried it at some point in their lives; more than a third of them have used it in the last year.
I also can’t ignore what I’ve seen as a pediatrician. I’ve seen young people brought to the emergency room because they’ve consumed too much alcohol and become poisoned. That happens thousands of times a year. Some even die.
And when my oldest child heads off to college in the not-too-distant future, this is what I will think of: Every year more than 1,800 college students die from alcohol-related accidents. About 600,000 are injured while under alcohol’s influence, almost 700,000 are assaulted, and almost 100,000 are sexually assaulted. About 400,000 have unprotected sex, and 100,000 are too drunk to know if they consented. The numbers for pot aren’t even in the same league.
I’m a pediatrician, as well as a parent. I can, I suppose, demand that my children, and those I care for in a clinic, never engage in risky behavior. But that doesn’t work. Many will still engage in sexual activity, for instance, no matter how much I preach about the risk of a sexually transmitted infection or pregnancy. Because of that, I have conversations about how to minimize risk by making informed choices. While no sex is preferable to unprotected sex, so is sex with a condom. Talking about the harm reduction from condom use doesn’t mean I’m telling them to have sex.
Similarly, none of these arguments I’ve presented are “pro pot” in the sense that I’m saying that adolescents should go use marijuana without worrying about consequences. There’s little question that marijuana carries with it risks to people who use it, as well as to the nation. The number of people who will be hurt from it, will hurt others because of it, begin to abuse it, and suffer negative consequences from it are certainly greater than zero. But looking only at those dangers, and refusing to grapple with them in the context of our society’s implicit consent for alcohol use in young adults, is irrational.
When someone asks me whether I’d rather my children use pot or alcohol, after sifting through all the studies and all the data, I still say “neither.” Usually, I say it more than once. But if I’m forced to make a choice, the answer is “marijuana.”
Dundee Evening Telegraph - 19th March
A new Dundee nightspot has been branded “reckless” by alcohol addiction charities — after vodkas were advertised for just 50p each.
Beau nightclub, in the city’s Cowgate, is selling the spirit cheaply in a bid to entice revellers to visit on Friday nights.
Bottles of beer, alcopops and other spirits are also advertised at just £1 on the venue’s Facebook page.
The club, formerly Deja Vu, opened its doors for the first time on Friday. A Facebook post states that the club operates a “smart drinking policy”.
But Kathryn Baker, service manager at the Tayside Council on Alcohol, said: “This would appear to be encouraging people to drink as much as they possibly can before falling down. Other pubs and clubs are managing to survive without selling alcohol as cheaply as that.”
Councillor Ken Lynn, city health and social work convener, blasted the pricing as “disgraceful” and said the offer could lead to public order issues.
He said: “It flies in the face of everything the Scottish Government is trying to do in terms of minimum pricing.
“This will definitely lead to people drinking more and will contribute to higher crime levels and ultimately poorer health. I would have hoped that this sort of thing was in the past — it is completely and utterly irresponsible.”
Dave Barrie, manager of Dundee alcohol and drug addiction charity Addaction, agreed. He said: “It is important businesses promote sensible and safe alcohol use and selling extremely cheap spirits is not doing that in any shape or form.
“It is clearly a way of making money and promoting sales and the club itself.
“The city’s alcohol and drug issues are quite significant and this is not helping. If this were to set some sort of precedent for nightclubs and bars in Dundee then that would be very worrying.”
But Beau owner Tahir Ramzan said it was up to the club who is let in.
He said: “Nobody is served more than two glasses at a time, we don’t do doubles as part of the offer, and it is up to staff to decide not to serve a person if they feel they have had too much to drink.
“Who supervises all of the people who are pre-loading before they come to the club? No one.
The Guardian - 16th March
Upstairs from one of my favorite Oakland dive bars, 10 people of varying ages and backgrounds are sitting in a circle, talking about their drinking problem.
“I make plans for my non-drinking days so that I’m not thinking about it so much – I work out, I schedule late work meetings, so it’s not even a temptation,” a tall, thin older woman says. Later, she explains that there was a time not long ago when the idea of getting through any day without five or six drinks seemed impossible to her.
“Go out later, hold off on that first drink, set up a game for yourself like ‘I can only buy one drink and then I have to get any others I want bought for me’,” adds a young man in stubble and a newsboy cap. “Hold off on your second drink, too,” adds the older man sitting next to him. “I used to order my next drink halfway through my first, so I’d be halfway through my second before the effects of the first one would kick in and then forget about it.”
This is Moderation Management (MM), a program whose rising popularity and success rate is posing the first real challenge in decades to the traditional, black and white approach to addiction.
The program typically starts with 30 days off booze altogether – “doing a 30” in MM parlance – followed by a slow reintroduction of alcohol, and eventually a plan to limit your intake: no more than 14 drinks a week for men, nine a week for women, and no drinking more than three or four days a week for either. There’s increasing talk of applying MM to marijuana use as well, although that’s not officially condoned by the nonprofit of the same name, which administers the program.
“People do come in lately who want help moderating marijuana and because it’s still illegal in California, we shy away from it,” explains Marc Kern, the organization’s director. “That doesn’t mean they can’t come to meetings and listen and stuff like that. But in states that have legalized it, I can see a time where there’s a different MM – Marijuana Moderation.”
While there is a framework to MM, based on Kern’s book Responsible Drinking, it’s also a program that prides itself on flexibility and enabling people to find their own paths forward. Three out of the 10 people at the meeting I attended said they weren’t ready to do a 30 yet, but were planning shorter breaks. One man celebrated the fact that he’d taken one day off from smoking weed and drinking. He does both in moderation daily, and his concern was more about the frequency and the fact that he can never seem to take a day off than the amount of any particular substance consumed.
Another woman nearly started to cry when talking about issues with her son, her marriage, and her stressful job. She said the only thing getting her through was the bottle of wine she drinks every night. She’d had a few occasions recently where she blacked out from drinking, then spent days in bed depressed. The group gave her ideas for ways she could take a few days away from all of it – the stress, the husband and the drinking – and suggested more therapy to deal with the psychological triggers of her drinking and depression.
A young man in the group explained that he had bipolar disorder, that he was feeling great on his new medication, but that there might be a problem when it comes to alcohol. “I’m not someone who drinks when they’re depressed, I drink when I’m up,” he said. “If I’m feeling good, I want to be out being social, and that means drinking.” The group offered some tips and tricks for sticking to the four-drink-a-night maximum, and for finding ways to be social without drinking. When the older man sitting next to him talked about his daily marijuana use and how it keeps him from being too irritable about anything, the bipolar man raised an eyebrow and gently suggested that using marijuana as a mood stabilizer was different, and more problematic, than just smoking pot because you like it and think it’s fun.
There was no therapist in the room, and the moderator, a two-year MM “veteran”, gently steered people away from delving too deeply into issues that might be better addressed in therapy.
Moderation Management has been around since 1994, but it was living more or less in the shadows from 2000 to 2012, mired in controversy over its founder, Audrey Kishline. After starting MM, Kishline left the group, realizing that she could not moderate her drinking after all. She returned to AA, then fell off the wagon, drunk-driving in March 2000 and killing a man and his 12-year-old daughter. She was released from prison in 2003, and in 2014, plagued by guilt and other demons, Kishline killed herself.
In the year since since Kishline’s death, MM has had something of a resurgence, bolstered by the launch of the US National Institute of Health’s Rethinking Drinking program and a 2014 report from the Centers for Disease Control calling out “excessive drinking” as something both independent of alcohol dependence and a major public health issue that is not being addressed by currently available tools and programs.
MM began to add more in-person meetings and last year, the organization launched a campaign around Dryuary, encouraging people to take the month of January off from drinking. It was so successful, they now plan to do it every year.
“Historically, MM has been looked upon as enabling alcoholics, and then the tragedy with Audrey knocked us in the stomach and we really pulled back after that,” Kern says. “Only now, in the last year and a half to two years, have we started to come out again. The notion of figuring out if you can moderate, rather than going straight to abstinence as step one of dealing with an alcohol problem, is pretty universal. I haven’t talked to every single person in AA, but I’m sure they’ve all tried moderation on their own. But before MM there was no book or guidelines or anything, so people would just go out and try moderation naively on their own, and without any support a lot of them would fail.”
Kern has been helping patients with moderation in a clinical setting for more than a decade, which entails a formal therapeutic protocol that includes using a Breathalyzer and closely monitoring patients’ progress. He also managed to get MM approved by the city of Los Angeles and the state of California as a program for first-offender drunk drivers 15 years ago. Still, Kern says most of the drunk-driving schools in the state automatically send people to abstinence programs (typically Alcoholics Anonymous or the non-religious version, Smart).
“The current status of the addiction field is based 97% on this black and white idea that you’re either an addict or you’re not, and if you’re an addict the only path is abstinence,” Kern says. “The success rate is far from optimal with that approach, so for the first time ever the US government is encouraging people to look outside the box.”
The US might be another decade away from, as Kern puts it, “taking full ownership as a society that there are many roads to recovery”, but other countries have been quicker to embrace MM. The UK National Health Service promoted “dry January” this year, while Australia has “Sober October”. There are currently MM meetings in England, Scotland, Ireland, Thailand, Germany, Belgium and Canada.
“The British have been struggling with over-consumption for so many decades, and they’re not so religious-based as we are here, so they’ve really welcomed MM,” Kern says. “They are much more open to a harm-reduction approach, and the idea of incremental steps and adopting a strategy that doesn’t make the threshold of getting treatment so high. They take the approach of, ‘Let’s get people started thinking about their drinking’ and they see reducing drinking as a success, whereas in this country if you reduce you’re still an alcoholic with a problem, which is not actually what the addiction literature suggests.”