A national alcohol strategy nears but will it be a short measure?

Those who work in the alcohol misuse field must feel like New
Labour supporters did in 1997. Having longed for the day to arrive,
the time has come to see whether the waiting has been
worthwhile.

For years there has been pressure on the government to introduce a
national alcohol strategy. The government was accused of ignoring
the impact of alcohol misuse and concentrating on drugs.

But cynics have suggested that tackling the effects of alcohol, a
socially sanctioned and legally accepted drug, could be tantamount
to committing political suicide.

However, the government pledged its dedication in July 1999 in the
white paper Saving Lives: Our Healthier Nation and
stipulated in the NHS Plan that the Department of Health would
implement a strategy for England by 2004.

That date is now within sight but, compared with the rest of the
UK, England is lagging behind. Wales produced its strategy
Tackling Substance Misuse in Wales in May 2000, Northern
Ireland published its Strategy for Reducing Alcohol Related
Harm in September 2000, and Scotland produced its Plan for
Action on Alcohol Problems in January this year.

In England, a strategy unit was set up in the summer to review and
analyse policy and now the time has come to develop it. Last month,
the unit published a consultation document with the Department of
Health. The National Alcohol Harm Reduction Strategy
consists of 61 questions on seven main areas, including vulnerable
groups, crime and antisocial behaviour, and prevention and
treatment.

The “harm reduction” part of the document’s title hints at what
some see as the strategy’s main focus. This is elaborated in the
introductory statement, which reads: “Not everyone drinks in
moderation and alcohol misuse can have serious consequences. Some
of these consequences can be seen clearly: town and city centre
violence and disorder on weekend evenings, teenagers drinking in
parks and public places, and people with serious alcohol problems
who drink on the streets and are at risk of homelessness.”

Those who worry that the negative health effects of alcohol misuse
will be engulfed by other agendas may have just reason.

The content and format of the consultation document have led people
to query whether the time frame for formulating the strategy is
realistic. The list of questions seems little more than a starting
point for gathering information, yet the final strategy is expected
early next summer.

Penny McVeigh, chief executive of Norcas, a drug and alcohol
service provider based in East Anglia, says the feeling about the
consultation is that “something is better than nothing”. She
believes the consultation is a good “early discussion document” but
would like to be able to respond to more concrete proposals.

She also considers the consultation document to be too broad. “It
is aimed at a huge percentage of people that clearly you can’t aim
a strategy at. Is it about education, reducing crime or saving the
NHS money? You can’t have a strategy that is implicitly about half
the population.”

She adds that the consultation document fails to touch on some
issues. “There is only one mention of mental health, but most
people who come to us have some sort of mental health problem. The
area is not explored in depth. How are other agencies going to be
brought in?”

There is also a problem over accessibility. McVeigh says that in
rural areas service users sometimes have to travel long distances
for help. Then there is the burden of the curtain-twitching nature
of village life, which necessitate more discreet services, such as
the introduction of alcohol workers in GP surgeries.

Others believe that it is right that the consultation document is
broad. Richard Kramer, head of policy at substance misuse charity
Turning Point, says: “It needs to recognise that the issues are
complex. But the principles that underpin it need to be clearly
defined.”

His organisation has identified four areas on which the strategy
should focus: treatment in communities; education, information and
advice for young people; more investment to support the local
delivery of services; and integrated solutions – “the recognition
that people need support from health, social care and
education”.

He adds that alcohol misuse must not be viewed in isolation as it
often occurs alongside other problems and requires joined-up
treatment and commissioning of services.

Since the National Treatment Agency was set up in April last year
to oversee treatment for drug misuse there have been calls for it
to be responsible for alcohol misuse too. Turning Point is keen for
its remit to be extended in this way and Kramer insists that doing
so would enhance the status of alcohol misuse rather than diminish
it. He would support linking the approach to drug misuse in
general.

“There needs to be a joint approach to commissioning services,” he
says. “We wouldn’t want the alcohol strategy developed in isolation
from the drug approach. But it does need funding. We want the same
status to be afforded to alcohol as to drug treatment.”

There is a sense of relief that the idea of an alcohol strategy is
becoming a reality. Alcohol Concern has been waiting for about 10
years. Geethika Jayatilaka, the charity’s director of policy and
public affairs, says: “This offers us a significant opportunity and
we have to take it.”

Alcohol Concern has identified three main elements on which the
strategy should focus: the empowerment of local communities;
preventive measures; and improved funding for treatment services.

She suggests using preventive measures that do not depend on people
identifying themselves. For example, GPs and nurses would talk to
heavy drinkers and other public service workers would be trained to
identify alcohol problems. But the message should be broad.

She says: “We want a public health approach. It’s about improving
awareness about what alcohol misuse means. It goes more widely than
street drinkers. It’s about improving the early pick-up of their
problems.”

She condemns the apparent disparity between need and service
provision. “Funding streams for local services are patchy at best.
In the North, people are drinking more but services are
concentrated in London and the South East. Treatment services are
poorly funded and need more resources.”

John Beer, chairperson of the Association of Directors of Social
Services health and social inclusion committee, says all those
involved in drug action teams, including social services directors,
have been asking for a strategy for a long time. He wants the
strategy to ensure that the effects of alcohol misuse are not
played down in the efforts to deal with drug problems.

Beer does not consider the consultation to be too broad, saying
that the effects of alcohol misuse impinge on several areas. He
identifies three ways in which alcohol particularly affects the
work of social services and where the strategy could help: the way
it contributes to violence against children and women, to
antisocial behaviour and crime, and to mental health. “Some people
who are addicted to alcohol have a mental health problem that needs
to be addressed,” he says.

The consultation period finishes on 15 January. This is to be
followed by an analysis and then the final report in the summer.
The publication of a national alcohol strategy will be the
culmination of years of waiting. But its production is merely the
starting point. Its success will depend on how it is
delivered. 

– The National Alcohol Harm Reduction Strategy can be
found at
www.strategy.gov.uk/2002/alcohol/Consultationdoc.shtml