Bigger Picture on alcohol services

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Compiled by Natalie Valios, Deputy Features Editor with
Community Care.

Tackling alcohol problems has taken a back seat compared with
the war on drugs being waged by the government.

We’ve had a drugs tsar, a 10-year drug strategy launched in 1998
replaced by an updated drugs strategy unveiled last year, local
drug action teams, and drug treatment orders. On top of this, the
National Treatment Agency for Substance Misuse was set up in April
2001 to increase the availability and effectiveness of treatment
for drug misuse in England.

And even though the government pledged to combat alcohol in its
white paper “Saving Lives: Our Healthier Nation” in July 1999,
following this with an undertaking in the NHS Plan that the
department of health would implement a strategy for England by
2004, alcohol remains somewhat on the backburner.

Despite the NTA’s all-encompassing title, there was no mention
of alcohol within its remit much to the consternation of both drug
and alcohol workers. They pressed their case and there are signs
that the government might relent and broaden its remit this summer,
when the alcohol strategy is due, finally, to be launched.

Researchers believe the first experiences of drinking begin
around 11-years-old but can be as early as eight. About 1,000
under-15s are admitted to hospital every year with alcohol
poisoning. One in 13 people are dependent on alcohol, that’s twice
the number dependent on drugs. According to the British Crime
Survey 2000, alcohol misuse is implicated in 40 per cent of violent
crimes. Government figures show that it is also implicated in up to
40,000 deaths per year in England and Wales, and is directly
responsible for 5,000 deaths.

In 2001 a survey by the European School Survey Project on
Alcohol and Other Drugs (Espad) found that 15 to 16-year-olds in
the UK drink more than their European counterparts. The Alcohol and
Health Research Centre conducted the UK part of the survey. It
found that 91 per cent of respondents had been drinking alcohol
during the past 12 months. Over two thirds of UK pupils had been
drunk in the previous year, compared with a European average of 52
per cent.

And more recent figures show that alcohol-related deaths among
young women have tripled in 20 years and an average of two young
men and one young woman now die every day in England and Wales from
the effects of alcohol. And the trend of people dying younger from
alcohol-related causes is predicted to continue.

An estimated 920,000 children live in families where one or both
parents have problems with alcohol. Research has also shown that
heavy drinking can contribute to anxiety and depression, and
accelerate or uncover a predisposition to a psychiatric disorder or
psychosis.

With all these figures to hand, why is that the government has
appeared to be so reluctant to tackle this increasing problem?
Alcohol is viewed as a socially acceptable substance in a way that
drugs never have. Teenagers getting drunk is seen as a rite of
passage. But where those teenagers who experiment with drugs are
likely to give them up after five years, some young drinkers will
continue to drink heavily throughout their lives, those who started
drinking heavily at the same age are more likely to be hooked and
to, therefore, continue.

Finally, after years of waiting for action, a Cabinet Office
strategy unit was established last summer to review and analyse
policy in England. It was asked by Tony Blair to examine several
areas including:

• hazardous drinking by underage drinkers who are more vulnerable
  to detrimental health and other impacts of alcohol misuse;
• alcohol-related crime and anti-social behaviour;
• problems faced by vulnerable or “at risk” groups;
• education and communication about the effects of alcohol.

In October 2002, the unit published a consultation document with
the department of health called The National Alcohol Harm Reduction
Strategy, designed to promote action to help people misusing
alcohol and identify, prevent and manage the consequences of
misuse, including disorder and anti-social behaviour. Consultation
ended in January and the final strategy is expected this
summer.

But, England is still bringing up the rear; in May 2000, the
Tackling Substance Misuse in Wales strategy was produced, Northern
Ireland published its Strategy for Reducing Alcohol Related Harm in
September 2000 and Scotland announced its Plan for Action on
Alcohol Problems in January 2002.

Those working in alcohol services have a wishlist of the issues
they would like to see included in the strategy: treatment in
communities, education, information and advice for young people,
more investment to support the local delivery of services,
integrated solutions, and preventive measures that don’t depend on
people identifying themselves as a problem drinker.

They are clear that the strategy must ensure that the effects of
alcohol misuse are not played down in the efforts to deal with drug
problems. They also want the strategy to include the needs of
particular groups, for example people from ethnic minority
communities, older people and young people who may need
age-specific treatment, and those with a dual diagnosis of mental
illness and substance misuse. There are concerns that the
consultation document mentioned mental health just once, even
though many people who present at alcohol services have some sort
of mental health problem.

Alcohol is at least now on the agenda. The next concern is how
much money the government is prepared to put into initiatives to
tackle its misuse. In December 2002 it announced it would be
investing £1.5 billion to tackle drug misuse. Unlike drug
treatment and prevention services, similar services for alcohol
have not received any specific central government funding. This has
led to a situation where there are insufficient resources and
services available.

The consultation document is available
here

Useful websites:

• Action on Addiction: www.aona.co.uk
• Alcohol Misuse information (department of health site): www.doh.gov.uk/alcohol
• Alcohol Concern: www.alcoholconcern.org.uk
• Alcohol Focus Scotland: www.alcohol-focus-scotland.org.uk
• Drugs and alcohol information for professionals in Northern
  Ireland: www.drugsalcohol.info
• The Federation (of Black and Asian Drug and Alcohol Workers):
  www.thefederation.org.uk
• Institute of Alcohol Studies: www.ias.org.uk
• London Drug and Alcohol Network: www.ldan.org.uk
• Medical Advice on Alcoholism: www.medicouncilalcol.demon.co.uk
• National Association for Children of Alcoholics: www.nacoa.org.uk
• National Treatment Agency for Substance Misuse: www.nta.nhs.uk