Alcohol misuse is associated with a wide range of social
and personal problems, but there is a fear that the
government’s long-awaited strategy will fail to live up to
expectations, writes Alcohol Concern’s Eric Appleby.
Here he describes what policies are needed.
There are an estimated 10 million people affected by
excessive drinking in the UK. Heavy drinking by parents has been
identified as a factor in more than 50 per cent of child protection
case conferences, and more than one million children live with a
parent who has a serious alcohol problem.
According to the Youth Justice Board, 20 per cent of pupils who
were permanently excluded from school had previously been suspended
for drinking alcohol at school. In one year, 72,500 hospital
admissions for mental and behavioural disorders were due to
The government clearly has a responsibility to achieve a better
balance between the benefits alcohol brings, in terms of individual
pleasure and tax, and the extensive harm it wreaks for millions of
people. Yet the lack of any coherent national strategy on alcohol
has blighted efforts to tackle the problem. Treatment services
remain severely under-funded, with few parts of the UK having the
range of services needed to respond to increasingly complex
Concern is growing that when the government’s national
alcohol harm reduction strategy finally comes out, it will contain
a watered down set of proposals.
It seems likely, based on this administration’s track
record, that community safety initiatives will feature strongly.
But what about the less visible, and more expensive initiatives
– particularly those for people who need treatment for
The Commission on the Future of Alcohol Services was set up by
Alcohol Concern to investigate what services are needed and how
they should be provided. An expert panel was convened, and
consultation held with key stakeholders in alcohol treatment,
including users and potential users of services. The work of the
commission aimed to provide a benchmark against which the
government’s long-awaited strategy can be judged.
Far reaching recommendations
The report’s recommendations are far reaching and start
with the need for a cross-departmental alcohol strategy group
within government. This body would have responsibility for setting
out meaningful targets – such as reducing alcohol-related
liver disease, cutting the number of deaths from drink-driving,
reducing the incidence of facial injuries in licensed premises and
so on – and allocating resources where needed.
Tackling the damage done by alcohol at the individual level
should then be co-ordinated by the National Treatment Agency and
alcohol and drug action teams, with new ring-fenced money to be
spent on alcohol services, without replacing existing
Alcohol services are facing serious structural and planning
problems – against a backdrop of increasing referrals and
alcohol problems in the communities they serve. The immense
investment in drug services in recent years has in many respects
damaged alcohol services, and planning and delivery priorities have
become distorted. More than 30,000 people die as a result of
alcohol abuse, roughly 10 times the number who die as a result of
drug use. Yet 10 times as much money is spent on drugs services as
on those for alcohol misuse.
Barrage of targets
The National Treatment Agency for Substance Misuse (NTA) –
the health authority responsible for the treatment arm of the drug
strategy – is pushing hard to achieve a barrage of
drugs-related targets. It is hardly surprising that alcohol gets
pushed far down the list of priorities.
Although there are many excellent alcohol treatment projects,
the commission found that no part of the UK had the full array of
services needed to respond to the range of alcohol problems. The
key elements most often missing, or poorly developed, in the
current range of services include screening and brief interventions
in primary care, responses to clients who are not ready to change
their drinking and services for family members and carers.
The commission also looked at workforce development. It argued
that the creation of clear career pathways into, through and beyond
the alcohol sector, is a matter of priority and should be tackled
by the National Treatment Agency. Furthermore, an estimated 200,000
generic professionals will need training in alcohol issues in order
to respond to the millions of hazardous drinkers who never make
contact with treatment services.
Of particular importance is the training of GPs. An average GP
sees 360 heavy drinkers a year, yet intervenes with fewer than
eight. At conservative estimates, we have six million heavy
drinkers attending their GP and not receiving appropriate
treatment. Most of these six million will not need specialist
treatment, and simple, brief interventions provided within the GP
surgery are known to be effective.
Perhaps the most important recommendation of the commission is
to set specific targets for investment. These were based on
estimates of need, and reviews of current initiatives. For
treatment services, 150,000 to 300,000 people are likely to need
help each year, in contrast to existing services which are already
overstretched by some 100,000 referrals each year. A threefold
increase in funding for initiatives to tackle alcohol-related harm
at an individual level is recommended. This includes a target of
doubling treatment capacity, and additional training and services
for GPs to increase the number of early interventions.
Alcohol Concern believes that whatever impact the commission
document has on the forthcoming alcohol strategy – and we
hope it is considerable – the report provides a reference
point for planners and providers of services. While uncertainty
still surrounds the national strategy itself, the report offers a
framework for action to begin now, at a local level.
Eric Appleby is chief executive of Alcohol
The Commission on the Future of Alcohol Services arrived at the
– Increase threefold the funding for services for individuals
experiencing alcohol-related harm over the next three years. Over
the next 20 years funding will need to increase even further.
– Expand the local and national commissioning capacity to
oversee the use of these new funds.
– Develop a formula for allocating funding which reflects both
need and existing resources in different parts of the country.
– Extend the National Drugs Treatment Monitoring System to
include services providing treatment for those with alcohol
problems so that the intelligence gathered can inform local and
national strategic development.
– Develop a tool or framework to help audit the alcohol-related
community development needs of each area.
– Invest further in the development of self-help groups.
Alcohol and drug action teams should…
– Ensure that generic workers can offer appropriate
interventions to people experiencing
– Ensure that clients in greatest need have access to local
services including detoxification, care planned counselling,
structured day care and residential rehabilitation.
– Review the needs of particular groups in their community, such
as women drinkers and young drinkers, in order to ensure the
provision of appropriate responses.
– Avoid establishing walk-in and “first point of
access” services as joint alcohol and drug agencies, other
than for those aimed specifically at young people.
Local community safety partnerships
– Consider public information and education campaigns on
– Consider working to improve the management of licensed
premises associated with incidents of public disorder.
– Consider identifying communities which have particular
problems related to alcohol.
– Consider ways in which the wider environment can be better
managed to reduce the impact of alcohol use.
– Consider the local use of the enforcement powers, which are
available to both the police and local authorities, as a means of
reducing alcohol-related harm.
1 The full
commission report – the executive summary is available as a