Over the limit

This week sees the start of new licensing laws in England and Wales that could result in some pubs and clubs staying open 24 hours a day, seven days a week. The government hopes that more flexible opening hours will alter familiar drinking patterns in the UK and help reduce the disorder associated with “chucking out time”.

It is an admirable intention and one that may be welcomed in towns and cities blighted by crime and disturbance after the bars shut. But while a reduction in antisocial behaviour may be achievable, it is likely to come at a price. Greater availability of alcohol encourages increased consumption, and as those in the alcohol treatment sector are keen to point out, will in all probability lead to more people needing specialist support.

And therein lies the crux of the problem. Alcohol services are already at full stretch delivering help to the 1.1 million people who are dependent now; they have little capacity to expand should the numbers needing help rapidly increase. Waiting lists are already long with some people having to wait six and half weeks for an initial assessment.(1) Only one in 18 people who need help are able to get it – and only one in 102 in north east England. This contrasts to parts of the US and Canada, where it is regarded as too few if only one in 10 people of those who need help are being treated.

The main problem for alcohol treatment services is funding. The government has not ploughed money into the alcohol sector in the way it has for drug treatment, and unlike the drugs strategy, the alcohol harm reduction strategy published last year,(2) has done little to kick start investment.

Don Shenker, director of policy and services at Alcohol Concern, says the alcohol strategy has had little impact. “What has happened is that alcohol services have to dig around much more creatively for bits of funding that allow them to stay open and work with clients.”

For some services, this has meant taking on work with drug misusers. In theory the money allocated for drugs can only be used for drugs clients but some services have found ways to sidestep this.

“They’ve changed from calling themselves alcohol services to calling themselves alcohol and drug services, and opened their doors to drug users in order to continue working with alcohol users,” says Shenker.

While reorganisations like this mean that agencies can still help alcohol clients, it does not necessarily mean that they receive the same calibre of service because less is known about their cases. Although drugs clients are monitored carefully, data is still not collected about alcohol misusers, even when they are seen by combined drug and alcohol services.

“We don’t know how many alcohol clients are entering treatment in the country. If their primary problem was a drugs problem we’d know where they come from, how long they have had the problem for, how many times they have had treatment, and what happens to them afterwards. This is not the same for alcohol cases, we don’t even know what age they are,” says Shenker.

More flexibility
Liz Smith, chief executive of Alcohol and Drug Services, which provides services in the north of England, believes that life would be easier for treatment providers if they were granted more flexibility over how they are allowed to use their resources.

“There are districts where the drugs money is so ringfenced that they are not allowed to help anyone with alcohol problems. We have alcohol clients who go to our services and all they can get is one-to-one counselling yet they see all the provision available for people with a drug problem.”

Her service is not alone in this. In some areas drug misusers can access complimentary therapies such as reflexology whereas alcohol misusers are not allowed to, even though they are being treated on the same premises. Also, it is not unheard of for drugs clients to leapfrog their alcohol counterparts to the front of the queue for services.

Smith believes that a large part of the problem is down to the government not setting a public service agreement (PSA) for how many people should be in alcohol treatment.

“Without a national PSA what guidance do local primary care trusts have? They haven’t got any targets so local commissioners have no idea about what they should be working to,” she says.

Need for targets
By contrast, targets have been in place in the drugs sector for some time. Just last year the spending review reiterated a previously set PSA to increase the participation of drug misusers in treatment programmes by 100 per cent by 2008. Having such targets in place has engendered action as last month the National Treatment Agency for Substance Misuse announced an 89 per cent increase in people in treatment between 1998-9 and 2004-5.

That alcohol services need greater  financial support and expansion is not in question. Some voluntary sector providers are known to have approached 14 different funders in order to scrape together the resources they need to keep going. The government has pledged an additional £15m for 2007-8, but given that the annual spend on specialist alcohol treatment is £217m, this is hardly sufficient.

Only time will reveal the impact of the new licensing laws and whether there is a knock-on effect on already beleaguered treatment services. Ten years ago the average age of a person using alcohol services was 35 or over; it is now just as likely to be someone of 25. With alcohol becoming more readily available over the coming years, this age trend is likely to continue downwards.

So it is perhaps with good reason that Don Shenker remains sceptical: “The more a country drinks the more problems a country has with alcohol. Extending the drinking hours is going to increase the scale of the problems we have with alcohol and increase the number of people who need specialist support.”

Whether they ever get it will be another matter.

(1) Alcohol Needs Assessment Research Project, Department of Health, November 2005
(2) Alcohol Harm Reduction Strategy for England, Prime Minister’s Strategy Unit, 2004

Detection and prevention
It is already known that about 40 per cent of admissions to accident and emergency hospital departments are related to alcohol – a figure that can rise to 70 per cent at peak times. With the new extended licensing hours, even more people could end up seeking help in hospital after a night of excessive drinking.

Adrian Brown is a clinical nurse specialist for alcohol at St Mary’s Hospital in London. He sees patients who have come through A&E and have tested positive after taking the one-minute Paddington alcohol test. Brown meets patients for a one-off session usually within 24 hours of their arrival in the hospital, and refers them to local treatment services if necessary.

But his role is not just about detecting drinkers who are already dependent on alcohol, but to pick up on individuals who may be starting to drink heavily or binge drink.

“This is not just a service to detect alcoholics, this is very much a prevention strategy. We have extended the service to the population who don’t necessarily need detox or treatment right now but if they continue with their current lifestyle they may run into trouble.”