1. ALCOHOL – THE FACTS

Alcohol consumption is increasing, particularly amongst women and young people. The costs of alcohol misuse, including to the health service and the criminal justice system, as well as the personal cost of alcohol are increasing.

a. Drinking Habits

People in Britain are drinking greater quantities than ever before. The average alcohol consumption for men has increased from 15.7 in 1992 to 17.0 units in 2002. The increase among women was from 5.6 to 7.6 units over the same period.[1] The number of people drinking over the recommended limit (21 units a week for men 14 units a week for women) has also risen. 1 in 3 men and 1 in 5 women now exceed this limit in their weekly consumption. This contrasts with 1 in 4 men and 1in 10 women exceeding the limit in 1988.[2] The increase in alcohol consumption has been most marked among women and young people.

In 2002/03, according to the General Household Survey 2002, around two thirds of adults aged 16 and over in Great Britain had had an alcoholic drink on at least one day during the previous week (74 per cent of men and 59 per cent of women).
Nearly one in three adults (30 per cent) had exceeded the recommended daily benchmark (of 4 units for men and 3 units for women) on at least one day during the previous week. Men were more likely to exceed the benchmark than women - 38 per cent of men compared with 23 per cent of women.

Women

The General Health Survey reports that in its history there has been slight increase in the proportion of men drinking and ‘a much more marked one’ among women. Women drinking above the recommended weekly benchmark of 14 units a week has risen from 10% in 1988 to 17% in 2002. [3]

Young people

Young people aged 16-24 are the heaviest drinkers. This increase was greatest among women from 16-24 with average weekly consumption for women in this age group increased from 7.3 to 14.1 units between 1992 and 2002[4]. Heavy drinking is also most prevalent among men and women of this age group.

Children

Alcohol use among younger children (11-15 years) has been rising and the proportions drinking rise sharply with age. Statistics from Alcohol Concern underline the worrying increase in drinking among young people. The average amount drunk by 11-15 year olds as a whole in 1990 was 0.8 units a week rising to 1.6 units in 1998.[5] Amongst 11-15 year olds who do drink, the average rose from 5.3 units in 1990 to 10.5 units in 2002.[6]

Binge drinking

Figures from the Government’s Strategy Unit based on Accident and Emergency admissions showed that 5.9 million people (4 million men and 1.9 million women) had binge drunk which was defined by them as having drink more than twice the recommended daily guidelines on at least one occasion in the last week.[7]

The European School Survey Project on Alcohol and Other Drugs (ESPAD) define binge drinking as consuming more than 5 drinks in a row. The UK results of this survey showed that among 15-16year olds showed that 26% of boys and 29% of girls questioned admitted having binge drunk3 times or more in the previous month. The figures, based on interviews with more than 2,000 pupils in a sample of schools in 2003, mean binge-drinking levels for boys have fallen from 33% since the last study in 1999, while those among girls have continued rose 2% from 27% in 1999.

b. The Effects of Alcohol Misuse

Crime

  • The Home Office points to the British Crime Survey 2002 according which estimates that in almost half of all violent incidents in 2001-2 (47%) victims described their assailant as being under the influence of alcohol.
  • 1 in 5 violent incidents take place around pubs and clubs and of that 70% on weekend evenings.
  • Approximately one-third of incidents of partner violence occurred when the perpetrator had been drinking[8]

Health

  • Alcohol was directly responsible for 6000 deaths in the Britain in 2001 according to statistics from Alcohol Concern [9]According to the World Health Organisation alcohol is responsible for almost one in ten of all ill health and premature deaths in Europe. The WHO lists alcohol as the third most important risk factor after high blood pressure and smoking as causing premature ill health and premature death in Europe.
  • Up to 35% of all accident and emergency attendances and ambulance costs are alcohol related with this figure rising between midnight and 5am to 70%.[10]
  • Alcohol misuse costs the NHS up to £1.7 billion each year.[11]
  • Binge drinkers are in the majority, under 25. They are more likely to be at risk of accidents and alcohol poisoning, male binge drinkers are more likely to be victims of or commit violent assault. There is also a greater risk of sexual assault.
  • Chronic drinkers are more likely to be over 30, around two thirds are men [12] As well as the effect on their families health risks to themselves include long term ill health, increased risk of cirrhosis, stroke or cancer and premature death.
2. ALCOHOL POLICY

2005 will see the implementation of the Licensing Act 2003, with a move towards more flexible drinking hours. How will this legislation work? What other initiatives are coming from central government and other agencies?

a. Government policies

There have been a number of policy developments in the past year:

  • The Licensing Act 2003
  • National Harm Reduction Strategy for England, March 2004
  • Choosing Health – Health White Paper, November 2004
i. The Licensing Act (Department of Culture, Media and Sport)

Timetable for implementation of the Act in 2005:

  • 7 January 2005 -The date before which licensing authorities must have determined and published their first licensing policy statement, which will apply for a three year period.
  • 7 February 2005 - Licensing authorities will begin processing applications.
  • November 2005 - The old licensing regimes will finish and new premises and club premises licenses come into effect.
  • Licence authorities to be created This significant change takes licensing alcohol out of the magistrates’ courts and put into the hands of the local authority. The licensing authorities will, in principle, be self-financing with central government setting fees for licenses paid by applicants and funding the administration. Licensing authorities will publish licensing policy statements - these will be critical as they will show how authorities will apply the objectives in their area.
  • Licence applications The Act streamlines existing laws so that a single premises license will be applied for, and a new system of personal licenses are to be introduced relating to the supply of alcohol. There will always have to be a personal license holder on the premises when alcohol is being sold.
  • License applications will be assessed against four licensing objectives.

These are:

  • the prevention of crime and disorder;
  • public safety;
  • the prevention of public nuisance; and
  • the protection of children from harm.

A licensing authority may only restrict licensable activities where it is necessary for the promotion of these licensing objectives.

  • Licensing hours to change The act will allow licensed venues to vary their opening hours and theoretically to open 24 hours. This, the Government argues, will make policing easier (there will not be one fixed closing time when everyone arrives on the street at once) and will discourage concentrated drinking prior to closing time.
  • Alcohol related disorder The police will have powers immediately to close licensed premised in the event of disorder occurring or being anticipated. The police, local residents and other bodies may ask licensing authorities to review particular licences if the four licensing objectives are flouted.
  • Children Licensed venues will be required to set out how they will ensure the protection of children. It will be an offence to allow a child under 16 into premises which are used solely or primarily for the sale of alcohol unless they are accompanied by an adult. It will be an offence to supply alcohol to children, or for children to buy or consume alcohol.
  • Government response to criticism of licensing law. The Government recently responded to criticism that the new law might lead to higher levels of binge drinking and anti-social behaviour and questions from police as to how policing of areas with venues that open later.
  • New ‘Alcohol-disorder zones’ are to be set up where there have been problems with binge drinking.
  • In these areas people handed on the spot fines for drink related disorder can be banned from pubs and bars in an area for a specified time. Bar staff will be fined for serving people who are drunk. Children will be fined if they try to buy alcohol.
  • Venues where there have been persistent problems with binge drinking will be given an eight week warning. If they fail to improve they will be forced to contribute towards the cost of policing.

Concerns have been expressed that 24 hour opening may exacerbate rather than modify the existing culture of binge drinking in Britain.

  • Professor Ian Gilmore head of the Royal College of Physicians says ‘The College believes reducing the availability of alcohol and increasing the priceis the way forward but thisis unpalatable for politicians.’ He went on to criticise the plans to extend licensing hours saying that it was fanciful to think that Britain would become "a Mediterranean-style wine sipping, non-binge drinking culture, by licensing regulations". The BMA has called for post change research to be undertaken on the health effects following the change in licensing hours.
  • The Police Federation has voiced its support for greater flexibility in closing times but says that it ‘strongly opposes any move to permit 24/7 drinking which would place a strain on police resources’
  • Alcohol Concern has specifically criticised the fact that local authorities when granting licenses are not further encouraged to take account of the number of premises but instead must assess the application only on its own merits in reference to the objectives. Licensing authorities can state that an area is overburdened or “saturated” and that they will not be encouraging more applications but it is emphasised that any applications must be assessed on individual merit.
  • Alcohol Concern has also argued that although the aims of the Act – reducing binge drinking and tackling alcohol-related crime – are admirable, the essentially deregulatory nature of the Act will make it harder for local residents and local authorities to object to licenses.

ii. The National Alcohol Harm Reduction Strategy for England

The Prime Minister’s Strategy Unit made a special study on the issue of alcohol misuse in England,[13] but was not completed until after the Licensing Act became law. The National Alcohol Harm Reduction Strategy for England recommended:

  • Better communication and education around risks of alcohol, to children and those most at risk e.g. binge drinkers, the message of dangerous drinking simplified, information for employers.
  • Better health and treatment through; work on early prevention, national audit of provision of services, pilot schemes on the benefits of early detection. Current treatment services are patchy, set up ‘on a historical basis rather than designed to meet need’and ‘There is a clear perception amongst providers that alcohol receives a low priority and needs more resources’. ‘Better information is needed to inform future provision’the report states.
  • Crime prevention through; greater use of exclusion orders, anti social behaviour orders, licence enforcement and licensing bouncers.
  • Industry co-operation will be voluntary on responsible marketing to discourage unsafe drinking habits, labelling, pledge not to manufacture products irresponsibly e.g. aimed at younger people, financial contributions to schemes addressing alcohol misuse.
  • The local development of a `Code of Conduct’, overseen by a body comprising of local industry representatives, police, and the licensing authority, led by the local authority.

The report points out that several departments have a stake in alcohol related issues and states that: ‘Government has, until now, not taken a strategic approach to addressing alcohol issues’. The reports proposal states that it is essential for departments to work together and has suggestions for doing. It states that it is particularly important for the Department for Health and the Home Office to work together and stated that the Minister of State for Policing and Crime Reduction (Home Office) and the Parliamentary Under-Secretary of State for Public Health (Department of Health) will assume joint responsibility for delivery of the strategy’

iii. Choosing Health - The Health White Paper

The Health White Paper, published in November 2004 includes 'encouraging and supporting sensible drinking' as one of its six overarching priorities, alongside smoking, diet, exercise, mental health and sexual health.

The White Paper included some recommendations from the Strategy Unit, including promises of work to improve training for NHS staff. It promised:

  • National and local audits of the demand for and provision of local treatment to be published in April. This is to be followed in May by a guidance document ‘Models of Care’ on the organisation of alcohol treatment together with a roadmap of how this will be put into practise. From this, a programme will be developed for the improvement for treatment services. These initiatives will be supported from April 2006 through additional funding from the Pooled Treatment Budget for Substance Misuse.
  • An improvement on training of health professionals together with pilot projects, and similar initiatives in criminal justice settings aimed at improving and innovating on early intervention.
  • A commitment ‘work in partnership with the Portman Group to develop a new and strengthened information campaign to tackle the problems of binge drinking.’
  • Action on advertising and sale of alcohol through a voluntary social responsibility scheme for producers and retailers with information on labels and in outlets; responsible drinking reminders on advertisements and age checks to combat underage drinking.

Alcohol Concern welcomed the White Paper while expressing concern at continuing short-term funding problems for treatment, and disquiet at the role of the industry’s ‘Portman Group’ in funding education and information services.

iv. Home Office Initiatives

The Alcohol Misuse Enforcement Campaign is a joint initiative between Association of Chief Police Officers and the Home Office. Campaigns in the summer and at Christmas increased policing in 92 and 130 areas respectively, concentrating on particular areas such as town centres. The summer campaign found that 52% of clubs and pub and 32% of off licences served alcohol to under 18s. Police have also been able to hand out penalty notices for disorder to individuals.

Local authorities are also taking initiatives to combat alcohol-related disorder. Crime and Disorder Reduction Partnerships require local authorities to work with the police and other agencies on strategies to reduce crime at a local level. The Strategy Unit recommended the example of Manchester City Safe. This crime reduction initiative involves producing posters on the harms of excess drinking, providing wardens to patrol taxi and bus queues, targeting trouble spots with extra policing and the promotion of good management in licensed establishments.

b. Industry Response

  1. The Portman Group

The Portman Group is an industry-funded body to promote safe drinking. Their activities are essentially threefold;

  • Educating the public on safer drinking,
  • Lobbying on alcohol regulation,
  • Regulating its members through a voluntary code of conduct. (NB The Group only regulates the actual drink products, not “special offer” marketing which can often cause problems.)

The Portman Group’s website takes a friendly ‘watch what you’re drinking’ approach: there is information about alcohol consumption. They provide a ‘unit counter’ for the alcohol content of particular drinks, and run two initiatives – “I’ll be Des” aimed at encouraging groups of friends out drinking to have a designated driver, and “If you do drink, don’t do drunk” aimed at students

However, more controversially the Portman Group offers funding to academics, local authorities and other groups to run research, conferences and produce websites and posters on responsible drinking. They work with the Department of Health and were recognised in the White Paper. Criticism of the Portman Group comes from the fact that it is not independent of the industry. Alcohol Concern also argue that it should not be given a public role in education when there are clearly so many breaches of its voluntary code by members of the industry.

ii. Other Industry Involvement

Some drinks companies, eg Scottish & Newcastle and Coors, have announced their intention to introduce informative labelling, including the amount of units on a bottle together with the recommended daily limits for men and women.

An increasing number of companies are including what they see as a “responsible drinking message” on advertising (eg “please drink X responsibly”). However some of these are ambiguous, perhaps deliberately so, eg “Enjoy Carling. Take it Easy.”

The Alcohol Harm Reduction Strategy sees a future role for local venues in co-operating on policing and safety city centres in the future as mentioned above, with other groups proposing a local fund to pay for policing costs arising from alcohol consumption.