Does a preoccupation with binge drinking mean the health aspects of alcohol are being overlooked?

The health select committee recently reported that government alcohol policy should move beyond public order in town centres and increase its focus on health. DDN reports.

The press loves a good ‘binge Britain’ story, especially if its moralising tone can be accompanied by pictures of young women in various states of undress on a night out.

The press loves a good ‘binge Britain’ story, especially if its moralising tone can be accompanied by pictures of young women  in various states of undress on a night out.  But, when it comes to policy, is there a risk that the public order aspects of our alcohol culture are in danger of eclipsing public health?  The House of Commons health committee thinks so, with its report (see news, page 5) on the government’s alcohol strategy (DDN, April, page 4) stating that, while its attempt to bring a coherent approach to tackling the issues is welcome, the strategy’s focus on public order ‘overshadows the health issues’. Although binge drinking and related public disorder and anti-social behaviour are certainly important, said committee chair Stephen Dorrell MP, ‘the health impact of chronic alcohol misuse is in our view also significant and greater emphasis needs to be placed on addressing that impact’.

As well as calling for a ‘re-examining’ of alcohol advertising regulations, including the possibility of a version of the French ‘Loi Evin’– which is designed to restrict children’s exposure to alcohol advertising, including viral marketing (DDN, June 2011, page 21) – the committee wants to see a central role in developing policy objectives given to Public Health England, adding that the controversial ‘responsibility deal’ (DDN April 2011, page 4) is ‘not a substitute for government policy’.

Many treatment organisations have issued statements agreeing with the committee’s findings,
with Addaction and Turning Point both calling for more investment in early intervention and specialist treatment. The Royal College of Psychiatrists stated that it expected the Department of Health’s planned guidance on the development of alcohol services to ‘highlight the strong evidence base supporting
screening and brief intervention’, particularly in primary care, but it also wants to see separate
guidance issued on the capacity of services.  ‘The health committee described the state of alcohol services in England as “dire” in 2010 and we see no evidence that this situation has changed,’ said a joint statement from chair of the college’s faculty of addiction psychiatry, Dr Owen Bowden- Jones, and Scottish chair Dr Peter Rice. 

What liver disease charity the British Liver Trust wants to see to address this situation is far more investment in alcohol specialist nurses, with the one-million-plus annual alcohol-related hospital
admissions meaning that 70 per cent of all alcohol costs to the NHS are incurred in hospital. Existing good practice models could easily be translated into routine care for alcohol-related conditions, the
trust believes.

Given the intense cost pressures on the NHS, however – £20bn of ‘efficiency savings’ needed by 2015 and even more expected to be announced after that – how likely is it that the government will actually take the message on board and employ more specialist nurses?

‘The government has committed itself to delivering an effective alcohol strategy, and with
respect to specialist alcohol nurses the figures speak for themselves,’ the trust’s chief executive Andrew Langford told DDN.

‘So far, they have been bold with minimum pricing so I am hopeful they’ll take on board the evidence. We know that alcohol treatment services have been the poor relation when compared to the
investment in drug services – a specialist alcohol nurse would go some way in bridging that gap.’ Employing specialist staff would save money in the long run, but presumably that means policies need to be fundamentally reformulated to bring more of a focus on long-term strategy? ‘With regards to addressing preventable liver conditions as a whole, yes they do,’ he says. ‘Alcohol is a public health issue which requires a long-term attitude and a consistent approach. We have spent decades making alcohol cheaper, more available, allowing it to become a normal part of everyday living – to reverse that and to inform a generation who are used to such a relaxed approach to alcohol 

will take time.’ The trust has repeatedly stated that the impact of chronic alcohol misuse isn’t given the
prominence it deserves, citing data from Liverpool PCT that almost all (90 per cent) of its hospital admissions related to alcohol are actually for chronic conditions.  ‘There is no denying that binge drinking has preoccupied the media, however it’s the chronic and habitual drinking, often in the home, that is our biggest problem,’ says Langford. ‘I still don’t believe that people are able to make an informed decision on how much they drink and, importantly, the health impact it might be having, which is why measures such as health information on packaging should be better. We are also faced with an often- symptomless condition, with the liver not showing signs of complaint until late on in disease progression. Sadly, and probably the most difficult message to drive home, is that preventative action is the way to protect yourself from a preventable liver condition.’ DDN