There’s still time to book… https://www.drinkanddrugsnews.com/conference

‘Don’t get mad, get organised’ said Si Parry from Morph at the first DDN national service user involvement conference in 2008, and it was a message that set the tone for this dynamic event, as delegates spoke out, question­ed, participated – and most of all claimed it as their conference, giving it a unique life of its own.

While more than 500 people attended that first conference, most delegates were coming wearing the badge of their local drug and alcohol action team (DAAT), and while there were a few nascent service user groups attending they were clutching homemade leaflets and often completely reliant on their local service for survival.

Fast forward nine years, and how things have changed. Many of the groups that were just starting out back then – and some that weren’t even a twinkle in their founders’ eyes – have developed beyond all recognition. The 2015 conference saw a service user exhibition area filled with professional stands and high quality materials to rival the larger treatment providers.

Of course it’s not a story of untrammelled success, and sadly some groups have not survived round after round of budget cuts. It would also be naive to claim that starting and funding a group is easy, and most successful groups credit the support they received from a local commissioner or drug worker who believed in them and backed them from the early days. It’s a long hard slog making sure service users are represented meaningfully, and the purpose of the conference has never been clearer.

Many groups have managed to grow far beyond their original remit, and engage in a wide range of activities that would have been hard to imagine when they started up. Across the country we’ve been charting some highly motivated groups prepared to challenge stigma and support their members’ personal journeys. Peer-led groups now operate as equal partners supporting local treatment services, contributing widely to the community. Campaigning for national naloxone provision and other outreach initiatives has also seen groups break down the traditional barriers between harm reduction and recovery to share common ground.

Peter Yarwood from Red Rose Recovery was inspired to start a group after hearing speakers at a previous year’s DDN conference. ‘Our organisation is here for people who aren’t yet members – it’s for people that don’t know who we are yet,’ he said.

Hopefully this year’s event will once again be the empowering networking opportunity that will inspire service user groups and recovery groups to start up, grow and flourish all over the country.

See you in Birmingham!

Harry Shapiro has launched a new drug information service with his former DrugScope colleague, Jackie Buckle. He tells us more

I am very pleased to announce the launch of DrugWise, a new online drug information service carrying on the drug information tradition of DrugScope and – for those of you with long memories – its predecessor, the Institute for the Study of Drug Dependence.

As you can imagine, 2015 was a ‘bit of a year’, but with the generous assistance of the field, my colleague Jackie Buckle and I were able to continue with the seamless delivery of DS Daily directly to subscribers, five days a week. We also set up a legacy website so that people would have access to all the reports and information sources of DrugScope. But this did set me wondering.

DrugScope had two main functions; one was to be the advocacy agency for drug and alcohol treatment and focus on the attendant policy issues affecting drug users, such as welfare reform and mental health. The other half of our work focused around general drug information in all its various manifestations, for anybody who needed it – information that was up to date, evidence-based and non-judgmental.

With the demise of DrugScope, the advocacy work was taken up by Collective Voice while Making Every Adult Matter (MEAM) carried on with the related policy issues. But there remained an information vacuum and I was still being contacted by journalists for comment and background on the usual wide range of issues. And so Jackie and I came to the decision to set up DrugWise and with the very welcome assistance of the Brit Trust, the site is now up and running.

DrugWise will perform a number of functions. For a UK audience, we will update and develop drug information from DrugScope, write new thematic reports on topical issues and provide an archive not only of DrugScope reports, but hopefully in time, a complete and searchable archive of Druglink magazine articles back to 1986. The site will also be a platform for the public affairs work I am currently involved in around the issue of prescribed and over-the-counter drug dependency through the All Party Parliamentary Group on Prescribed Drug Dependence and the Opiate Painkiller Dependency Alliance. I will also be continuing the media, lecturing and public speaking work under the DrugWise umbrella.

But the ambition is for DrugWise to be more international and to broaden the focus beyond drugs to alcohol and tobacco. From a health and wellbeing perspective, it has never made much sense to separate out these substances when there are so many synergies in terms of harm reduction, treatment and recovery and education and prevention – and not least because most of those with serious drug problems are also often smoking and drinking.

Certainly across the spectrum of global drug policy, there is a growing demand that policy should be evidence rather than morally-based – and since the advent of e-cigarettes, a public health hearts and minds battle has broken out between experts with all the rancour normally associated with the drugs war. So it seems that now more than ever, it is important for policy-makers and practitioners to have access to the best evidence available across substances and interventions.

One problem though is that the material is often spread across national and international agencies and so what the DrugWise I-Know international knowledge hub aims to do is to try and bring together the most robust and reliable documentation in one place. However, every country has its own health, prevention and criminal justice systems and cultures and so there is no attempt to analyse the material – simply bring it to the attention of professionals across the disciplines.

These are the basic building blocks of DrugWise and despite the solid foundations on which it is built, it is nevertheless early days. But we are very keen to get your ideas and feedback about the service and how you think it might develop – and we will be very keen also to engage in partnerships where drug information and communications input is required.

There is every indication that the treatment sector will be coming under increasing financial pressure, so here’s hoping you all can navigate safe passage through the choppy waters of the coming months.

Contact Harry Shapiro or Jackie Buckle at www.drugwise.org.uk.

Education and training are often discarded when substance use takes over. Richard Johnson describes how ANA’s new programme is helping clients to reconnect

ANA was founded in 1998 for people who have become reliant on drugs and/or alcohol and provides residential treatment centres in Hampshire. As part of our philosophy of abstinence, we have developed a toolkit to strengthen resilience and recovery capital among our diverse client group.

We developed an approach to education with a local further education provider, Highbury College in Portsmouth – a partnership that was recognised as good practice by the NTA in 2010 – and have been building on it since.

Over the last two years we have been working closely with the college to have our second stage treatment programme, called our Road to Recovery course (R2R), accredited as a qualification in its own right. It combines therapeutic inputs with a life skills programme, delivered through a series of seminars and workshops.

As part of the course, clients are expected to complete workbooks and, although we make provision for those who cannot or prefer not to use the written word to express themselves, most do choose to use them. We had all of our workbooks retyped and printed and our lecture notes and presentational aids revamped, including power points, lesson plans and hand-outs, and put everything in individual folders for each client to be given upon admission.

The workbooks are added to other materials to compile an individual portfolio for each client. In building these portfolios, we realised just how many educational skills our clients acquire throughout the process; it soon became clear that many of our clients had become more self-aware and had developed better interpersonal, problem solving and practical skills since going through treatment.

We tentatively showed the client portfolio to the Community Education Department at Highbury College and they enthusiastically confirmed that the portfolio had significant educational value, resulting in their accreditation. The college has been enormously supportive, visiting ANA to train the R2R staff and counsellors. Clients are also invited on a tour of the college, in preparation for further education after our second stage.

So far, 12 clients have successfully completed the R2R course and received an accreditation, through their own recovery, from the college – an enormous achievement for each of them. The course is accredited at level one, which means that many clients will not have to undertake an access course when starting college, giving them back a year of their lives in study time.

The course is helping to break down barriers to education for clients and equip them with additional skills for life. Access to education was one of the key priorities in the government’s 2010 drug strategy, and is likely to continue to be so. The qualification makes recovery tangible; it demonstrates what clients have to do, what they have achieved and what they are capable of doing in the future. It also supports the concept of ‘better than well’ and has a very great impact on client recovery capital and self-esteem.

Rosanna O’Connor, director of alcohol, drugs and tobacco at Public Health England commented: ‘There is a very significant need for better education, training and employment support for people in drug and alcohol treatment, whether in the community or in residential rehab.

‘This project, being developed by ANA, is an excellent example of how some treatment providers are taking the initiative, providing people with tailored educational support, leading to qualifications, skills and the essential confidence needed to access employment.’

The next stage is to seek national accreditation and invite other treatment providers to have their programmes accredited. We feel that the initiative facilitates very positive community reintegration through study and education, and helps people take confident strides towards the job market.

Richard Johnson is CEO of ANA Treatment Centres and ANA Works, www.anatreatmentcentres.com

Kit Caless examines some of the issues behind the rush to outlaw new psycho­active substances (NPS)

The third reading of the Psychoactive Substances Bill took place in Parliament on 20 January, and is due to be become an act on 6 April 2016. The bill has been subject to some controversy over definitions, not least the chance that poppers (alkyl nitrites) could be outlawed – which led to MP Crispin Blunt ‘outing’ himself as a popper user during the debate in Parliament. The accuracy of reports on harm, efficacy of a blanket ban, and accusations of rushed legislation have been consistently raised. One of the major issues with NPS has been a sharp rise of misuse in UK prisons.

In December 2015 HM chief inspector of prisons, Nick Hardwick, released a hard-hitting, upfront report on the misuse of substances in prisons. In the report he stated that NPS have created ‘significant additional harm’ and ‘are now the most serious threat to the safety and security of the prison system that our inspections identify.’ At the time the report was being made, ‘there was an acceleration in the use and availability of NPS’. Synthetic cannabinoids like Spice and Black Mamba were used by 10 per cent of those surveyed. This is much higher than in the community, where only 6 per cent of those surveyed said they had used synthetic cannabinoids in the two months before going into custody.

Right now, NPS are banned in prisons, but their legal status and wide accessibility outside the prison gates makes them an attractive proposition for smuggling into prisoners. As Hardwick’s report states, ‘despite the high mark-up, they [NPS] are still relatively cheap in prisons.’ On top of this, current testing methods cannot detect synthetic cannabinoids, and new testing regimes can struggle to keep up with ever changing composition. It takes time to develop new drug tests, change legislation and develop new resources. When you’re testing for such a variety of chemical compositions, the NPS market likely always remains one step ahead.

Media reports have tended to focus on novel smuggling techniques, including drugs in tennis balls catapulted over prison walls, or even flown in using drones. Category C training prisons, which have large perimeters and relatively free prisoner movement as they go to and from work, are most susceptible to drugs coming over the wall. Of course, usual routes are also taken, through social visits and internal corruption. Hardwick controversially states that, ‘it has sometimes been difficult to make best use of the information available from individual establishments and other sources to identify changing needs and modify the strategy accordingly. In part, this reflects a too-willing acceptance in some establishments that drug misuse is an inevitable part of prison life and cannot be reduced.’

The danger of NPS use in prisons is highlighted in the report through anecdotal and quantitative evidence. Nineteen deaths in prison occurred between April 2012 and September 2014, where the prisoner ‘was known, or strongly suspected, to have been using NPS-type drugs before their deaths.’ The report surveyed more than 10,000 prisoners and found that, ‘debt associated with synthetic cannabis use sometimes leads to violence and prisoners seeking refuge in the segregation unit or refusing to leave their cells. Debts are sometimes enforced on prisoners’ friends or cell-mates in prison, or their friends and families outside.’

Not every prison has the same issues and it is not just the supply of NPS that is the problem in the UK prison network. Why have NPS become so attractive to prisoners? What can be done to tackle these problems? Should the focus, as some argue, be on the reasons why drugs are used in prison (boredom, demotivation, corruption), or on testing and punishment for usage? Hardwick says that any new strategy ‘needs to go beyond specific drug services to reducing demands for drugs by offering attractive purposeful alternatives, reducing prison violence and creating positive staff prisoner relationships.’

Kit Caless is Addaction’s communications officer for London and the south

There are no quick and easy answers to any of the questions posed by the prevalence of NPS in Britain and its prisons. But the debate is still in full swing.

You can join in by attending ‘New psychoactive substances: no longer a novelty – the expert view’,

15 March in London.

Details at http://bit.ly/1nl0Kzr

‘It’s unworkable’

The psychoactive substances bill is an unnecessary and unworkable law, Niamh Eastwood, Release’s executive director, told the HIT Hot Topics conference, as the ‘unstoppable’ bill was rushed through parliament.

‘It’s opened a Pandora’s Box,’ she said. Media reports of our streets being ‘awash with these drugs’ meant that ‘we have to respond, regardless of harm or prevalence… but it’s a tiny number compared to the treatment system not being responsive to the needs of people accessing it.’

The Centre for Social Justice had used its Broken Britain report to justify the progress of the bill through the House, said Eastwood, quoting Vice, that ‘the death stats that government’s using to ban legal highs are total bullshit’.

Last year’s Global Drug Survey (GDS) had highlighted the extent of alcohol and tobacco use. But prohibition was not about the drugs, said Eastwood, it was about ‘social control’ and ‘the othering of certain groups’, including young people in deprived areas and people in prison.

The bill had not only created ‘a number of strange possession offences’, but penalties showed ‘no proportionality’. Furthermore the ban on exportation and importation of psychoactive substances for personal use meant head shops would close and people would buy ‘dodgy stuff’ online.

Quoting ACMD advice to the Home Office that ‘the psychoactivity of a substance cannot be unequivocally proven’, Eastwood said it was an example of needing to speak out when things were wrong. Proving psychoactivity was difficult, making the legislation unenforceable.

‘Get out there and tell people that this is one of the worst pieces of legislation ever drafted,’ she said. ‘It’s an affront to our brains.’

Professor Harry Sumnall, of the Centre for Public Health at Liverpool John Moores University, said that from looking at treatment data, NPS didn’t seem to be an issue for treatment services – a long way from Neil McKeganey’s picture of ‘a scourge that could grow to eclipse heroin’, reported by the Scottish Daily Mail.

We were becoming prone to ‘risk illiteracy, where we don’t have a good handle on risk,’ he said. This could make us powerless to act or react.

The key message to emerge was, ‘don’t panic, we already know what to do’, said Sumnall. Existing approaches were ‘entirely suitable’, with classic harm reduction components ‘absolutely vital’, including messages around not sharing syringes.

‘It’s not about new drugs,’ he said. ‘We’re not seeing new and novel harms… It’s about understanding cultural practices.’

Helping families through the guilt and anger of losing a loved one can be gruelling for practitioners. Esther Harries looks at how to be prepared

The Bereaved Through Substance Use Guidelines were launched in June 2015 and represented the culmination of joint research between the Universities of Bath and Stirling on the experiences of families bereaved through substance use.

In the introduction, the guidelines invite practitioners to seek effective clinical supervision while working with family members following bereavement.

Although the focus is on practitioners who come into contact with substance-related deaths, the research could be equally valid for family support practitioners – particularly if they are working with the family and the client in treatment, where family meetings are integrated into the care plan.

McAuley & Forsyth (2011) conclude that ‘when someone dies of a DRD it is not only the needs of friends, family, or witnesses that need to be taken into account. The presence of grief-related reactions in almost 90 per cent of this sample suggests that staff who were involved in the care and treatment of the deceased also need to be considered when dealing in the aftermath of the event.’

Their study of the impact of a drug-related death on those who have experienced it as part of their caseload found that 65 participants were identified as having experienced at least one drug-related death on their caseload and 88 per cent identified at least one reaction: ‘The most common feelings identified were sadness (83 per cent); guilt (40 per cent) and anger (37 per cent): 26 per cent reported feeling helpless; 21.5 per cent had cried and 18.5 per cent had difficulty in concentrating.’

As a counsellor and clinical supervisor, I have witnessed the following thoughts and feelings from both family members and practitioners:

Guilt – ’I should have…’

Grief

Disbelief: ’They were doing so well…’

Anger – Perhaps directed towards the treatment system for its perceived failures.

Sad reflection: ‘What if..?’

Practitioners can also be supporting families with a loved one’s addiction as they experience a series of losses, ‘a living bereavement’, that includes the fear that their loved one may die. The intensity of this work can, without proper support, have considerable impact on the psychological well-being of the practitioner, particularly if they are involved in a serious case review and/or an appearance at the coroner’s court.

The trauma therapist Michael Gavin (www.embodiedtherapy.net) acknowledged in 2015 how challenging working with trauma can be: ‘People tell you stories of unbearable experience, and you have to listen’.

He states that the aim of supervision is to make therapy as safe and effective as it can be for both practitioner and clients or patients. For example, practitioners might be helped to improve their skills in specific ways (see box).

McAuley and Forsyth (Journal of Substance Use, February 2011) add that ‘providing a debriefing session and one-to-one support, like that proposed by Redinbaugh et al (2003), on both the events leading up to death, and staff feelings and emotions in its aftermath, should be available to those who need it and, therefore, should be considered for future policy and practice. It can also deter any notion of a ‘blame culture’ being developed and promote a working environment where each death can be used as an opportunity to reflect and learn lessons for the benefit of future practice’.

Practitioners might be helped to:

Master the skills of self-awareness, mindfulness, and of managing both their own arousal, and that of clients.

Find and cultivate their own reliable sources of safety and resilience, both internal and external.

Build a capacity for a calm yet assertive personal presence.

Foster their individual talents, style and insights as a basis for a sense of personal authority.

Find a way back to common sense (not so common!) and a sense of humour in the face of the unbearable and ‘unspeak-about-able’.

Esther Harris is an independent practitioner in counselling and clinical supervision

Stigma, misunder­standing and a lack of communication cloud our policy and practice on drugs, said speakers at HIT Hot Topics. DDN reports on their ideas for a fresh approach. Photos by Nigel Brunsdon

‘As long as drug users are marginalised and stigmatised there are going to be harms,’ said Pat O’Hare, opening HIT’s annual Hot Topics conference. The question was, how could we tackle this against a backdrop of disinvestment, where harm reduction was being ‘dismantled bit by bit’?

Alex Stevens, professor at the University of Kent, used statistics to show how drug deaths were misused, ‘to scare and to support ineffective policies’. The attention on new psychoactive substances (NPS) had brought ‘the most radical departure in drug policy’ – but meanwhile heroin deaths had increased by 64 per cent.

‘So why aren’t we focusing on heroin? Because of who these people are,’ he said.

Death rates were particularly linked to deprived areas in the north of England, and specifically to men who had lost industrial jobs in the 1980s and ’90s and turned to heroin use as ‘it was all there was’. This group was now middle aged and becoming very vulnerable.

Looking at how deaths were reported in the national papers gave a snapshot of how different drug users were perceived. Following deaths from NPS, descriptions typically included the words ‘brilliant, student, gifted’. Heroin or methadone deaths were more likely to contain language related to ‘junkie’.

This discrimination was used to support ineffective policies, the psychoactive substances bill, prohibition in general, cuts and churn in services, and recommissioning, he said. Not only were people were being written off as ‘not useful’, but ‘the shortage of public funds is being used as an excuse for lack of action,’ he said.

So how could we try to change public perception – and therefore change policy?

US professor and research scientist, Carl Hart, threw a challenge to the audience to embrace ‘the three Cs’ – their convictions, capability and courage. Commenting that ‘you British are very controlled’, he said ‘I’m going to ask that you get a little more angry.’

‘Drugs are used as scapegoats,’ he said, quoting examples such as a newspaper headline from the 1930s: ‘Negro cocaine fiends are a new southern menace’…‘I hope this gives you conviction to change our narrative,’ he said. Using capability and courage involved critical thinking and calling on the facts to challenge exaggerated science.

‘One of the facts that people ignore is that 80-90 per cent of drug users do not have a problem,’ he said. ‘You have to have courage to tell people we have exaggerated the harmful effects of drugs. You have to have courage to challenge scientists in a public space.’

It was not a formula for popularity, he acknowledged. ‘Be prepared to lose funding, friends, professional achievements and respect… but history will judge you favourably because you are right.’

‘Hold them accountable with the facts,’ he added. ‘You have to publicly embarrass people. If you don’t, our people quietly suffer.’

Bengt Kayser, teacher and researcher at the University of Lausanne, Switzerland, explored the topic of doping to demonstrate a culture of exaggerated responses and moral panic. ‘Myths get a ring of truth because they are published in a scientific journal,’ he said. ‘Debunking this type of myth is important.’ Responses could become exaggerated and moral panic could too easily turn into a moral crusade.

‘Sebastian Coe is dangerous for harm reduction in England because he pushes zero tolerance,’ he said. There were risks, he acknowledged, but it was important to keep them in proportion, ‘or people will run away from us.’ Harm reduction was the answer, coupled with evidence-based policy-making. To have any hope of changing the narrative, we needed to spread clear and effective messages, according to Jamie Bridge and Nigel Brunsdon, who gave insight into using photo-based campaigns. ‘Back in the old days, campaigning was left to the TV,’ said Brunsdon, showing images of some of the most effective public health campaigns, such as ‘Charlie says’ (child safety), ‘Don’t die of ignorance’ (Aids) and ‘Coughs and sneezes spread diseases’. Back then there was no immediacy, with months of lead-up time for publishing in magazines. Modern devices, however, brought the opportunity of hashtags and hundreds of immediate hits.

Recalling the ‘Support. Don’t punish’ Facebook page, he said: ‘I can join in an international campaign just like that. All the barriers are taken away from me.’ The #SupportDon’tPunish campaign had borrowed from successful campaigns such as #NoH8 (against anti-gay marriage legislation), #NotinMyName (young Muslims showing solidarity against terror attacks) and the #BeTheGeneration Global Fund campaign, to create a global day of action around the world, added Bridge.

‘We constantly struggle with the stigma of our cause,’ he said. But if you had a sellable idea you could keep finding reasons to bring it back into public consciousness. ‘Keep pushing,’ he urged, ‘you need to bring it to people.’ Brunsdon gave tips and tricks to help change the narrative through viral campaigns. ‘You can’t force a campaign to go viral, but you can nudge it along,’ he said. ‘Give people the tools and tell them what you want them to write. The more barriers you remove to action, the more likely it is to happen… Have simple messages, be original, have goals and targets. Have good simple hashtags.’

Brunsdon illustrated this with a preview of his new website, harmreductionisbeautiful, due to go live in a few weeks. The site aimed to overturn the way drug use and harm reduction were perceived.  ‘It’s about changing the narrative – it’s always depressing images of injecting in alleyways, and never celebratory. The idea is simple – you put up messages and have a selfie with it. Any of you can contribute to this and can download any of the images to use.’

Ethan Nadelmann of the Drug Policy Alliance brought a perspective from the US that zoomed in on Liverpool, the conference venue, as ‘the birthplace of harm reduction’.

‘Americans have no interest in what’s happening outside our country,’ he said. ‘We continue to fall tragically short in areas where you have led the way… areas like physician independence in prescribing.’ But, he continued, ‘when I hear how bad it is here right now, with the decimation of resources, the demonisation of people who use drugs, the sense of fear of people trying to do the right thing, the indifference to human life that this government is demonstrating, I know that place very well.’ We needed to keep pushing forward while playing good defence as well, he said, and this involved ‘addressing the fears of those who oppose us.’

The US was still involved in ‘the horrific drug war’ of the late 1990s, which had perpetuated incarceration. We had to think ‘how do we shift public views?,’ he explained. Nadelmann used the example of cannabis – medical marijuana – to show how the nature of debate could be shifted, and how ‘we could play ball in the big league of US politics’.

‘We changed the image of a marijuana user, from a kid to an older woman recovering from breast cancer, or someone recovering from Aids,’ he said. ‘When the pictures were shown, they touched the hearts of the hardest Republican. We focused on what we had in common.’

Equally important was finding ‘what drives our opposition’ – ‘Fear is the driving element of the war on drugs, fear of not knowing how to deal with diversity,’ he said. This involved using their language (‘pivotally important’) and exploring common ground: ‘We’re doing recovery and it works. “Grant us the serenity…” That is the prayer of the drug policy movement as well.’ It was about taking ‘unlikely voices and allies’ and embracing common values, Nadelmann told the audience.

‘Being as open and responsive as possible will lead you out of this dark period and restore you as the leader of the world in dealing with drugs.’

Concluding a thought-provoking day enhanced by plenty of audience interaction, Pat O’Hare concluded: ‘Drug policy reform is the best harm reduction. Keep the faith, keep the passion.’

A major new report sheds light on the alcohol habits of the over-50s. Are they risking drinking themselves into an early grave?

Last month the government revised its sensible drinking guidelines for the first time in 20 years, bringing the recommended weekly levels for men down to match those for women – at 14 units (see news story, page 4). One reason for the revised limits, says the government, is that the links between alcohol and cancer were ‘not fully understood’ when they were first issued in 1995.

Now a new report from the Drink Wise, Age Well programme, whose partners include the International Longevity Centre (ILC-UK) and treatment charity Addaction, highlights the fact that it may well be the over-50s who are most risking their health through their drinking habits. Drink wise, age well: alcohol use and the over 50s in the UK is the largest ever study of its kind, surveying nearly 17,000 people from across the country. It found a population whose problem drinking may well be ‘hidden in plain sight’.

Not only were age-related issues such as bereavement, retirement, loneliness, money worries and loss of a sense of purpose leading people to drink more in many cases, those people were also far less likely to seek help. Nearly 80 per cent of those identified as higher-risk drinkers drank ‘to take their mind of their problems’, says the report, with ‘not coping with stress’ the strongest predictor for being a higher-risk drinker.

A quarter of respondents had no idea where to look for support – and said they wouldn’t ask for help even if they did know – while more than 80 per cent of those identified as being at increased risk from their drinking had never been asked about it by a professional. More than half of over-65s also thought people ‘had themselves to blame’ for any alcohol problems.

Although most survey respondents were found to be lower risk drinkers, a ‘significant minority’ were not, says the document, and it’s a problem that’s likely to get worse. More than a third of the UK population is over 50, and by 2040 nearly one in four will be 65 or above, shoring up major problems if the ‘drinking patterns of older adults do not change’. Between 1991 and 2010, alcohol-related deaths among the 55-74 age group in England increased by 87 per cent for men and 53 per cent for women, meaning there is a ‘pressing need’ for action to reduce alcohol-related harm.

As the report points out, the image that harmful alcohol use tends to conjure up is one of young people binge drinking. Is the issue of older drinkers still largely a hidden one? ‘Very much so,’ head of the Drink Wise, Age Well programme, Julie Breslin, tells DDN. ‘Quite often drinking in later life takes place behind closed doors, and therefore is not as visible as young people’s drinking in a town or city centre of a Saturday night. Also our report shows a high level of stigma for older drinkers, so it’s quite possible that if there is an issue they won’t tell anyone.’

The report highlights the lack of a coherent plan to address alcohol-related harm in older drinkers, so what could be done at government level – should there be a national strategy? ‘From a starting point we’d like to see more consistent UK-wide collection of data on alcohol use and older adults,’ she says. ‘For example, PHE have only recently started collecting alcohol statistics on adults aged 75 and over, and in order to compare and assess the scale of the problem we’d like to see some consistency in the information gathered across the four nations. Secondly, we’d like to see alcohol and ageing on the agenda across a number of cross-care areas, such as dementia, retirement, social isolation. Alcohol use doesn’t happen in a vacuum.’

The programme is also advocating for the needs of older people to be specifically highlighted in existing government strategies, in order to raise the issue in professional and commissioning circles. ‘Up until now only the Wales and Northern Ireland alcohol strategies particularly reference the needs of older adults,’ says Breslin.

One of the major issues identified by the report is a widespread confusion and lack of awareness around units and guidelines. Will the recent revisions go some way to rectifying that or is there still a lot more to be done to get a clearer message across? ‘In our report nearly three quarters of respondents were unable to correctly identify recommended units,’ she says. ‘Hopefully the new guidelines are a good starting point and easier to digest. However for many people even the concept of “units” is difficult to grasp and we may need to work together to find better ways to communicate the message. It would be helpful to provide resources that allow people to self-measure and start to understand their own consumption better.’ The drinks industry also needs to share a responsibility in getting the message across, she stresses – they may have put unit information on labels but it ‘could be a lot bigger’.

As older people have been drinking for longer, the harm becomes accumulative, she points out, although the fact that over-50s are far from a homogenous group is itself a challenge. ‘You could have an extremely fit and healthy 73-year-old, versus a 52-year-old with multiple health issues. We think more discussion and exploration is required in relation to the guidelines and how we provide nuanced age-specific advice.’

There’s always been a strong anti-‘nanny state’ feeling in the UK, however, and many are likely to say, ‘If they haven’t got much else in their lives let them enjoy a drink – why take that away?’

‘The “nanny state” backlash is certainly something we’re prepared for and we saw this very much in the recent revision of the alcohol guidelines,’ she says. ‘However we believe that older people in particular do play an active role in their own health and wellbeing, and given the right information make healthier choices. How alcohol affects us, particularly as we age, is something most people would want to know about in order to make this choice, in the same way they would take care of other health areas.’

Assuming that older people don’t want to make healthy choices or live active and healthy lives is an ageist approach, she argues, adding that when they do access alcohol treatment they tend to have better outcomes – the problem is that they’re less likely to engage with treatment in the first place. ‘Assumptions that people are too old to change are unhelpful and actually quite discriminatory,’ she states.

If the aim is to help people experience a better quality of life in their later years, a key starting point is ‘clear and credible information’, she stresses. ‘Many people identified positive reasons for alcohol use such as socialising and relaxation, and these are important factors for people as they age. We’re not telling people not to drink – we’re highlighting what the particular risks are for older people and proving advice and information.’

People have to be motivated to improve their health, however. If someone is lonely, perhaps bereaved, and feel they have little to live for they may well know they’re doing themselves harm but think, ‘So what?’ What, realistically, can be done to counter that?

‘Of course major life transitions such as bereavement and retirement can be a trigger for increased alcohol use, and people may feel that there’s little in their life to change for. In our direct engagement and support service, where we work with people over 50 who are already drinking problematically, our philosophy is that it’s our job to help people find the motivation that will help them make that change. Very often the first stage of engagement is about relationship building and dealing with practical issues.’

The problem, she points out, is that it’s resource- and time-intensive. ‘We are very lucky to be funded so we can work in this way,’ she says. ‘What can happen with busy generic addiction and social work services is resources may be stretched, and if an older person – on the face of it – is not showing motivation to change, resources may be allocated elsewhere. We know that it takes time, repeated home visits, and lots of patience for someone to start to find their own drive for making a change, and this is the model we adopt.’

Equipping people with social supports and coping strategies – ‘resilience interventions’ – is also vital, she says, so that when they do experience difficult life changes they are better able to cope without turning to alcohol.

The report says that what’s needed is an ‘age-nuanced’ approach – what would some of the elements of that look like? ‘At a wider level there needs to be a multi-agency approach to ensure older adults don’t fall through the net,’ she says. ‘Frontline staff and practitioners should receive training that specifically challenges stigma and attitudes, whilst equipping people to better recognise and respond to older people who may be drinking.’

Among the best-placed people to step in are health professionals, particularly GPs, as they’ll usually be the ones older people have the most regular dealings with. What can be done to raise awareness among them, and help them spot any warning signs? ‘Health professionals have more and more demands on their time, but better alcohol screening of patients is a good starting point and in some areas this is already offered. If older patients are re-presenting with issues such as low mood, sleep disorders, stomach problems, then alcohol use may be a contributing factor.

‘It also may be the case that whilst people are not drinking at particularly high risk levels, they are experiencing some health implications due to age-related changes,’ she continues. ‘It’s important for community agencies to work closely together so that GPs have an easy and accessible referral route when they do identify someone.’

www.drinkwiseagewell.org.uk