Priorities for Health: Alcohol misuse
November 2006
Introduction
In August 2006, BMA Scotland conducted a survey of members to identify their priorities for health. Around 600 doctors from all branches of the profession responded to the survey and their priorities for tackling alcohol misuse are reflected in this policy briefing.
The health impact of alcohol misuse in Scotland
Alcohol is the cause of one in 30 of all deaths in Scotland. Alcohol Focus Scotland estimates that alcohol costs the NHS £110 million, with the overall cost to Scotland (including social work, criminal justice, emergency services and economic costs) equalling £1.1billion per year [Reference 1].
In 2003/04 more than 26,000 people were admitted to Scottish hospitals with an alcohol related diagnosis. This represents 4% of all hospital admissions. Between 1996 and 2004, the rate of emergency admissions to hospital rose by 40% for men and 30% for women with acute intoxication and harmful use of alcohol. The number of people with alcoholic liver disease went up by 73% (men) and 81% (women). Chronic liver disease increased by 92% and 100% respectively [Reference 2].
Deaths caused entirely, or in part by excessive consumption of alcohol have increased significantly since the early 1990s, most predominantly among men aged between 45 and 59. In 2003, there were around 2000 alcohol related deaths in Scotland. People living in deprived areas are four times more likely to die an alcohol related death than those in the least deprived areas [Reference 3].
In 2000, male liver cirrhosis mortality rates in Scotland were 2.5 times the rates in England and Wales [Reference 4]. The problem is also becoming more acute for women. The number of Scottish women dying from alcohol related diseases reached an all time high of 492 in 2005, more than double that recorded in 1984 [Reference 5].
Half of Scottish men and a quarter of Scottish women exceed recommended limits for alcohol consumption, more than their counterparts in England, Wales and Northern Ireland [Reference 6].
Young people and alcohol
There has been a 60% increase in reported drinking by 15 year olds and more than a 100% rise in drinking by 13 year olds [Reference 7].
Regular heavy alcohol consumption and binge drinking are associated with physical problems, antisocial behaviour, violence, accidents, suicide, injuries and road traffic accidents. They can also affect school performance and crime. Alcohol misuse is associated with a range of mental disorders and can exacerbate existing mental health problems. Adolescents report having more risky sex when they are under the influence of alcohol; they may be less likely to use contraception and more likely to have sex early or have sex they later regret [Reference 8].
These figures reflect a worrying trend of alcohol misuse and clearly demonstrate Scotland’s alcohol problem. The reasons underlying these trends require further research, but changing social attitudes, easy availability and cheap drinks promotions particularly in supermarkets and other off sales outlets all contribute to increased alcohol consumption by adults and children.
Interventions
Alcohol harm reduction strategy must be multi-layered. It should include, for example, measures to better inform people on safe and dangerous drinking levels and raise awareness of the consequences of alcohol misuse.
The price of alcohol should be increased to discourage excessive drinking
The relative cost of alcohol has fallen by around a third over the past 20 years [Reference 9]. Cheap drinks promotions which encourage people to buy more alcohol, particularly in supermarkets and off licenses must be controlled.
There is evidence that increasing the price of alcohol may be an effective method of reducing use by adolescents. The evidence that tax and price increases reduce alcohol rated harm is stronger than that for the efficacy of educational measures. However, it can prove impractical and do nothing to tackle adolescents’ attitudes [Reference 10]. Any pricing strategy must form part of a wider alcohol strategy.
Almost 70% of doctors who took part in the BMA’s survey on Priorities for Health supported a strategy to increase the price of alcohol to discourage excessive drinking.
Labelling of alcohol products
More than eight out of 10 doctors who responded to the BMA’s survey believe that alcoholic drinks manufacturers should be compelled to clearly label their products with the number of units of alcohol in each product.
It is the responsibility of the drinks industry, both producers and retailers, to ensure that their customers are fully aware of the alcoholic content of the beverages they purchase and the potential harmful consequences of excess consumption. The BMA believes that there should be a legal requirement for all containers of alcohol offered for sale and advertisements to carry:
- A prominent common standard label which clearly outlines the alcohol content in terms of units;
- Information on the maximum recommended daily level of alcohol consumption; and
- A warning of the dangers of excessive drinking.
A 2003 survey published by the Scottish Executive found that 49% of 15 year olds reported buying alcohol for their own consumption [Reference 11]. But prosecution rates for under age drinking and, more importantly, for selling alcohol to under age children are low. In the BMA’s survey of members, 97% of doctors said that stricter enforcement of age restrictions, particularly for off sales, was an important factor in reducing drinking amongst young Scots.
In Scotland, 52 under-16s and 145 17 year olds were charged with under age drinking in 2004-05, this is an increase from 18 and 67 respectively in 2000-01. In 2003 there were only 50 prosecutions for under-age sales in Scotland [Reference 12]. Despite the increase in prosecution of young drinkers, these figures do not reflect the extent of the under-age problem and much more needs to be done to target those selling outside the law. 96% of doctors believe that licensees (both on and off sales) must be made to take their legal and social responsibilities seriously with appropriate penalties for those found guilty of selling alcohol to under age people and those who break the law should immediately lose their license to sell alcohol.
Alcohol awareness education
Education is an important strategy if it incorporates understanding of adolescents’ attitudes and an element of social skills development. Health education policy in schools has recently begun to move away from the traditional emphasis on risk, towards and emphasis on the social and environmental factors which influence drinking, smoking and drug use.
School based education is the most common method used to prevent the uptake of adolescent drinking. This approach can have several drawbacks, the most obvious being that school-based education programmes often fail to reach to most vulnerable adolescents who may be excluded or non-attenders at school. Education programmes for adolescents may also be provided too late since attitudes may already be established. 91% of doctors responding to the BMA survey said that more alcohol awareness education should be introduced into schools, starting at primary school level. The BMA therefore suggests that policy makers should consider targeting children as young as 4-8 years of age.
Some adolescents are more vulnerable than others to hazardous drinking and it is important that health policy recognises this fact and targets intervention to ‘at risk’ populations.
Specialist Health Services
Multi-professional and multi-tiered service provision should be provided within the NHS. Co-ordinated core services are required for those in need of support and treatment including outreach work, screening and treatment in primary care, hospital and alcohol service settings, longer term specialist remedial treatment and self-help support groups.
Conclusion
In order to tackle Scotland’s drinking problem:
- The price of alcohol should be increased to discourage excessive drinking
- Labelling of alcohol products should be compulsory
- There should be stricter enforcement of current legal age restrictions, particularly for off sales.
- More alcohol awareness education should be available in schools, starting at primary school age.
- Better specialist health services should be available within the NHS.
1. Scottish Executive Cost to Society of Alcohol Misuse in Scotland: An Update to Alcohol Misuse in Scotland Trends and Costs (Edinburgh) 2005
2. NHS Quality Improvement Scotland Clinical Indicators 2005
3. Alcohol Focus Scotland Manifesto Promoting responsibility, reducing harm, changing culture (Glasgow) 2005
4. Scottish Executive Health Department Sizing the Problem (Powerpoint presentation) 2006
5. NHS Scottish Health Statistics Alcohol related deaths (1980-2004) & hospital discharges (1966/97 to 2004/05) 2005
6. Scottish Executive Plan for Action on Alcohol Problems (Edinburgh) 2002
7. Scottish Executive Health Department Health in Scotland (Edinburgh) 2004
8. Alcohol Concern Alcohol and Teenage Pregnancy (London) 2002
9. Alcohol Focus Scotland Manifesto: Promoting Responsibility, Reducing Harm, Changing Culture (Glasgow) 2005
10. BMA Board of Science Adolescent Health (London) 2003
11.P Bradshaw Underage drinking and illegal purchase of alcohol Scottish Executive Social Research 2003
12. Statistics from Alcohol Statistics Scotland 2005, National Alcohol Information Resource - www.alcoholinformation.isdscotland.org
For more information contact:
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk