National Alcohol Strategy for England
Department of Health/Strategy Unit [2004]

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Foreword - Tony Blair

Millions of us enjoy drinking alcohol with few, if any, ill effects. Indeed moderate drinking can bring some health benefits. But, increasingly, alcohol misuse by a small minority is causing two major, and largely distinct, problems: on the one hand crime and antisocial behaviour in town and city centres, and on the other harm to health as a result of binge- and chronic drinking. The Strategy Unit’s analysis last year showed that alcohol-related harm is costing around 20bn a year, and that some of the harms associated with alcohol are getting worse. The aim has been to target alcohol-related harm and its causes without interfering with the pleasure enjoyed by the millions of people who drink responsibly.
... it clearly shows that the best way to minimise the harms is through partnership between Government, local authorities, police, industry and the public themselves.
For Government, the priority is to work with the police and local authorities so that existing laws to reduce alcohol-related crime and disorder are properly enforced, including powers to shut down any premises where there is a serious problem of disorder arising from it. Treatment services need to be able to meet demand. And the public needs access to clear information setting out the full and serious effects of heavy drinking.
For the drinks industry, the priority is to end irresponsible promotions and advertising; to better ensure the safety of their staff and customers; and to limit the nuisance caused to local communities.
Ultimately, however, it is vital that individuals can make informed and responsible decisions about their own levels of alcohol consumption.
Everyone needs to be able to balance their right to enjoy a drink with the potential risks to their own - and others’ - health and wellbeing. Young people in particular need to better understand the risks involved in harmful patterns of drinking.

The annual cost of alcohol misuse includes:

  • 1.2m violent incidents (around half of all violent crimes);
  • 360,000 incidents of domestic violence (around a third) which are linked to alcohol misuse;
  • increased anti social behaviour and fear of crime – 61% of the population perceive alcohol-related violence as worsening;
  • expenditure of 95m on specialist alcohol treatment;
  • over 30,000 hospital admissions for alcohol dependence syndrome;
  • up to 22,000 premature deaths per annum;
  • at peak times, up to 70% of all admissions to accident and emergency departments;
  • up to 1,000 suicides;
  • up to 17m working days lost through alcohol related absence;
  • between 780,000 and 1.3m children affected by parental alcohol problems; and
  • increased divorce - marriages where there are alcohol problems are twice as likely to end in divorce.

Working with the alcohol industry:
The strategy will build on the good practice of some existing initiatives and involve the alcohol industry in new initiatives at both national level (drinks producers) and at local level (retailers, pubs and clubs).
Participation in these schemes will be voluntary. The success of the voluntary approach will be reviewed early in the next parliament. If industry actions are not beginning to make an impact in reducing harms, Government will assess the case for additional steps, including possibly legislation.

CHAPTER 1: INTRODUCTION

Alcohol plays an important role in our society and in our economy. However, where it is misused alcohol is also a major contributor to a range of harms, at considerable cost. These harms include:

  • harms to the health of individuals;
  • crime, anti-social behaviour, domestic violence, and drink-driving and its impact on victims
  • loss of productivity and profitability; and
  • social harms, including problems within families.

Government already intervenes in many ways to prevent, minimise and deal with the consequences of the harms caused by alcohol. For example, Government provides information on sensible drinking and health services to people experiencing harms. Through the criminal justice system, Government deals with criminal and anti-social behaviours that may also result from alcohol misuse. However, Government interventions to prevent, minimise and manage alcohol-related harms have never before been brought together into a coherent strategy.

CHAPTER 2: ALCOHOL AND ITS HARMS

Summary:

  • Alcohol plays an important and useful role both in the economy and in British society generally.
  • Around a quarter of the population drink above the former recommended weekly guidelines, which increases the risk of causing or experiencing alcohol-related harm.
  • The Strategy Unit calculated that the cost of alcohol-related harms in England is up to 20bn per annum.
  • There is no direct correlation between drinking behaviour and the harm experienced or caused by individuals. However, those most likely to be affected themselves, or harm others, are binge-drinkers, chronic drinkers, the families of those who misuse alcohol, and people with multiple problems (including drug abuse and being homeless).
  • The likelihood of causing or suffering harm is also affected by a complex interaction of factors, such as an individual’s personality, family background and cultural background.

Alcohol has an important place in our society and brings many benefits
Over 90% of the adult population drink. The majority do so with no problems the majority of the time. For individuals, alcohol is widely associated with socialising, relaxing and pleasure. Drunk in moderation it can provide health benefits by lowering the risk of death from coronary heart disease and ischaemic stroke for those over the age of 40. While it is outside the scope of this report to quantify the economic benefits in detail, alcohol plays a key role within the leisure and tourist industry. It accounts for a substantial section of the UK economy: the value of the alcoholic drinks market is more than 30bn per annum and it is estimated that around one million jobs are linked to it.

Alcohol misuse does not lead automatically to harm

There is no direct relationship between the amounts or patterns of consumption and types or levels of harm caused or experienced, and it is likely that many of those who exceed the levels of alcohol consumption described above will not suffer harmful effects.
However, alcohol misuse does lead to an increased risk of harm, depending on a range of factors, including:

  • the amount drunk on a particular occasion and/or frequency of heavy drinking (the type of alcohol drunk has relatively little impact);
  • an individual’s genes, life experiences and personal circumstances;
  • the extent to which the individual has other substance misuse problems; and
  • the environment in which the alcohol is drunk (for example, a crowded and noisy environment can increase the risk of disorderly behaviour).

Alcohol misuse creates significant harms: We identified four key groups of alcohol related harms to be tackled:

  • Health harms: We calculate the cost of alcohol misuse to the health service to be 1.7bn per annum. Alcohol misuse is linked to: - annual expenditure of 95m on specialist alcohol treatment; - over 30,000 hospital admissions annually for alcohol dependence syndrome; - up to 22,000 premature deaths per annum; and - at peak times, up to 70% of all admissions to accident and emergency (A&E). In addition, the Chief Medical Officer’s Annual Report for 2001 identified a rising trend in deaths from chronic liver disease, with most cases most probably being caused by high levels of alcohol consumption.
  • Crime and anti-social behaviour harms. We calculate the overall annual cost of\par crime and anti social behaviour linked to alcohol misuse to be 7.3bn. Alcohol misuse shows strong links to violence. 1.2m violent incidents (around half of all violent crimes) and 360,000 incidents of domestic violence (around a third) are linked to alcohol misuse. More generally, alcohol misuse is linked to disorder and contributes to driving people’s fear of crime; 61% of the population perceive alcohol-related violence as worsening.
  • Loss of productivity and profitability. We calculate the overall annual cost of productivity lost as a result of alcohol misuse to be 6.4bn per annum - up to 17m working days are lost each year through alcohol-related absence. Alcohol misuse may also affect productivity of workers in their workplace and may result in shorter working lives.
  • Harms to family and society. We calculate the cost of the human and emotional impact suffered by victims of alcohol-related crime to be 4.7bn per annum. Between 780,000 and 1.3m children are affected by parental alcohol problems. Marriages where there are alcohol problems are twice as likely to end in divorce. In addition, up to half of rough sleepers have problems with alcohol.

Conclusion:
The harms to be addressed by the strategy span a range of areas and cost up to 20bn a year. Around 6m people have drunk more than twice recommended daily guidelines in the past week, and around 8m people above the former recommended weekly guidelines. This means that they are at greater risk of a range of harms. Some groups are particularly likely to cause or experience harm: binge-drinkers, chronic drinkers and vulnerable drinkers with multiple problems. Harms result from the interaction of a range of factors – no one single factor is to blame.

CHAPTER 3: THE FUTURE STRATEGY FRAMEWORK

Summary
This strategy aims to reduce the harm caused by alcohol misuse in England.
The four key ways that Government can act to reduce alcohol-related harms are through:

  • improved, and better-targeted, education and communication;
  • better identification and treatment of alcohol problems;
  • better co-ordination and enforcement of existing powers against crime and disorder; and
  • encouraging the industry to continue promoting responsible drinking and to continue take a role in reducing alcohol-related harm.

The Government also needs to ensure that interventions to reduce alcohol harms are:

  • coherent, as isolated interventions are unlikely to succeed;
  • sustained, as short-term initiatives will have little long-term impact;
  • strategic, as without a co-ordinated strategy there is likely to be little progress; and
  • measured, as without ways to chart progress, the success of the strategy cannot be assessed.

This strategy has the objective of reducing the harms caused by alcohol misuse in England. It recognises that there are both benefits and costs to alcohol use and, therefore, does not aim to cut alcohol consumption by the whole population. Instead it focuses on the prevention, minimisation and management of the harms caused by alcohol misuse.

The first key aim of the strategy is to improve the information available to individuals and to start the process of change in the culture of drinking to get drunk.
Individuals make choices about how much and how often they drink. Individuals are responsible for these choices, but they both influence and are driven by their peers and the wider culture of society.Accurate information is needed if individuals are to make informed choices about alcohol.
But information is only one factor influencing behaviour. The availability of alcohol, its role in our culture and the drinking behaviour by some groups in our society - particularly young people - all affect attitudes, which in turn shape and are shaped by culture. If individuals are to make responsible choices it is just as important to consider how to create social environments which discourage attitudes and behaviours which lead to the risk of harm.

The second key aim of the strategy is to better identify and treat alcohol misuse.

The third key aim of the strategy is to prevent and tackle alcohol-related crime and disorder and deliver improved services to victims and witnesses.

The fourth key aim of the strategy is to work with the industry in tackling the harms caused by alcohol.

The two main supply-side levers that are commonly cited as influencing harm are\par price and availability:
- price is controlled by Government through levels of taxation; it is also governed\par by the laws of supply and demand – for example, price promotions; and
- availability is controlled through restrictions on suppliers (planning and licensing law) and individuals.

There is a clear association between price, availability and consumption. But there is less sound evidence for the impact of introducing specific policies in a particular social and political context:
- our analysis showed that the drivers of consumption are much more complex than merely price and availability;
- evidence suggested that using price as a key lever risked major unintended side effects;
- the majority of those who drink do so sensibly the majority of the time. Policies need to be publicly acceptable if they are to succeed; and
- measures to control price and availability are already built into the system.

So we believe that a more effective measure would be to provide the industry with further opportunities to work in partnership with the Government to reduce alcoholrelated harm. Every consumer of alcohol has contact with the industry in one form or another. By contrast, only a small proportion of consumers will come into contact with Government services because of their consumption. Industry should do more to play a key role in:
- preventing problems arising - for example, industry can play a greater role in disseminating messages which strongly encourage responsible consumption and ensuring that establishments’ layouts are designed to minimise harm; and
- tackling alcohol-related harms – for example, by working with the police to exclude trouble-makers and helping provide transport home for its clients.

We therefore propose that Government involves the industry in the prevention, minimisation and management of the consequences of alcohol misuse on a voluntary basis.

If these interventions are to be successfully delivered they need to be: coherent, sustained, strategic, measured and publicly supported:
- Coherence: Isolated interventions are unlikely to succeed. For example, education on the impact of alcohol misuse is more effective where it is backed up with measures in the community. Detoxification in a hostel or prison is unlikely to have much impact if not backed up by aftercare and support.
- Sustained commitment over a period of time: Short-term initiatives will have little long-term impact. For example, the transformation in attitudes to drink driving has taken decades of effort both in publicity and in supporting measures such as enforcement and punishment.
- Clear objectives: Without clear objectives and a strategy to deliver and monitor them there is likely to be little progress. This applies at the level of both central and local government.
- Measuring progress: Without ways to chart progress, the success of the strategy cannot be assessed and monitored.
- Publicly supported: Interventions must fit with social and community values, and must be understood and supported by the public. Interventions without this support will be unlikely to work.

Who is responsible for making the strategy happen?

Who? Responsibilities What they can expect from others
Individuals
& families
Their own choices about what they and those for whom they are responsible drink, where and how. The consequences of those choices, both as experienced by themselves and in their impact on others. Individuals cease to be responsible only where they are genuinely unable to exercise that choice (for example those who are mentally ill) or could not be reasonably expected to exercise it (which is why we protect the under-18s in legislation). Intoxication does not relieve an individual of responsibility for their actions. Clear and accurate information, and encouragement to make responsible decisions. Support to deal with the adverse consequences of their own or others’ actions. Protection from others’ actions where harm is caused. Social environments which do not encourage excessive drinking.
Alcoholic drinks
industry
Giving accurate information about the products it sells - and warning about the consequences. Supplying its products in a way which minimises harm. Work with national agencies and local partners to tackle the harms which the supply of its product creates. Fair regulation consistent with these responsibilities. Provision of services for which it pays through business rates and taxes as does any other business.
Government Ensuring that consumers receive clear information, both through its own efforts and through working with the industry. Supporting those who suffer adverse consequences. Protecting individuals from harm caused by the alcohol misuse of others – for example, through effective enforcement of the duties on enforcement agencies. Protecting against harms caused by the supply of alcohol where appropriate, and for regulating to the minimum necessary to achieve this. Ensuring a fair balance between the interests of all stakeholders. Providing the right strategic framework. To fulfil their responsibilities. Voluntary co-operation and partnership working.