TONY GOODALL

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TONY GOODALL

• Keynote Speech

Alcohol Substance Misuse Lead, NHS Leeds
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Change UK Drinking Culture?Tony Goodall
tonygoodall_at_talktalk.net

• What culture are we changing?
• Alcohol industry solution
• Parenting and alcohol
• Pint Pot Theory
• How much are we really drinking?
• Effective alcohol policy

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8th Century England

• In your dioceses the vice of drunkenness is too
  frequent. This is an evil particular to pagans
  and our race. Neither the Franks nor the Gauls
  nor the Lombards nor the Romans nor the Greeks
  commit it.
• St Boniface in letter to Archbishop of Canterbury

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11th Century England

• William of Malmesbury reported that the
  English partly lost the Battle of Hastings
  because they had been drinking.
• This led them to fight
• With more rashness
• and precipitate fury
• than with military skill.

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British Drinking Culture looks to Northern not
Southern Europe

• MEDITERRANEAN
• wine-based
• wine part of diet
• regular part of meals and family life
• strong sanctions against public drunkenness

• NORTH EUROPEAN
• beer-based
• less frequent but heavier
• often pub-based
• an end in itself
• public drunkenness tolerated and even expected

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Drinks Industry say Change the culture

• by Education
• by Law Order
• But do they work?

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Alcohol Education but does it work?

• Industry does invest in education
• NICE report 2007 could find no proof of anything
  that worked
• PSHE to become statutory.
• As well as protected timetable time NEED funded
  supply cover for teacher training.

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Alcohols 3D Pronged Attack on Health

• Drunkenness
• Dependence
• Disease

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Law Order is local issue but why is it in
spotlight?

• Responsibility for local Alcohol Strategies
  placed with CDRPs.
• Crime and social disorder is easy it is caused
  by someone else
• We are all on the same side bad for industry,
  government, police and public
• We are uncomfortable to be in 30-40 drinking at
  damaging levels for our health

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Licensing Act EW 2003

• Objectives
• the prevention of crime and disorder
• the prevention of public nuisance
• public safety
• the protection of children from harm.
• Need 5th Objective as in Scotland the
  protection of public health

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BINGEING ICEBERG
Street Violence
Domestic Violence
Rows Sickness Rip-off
Unwanted Sex
Health Damage
Good Night Out
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Student Experiences of Non-Consensual Sex when
Drunk

• Just over 1000 University students 18-24 years
• 30.7 experienced alcohol-related non-consensual
  oral, vaginal or anal sex since age 14
• Victims - those drinking more extreme prior to
  act
• 1-2 drinks - 3.2 of victims
• 10 drinks - 33.4 of victims
• Nearly half consumed drinks over shorter time
  periods (3-4 hours) Grunby et al in
  Preparation

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Drinking as a Sportone-in-the-eye

• DOCTORS warned
• against a new craze
• of taking alcohol
• through an eye socket
• because revellers
• believe they get them
• drunk quicker and stay
• in their system longer
  Aug 2008

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Pub Golf
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Passive Drinking

• Intimate Partner Violence
• gt 1/3 committed under alcohol
• Nationally 126,000/ year
• Road Traffic Accidents
• Around 8,000 where people injured by drunk
  drivers
• Crimes (Annual, England)
• 311,000 violent (recorded)
• Foetal Alcohol Syndrome
• Elder Child Abuse
• Stress of living with an alcoholic

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Route of Alcohol MisuseAdverse Childhood
Experience (ACE)

• Violence in childhood (towards child / parent)
• parental substance use
• mental health or criminal problems
• Four or more ACEs
• Any cancer x 1.9
• Current smoker x 2.2
• STIs x 2.5
• Illicit drug use x 4.7
• 50 sexual partners x 7.4
• Alcoholism x 7.4 Felitti et al, 1998

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Children, young people and alcohol how they
learn and how to prevent excessive use JRF Nov 09

• Key influences are
• Family processes and structures
• Less consensus about influence of peers,
• Direct advertising and indirect media
  representations, product placements, etc
• Country, ethnicity and race, religion,
  socio-economic status, and other cultural factors.

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Family interventions are Most Effective JRF
Nov 09

• Best aimed at enhancing family bonding and
  relationships including eating together 5 or more
  times a week
• Child liking relationships with a parent
• High level of family co-operation
• Older siblings willingness to use substances are
  predictors of later use by younger siblings

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Peer Influence? JRF Nov 09

• It is not so much that young people are
  influenced by their peers but that they select
  likeminded peers leading to a process of mutual
  influence

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Marketing? JRF Nov 09

• Media has a major impact
• Impact can be mediated by parental counter
  reinforcement of media messages, open
  communication, parental monitoring, and clear
  rules can help to offset media influences

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Needs planned community prevention including-
JRF Nov 09

• Effective parenting training programmes
• Organisational change programmes in schools,
  PSHE
• Enforcement of laws relating to underage sales
  and selling to drunk people
• Altering community cultural norms so that
  drunken behaviour not tolerated or encouraged
• Effect planned policy changes with respect to
  price, availability and accessibility

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Educating Parents and Children

• 9-11 year olds
• 3 in 5 think people drink to forget your problems
• 27 think beer drinkers consume
  4-6 pints/evening
• 30 think wine drinkers drink
• 5 or more glasses a night
• Life Education Survey, 2008,
  n1491

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PINT POT THEORY
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PINT POT THEORY
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PINT POT THEORY
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Drinks Industry Claim 2008

• Average alcohol consumption in the UK is falling?
• Number of people drinking over the recommended
  weekly limits is falling?
• Underage drinking is declining but those who
  drink consume more?
• Binge drinking is declining?

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How much do we really drink? Bellis et al In
prep, HM Revenue Customs G HS 06

• Exceed weekly limits
• 31 men 20 Women
• Of all drinkers, exceed by twice sensible daily
  limit
• 1 in 4 men 1 in 5 women (Abstainers 14
  adults)
• Drinkers weekly units (mean)
• by Survey 16
• by Sales (Taxation) 26 units
• Excludes - Illegal sales, personal imports,
  consumption abroad, home brew (last estimated at
  4 units/week)
• Where are the missing 40million bottles of wine??
• England 1-17 year olds consume about 20million
  units of alcohol per week

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Alcohol-related DeathsPlant et al October 09

• Since 1970 consumption/person lt by 60.
• Now drink average extra 4 litres pure alcohol /
  person / year
• 75 more affordable than 1980
• Alcohol-related deaths X3 since 1984
• All these deaths are avoidable
• Research presents strong case for government
  policies to
• reduce population consumption

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Young Women and Alcohol EU Commission Alcohol
Report 06

• Over last 10 years, binge-drinking in UK girls
  2nd highest in Europe
• Only UK, Ireland and Finland show girls getting
  drunk more than boys
• Women ARHAs jumped 23 in two years to 70,000 in
  2008
• Five to 10 years of heavy drinking could lead to
  liver disease in women
• Link between alcohol consumption, emancipation of
  women, and increasing role of women in workplace

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Alcohol Consumption of young Women in UK and
Europe (litres per head per year)Datamonitors
predictions for drinks industry
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Chronic Liver Disease and Cirrhosis, Females,
Rate per 100,000
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Russia and Spain

• Half of all deaths of Russians ages 15 to 54 are
  caused by alcohol-related diseases
• Beer is now main drink in Spain as young people
  adopt British binge drinking culture

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WHO Europe top 5 ways to reduce alcohol-related
harm

• Raise prices through taxes
• Advertising ban
• Restrict availability
• Random traffic breath tests
• Screening and brief intervention

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Professor David Nutt was asked to resign after
his claims ecstasy and LSD were less dangerous
than alcohol
Advisory Council on Misuse of Drugs 30th
October 09
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Advisory Council on Misuse of Drugs Sept 06

• Of all the psychoactive drug producers, the
  alcohol industry is at present uniquely able to
  market its product with all creativity and
  resources it can muster.

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Advisory Council on Misuse of Drugs Sept 06

• We recommend that a much stricter code for
  alcohol advertising and sponsorship should be
  established Including prohibiting advertising on
  TV or in cinemas showing films for under-18s and
  sponsorship of sports or musical events attended
  or watched by under-18s.

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Spending on Marketing

• Government spent
• 10million (2008)
• Industry spent
• 800million (2002)
• including sports and music sponsorship

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Number of alcohol adverts during 7 day period
Alcohol Concern Dec 2006
1200
1000
800
Pre Watershed
Post Watershed
600
400
200
0
Government
Branded Alcohol Ads
Supermarket
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TV Alcohol Adverts by time of day Alcohol
Concern Dec 2006
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Voluntary agreementCorporate Social
Responsibility
Please enjoy our product in moderation
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strong evidence that increasing the price of
alcohol reduces consumption overall and may have
a disproportionate effect on consumption by young
people Government should seriously consider
progressively raising duty on alcohol.
Advisory Council on Misuse of Drugs Sept 06
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Government reaction

• Dismissed advice before ink dry
• After pressure commissioned research from Dr
  Petra Meier ScHaRR Sheffield University
• A 50p minimum unit price would save 3,393 lives
  each year in England.

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Consumption of alcohol in the UK relative to its
price The Academy of Medical Sciences 04
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Low Price Binge Drinking Alcohol Concern 07
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Off-sales v On-sales Affordability
ScHaRR 09
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Who drinks the cheap booze? ScHaRR
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GOVERNMENT REACTION TO ScHaRRDepartment of
Health spokesman-

• good evidence that cheap alcohol is linked to
  people drinking more and subsequent harm to their
  health, it is important that any Government
  interventions reduce harm without impacting
  unduly on the majority of responsible drinkers.
• We will look to develop further the evidence base
  in this area

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National Association of Cider MakersHouse of
Commons Health Select Committee 09

• Majority of public drink sensibly and alcohol
  is misused by a minority of drinkers
• General population measures such as raising
  prices are not appropriate means for tackling
  misuse
• it penalises the majority of sensible drinkers
  without necessarily dealing with alcohol misuse.

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Proportion of men womens consumption in
heavier occasions (6 or 8 units)
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CMO Sir Liam Donaldson advised government in 08
Annual Report

• England is drinking far too much. England has
  an alcohol problem. Alcohol is harming society.
• Alcohol is not simply a problem for the
  minority who are dependent it is a problem for
  everybody. recommends minimum price per Unit

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Prime minister stated day before report was
published

• As we crack down on binge and underage
  drinking, its also right that we take action
  that is properly targeted and effective. And we
  do not want the responsible, sensible majority of
  moderate drinkers to have to pay more or suffer
  as a result of the excesses of a small minority.

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Vested Interest??

• Industry maximise profits
• Public Health protect health
• Government promote wealth
  protect health
• Both sides lobby government
• Who has most muscle??

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Why does government parrot industry mantra?

• Is it purely powerful lobbying?
• OR
• Is it because this would be unpopular??
• If so government should be trying to persuade
  public
• Role of Public Health to advocate healthy public
  policy

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General Election 2010

• Need to encourage public support for minimum unit
  price so that whoever is in power can introduce
  healthy public policy
• Make alcohol less affordable
• Making the easy choice the
  healthy choice

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Final Word

• '' Alcohol can
• kill anything alive and preserve anything that's
  dead''
• Bob Dylan
• tonygoodall_at_talktalk.net