Professor Eileen Kaner and Professor Anne Ludbrook discuss the NICE public health guidance that aims to tackle the worrying rise in levels of alcohol consumption, binge drinking and alcohol-related deaths across the UK.
This podcast was added on 2 Jun 2010
Interviewer: Hello and welcome to this podcast from the National Institute for Health and Clinical Excellence. Over the last few years we have seen a worrying rise in levels of alcohol consumption, binge drinking and alcohol-related deaths across the UK.
In response to this, NICE has published a piece of public health guidance that aims to tackle hazardous and harmful drinking.
Joining me to discuss the guidance is Professor Eileen Kaner, who was the chair of the guideline development group.
Q1 Interviewer: So Eileen, so just how big a problem is alcohol misuse in today’s society?
Eileen: It’s been estimated that 1 in 4 people are now drinking at levels that are at risk to their health and wellbeing, and this problem costs the country about £25 billion each year in tackling it, so it’s a very large problem that affects all sections of society.
Q2 Interviewer: Now the guidance sets out a number of recommendations, one of which looks at restricting the advertising of alcoholic products to children and young people. Could you give me a bit more detail on how this would work and the evidence behind this?
Eileen: There is very clear evidence focused on children and young people that shows that the amount of exposure they have to adverts and images of alcohol in films and other media actually affects their attitudes towards alcohol, and how much they drink.
And so we have recommended that it is in the best interest of young people for us to reduce the amount of exposure they have to alcohol advertising. It’s not clear at this moment what the best way of going about that because often young people see adverts that are intended for adults, and there are newer forms of media coming along all the time.
So what we have suggested is that the government looks at this issue in quite some detail and weights up the options for how we might best approach restricting the exposure of children and young people to alcohol advertising.
Q3 Interviewer: Now there is an argument that by focusing on things like the advertising of alcoholic products we neglect the underlying root causes that lead people to drink in the first place. What do you make of this?
Eileen: There are a number of reasons why people drink alcohol, may people drink it because we enjoy it and it’s a pleasurable thing to do, but often people find that the amount they drink rises over time and they sometimes don’t know how much they are drinking.
There are many social pressures for us all to drink and stresses at work and in our lives that lead us to assume that if we get to the end of a hard day having a drink of alcohol would be a good way of unwinding and dealing with that stress.
But actually the reverse happens, alcohol is something that adds to our stresses and can contribute to feelings of anxiety, altered mood and depression. So it’s not really a good way of trying to combat stress and busy lives, although it is the first thing that people do.
Q4 Interviewer: Now in the guidance there are a number of recommendations that are set out for healthcare professionals. A number of these look at screening individuals to identify their risk of developing alcohol use problems. How will this screening work and who would be doing it?
Eileen: When we talk to people who have had alcohol problems they often say that there have been many opportunities that if somebody had asked them a few questions about their drinking there might have been a moment there that would have been helpful in terms of receiving advice and counselling about how to reduce the amounts they were drinking.
There is a large amount of evidence that suggests that early identification using short screening tools is a very accurate way of identifying those whose drinking has risen to levels where it might be affecting their health and wellbeing.
In terms of who should be doing this kind of activity, certainly in general practices GPs and nurses see patients for a wide range of problems and often heavy drinking can contribute to these problems. This is a perfect opportunity to ask some questions about levels of drinking so as to identify who might need a little bit more advice and counselling.
And then we also know that in busy accident and emergency departments, people are coming in for a range of reasons, and many of those people have been drinking alcohol and again there is a teachable moment there were somebody has perhaps gone out for a night to enjoy themselves and they have had a drink and then been involved in alcohol related violence and they find themselves in A&E. And that is a moment in which people are more likely to consider a change in their drinking behaviour.
So we are encouraging public health practitioners from a range of settings to think about asking questions about alcohol with the people that they are seeing.
Q5 Interviewer: I’m joined now by Professor Anne Ludbrook to discuss another of the recommendations in the NICE guidance which looks at establishing a minimum price per unit for alcohol. So Anne, just how would this lead to a reduction in drinking?
Anne: We know that the amount consumed by individuals and at a national level is affected by how affordable alcohol may be. Therefore increasing the price is a good way of reducing consumption and therefore reducing alcohol-related harms.
The concept of minimum pricing is a particularly targeted approach. It would mean that alcohol cannot be sold below a certain price level and that it would be equated by the alcohol content of particular drinks.
Heavier drinkers tend to gravitate towards drinking the cheaper products and other ways of increasing price, such as increasing taxes, still gives opportunities for people to gravitate towards these cheaper drinks and therefore not address their alcohol consumption.
Putting in a minimum price or floor price means you cannot get that down to much lower prices. It also deals with the problem that supermarkets have tended to absorb tax increases in the past and sold alcohol below cost as a loss leader to get people into their shops. Therefore minimum pricing addresses all of those sorts of issues as well as making alcohol less affordable.
Q6 Interviewer: So why has NICE not agreed on a price per unit for alcohol?
Anne: Well it’s not really the role of NICE to set what the minimum price should be. What NICE is recommending to government is that this is an effective strategy for tackling alcohol problems.
But of course there are things to be weighed up about the particular level of price. The higher the price is set, the more it will tackle the alcohol problems we face but it will also potentially have more impact on business and consumers.
The NICE report has set out all the evidence on how much of an impact it will have on alcohol harms and on other sectors of the economy. And really it is the Government’s job to look at those different aspects of the policy and come to a determination about where the level should be drawn.
Q7 Interviewer: How much does alcohol-related harm currently cost the NHS and if we introduce things like minimum pricing how much could we potentially save?
Anne: Alcohol-related harms don’t just impact on the NHS, across the whole economy alcohol-related harms in England are estimated to cost about £25 billion. And just to put that into context, the Government is looking to make reductions in public sector spending of about £6 billion. So it really is a very significant amount of money every year due to alcohol-related harms.
Of course part of that is the NHS treatment costs, it’s also the costs of the police in dealing with alcohol-related disorder, its costs to employers because people take time off due to problems or they come to work and are not very effective if they are hung over. And its costs across the whole of society.
Professor Eileen Kaner and Professor Anne Ludbrook, thank you very much.
This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.
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This page was last updated: 19 September 2012