Hello and welcome to the Alcohol Alert, brought to you by The Institute of Alcohol Studies.
In this edition:
The Westminster administration relies on its experiences of managing last year’s lockdowns to enforce a ban on takeaway alcohol in England
Researchers find that an app designed to help people drink less received a celebrity boost 🎵 Podcast feature 🎵
Pandemic makes this year’s Dry January the toughest yet
Irish shoppers are no longer allowed to buy discounted alcohol
New PACTS report finds that a lower drink drive limit ‘would have a totemic impact’ on UK road safety
Member of Parliament for Bury South, Christian Wakeford is to become the new chair of the All-Party Parliamentary Group on Alcohol Harm
Regulator clears racy alcohol television ad of wrongdoing
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Lockdown 3: Westminster uses 2020 vision to enforce alcohol takeaway ban in England
The new year began with a now-familiar focus towards lockdown-induced restrictions on alcohol sales during the pandemic, with the government banning alcohol takeaways from licensed premises (The Independent, 05 Jan):
Alcohol takeaways are to be banned… until mid-February in England as Boris Johnson clamps down on socialising under the new lockdown regime.
All restaurants, pubs and other hospitality settings must close their doors to customers… under the new rules announced by the prime minister… venues will no longer be able to serve takeaway or click-and-collect alcohol.
The other Home Nations tightened their rules too, with Scotland, Wales and Northern Ireland still permitting alcohol takeaways, but under more stringent conditions and while licensed premises (throughout Northern Ireland, and in tier level 4 in Scotland and Wales) remained closed to normal custom (BBC News Business, 13 Jan).
Alcohol industry players claim that the uncertain trading environment faced by the hospitality sector had a significant impact on alcohol sales last year. The Morning Advertiser reported that 37 pubs a month ‘vanished’ in 2020, not because of a shift in operations from wet- to dry-led sales, or the rise of venues such as micropubs replacing traditional outlets, but simply because they had received insufficient support to remain a financially viable concern while shut (11 Jan). Chair of the Campaign for Real Ale (CAMRA) Nik Antona claimed that the new lockdown restrictions ‘could tip hundreds of pubs over the edge into insolvency in the coming months’, and called on the government to allow pubs to act as off-licences during the lockdown by selling pints in ‘sealed containers’ (Evening Standard, 07 Jan).
However, there were also suggestions that appeals for support should instead focus on compensating venue owners for enforced closures of their premises.
According to The Independent, the Wine and Spirit Trade Association (WSTA) annual market report estimated 5%, 10%, and 15% declines in beer, wine and gin sales respectively in the year to October 2020, despite retailers enjoying ‘a boom in alcohol sales during the pandemic’ (07 Jan).
Based on these industry data, the WSTA chief executive claimed ‘it’s a myth that people are drinking more during lockdown’, a statement which runs contrary to evidence from Public Health England and several independent research groups which have reported increased rates of heavy drinking during the pandemic. Two studies published this month reported that a significant minority of people’s alcohol intake had increased. The first examined vulnerable populations, tracking health behaviours during the early days the lockdown: of the 1,044 participants involved, 30% had a ‘COVID-19 at risk health condition’, 37% were classed as deprived and 6% self‐reported a mental health condition, yet relative to pre‐pandemic levels, participants’ drank more alcohol on average and did so more often (British Journal of Health Psychology, 06 Jan).
The second, a much bigger study (of more than 30,000 adults, published in Drug and Alcohol Dependence journal) found that roughly the same proportion of drinkers admitted to drinking more as those who reported drinking less (26·9% versus 25·7%) than usual during the first lockdown (The Independent, 14 Jan).
The one in four who were more likely to report upping their intake were younger women with post-16 educational qualifications and a household income over £30,000. The University College London research team also found that having an anxiety disorder, being stressed about finances or about catching or becoming seriously ill from COVID-19 were factors associated with drinking more. The authors noted that it is possible that people with anxiety disorders are changing their drinking behaviour to self-medicate or as an unhelpful coping mechanism during a period of increased anxiety. Lead author Dr Claire Garnett said:
Women might be more likely to drink more than usual during lockdown because they have been more negatively affected by the pandemic through increased gender inequalities as women are more likely to lose their jobs and carry the burdens of increased childcare and housework.
Co-author Dr Melissa Oldham stressed the importance of ‘targeted approaches to provide support for certain groups who are more likely to drink more is needed, particularly with the start of this third lockdown.’
Meanwhile, some health experts had some sobering advice for those in line for the COVID-19 vaccine. On BBC Panorama, emergency medicine specialist Dr Ronx Ikharia demonstrated how three glasses of prosecco (4·5 units) was enough to reduce the levels of white lymphocyte cells – crucial for warding off viruses and other pathogens – in the blood by up to 50%, therefore weakening the body’s immune response to the vaccine (06 Jan). However, the message was somewhat undermined by BrewDog’s stunt to offer its closed outlets across the United Kingdom as COVID-19 vaccination centres where those vaccinated could walk away with a ‘special commemorative beer’ (Lonely Planet, 20 Jan).
The craft beer brewer is one of many alcohol industry actors looking to exploit the pandemic, according to a report commissioned by Movendi International that provides ‘a comprehensive picture of the individual, societal and policy dimensions of the interaction between alcohol and the coronavirus crisis’.
‘Alcohol and the coronavirus pandemic: individual, societal and policy perspectives’ offers the following solutions for governments to reduce the alcohol burden and mitigate the pandemic (26 Jan):
Maintain and improve alcohol policy measures;
Limit alcohol availability and affordability and make use of evidence-based alcohol pricing policies;
Ensure effective public health messaging on alcohol and COVID-19 from health authorities;
Make clinical and treatment provisions for people experiencing all types of alcohol-related problems; and
Increase access to mental health services, including online services.
In the UK, given the difficulty of accessing treatment services and of maintaining a healthy relationship with alcohol for many adults in 2020 due to the threat of COVID-19, the British Liver Trust fear that the pandemic could lead to tens of thousands more liver disease cases in 2021. They call ‘for every person in the UK to consider their liver health and take a simple quiz to assess their risk’ (04 Jan).
Vanessa Hebditch, director of policy and communications said:
In early 2020, our Love Your Liver health screening roadshow was ready to tour the nation, offering free liver health checks to the general public at high streets up and down the country.
Unfortunately, COVID-19 forced us to postpone the roadshow. That meant that around 4,000 people will have missed out on a free liver health check. If we look at the statistics from previous Roadshows, around 650 of those would have shown signs of possible liver damage.
We are very concerned that while thousands will have missed out on valuable liver health advice, some of those people will already have undiagnosed liver disease which won’t show symptoms until the very late stages when treatment options are limited.
2020 was a really stressful year for everyone. We know from our research that a lot of people drank more alcohol and ate unhealthier food last year – two major risk factors for liver disease. We also know that some people have missed out on appointments and treatment while healthcare resources have been diverted elsewhere as a result of the pandemic.
The Adrian Chiles effect – a natural experiment
🎵 Podcast feature 🎵
The celebrity influence of broadcaster Adrian Chiles on the Drink Less app caused a spike in middle-aged men engaging with the app, according to a study published in BMC Public Health (06 Jan).
Researchers at University College London found that the weekly average of 179 downloads between May 2017 and mid-August 2018 rose to 14,866 total downloads in the week commencing 20 August 2018, when Chiles’s show Drinkers Like Me was first broadcast. He also advised: ‘I encourage anyone, don’t judge yourself, don’t panic you’re not going to drop dead, but go on an app like “Drink Less” and measure what you’re drinking, be honest with yourself for three weeks.’
The study reported a ‘step-level increase in app engagement – number of sessions and number of days used – which continued to increase over time’. No effect of media coverage was detected on employment type or on the percentage of at-risk drinkers, though the mean Alcohol Use Disorders Identification Test score was lower after the media coverage.
In our podcast interview, lead researcher Dr Claire Garnett said of the findings:
It shows that celebrity influence and the subsequent national media coverage that comes with it can clearly have a really substantial impact on who uses an app or additional intervention and how they engage with it.
In other research
Higher smoking frequency at admission is associated with higher illicit opioid and alcohol use frequency after six months of specialist addiction treatment, according to research released in Drug and Alcohol Dependence (01 Jan).
Two cross-lagged panel models* estimated (separately for opioid and alcohol use disorder patients) the relationships between smoking at admission and change in main drug over six months, and between main drug use at admission and change in smoking over six months. Within the alcohol use disorder cohort, alcohol use frequency fell from 21·2 days to 14·4 days while smoking tobacco reduced from 12·6 days to 11·5 days. Higher smoking frequency at admission was associated with a relative increase in alcohol use at six months (0·03 days), and each additional day of alcohol use at admission increased on average the tobacco use reported at six months by an estimated 0·04 days.
A study of over 309,000 regular drinkers from the UK Biobank UK has found that different patterns of alcohol consumption could be associated with a lesser risk of alcohol-related negative health outcomes (BMC Medicine, 12 Jan).
Researchers from the University of Glasgow found that regular spirits and beer/cider drinkers had a higher adjusted risk of death, major cardiovascular events, liver cirrhosis and accidents/self-harm when compared to those who drank red and white wine, after adjusting for alcohol amount consumed overall. Similarly, drinking alcohol without food was associated with a 10% higher adjusted relative mortality and cardiovascular risk when compared to alcohol consumed with food.
The results also showed that spreading alcohol consumption over three to four days in a week was associated with lower adjusted relative mortality, cardiovascular and cirrhosis risk than consuming alcohol daily; and lower mortality and cardiovascular risk than binge drinking similar amounts of alcohol.
Commenting on the study’s findings, Dr Bhautesh Jani, clinical senior lecturer in general practice at the university's Institute of Health and Wellbeing, also warned of the health risks of regular alcohol consumption above the low risk guidelines:
Of the regular alcohol drinkers we studied, less than half reported consuming the recommended amount for low risk alcohol consumption, so our first suggestion would be for regular drinkers to follow the recommended government guidelines. Other ways to further lower the alcohol consumption related health risks, based on our findings, might be to spread consumption over the course of three or four days – whilst being careful not to increase their overall intake – and consider… drinking with meals where possible.
People with epilepsy are at increased risk of dying from alcohol misuse, according to a study published in Frontiers in Neurology journal (21 Jan).
An analysis of the relative risk of alcohol-specific mortality in people with epilepsy, and the extent to which problematic alcohol use was previously identified in the patients' medical records, identified a five-fold increased risk of alcohol-specific mortality in people with epilepsy vs. those without the condition.
The research team delineated cohort studies in two population-based datasets, the Clinical Practice Research Datalink (CPRD GOLD) in England and the Secure Anonymised Information Linkage (SAIL) Databank in Wales between 2001 and 2015, linked to alcohol-related hospitalisation and alcohol-specific mortality records. They concluded that the causality between alcohol misuse and epilepsy could run either way, and stressed the importance of accurately quantifying the risk of death among epilepsy sufferers.
England and Scotland have topped the international rankings for drunkenness again (25 Jan). The Global Drugs Survey (GDS) for 2020 suggests the UK’s drink problem is far more dangerous than any other country: more than 5% of people under 25 years of age reported having sought hospital treatment after getting drunk, compared with the international average of 2%.
The survey questioned more than 110,000 people from more than 25 countries between November 2019 and February 2020.
It repeated last year’s finding that UK drinkers get drunk most often of all countries’ individuals: people in Scotland and England said they had got drunk on average more than 33 times in the last year, more than twice the rate of several European countries, including Poland, Hungary, Germany, Greece, Romania, Spain, Italy and Portugal.
Only 7% of Scottish and English people surveyed reported not having been drunk at all in the past 12 months. Only Danes and Australians had a lower proportion, at 5%.
Professor Adam Winstock, the chief executive and founder of the GDS, said: ‘We don’t have a culture that is honest about the impact of intoxication. Drinking is a lousy coping strategy and it is putting a higher burden on the NHS. British people have never really embraced moderation when it comes to drinking. While many other cultures regard alcohol as an accompaniment to a social event and frown upon public drunkenness, we’ve often embraced it as a cultural identity. The challenge is making people realise drinking a bit less does not make you boring. In fact, you’ll probably have a better night. It’s like as a country we need to leave our adolescence behind.’
Professor Winstock urged the government to stand up to the alcohol lobby and introduce mandatory health warning labels and minimum pricing, and lowering the drink-drive limit, remarking that they were all ‘incredibly sensible things that have been recommended by several commissions, but have been ignored in the face of resistance from the alcohol lobby.’
* a cross-lagged panel model is a type of structural equation model that measures two different variables (smoking vs alcohol use disorder) at two points in time (admission vs six months later).
Dry January 2021 – attempts at abstinence come under pandemic’s influence
Organisers of the country’s biggest alcohol abstinence campaign, Alcohol Change UK, rang in the new year with a record number of participants ready to ‘forego booze’ for the first month of 2021, according to The Guardian (31 Dec 2020):
The charity Alcohol Change UK said its polling shows more than 6·5 million adults intend to participate in Dry January – up from 3·9 million last year. That is the equivalent of one in five of people who drink alcohol.
However, some media coverage cast doubt on the impact of the nationwide initiative. Trade mag Drinks Business quoted a snap poll from ‘creative insight agency’ KAM Media claiming that 2·7 million out of 10.8 million participants who began the challenge on the first of January gave up by the end of the first week (06 Jan).
And writing in Prospect Magazine, philosopher Julian Baggini suggested that Dry January would do little to stop the problematic consumption patterns inherent in British drinking culture (13 Jan):
Dry January merely replicates the source of the problem it is supposed to be solving. It reinforces the idea that we need to go through a period of complete abstention to make up for our festive excesses. It perpetuates the binge-purge cycle rather than short-circuits it… if you want to change your habits, it is better to start a routine you can sustain, such as limiting drinking days and quantities, rather than going through a one-off challenge in which no new habits are learned.
Away from notions of ‘falling off the wagon’ and purges doing more harm than good, Alcohol Change UK’s chief executive Richard Piper took to social media to explain that the true message of Dry January is less about pursuing an unattainable mode of perfection in abstinence and more about drinkers becoming more aware of their alcohol habits in order to help control them, acknowledging that reducing your drinking is a process, not an event.
No more alcohol multibuys and discounts for Irish shoppers
The days of discounted alcohol sales by supermarket voucher schemes and multibuy deals in Ireland are over, as the government brings into force another element of its Public Health (Alcohol) Act 2018 (Irish Times, 08 Jan).
Popular deals such as ‘buy six bottles for €50’ or ‘buy six and get 25% off’ will no longer be permitted. Offering loyalty points on alcohol sales will also be prohibited, while short-term promotions, of three days or less, can no longer take place. Discounts on the price of individual bottles of alcohol will still be allowed.
Commenting on the development, Eunan McKinney, Alcohol Action Ireland’s head of communications, said:
We welcome this latest step on what is a very long journey to implementing the Public Health Alcohol Act; the operation of these regulations now ensures that people are not further incentivised, or rewarded, for using alcohol.
The fundamental action that is required next is the immediate implementation of minimum pricing of alcohol products, which has been interminably delayed by government inertia, yielding to the concerns of the alcohol producers.
The country’s chief medical officer Dr Tom O’Connell also welcomed the move, as he considered limiting off-licence opening hours to help stop the spread of COVID-19.
No more stalling on the drink drive limit: A lower drink drive limit ‘would have a totemic impact’ on UK road safety, according to the Parliamentary Advisory Council for Transport Safety (PACTS) in a new report, ‘Drink Driving: Taking Stock, Moving Forward’ (25 Jan).
In their comprehensive review of UK drink-driving, PACTS analysed casualty and crime drink drive data, and conducted interviews with 30 drink drivers, concluding that with no progress made in several drink drive policy areas – such as the annual number of drink drive deaths stalling at roughly 240 for the last decade – the UK’s drink-driving legislative framework is no longer adequate, recommending several interventions to save lives in future.
Commenting on the report, David Davies, executive director of PACTS, said:
Drink-driving is often cited as a road safety success story, yet it remains a major killer and progress has ground to a halt since 2010. Not only is better enforcement important but also the problems of mental health and alcohol dependency need to be recognised.
Scotland introduced a reduced drink drive limit in 2014, in line with most other countries in Europe. It has been accepted by the public; it has not significantly impacted pubs and restaurants or overloaded the police or the courts. Northern Ireland plans to go further, with a zero limit for novice and professional drivers.
A lower limit is not a magic bullet but government polices to reduce drink driving will lack credibility as long as they avoid this change.
New Year, New APPG chair: Member of Parliament for Bury South, Christian Wakeford, will become the new chair of the All-Party Parliamentary Group on Alcohol Harm (20 Jan). The next public event will take place on 10 March and will be sponsored by Alcohol Change UK.
Racy alcohol ad cleared by watchdog: The Advertising Standards Authority (ASA) have rejected calls to ban a television advert said to link alcohol with sex (06 Jan).
The complainant challenged whether the ad for Laphroaig whisky was irresponsible because: it linked alcohol to sexual activity; and it portrayed alcohol as indispensable.
The ASA ‘considered that the ad clearly showed people’s reactions to tasting Laphroaig whisky, which was well known for its unusual taste'‘ and ‘noted the reference to “You’ll always remember your first” alongside the facial expressions, which showed various reactions after tasting the whisky’.
However, despite acknowledging that one could interpret the advert’s catchphrase as a reference to losing one’s virginity, the regulator decided that the ad actually gave an illustration of the different reactions people had encountering a distinctive taste for the first time, and so ‘did not imply any link between drinking Laphroaig whisky and sexual activity, sexual success or seduction’. They also considered that the ad did not portray alcohol as being indispensable, based on the fact that a key scene appeared to be more of ‘a light-hearted expression of [the actor’s] enjoyment of the whisky’s flavour’.
The ad watchdog found that the ad was not in breach of its newly updated alcohol rules of the CAP (rule 18·9) and BCAP (rule 19·10) Codes, which now include minor amendments to ‘clarify the language used to describe the ABV [Alcohol By Volume] thresholds at which drinks are subject to the alcohol rules and what strength a “low alcohol” drink is considered to be’.
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