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My name is Sally Marlow and I research alcohol problems in women at the Institute of Psychiatry, King’s College London.  I started this blog to communicate the science, psychology and culture underlying drinking problems, and to put right some of the misinformation out there about women and how they use alcohol.  All views expressed here are my own.

It’s not big and it’s not clever Tony

There’s something really tragic about Tony Abbott being filmed downing a beer in seven seconds – see the film, and accompanying news comment here BBC News: Tony Abbbott downs beer in seven seconds

It’s just wrong on so many levels, over and above any desire he might (or might not) have had to get drunk quickly. There was clearly some sort of peer pressure he succumbed to – not good in a Prime Minister.   Abbott has spoken publicly about the dangers of binge drinking….. hypocrisy is also not good in a Prime Minister. There was also clearly some sort of macho showing off – not good in any middle aged man, but particularly not good in a Prime Minister.

It’s complicated though, because as well as having a political stance on alcohol and binge drinking, Tony Abbott has a personal relationship with alcohol – all of us do. I have no idea what Abbott’s relationship with alcohol is, and would not want to speculate on it.  I would speculate however that his personal relationship with alcohol informs his drinking behaviour. It would have done on this occasion, just as it would have done if he’d been filmed sipping a glass of champagne at a wedding.

Here’s the thing.  We all have a relationship with alcohol, and how alcohol affects us informs how we think society should deal with alcohol.  The problem is that “we” includes politicians, who make decisions about alcohol and alcohol policies.  Perhaps this is why politicians so often ignore evidence about alcohol – their own opinions and beliefs trump the findings of medical, psychological, social and genetic scientists.  If you’re a politician, it’s a small step from your personal relationship with alcohol informing your drinking behaviour to allowing that relationship to inform policy decisions.

That’s why I think this footage of Tony Abbott isn’t just wrong, it’s dangerously wrong.

Alcohol and Suicide

This week saw a very moving and important examination of middle-aged male suicide by Simon Jack in BBC One Panorama: A Suicide in the Family.  There is also an article Simon Jack wrote to accompany the programme here BBC News: Fatal silence by Simon Jack.

Alcohol is implicated in a sizeable number of cases where people take their own lives, both at the time of death, and in the run up to it.

Post mortems reveal excess alcohol levels in about a quarter of those who commit suicide.  Alcohol lessens inhibitions, and for those contemplating suicide, it’s thought that in the moment, maybe alcohol removes some of the internal barriers to taking one’s own life.

It’s also known that about one in five people who have severe alcohol dependence take their own lives, (four in five of these are men).  In those who commit suicide who also are dependent on alcohol, other things have been found to be important:  divorce and separation; death of a loved one; legal problems; employment problems such as job loss; a history of trauma, abuse or violence; a history in the family of addiction problems especially with alcohol; and past attempts at suicide.

Rates of alcohol problems are also higher in groups where rates of suicide are higher, including veterans,and people with mental health problems.

Where am I going with this?  Just that this is yet another area where alcohol is involved, and maybe if we looked deeper at alcohol as well as all the other things that are involved, we might be able to make things a little better, not for everyone who is contemplating suicide, but for some.

Belfast

How has it taken me 48 years to visit Belfast for the first time? Tomorrow I’m guest speaker at a seminar for the Substance Misuse and Child Welfare Special Interest Group at Queen’s University Belfast, and I’m looking forward to discussing my work with what I understand will be a truly multi-disciplinary audience.  SIG seminar 115)

Taking away benefits

The government are considering taking benefits away from people with drug and alcohol problems, and those with obesity, unless they go into treament. Full story here http://www.bbc.co.uk/news/uk-31464897  This blog is much longer than I usually would post, but bear with me, there’s a lot of reasons why this idea is a nonsense.

1. We know that genes, environment and social factors all contribute to whether a person drinks too much/takes drugs/can’t control their weight.  In other words, some people are more vulnerable than others.  I recently looked at a sample of women who drink too much coming before the family courts.  71% had a history of psychiatric problems, inclding 58% who had attempted suicide.  23% of them had been in local authority care when they were children.  87% had experienced domestic violence.  And we think the solution for these women would be to dock their benefits?

2. We know that under austerity measures all treatment services have had funding cut by local authorities over the last 4 – 5 years.  In my role as a trustee of a charity which provides such treatment services http://blenheimcdp.org.uk/ I see how we are being asked to provide more and more for less and less.

3. So treatment services, currently undervalued and not a priority, are suddenly going to have to gear up to treat a new wave of people who CRUCIALLY do not currently want to be treated.  In addiction treatment, the common model is called the Prochaska and DiClemente Cycle of Change, and it involves working with clients to find out where they are on a cycle of motivation.  People who have been coerced into treatment do not do as well as people who have come into treatment of their own free will.  You don’t have to be a rocket scientist (or an addiction scientist) to work out why. And for women with children going into treatment can be an extremely unattractive option – who is going to look after your children when you’re in treatment? Will they go into care?  Will you lose them through the courts while you’re trying to address your problems in a system which is underfunded, without the resources to treat you properly?

4. Addiction is often described as chronic and relapsing.  Chronic means long-term – this is not something people get for a few weeks, then go into treatment to get fixed, then come out again and all is fine.  Relapsing refers to the fact that even after years of non-use of alcohol or drugs, people may slip back into addiction.  Recent high profile cases include Phillip Seymour Hoffman, and Robin Williams who checked himself into treatment not because he was drinking again after years of not doing so, but because he was terrified that he would.  It’s a myth that treatment works well for everybody.  I see people in services who are back for the seventeenth, eighteenth time.  The inspiring thing about these people is their resilience.  It takes guts to keep picking yourself up and keep coming back, desperately hoping that this time you’ll be able to make it.

4. Governments very rarely take action to address any of these issues from prevention, yet there are some things we know would be effective in driving down rates of addiction and obesity in the population as a whole.  These include measures affecting price and supply such as minimum unit pricing for alcohol and a sugar tax.  WE HAVE ENOUGH EVIDENCE NOW TO KNOW THAT THESE WORK.  In countries where they have been introduced, related problems have dropped, droppped, dropped.

5. And if goverments can’t do the easy things, listed above, then how bad are they when it comes to other prevention measures?  Think back to my first point, and although it’s crude, let’s characterise a woman from my recent study who was drinking excessively:  in care as a child, mental health problems, having experienced domestic violence.  We’re rubbish at tacking social problems such as these – look at Rotherham as just one example.   So, we punish those we’ve let down by taking away the safety net we promise to provide for those who are in trouble?

It might take a generation to see results, but if we start looking at causes, and putting our energy into that; plus if we gear up treatment services; rather than taking little bits of money away from people we have by and large failed, who knows?  We might actually start doing the right things.

“The stigma of addiction is a pernicious and inhumane phenomenon”

Not my words, but the words of a North East policeman, Mike Barton, Chief Constable of Durham Constabulary.  It’s good to see a policeman arguing for changes in how we deal with drug addiction from three angles:  money, health and humanity. Read his full blog for Huffington Post here.  Mike Barton’s Huffington Post blog

Meanwhile in London, we are reminded of the phrase “good cop, bad cop” by a tweet from Ray Hodgson at Alcohol Research UK

 

Alcohol and the armed forces

More research coming out of King’s today on high prevalence of alcohol problems in the armed forces.  The BBC have summarised it here Armed forces alcohol abuse strategy criticised

This follows the excellent BBC 2013 Panorama documentary Broken by Battle, examining high rates of suicide in those who leave the armed force.  It’s no longer available on iplayer, but iwas widely reported at the time, and is summarised here “ UK soldier and veteran suicides “outstrip Afghan deaths”

The link?  Alcohol is strongly linked to suicide, and strongly linked to mental health.  Suicide is also strongly linked to mental health.

We understand these links exist.  So why can’t we get it together to support those in the armed forces, both whilst in service and after they leave?

Times article on “tied” pubs: Freudian slip?

A Times article today reports that the Commons vote on an amendment to the Small Business, Enterprise and Employment Bill (removing the right for big companies to charge their pub tenants inflated prices for beer)  ”could help to revive the pub trade. Cheers to that……   Cutting the beer tie would slowly bring back market forces to a sector that is sclerotic and skewed, and bring hope to others snared in the coils of oligopoly.” Times article (warning includes Murdoch’s paywall!)

The word sclerotic is more commonly used to describe livers ravaged by alcohol.  Does the journalist who wrote the leader have a dark sense of humour?

Not just a young person’s problem

Yesterday the media gave some coverage to a new report by Public Health England detailing the numbers of people in alcohol treatment.  In particular they picked up on the fact that increasing numbers of women over 60 are in treatment than were five years ago, compared with women under 29 where less are in treatment.  The same also holds true for men, but with slightly smaller fluctuations.

If you read my blog regularly you’ll know I get fed up with media stories about young people binge drinking.  That’s not to say there aren’t alcohol problems in young people, because there are.  However, there are problems in older people too, and these are rarely reported, which is why it was good to see so much interest in the figures.  I did seven media interviews yesterday alone on this topic, which gives some indication of the prominence it received, although most of these were in the morning/early afternoon, and by the evening, the story had dropped off the headlines and the websites.  However, something does remain:  for a taster, only a couple of minutes long, listen here to my interview with Sarah Montague on Radio 4′s Today

Drinking and pregnancy back in the news

Today the Court of Appeal will hear whether a child with Foetal Alcohol Syndrome whose mother drank while she was pregnant with her is entitled to criminal injuries compensation. the full story is here in the Independent

The label Foetal Alcohol Syndrome covers a range of deficits which have been linked to the toxic effects of alcohol when it crosses from the mother’s bloodstream into the foetus via the placenta during pregnancy.  These deficits can include learning and behavioural difficulties, congnitive deficits, and a particular set of facial features.  More here  National Organisation for Foetal Alcohol Syndrome UK

Sky News have been covering this story this morning, and it was good to see that both of their interviewees, one an adoptive mother of a child with Foetal Alcohol Syndrome, and one a doctor with a special interest in Foetal Alcohol Syndrome, both saw absolutely no merit in prosecuting women who drink while pregnant. Dr Mary Mather, Medical Director for Parents for Children said (and I paraphrase) Criminalising women is not going to help…..  no woman intentionally harms their baby.  Rather than dragging women through the courts we should spend the money on preventing this disability.

I blogged about alcohol and pregnancy earlier this year, and pointed out the inconsistent advice we give pregnant women in the UK:  Being pregnant is hard enough now this. NICE guidelines basically say don’t drink during pregnancy, but if you do, just drink a little bit, and only a few times a week.  The words fence and sitting come to mind.