Learning more about alcohol in Scotland

I’m in Edinburgh on a course organised by the UK Centre for Tobacco and Alcohol Studies UKCTAS where the subject under discussion is Alcohol Policy in Practice. There are two areas where I’m learning loads – the course itself is filling in gaps about alcohol policy for me; but also post referendum, the other delegates have already opened my eyes to aspects of Scottish independence debate I hadn’t even considered.

So, here are some images which capture both:  First a list of companies the 45% campaign is urging fellow Scots to boycott.

Boycotted companies Scotland

 

And second, a reminder of the importance of the alcohol industry in Scotland: an instantly recognisable association.

Glass of scotch whiskey and ice

It’s far from grim up north

I was in Newcastle today, visiting the Institute of Health and Society at Newcastle University, where I’d been asked to present some work to the alcohol team.  It was great to be back in the north-east again – I was born and grew up in Stockton-on-Tees, and there’s something about getting on the train from King’s Cross which takes me right back.

After my talk I got to chat to some of the members of the team about what they are up to. It’s an interesting set-up in Newcastle – lots of bright young researchers, the majority of them women, genuinely interested in alcohol and its effects, and all wanting to make a difference.  Perhaps the location drives that interest – the north east is a hot-spot for alcohol consumption and harms, topping the list of UK regions for both, and even as I made my way back to the train station in the early evening there were signs that people were already out on the town.

It was good to meet new colleagues today –  quality people doing quality research.  Academia is often so fragmented that visiting another university and talking to people about what they are doing and why can only be a good thing.

So thanks to Dorothy Newbury-Birch, Stephanie O’Neil and Amy O’Donnell for their hospitality, and for giving me plenty to think about on the journey home.

 

In York with the Society for the Study of Addiction

I’m in York to present some of my PhD findings to the Society for the Study of Addiction at their annual symposium.  It’s a great event – a yearly chance for people from all areas of addiction research to get together, share their work, and talk about how to move the field forward.

York of course is beautiful.  I grew up in the North East, and coming to York was always a big event.  I feel at home here, in this ancient city with its city walls and cobbled streets, with the rivers running through the city and the presence of the Minster everywhere.

It’s been a full day of presentations, and I can’t do justice to them all here, but three things struck me particularly.  Firstly there have been two presentations from colleagues from the USA, Kathleen Carroll on time-limiting treatments, and Katie Witkiewitz on improving treatment outcomes.  Both stressed the importance of the individual, and spoke about how individual needs, and improvements for those in treatments, were not well served by looking at what works on average.  Human beings are hugely variable, so it should not be a great surprise that addicts are also hugely variable.  I loved Katie Witkiewitz’s explanation of her approach to statistical analysis – whereas most researchers treat variability in their data as error, she treats it as the part that could provide the answer.  Secondly, there was a section on patient and service-user involvement, and a service-user talked to us about his experience.  Conferences such as this benefit hugely from that input from those with the problems we research – they remind us why we do what we do, and that it’s not just pure science for the sake of science, it has real results, and impacts lives.  Thirdly, there was a presentation of an exceptional piece of work from Linda Ng Fat, a PhD student at UCL funded by Alcohol Research UK, who has looked at existing data sets to examine the controversy surrounding beneficial effects of moderate drinking.  Excellent stuff, and great to hear it from someone who is at the beginning of her career.

The annual lecture was given by Professor Robert West, a world expert on tobacco.  I’ll confess, it made me rather wistful for the days when I was a smoker, despite the fact his lecture could not have articulated the harms, and the self-deception of smokers around those harms, any clearer.

I’m looking forward to tomorrow.  Fortunately I’m on first, so after that I can relax and listen to everyone else.  I’ll post my slides up on this blog after the presentation.

 

New evidence, but what does it mean?

A report was published on Friday which highlighted that death rates from alcohol are rising worryingly steeply in one group of the population – women aged between 33 and 43.  This is against the trend for all older age groups, and for men. There is a link to the report at the bottom of this post.

The authors, Deborah Shipton, Bruce Whyte and David Walsh, put the increase down to “historical factors”. What are those historical factors?  Well, let’s think about these women.  They were born between 1970 and 1979.  They would have started drinking at some point around 1988 to 1997, and if their drinking followed a normal pattern, they would have drunk more heavily in their late teens, early twenties, then the amount they were drinking would gradually have decreased as they got older.  What was going on at that time?  It was the rise of what has been dubbed “the ladette culture”, when women with increasing independence and disposable income began to challenge the stereotype of the woman staying at home, and became much more visible in bars, clubs and pubs, where they were drinking and partying alongside men.  As a feminist I would say a jolly good thing too.  However, for some (and it’s a small minority, even if it’s increased somewhat) it seems there was a price to pay. For some, those early heavy drinking days didn’t diminish.  Alcohol consumption continued at dangerous levels, even increased as tolerance to alcohol built up, and the harm caused by that consumption developed over the years.  Here’s the thing.  Women suffer greater physical harms at much lower levels of consumption, particularly with respect to liver problems and mental health issues.  Both of these were highlighted as major causes of alcohol-related deaths of women in this report.

The difficulty for me is that I celebrate the rights of women to do what they want to do and behave how they want to behave.  I celebrate the freedom and the independence which have created a situation where women can party long and hard if that’s what they choose to do.  But I can’t celebrate a tragic waste of life.  It’s another paradox about alcohol I can’t quite square with myself.

I did some tv and radio interviews on the report, and tried to articulate some of this, but it’s difficult.  I was misquoted and mis-attributed in a subsequent newspaper report, based on something I’d said (or not said) on the radio.  The newspaper even said I’d authored the report, which I didn’t.  There are so many messages to get out into the world about alcohol and addiction, but when they are so ambiguous, how do you communicate them?

Read the report for yourself and make up your own mind on this one.

http://jech.bmj.com/content/early/2013/06/27/jech-2013-202574

 

Book review: Intoxication and Society

I was asked to review a book for Addiction, which is an academic journal covering developments in the world of addictions research.  You can read the full review at this link, but a word of warning, it’s written in an academic style, as it was for an academic publication. 

 Intoxication and Society book review

The book is called Intoxication and Society, and is a collection of essays by Jonathan Herring, Ciaran Regan, Darin Weinberg and Phil Withington.  One of the topics it covers is where intoxication sits within the law.  It’s a tricky one, and we haven’t got it quite right.  There’s the issue of capacity – is an intoxicated person incapacitated to the point that they are not responsible for their actions?  No, in the eyes of the law, because they knowingly made a decision to drink, with an understanding that there could be serious consequences.   There’s another tricky point though.  Addiction is treated by psychiatrists and considered a mental disorder – if you have a drug or alcohol problem you will be admitted to a specialist ward in a psychiatric unit.  However, unlike any other mental disorder, you can’t be sectioned against your will for addiction, or forced to have treatment, even if you are clearly a danger to both yourself and others.  Interesting legal conundrums, but also intriguing philosophical questions.

They do it differently here

I am in Florida, attending a conference being held by the Research Society on Alcoholism.  It’s the largest annual international conference on alcohol, and my first introduction to the world of American research in my field.  Day one started in an enormous ballroom set up as a lecture theatre, with over 2,000 seats laid out to hear one speaker at a time.  The day continued with plenary sessions, and smaller symposia, then for those not involved in those there are poster sessions, which are like academic bazaars, where researchers try to attract the attention of attendees and persuade them their research is important.  It’s a bit of a bun fight to be honest, but how else do you get so much information across in such a short space of time?

Here’s the poster I presented  RSA 2013 final poster.   It tries to answer why some women with alcohol problems have their kids taken away from them, whereas other women with alcohol problems do not, and the findings are pretty shocking.  Women whose kids are removed are much more likely to be unemployed, in unstable housing and without a partner.  They have more children, and they have them younger.  They have higher rates of psychiatric illness and suicide attempts.  87% of them have experienced current or historic domestic violence, and 23% of them were in care themselves as children.  Perhaps if we could find a way to tackle some of the things in these women’s lives, they might cope better with motherhood, and their children be less at risk.  There must be a way to look after the mothers AND the children, rather than having to choose between the mothers OR the children.

Hidden

Yesterday I presented some work I’ve been doing to colleagues involved in alcohol research at the Institute of Psychiatry.  A lot of our research is concerned with treatment of people who have serious alcohol problems, or involves looking at how health services can intervene appropriately when someone has an alcohol problem.  The work I presented looks at a slightly different group – women with children, who may not be drinking so much that the wheels are coming off, but who are drinking to the extent that it is starting to affect their lives, and the lives of their families.  The interesting thing about this group of women is that it’s really hidden.  Excuse the generalisations, but in the main, these women may have an understanding that they are drinking too much, but they remain very wary of asking for help or support.  There is a huge anxiety that by doing so, the full might of social services will come down on them, and in a worst case scenario, their children will be taken away.  So, they battle their demons alone.  Some normalise their drinking, and deny to themselves and others that they have a problem.  Secrecy breeds shame, and shame triggers drinking.  Some try to cut down or quit, and find themselves in a cycle of binge/quit/shame (shame again…. will we ever escape it? )  Some turn to the internet and the anonymity of chatrooms to explore whether there is help available, but only under pseudonyms.  There they find support from others in the same situation, and the peer-to-peer advice, while powerful, is sometimes contrary to what we know is helpful.

There is an argument often put forward that this group of women do not need as much help as women whose alcohol problems have developed into something more serious, but I would argue that we need to take a both/and approach.  Treatment is absolutely vital for women who need it, but earlier action to help women on a pathway to serious problems would mean less reach the stage where treatment is necessary.  If we could find a way to reach these women and offer them support and anonymity, we could make a difference.  Perhaps this is an area where official bodies should be looking at a way to work with that powerful peer-to-peer mechanism to get the right advice and support out there, with respect for anonymity.

It’s a hugely problematic question – do you guarantee anonymity and reach many more people but perhaps miss instances of child neglect, or do you carry on as is, with social service involvement and child protection taking centre stage, but perhaps miss different instances of child neglect?

I don’t know where I stand on this one.  We simply don’t know how much harm stays hidden because we don’t provide anonymous help, but nor do we know whether more harm would be caused if we did.

Academia meets politics

A busy day yesterday.  I went to a conference at the Wellcome Centre first, run by Alcohol Research UK, one of my funders.  There were some great speakers, including Professor Sir Ian Gilmore, and Professor Mark Bellis.  Most of the talk was about minimum unit pricing, and lots of evidence was produced.  When you hear about minimum unit pricing in the media, there is talk of penalising responsible drinking, and a tax on the poor.  I am pretty libertarian in my outlook, but I’m in favour of minimum pricing, and that view is based firstly on evidence.  There is evidence in countries where a minimum price per unit has been introduced that all types of alcohol-related harms drop significantly, including liver disease (Russia) homicide (Russia), domestic violence (Australia).  It’s basic economics that when prices go up, demand goes down, and there is no evidence at all that alcohol as a commodity behaves any differently to any other.  A team at the University of Sheffield has been working for years on exploring different scenarios across different types of harm when alcohol is priced differently, and their findings are really compelling.  Secondly though my view is based on my values, on the sort of world I want to live in.  Alcohol doesn’t just harm the person drinking, it harms the people around them, and in this absolutely crucial in my view.  Often the victims of other people’s drinking are women – domestic violence, sexual assault, having to take on even more of the share of parenting while a partner is drunk.  I’m not saying all men become fiends when they have a drink, far from it, but some do.  As do some women.

So, after a day of evidence, I went off to the House of Commons for the All Party Parliamentary Group on Alcohol  to hear some opinions. There are some very good people on this group – Baroness Dianne Hayter, who used to be chairman of Alcohol Concern, a leading charity in the field, Tracy Crouch MP, and Sarah Wollaston MP.  The key speaker last night was Anna Soubry, Health Minister.  Two things were striking.  Firstly, these four are all women.  Secondly, the debate was interesting and covered many areas, but the people on the committee and their invited speakers did not discuss many of the research findings, indeed did not even seem aware of some of the key ones.

It’s great that these debates are happening, and moving in the right direction. However, to use a phrase I hate, is it time for a bit more joined-up thinking?

It’s academic……..

ProfI spent Thursday at the Institute of Psychiatry at an academic conference celebrating and commemorating the life of a man called Griffith Edwards, who died recently aged 83.  To anyone outside the field of addiction research, this won’t be a name which rings any bells, but he was as important to academics in drug and alcohol research as Crick and Watson were to the world of genetics.  People had flown in from all over the world to give presentations on different addictive drugs, legal and illegal, to discuss clinical findings and to make policy recommendations.  My research speciality is Women and Alcohol, and conferences like this are incredibly helpful in that I can catch up with what is going on across the whole field.

I was fortunate enough to be taught by Griff, and it’s fair to say he had a brain the size of a large planet.  However, despite all of his academic achievements, the things that stood out most for me were his respect for the patients themselves, and his belief that friendship was as important as scholarship.  I heard today that he once said that “respect, fellowship and a roof over one’s head could lead to miraculous results” in treating addiction.

I wondered how these basic qualities apply to women who drink too much.  Respect for these women is notable by its absence, in fact society has quite the opposite of respect for women with alcohol problems.  Fellowship also is missing for these women – because of the stigma and shame attached to drinking problems in women, many hide their drinking, and become more and more isolated from the friendship they desperately need if they are to get their lives back.

I remember Griff talking about the resilience of his patients, and how much he admired their bravery.  He gave us a case study of a woman who kept quitting and relapsing.  Her family and friends gave up on her, but she didn’t give up on herself.  Every time she went back to drinking, she tried to quit again.  Griff didn’t see her as a hopeless case, he saw her as a strong woman who battled time after time against her addiction.

I wish there were more like him.