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.
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?
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
The Financial Ombudsman has just found in favour of someone whose insurance company refused to pay out for a claim on travel insurance on the grounds that the policy holder had been drinking. http://www.bbc.co.uk/news/business-29325740
As a society we have made a decision that alcohol is legal. As a society, we also know that some people are more vulnerable to getting into problems with alcohol than others, and that the reasons for this include a person’s biology, their psychology, their life experiences, and their situtation at any given time. If we continue to sanction alcohol, then we also have a duty to pick up the pieces when it goes wrong for some people, and for the insurance companies not to play their part is simply hypocritical. I wonder how many board members on alcohol companies also have interests in insurance companies, and vice versa.
There’s more evidence out this week for those who are interested in favour of alcohol minimum unit pricing, and it’s published in PLOS One, one of the most respected scientific journals in the world. You can find the research here PLOS one article on minimum unit pricing Where the findings of this research differ from a lot of what we already know, is that having specifically looked at what types of drinkers minimum unit pricing would affect – light drinkers, moderate drinkers, and heavy drinkers – it finds that minimum unit pricing affects heavy drinkers, not light or moderate ones. This provides more evidence against the alcohol industry’s argument that minimum unit pricing penalises “responsible” (their word, not mine) drinkers. It doesn’t. It cuts down drinking in those who drink the most, ie those who are more likely to become dependent on alcohol, those who are more likely to suffer physical health complications because of their drinking, and those who are more likely to contribute to social harms in their families and communities.
I’ve written previously about how minimum unit pricing goes against the philosophical grain for me, but that I am convinced it’s the right thing to do. Read my reasoning here: Why I’m an unlikely supporter of minimum unit pricing
As the trolls who sent abusive messages to Caroline Criado-Perez and Stella Creasy MP are jailed today, a fact comes to light in Judge Howard Riddell’s judgement against Isabella Sorley I was not aware of. She has 25 previous offences recorded against her for drunk and disorderly behaviour, and says she was drunk at least for some of the time when she was sending abusive tweets.
Here’s some of what the judge said:
Ms Sorley, you were recently assessed as unsuitable for an Alcohol Treatment Requirement as you lack the necessary motivation… you are an intelligent and well educated woman. You have a 2(1) degree in Creative Advertising. To your credit you have mostly remained in work, even though you were unable to find employment in your chosen field. In addition you have real support from your family, for whom this has been a very harrowing time. Mr Caulfield has emphasised to me the disconnect between the pleasant and articulate person he has seen, and the person your record demonstrates. He points out these offences occurred in a 30 minute window well after midnight when you must have been heavily under the influence of alcohol. I accept that. However you have offended so many times when drunk that it must have been obvious to you that you needed to deal with this problem if you were not to continue to cause harm to others. His full sentencing report is here Judgement: Nimmo and Sorley
This suggests that alcohol has contributed to the harm not only suffered by Caroline Criado-Perez and Stella Creasy, but also by Isabella Sorley, who tonight will spend her first night of many in jail. She’s not the only woman with a drink problem to do so. I’m not arguing that Isabella Sorley was not responsible for her actions – certainly in the eyes of the law she was. I am however pointing out that the harmful effects of alcohol are everywhere. You only have to look a little deeper.
To those of you unfamiliar with the London School of Hygiene and Tropical Medicine, it’s an unlikely setting for some really quirky films of academic interest, including The Narcotic Farm, which I saw there recently. It’s a historical documentary with footage from the 40s onwards charting the establishment and running of American’s first ever drug treatment facility, The Lexington in Kentucky. There were two types of patients – those who were sent there as a result of criminal charges, and those who referred themselves voluntarily. There was a thriving jazz scene at the Lexington, and Sonny Rollins was just one of the musicians who spent time there. For the first time, those with drug addiction problems were treated rather than simply incarcerated. But for the first time, something else happened for those with drug addiction problems – they began to be experimented upon. Within Lexington was a research facility, but unlike today’s research which looks at treatment as well as causes, this research facility’s main work was observing the effects of drugs, and the way they did that was to give drugs of all types to those in the institution, and watch what happened. It’s an extraordinary documentary, and it’s available in three parts on youtube. The first part is here
A great discussion of the role and remit of Drinkaware has just been published in an academic journal called Addiction. Drinkaware is a body which provides information about alcohol and harms, and it is funded by the alcohol industry. Jim McCambridge and colleagues have written a damning critique of the information Drinkaware chooses to provide to the public, and how it chooses to provide it, but also, how Drinkaware sites are routinely used by the NHS, amongst others. This is a scandal waiting to happen.
I don’t usually post up academic articles, but this one is worth a read.
There have been some big stories about alcohol in the press in the past couple of weeks, and as I’m working on my PhD (it’s nine days until I hand it in, and I’ve had to re-do a load of stats), I’ve resisted the urge to blog about them. But, here’s a short summary, and in October I’ll revisit some of these things and talk about them in more detail.
Firstly, the proposal by the police that drunk people should be scooped up off the streets in drunk tanks, and pay a fine to cover the cost of medical treatment. In the news coverage I don’t think I’ve ever heard the words “responsible” and “irresponsible” uttered so many times. Leaving aside the logistics of deciding who’s drunk enough to be fined and thrown into the drink tank, which would be tortuous, let’s think about the motives for doing this. There is absolutely no evidence that it would stop people from drinking large amounts and getting into trouble. It is also the thin end of a large wedge – do we charge people who like scones and cream for heart problems, or those with mobility problems for not doing enough exercise while they were younger? So what does that leave us with – the motivation of punishment for using a substance society is happy to condone and governments are happy to take taxes from. Maybe that’s enough for some people, but it’s not enough for me.
Secondly, minimum unit pricing for alcohol reared its head again, with a representative from the drinks industry on BBC News saying “the evidence isn’t there” – it is actually, in the shape of over 100 peer-reviewed academic studies, including evidence from countries where they’ve tried it, and guess what, it works – less accidents, fights, liver disease, domestic violence… He also said the debate is behind us. It’s not. Saying something doesn’t make it true, however much you wish it. The debate is still alive and kicking, mainly because the evidence is so overwhelming.
And thirdly, Alastair Campbell has a novel out called My Name Is… about a woman who drinks. Brave for a man to have a go at this, even if he has a history himself with alcohol. I’m looking forward to reading it, and will review it here. It’s second on my list when I’ve handed in my PhD, after Cracked: why psychiatrists are doing more harm than good by James Davies – okay it came out six months ago, but I’ve been busy. It winks at me from time to time from its spot by the bed, saying “read me, read me” and soon I will be able to do just that. I’ll review this one too, particularly in terms of what it implies for alcohol and addiction.
Thanks if you’re still checking in and reading the posts. More to come….