Our fatal love affair with alcohol

For more than a year, Scotland has been bombarded with bad news about its love affair with drink. Every fresh bulletin has brought more shocking statistics: 45 Scots are dying because of alcohol every week, drinking among 13-year-olds has doubled, and at least 10% of admissions to A&E are drink-related.

Yesterday was probably the most damning yet. In 2002-04, the alcohol-related death rate for Scots was around double that for the UK as a whole - and that at a time when the nationwide total has itself doubled over the past 15 years.

The bad news for Scotland from the Office for National Statistics was shared between men and women and the focus for unfavourable publicity again fell on Glasgow, which had the highest rates for both sexes of anywhere in the UK.
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Other areas with high poverty levels, such as Inverclyde and West Dunbartonshire, were also prominent, as were island areas which have a hard-drinking reputation. But the top 20 tables also take in east coast bastions of middle-class wealth in Edinburgh and Aberdeen. It is truly a national issue.

However, while individuals clearly bear much of the responsibility for drinking themselves to death, the coincidental release yesterday of the Scottish Executive's new action plan for tackling the demon drink left ministers exposed to criticism from alcohol campaigners and opposition politicians over what they saw as the paucity of the plan's contents.

It was frank about the scale of the challenge in Scotland. Cirrhosis rates are falling across Europe, even in traditional wine areas such as France and Italy, while in Scotland they are spiralling. In the past 50 years, the rate of cirrhosis mortality has grown six-fold in Scottish men and four-fold in Scottish women.

Campaigners are crying out for cultural change around alcohol, equivalent to that which led the Scottish Parliament to ban smoking in public places.

With pledges to expand existing pilot schemes, start new ones, collect more data and increase education about sensible drinking, the action plan does not even crack open the door to a drastically different, sober world.

Jack Law, chief executive of the charity Alcohol Focus Scotland, said the agreement announced yesterday was vague and failed to address key topics.

"The agreement avoids the big issue about alcohol in Scotland - the link between price and harmful consumption, the fact that alcohol is significantly discounted to the extent that some alcoholic drinks are cheaper than water."

He has a point. The agreement between executive and the drinks industry covers barely two sides of A4, is not legally binding, and has oblique phrases like firms using "joint creative energies to market the principle of consuming low alcohol alternatives, within the context of making informed choices and unit awareness".a

It is understood the executive threatened the industry with raising the purchasing age for alcohol when it started discussions a few years ago, but the idea was later dropped.

Mr Law said: "With public concern about alcohol issues at an all-time high, this plan was a real opportunity for the Scottish Executive to deliver strong actions with clear timescales, supported by an appropriate level of funding. What is needed is action on both the price of alcohol and its availability, issues that are not effectively addressed."

Dr Peter Terry, chair of the BMA in Scotland, said doctors wanted an end to the "ridiculous pricing" of alcohol in off sales and supermarkets. "When alcohol is cheaper than bottled water, we have to worry about what message we are sending our children."

Arguably, alcohol is a more complicated problem than smoking, and the shift in attitudes that enabled the smoking ban followed decades of alternative strategies at every level of society.

However, there is a tangible sense of frustration in some quarters about the level of progress on alcohol so far. Under the new strategy, licensing boards are to tackle the overprovision of licensed premises, and the alcohol industry is requested to promote further the responsible serving of drink and consider whether marketing strategies, including packaging, labelling, and branding, are contributing to the drinking culture. But crucially, when it comes to pricing, the executive defers to Westminster.

Dr Jonathan Chick, a consultant psychiatrist at the Alcohol Problem Service in NHS Lothian, said there was frustration that such powers were reserved.

He was pleased that the executive had recognised the need to expand services for treating problem drinkers. However, a major part of the strategy involves a "partnership agreement" with the alcohol industry itself, and here he expressed scepticism.

Dr Chick said: "It is known that overall reduction of alcohol consumption in a population leads to the reduction of heavy and dangerous drinking, but this is a goal which would not be compatible with the aims of the alcohol industry, which is to increase sales, so there is a limit to how much a partnership agreement between the people and the industry can achieve."

Professor Gerard Hastings, director of the Institute for Social Marketing at Stirling University, went further, comparing it with "putting foxes into the chicken coop and asking them to be nice".

He added: "If the industry is promising to be nice, that is obviously a good thing, but we should not have any illusions. This industry's first and only loyalty is to their shareholders. It has to be by law, that is how corporations are set up, so to expect them to take on public health is just unrealistic."

Mr Law was even more damning. "The partnership agreement is rather vague and simply restates many of the initiatives already happening through the Drinkaware Trust or individual company's own codes of practice," he said. "Many of the initiatives allow the signatories to opt out of participation."

Experts suggest it is odd to expect the industry to do more to promote responsible drinking, when its own clever marketing of brands is arguably part of the current problem.

Tighter regulation of licensed premises is also part of the strategy. Dr Chick said that, until now, the executive had largely failed to help licensees adhere to legislation banning the sale of alcohol to customers who are clearly intoxicated. In five years, only about five Scottish premises had been prosecuted for this offence, he said.

Test purchasing to crackdown on outlets that sell to under-age drinkers is another part of the scheme. Professor Hastings said such measures had a role to play, but warned: "The great danger that sort of initiative could have is it exacerbates the forbidden fruit syndrome. It says drink is fine but only grown-ups are allowed to do it and that is one of the reasons why kids are drawn to it.

"We are now at a stage where we need to draw a line in the sand. I think we have done that successfully with tobacco. There is an anxiety here that we have not been doing that with alcohol."

Health Minister Andy Kerr yesterday admitted the executive had failed to meet its target on lowering the numbers of men and women drinking more than the recommended levels, and said the plan was only "part of a long-term process of cultural change".

He added: "We must all take personal responsibility for our society's excessive consumption. A culture of drinking to get drunk is not one to be proud of, and we cannot afford to assume it's someone else's problem."

The price of alcohol, he said, was "not a silver bullet", and it was right that the Treasury, rather than the executive, should determine the duty levels.

Dr Harry Burns, the chief medical officer, was unable to name any tangible effects resulting from the executive's last alcohol action plan in 2002. The best he could offer was that the death rates "might have been worse" if it had not existed.

Not the sort of news which we can celebrate - with alcohol or even a soft drink.

The Herald