Britain is currently experiencing a serious alcohol problem, as shown particularly by a steep increase in rates of liver cirrhosis mortality and by widespread alcohol-related disorder and harm among young people. The UK government introduced two major initiatives in 2004 - radical changes to the licensing laws regulating the sale of alcoholic beverages and an Alcohol Harm Reduction Strategy for England â€“ and these are described and criticised. In the opinion of most UK experts in the alcohol field and in a significant body of public opinion, neither of these developments is likely to lead to a reduction of alcohol-related harm. The UK government appears more concerned to support the welfare of the alcohol industry than to introduce effective measures to limit the damage caused by its products. However, it is speculated in conclusion that reactions to another "long wave" of alcohol consumption and problems may force the government to revise its alcohol policies

Heather, Nick

English

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Citation: Heather, Nick (2006) Britain's alcohol problem and what the UK government is (and is not) 
doing about it. Adicciones, 18 (3). pp. 225-236. ISSN 0214-4840 
Published by: Socidrogalcohol
URL: 
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Updated May 3rd 2006 @ 14:24 hrs
BRITAIN’S ALCOHOL PROBLEM AND WHAT THE UK GOVERNMENT
IS DOING ABOUT IT
Nick Heather
Emeritus Professor of Alcohol & Other Drug Problems,
Division of Psychology,
Northumbria University,
Newcastle upon Tyne, UK
Editorial for Adicciones
Introduction: Britain’s alcohol problem
The United Kingdom of Great Britain and Northern Ireland is currently experiencing
a serious alcohol problem. Historically, the UK has shown a relatively moderate per
capita level of consumption compared with other western European countries. In
more recent times, however, consumption in most of these countries has stabilised or
fallen, while in the UK it has continued to rise. An Interim Analytical Report, ordered
by the Government in preparation for its recent alcohol strategy (see below),
concluded that: “If present trends continue, the UK would rise near the top of the
consumption league table within the next 10 years (Prime Minster’s Strategy Unit,
2003, p.18). These trends have continued in the three years since the publication of
the report. “Binge drinking” (defined as drinking 8+ units of alcohol on a single
occasion for men and 6+ units for women, 1 unit = 8 g ethanol) now represents 40%
of all drinking occasions among men and 22% among women – a frequency of binge
drinking substantially higher than most other European countries (Prime Minster’s
Strategy Unit, 2003, p. 21).
The increase in alcohol-related harm in the UK is shown most starkly in rates of liver
cirrhosis mortality which, as well as being an indicator of a serious form of harm in
themselves, serve as a reliable marker for the level alcohol-related problems in a
population more generally (Academy of Medical Sciences, 2004). Leon and
McCambridge (2006) have recently shown that the UK has recorded the steepest rise
in rates of liver cirrhosis mortality in western Europe (see also Room, 2006). Between
1987 to 2001 rates in England and Wales in men rose by over two-thirds while in
Scotland they more than doubled. In women, rates increased by almost a half in
England and Wales and in Scotland. This stands in contrast to trends in most other
European countries, particularly those of southern Europe, where rates of liver
cirrhosis mortality have declined over the same period. While a complete explanation
for the increase in the UK is unclear, increased overall consumption is almost
certainly a major contributory factor. At the same time, a change in beverage
preferences from beer to stronger forms of alcohol in wines and spirits may also have
contributed to the increased risk (see Leon & McCambridge, 2006).
Another aspect of the UK situation that is causing special concern is public
drunkenness, rowdyism and alcohol-related violence and injury among young people.
The 1999 report of the European School Survey Project on Alcohol and Other Drugs
(Hibell et al., 2000) showed that British teenagers are among the heaviest drinkers in
Europe, equalled only by those in Denmark and Ireland. British teenagers report that
they are more likely to drink, get drunk and experience alcohol-related problems than
their counterparts in almost all other European countries. More than a third of British
15 and 16-year olds reported that they had been drunk at age 13 or earlier, compared
for example to only one in ten French or Italian teenagers. Rates of alcohol
consumption and problems among young women are especially alarming. The most
recent ESPAD survey in 2003 reveals the unprecedented finding that British girls
aged 15 and 16 have now overtaken boys of the same age in relation to the frequency
of binge-drinking episodes (Hibell et al 2004, Plant et al. 2005). Indeed, so alarming
has the increase in diagnoses of liver cirrhosis among young women become that the
UK Chief Medical Officer, the most senior medical authority in the country, was
moved to devote his annual report on the state of public health to this problem in 2001
(Donaldson, 2001).
The centres of cities, large or even medium-sized towns throughout the UK have
become “no-go areas” for many adults late on Friday or Saturday nights owing to
drunken disorder among young people spilling out on to the streets from a multitude
of “super-pubs”, disco bars and night-clubs. (As but one example, the relatively small
city of Nottingham had at the latest count 356 licensed alcohol retail premises in just
one square mile of the city centre.) Frequent media articles and TV documentaries
demonstrate the enormous strain this places on the police, accident and emergency
medical services and other local resources. This situation was originally caused by the
exodus of industry and commerce from town centres to out-of-town locations, leaving
a vacuum that local politicians were keen to fill by the “night-time economy” of the
consumption and leisure industry (Hobbs et al., 2003). This development has radically
transformed the way alcohol is consumed in modern Britain, many would say
considerably for the worse.
In the light of these trends and current levels of alcohol-related problems, it would be
reasonable to expect that the British government would take action to reduce alcohol-
related harm in the UK. In fact, the government introduced two major initiatives in
March, 2004 – radical changes to the licensing laws regulating the sales of alcoholic
beverages and an Alcohol Harm Reduction Strategy for England – although in the
opinion of most experts in the field and among a large body of public opinion, neither
is likely to improve the situation. We will consider each of these in turn.
Licensing law “reform”
In view of the evidence linking reductions in alcohol-related harm to hours and days
of restrictions on the sale of alcohol and to restrictions on the density of alcohol
outlets (see Babor et al., 2003, p.264)), it might be thought that the UK government
would take action to curtail hours of opening of public houses and other alcohol
outlets and limit or at least stabilise their density. In fact, quite the opposite has
happened; the government has introduced legislation that extends opening hours and
has done nothing to limit the ever-increasing number of alcohol outlets. The new Act,
which came into force in November 2005 and applies only to England, abolished the
nation-wide closing hours for pubs and clubs that had existed in different forms since
World War I and allowed any alcohol retailer to apply for a license permitting
drinking around the clock. In the first few months of the new law, not many outlets
have applied for 24-hour licenses but many have been granted permission to extend
opening by a few hours at night, especially at weekends, together with the provision
of live entertainment.
Perhaps more disturbing than the extension of open hours themselves is the
“guidance” issued by the government on the considerations that should be taken into
account in the assessment of applications for extended hours of sale. Replacing the
ancient system of control of alcohol licensing by magistrates, a new system of control
by licensing committees made up of local politicians has been introduced but Room
(2004) has described in detail how the government’s instructions have severely
limited the power of these committees to respond to local interests. For example,
“conditions may not be attached (to the granting of a license) which relate solely to
the health of customers …” (UK Ministry of Culture, Media and Sport, 2004, p.65);
public health, the government says, is dealt with in other legislation and is not
relevant to the law on the sale of alcoholic beverages. Furthermore, “conditions
relating to public nuisance caused by the antisocial behaviour of customers once they
are beyond the control of the license holder … cannot be justified … Beyond the
vicinity of the premises, these are matters for personal responsibility of individuals
under the law” (p.95). (The appeal to “personal responsibility” in the last sentence is
a familiar refrain of the Blair government; problems in society, such as increasing
alcohol-related disorder and disease, are merely problems caused by a relatively few
individuals, such as individual excessive drinkers or individual badly-managed public
houses – merely a few “bad apples” in the barrel; they are of not matters for collective
responsibility in society or things government could or should interfere with.) The
immediate consequence of this instruction, however, is to prevent local authorities
from having any power to reduce the excesses of the night-time economy. Room
(2004) provides several other examples of how the new licensing legislation has the
effect of “disabling the public interest” with respect to alcohol-related harm.
Why did the British government enact this legislation or issue this guidance on
licensing regulation? The clue is given in the recent transfer of overall control of
licensing matters from the Home Office, the government department with prime
responsibility for internal affairs, to the Department of Culture, Media and Sport
where alcohol licensing is dealt with by its tourism section. Thus the government
believes that the old restrictions on opening times were a nuisance to tourists to the
UK and a disincentive to their visiting the country, an issue clearly more important
than the health and welfare of the country’s permanent residents. Moreover, the
government appears seriously to believe that abolishing closing times will somehow
transform UK drinking overnight into a “continental-style café culture” in which
binge drinking will magically disappear. However, while widespread drunken
behaviour by young people in town centres is a genuinely new phenomenon, “binge
drinking” (i.e., simply drinking in order to become intoxicated) is a deeply-ingrained
British tradition going back many centuries, as it is in many other northern European
societies; even if it is true that extended drinking hours will have the effect of
“civilising” British drinking habits, this is likely to take several generations to occur.
Meanwhile the nation can expect a continuation and probably a further aggravation of
record levels of drinking, public intoxication and alcohol-related damage.
As might be expected, the government has hailed the effects of the new Act as a great
success, claiming for example that predictions that licensing reform would lead to an
upsurge in crime have not been borne out. Apart from being somewhat premature, this
judgement may well reflect changes in the recording of violent offences by an over-
stretched police rather than the real effects of the changes. It also contradicts the
experience of other countries – Iceland (Ragnarsdottir et al., 2002), Australia
(Chikritzhs & Stockwell, 2002), Ireland (Plant and Plant 2005, Plant and Plant 2006)
– in which an extension to drinking hours led to a well-documented increase in
alcohol-related violence and other adverse effects. The latter include accidents and
even illicit drug use. In any case, as Room (2004) points out, no proper system of
evaluation has been established by the government to monitor to the effects of the
new legislation in a scientifically respectable manner.
The Alcohol Harm Reduction Strategy for England (AHRSE)
References
Hibell, B., Andersson, B., Bjarnasson, T . Ahlström, S., Balakireva, O., Kokkevi, A.
and Morgan, M. (2004) The 2003 ESPAD Report: Alcohol and other drug Use
among Students in 30 European Countries, Stockholm: Swedish Council for
Information on Alcohol and other Drugs.
Plant, E.J. and Plant, M.A. (2005) “A leap in the dark?” Lessons for the United
Kingdom from past extensions of bar opening hours,” (Commentary) International
Journal of Drug Policy, 16: 363-368.
Plant, M.A., Miller, P. and Plant, M.L. (2005) “Trends in drinking, smoking and illicit
drug use among 15 and 16 year olds in the United Kingdom (1995-2003),” Journal of
Substance Use 10:331-339.
Plant, M.A. and Plant, M.L. (2006) Binge Britain: Alcohol and the National
Response, Oxford: Oxford University Press.


Britain's alcohol problem and what the UK government is (and is not) doing about it

Northumbria University Research Portal

Updated May 3rd 2006 @ 14:24 hrsBRITAIN’S ALCOHOL PROBLEM AND WHAT THE UK GOVERNMENTIS DOING ABOUT ITNick HeatherEmeritus Professor of Alcohol & Other Drug Problems,Division of Psychology,Northumbria University,Newcastle upon Tyne, UKEditorial for AdiccionesIntroduction: Britain’s alcohol problemThe United Kingdom of Great Britain and Northern Ireland is currently experiencinga serious alcohol problem. Historically, the UK has shown a relatively moderate percapita level of consumption compared with other western European countries. Inmore recent times, however, consumption in most of these countries has stabilised orfallen, while in the UK it has continued to rise. An Interim Analytical Report, orderedby the Government in preparation for its recent alcohol strategy (see below),concluded that: “If present trends continue, the UK would rise near the top of theconsumption league table within the next 10 years (Prime Minster’s Strategy Unit,2003, p.18). These trends have continued in the three years since the publication ofthe report. “Binge drinking” (defined as drinking 8+ units of alcohol on a singleoccasion for men and 6+ units for women, 1 unit = 8 g ethanol) now represents 40%of all drinking occasions among men and 22% among women – a frequency of bingedrinking substantially higher than most other European countries (Prime Minster’sStrategy Unit, 2003, p. 21).The increase in alcohol-related harm in the UK is shown most starkly in rates of livercirrhosis mortality which, as well as being an indicator of a serious form of harm inthemselves, serve as a reliable marker for the level alcohol-related problems in apopulation more generally (Academy of Medical Sciences, 2004). Leon andMcCambridge (2006) have recently shown that the UK has recorded the steepest risein rates of liver cirrhosis mortality in western Europe (see also Room, 2006). Between1987 to 2001 rates in England and Wales in men rose by over two-thirds while inScotland they more than doubled. In women, rates increased by almost a half inEngland and Wales and in Scotland. This stands in contrast to trends in most otherEuropean countries, particularly those of southern Europe, where rates of livercirrhosis mortality have declined over the same period. While a complete explanationfor the increase in the UK is unclear, increased overall consumption is almostcertainly a major contributory factor. At the same time, a change in beveragepreferences from beer to stronger forms of alcohol in wines and spirits may also havecontributed to the increased risk (see Leon & McCambridge, 2006).Another aspect of the UK situation that is causing special concern is publicdrunkenness, rowdyism and alcohol-related violence and injury among young people.The 1999 report of the European School Survey Project on Alcohol and Other Drugs(Hibell et al., 2000) showed that British teenagers are among the heaviest drinkers inEurope, equalled only by those in Denmark and Ireland. British teenagers report thatthey are more likely to drink, get drunk and experience alcohol-related problems thantheir counterparts in almost all other European countries. More than a third of British15 and 16-year olds reported that they had been drunk at age 13 or earlier, comparedfor example to only one in ten French or Italian teenagers. Rates of alcoholconsumption and problems among young women are especially alarming. The mostrecent ESPAD survey in 2003 reveals the unprecedented finding that British girlsaged 15 and 16 have now overtaken boys of the same age in relation to the frequencyof binge-drinking episodes (Hibell et al 2004, Plant et al. 2005). Indeed, so alarminghas the increase in diagnoses of liver cirrhosis among young women become that theUK Chief Medical Officer, the most senior medical authority in the country, wasmoved to devote his annual report on the state of public health to this problem in 2001(Donaldson, 2001).The centres of cities, large or even medium-sized towns throughout the UK havebecome “no-go areas” for many adults late on Friday or Saturday nights owing todrunken disorder among young people spilling out on to the streets from a multitudeof “super-pubs”, disco bars and night-clubs. (As but one example, the relatively smallcity of Nottingham had at the latest count 356 licensed alcohol retail premises in justone square mile of the city centre.) Frequent media articles and TV documentariesdemonstrate the enormous strain this places on the police, accident and emergencymedical services and other local resources. This situation was originally caused by theexodus of industry and commerce from town centres to out-of-town locations, leavinga vacuum that local politicians were keen to fill by the “night-time economy” of theconsumption and leisure industry (Hobbs et al., 2003). This development has radicallytransformed the way alcohol is consumed in modern Britain, many would sayconsiderably for the worse.In the light of these trends and current levels of alcohol-related problems, it would bereasonable to expect that the British government would take action to reduce alcohol-related harm in the UK. In fact, the government introduced two major initiatives inMarch, 2004 – radical changes to the licensing laws regulating the sales of alcoholicbeverages and an Alcohol Harm Reduction Strategy for England – although in theopinion of most experts in the field and among a large body of public opinion, neitheris likely to improve the situation. We will consider each of these in turn.Licensing law “reform”In view of the evidence linking reductions in alcohol-related harm to hours and daysof restrictions on the sale of alcohol and to restrictions on the density of alcoholoutlets (see Babor et al., 2003, p.264)), it might be thought that the UK governmentwould take action to curtail hours of opening of public houses and other alcoholoutlets and limit or at least stabilise their density. In fact, quite the opposite hashappened; the government has introduced legislation that extends opening hours andhas done nothing to limit the ever-increasing number of alcohol outlets. The new Act,which came into force in November 2005 and applies only to England, abolished thenation-wide closing hours for pubs and clubs that had existed in different forms sinceWorld War I and allowed any alcohol retailer to apply for a license permittingdrinking around the clock. In the first few months of the new law, not many outletshave applied for 24-hour licenses but many have been granted permission to extendopening by a few hours at night, especially at weekends, together with the provisionof live entertainment.Perhaps more disturbing than the extension of open hours themselves is the“guidance” issued by the government on the considerations that should be taken intoaccount in the assessment of applications for extended hours of sale. Replacing theancient system of control of alcohol licensing by magistrates, a new system of controlby licensing committees made up of local politicians has been introduced but Room(2004) has described in detail how the government’s instructions have severelylimited the power of these committees to respond to local interests. For example,“conditions may not be attached (to the granting of a license) which relate solely tothe health of customers …” (UK Ministry of Culture, Media and Sport, 2004, p.65);public health, the government says, is dealt with in other legislation and is notrelevant to the law on the sale of alcoholic beverages. Furthermore, “conditionsrelating to public nuisance caused by the antisocial behaviour of customers once theyare beyond the control of the license holder … cannot be justified … Beyond thevicinity of the premises, these are matters for personal responsibility of individualsunder the law” (p.95). (The appeal to “personal responsibility” in the last sentence isa familiar refrain of the Blair government; problems in society, such as increasingalcohol-related disorder and disease, are merely problems caused by a relatively fewindividuals, such as individual excessive drinkers or individual badly-managed publichouses – merely a few “bad apples” in the barrel; they are of not matters for collectiveresponsibility in society or things government could or should interfere with.) Theimmediate consequence of this instruction, however, is to prevent local authoritiesfrom having any power to reduce the excesses of the night-time economy. Room(2004) provides several other examples of how the new licensing legislation has theeffect of “disabling the public interest” with respect to alcohol-related harm.Why did the British government enact this legislation or issue this guidance onlicensing regulation? The clue is given in the recent transfer of overall control oflicensing matters from the Home Office, the government department with primeresponsibility for internal affairs, to the Department of Culture, Media and Sportwhere alcohol licensing is dealt with by its tourism section. Thus the governmentbelieves that the old restrictions on opening times were a nuisance to tourists to theUK and a disincentive to their visiting the country, an issue clearly more importantthan the health and welfare of the country’s permanent residents. Moreover, thegovernment appears seriously to believe that abolishing closing times will somehowtransform UK drinking overnight into a “continental-style café culture” in whichbinge drinking will magically disappear. However, while widespread drunkenbehaviour by young people in town centres is a genuinely new phenomenon, “bingedrinking” (i.e., simply drinking in order to become intoxicated) is a deeply-ingrainedBritish tradition going back many centuries, as it is in many other northern Europeansocieties; even if it is true that extended drinking hours will have the effect of“civilising” British drinking habits, this is likely to take several generations to occur.Meanwhile the nation can expect a continuation and probably a further aggravation ofrecord levels of drinking, public intoxication and alcohol-related damage.As might be expected, the government has hailed the effects of the new Act as a greatsuccess, claiming for example that predictions that licensing reform would lead to anupsurge in crime have not been borne out. Apart from being somewhat premature, thisjudgement may well reflect changes in the recording of violent offences by an over-stretched police rather than the real effects of the changes. It also contradicts theexperience of other countries – Iceland (Ragnarsdottir et al., 2002), Australia(Chikritzhs & Stockwell, 2002), Ireland (Plant and Plant 2005, Plant and Plant 2006)– in which an extension to drinking hours led to a well-documented increase inalcohol-related violence and other adverse effects. The latter include accidents andeven illicit drug use. In any case, as Room (2004) points out, no proper system ofevaluation has been established by the government to monitor to the effects of thenew legislation in a scientifically respectable manner.The Alcohol Harm Reduction Strategy for England (AHRSE)ReferencesHibell, B., Andersson, B., Bjarnasson, T . Ahlström, S., Balakireva, O., Kokkevi, A.and Morgan, M. (2004) The 2003 ESPAD Report: Alcohol and other drug Useamong Students in 30 European Countries, Stockholm: Swedish Council forInformation on Alcohol and other Drugs.Plant, E.J. and Plant, M.A. (2005) “A leap in the dark?” Lessons for the UnitedKingdom from past extensions of bar opening hours,” (Commentary) InternationalJournal of Drug Policy, 16: 363-368.Plant, M.A., Miller, P. and Plant, M.L. (2005) “Trends in drinking, smoking and illicitdrug use among 15 and 16 year olds in the United Kingdom (1995-2003),” Journal ofSubstance Use 10:331-339.Plant, M.A. and Plant, M.L. (2006) Binge Britain: Alcohol and the NationalResponse, Oxford: Oxford University Press.

Binge Britain: Alcohol and the National Response,

Trends in drinking, smoking and illicit drug use among 15 and 16 year olds in the United Kingdom

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Britain's alcohol problem and what the UK government is (and is not) doing about it

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