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An Evidence-Informed Approach to Alcohol Problems in Britain

An Evidence-Informed Approach to Alcohol Problems in Britain. Keith Humphreys Professor of Psychiatry, Stanford University School of Medicine Visiting Professor of Psychiatry, King ’ s College London. Alcohol Research UK Conference 12 March 2013.

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An Evidence-Informed Approach to Alcohol Problems in Britain

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  1. An Evidence-Informed Approach to Alcohol Problems in Britain Keith Humphreys Professor of Psychiatry, Stanford University School of Medicine Visiting Professor of Psychiatry, King’s College London Alcohol Research UK Conference 12 March 2013

  2. What is the Role of Science in Public Policy Formation? • Can identify emerging problems of policy concern • Can determine whether policies are delivering their promised impacts • Can suggest new policies that could be tried • BUT cannot tell us what we care about as a society

  3. Why Be Explicit About the Values Basis of Public Health? • Being a scientist does not convey the right or ability to rule • It’s undemocratic and potentially dangerous for scientists to represent their values as proven facts • Public trust may be gained by values-based appeals

  4. Three Evidence-Informed Alcohol Policies That Will Promote Public Health and Public Safety • Mandatory sobriety for alcohol-involved violent offenders • Expansion of treatment and recovery for alcohol dependent people • Minimum unit pricing of alcohol

  5. Mandatory sobriety for alcohol-involved offenders

  6. Mandatory Sobriety for Repeat Drink Drivers in South Dakota • All offenders orientated to programme rules • Twice-daily breath testing or alcohol-sensing bracelet • Alcohol use or no show results in prompt arrestand certain, modest punishment (1 night in jail)

  7. Domestic Violence and Mandatory Sobriety • Impact on arrests evaluated quasi-experimentally as program was rolled out over South Dakota • Counties with the programme experienced a 12% reduction in repeat drink driving arrests • Counties with the programme also experienced a 9% reduction in domestic violence arrests Kilmer, B. et al (2013). American Journal of Public Health. Jan;103(1):e37-43

  8. Current Status in the UK • Already in operation in Scotland • Programmes legally established in England and Wales as of 1 May 2012 • But implementation has been slow

  9. Expansion of treatment and recovery for alcohol dependent people

  10. Expanding Access to Alcohol Treatment • Well-validated psychosocial and pharmacological treatments for alcohol use disorders are now available • Prior UK policy funded drug treatment disproportionately • Creation of Public Health England is an excellent opportunity to expand access to alcohol treatment

  11. UK Treatment Professionals Under-Refer to Recovery Groups • Multiple randomized clinical trials show positive clinical benefit from facilitated access to 12-step groups • Yet many UK professionals are convinced that 12-step groups are rarely or never valuable • Professionals have a responsibility to educate themselves about the science and also to personally investigate (i.e., visit some open meetings)

  12. Timko RCT on AA/NA referral • 345 VA outpatients randomized to standard or intensive 12-step group referral • Higher rates of 12-step involvement in intensive condition at 6 month follow-up (82% located) • Over 60% greater improvement in ASI alcohol and drug composite scores in intensive referral condition Source: Timko, C. (2006). Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes. Addiction, 101, 678-688.

  13. Minimum Unit Pricing of Alcohol

  14. The Logic of Minimum Unit Pricing • Heavy drinkers spend about 80% less per unit of alcohol than light drinkers • Consumption of high-strength, low-cost beverages is associated with health and safety damage from alcohol • MUP thus may generate health and safety gains despite applying to a small minority of beverages

  15. Sheffield Group Modeling of Annual Impact of a 50p MUP in England • 2930 fewer deaths • 92,200 fewer hospital admissions • 274 million GBP lower spend Source: Purshouse, R.C., Meier, P.S. et al. (2010). The Lancet, 375, 1355-1364

  16. Direct Evidence from Canada • British Columbia studied from 2002-2009 • A 10% increase in average minimum price for all alcoholic beverages was associated with a 31.7% reduction in wholly alcohol-attributable deaths • The impact was evident despite concurrent expansion of private liquor stores in the province Source: Zhao, J., Stockwell, T., et al., (2013). Addiction. DOI: 10/1111/add.12139

  17. Other MUP issues in UK • Already the law in Scotland • “Save the pubs, support minimum pricing of alcohol” • MUP should be indexed to inflation • EU regulatory questions

  18. Summary • Science can help us make more public health-oriented alcohol policy iff we openly choose that value framework • Mandatory abstinence programmes are now in the law of England and Wales and should be implemented • PHE should enhance access to alcohol treatment and encourage knowledge and respect for recovery organisations • A minimum unit price for alcohol would reduce the public health and safety damage of heavy drinking

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