Having read Simon's suggestion (under the Alcohol Forum thread) about an alcohol thread, this is something that I have been thinking a lot about recently. Working in Regional Government it is very challenging to map out how all the alcohol research, policy and practice fits together. It reminds me very much of the drugs field before DAATs. I have run out of the sides of A3 that I have doodled on to make the connections. Obviously, this forum is primarily about clinical issues. I had a meeting yesterday with the North West RegionalAlcohol Delivery Team. We talked mainly about alcohol treatment and the differences between that and opiate treatment. People who dont live and breathe our world need to have the discussion about opioid maintenance medication and why we dont give 'quasi' alcohol substitutes (e.g. benzos) on a maintenance basis. The relationships between heroin, treatment and crime (acquisitive crime reduced by treatment)is different to that between alcohol, treatment and crime (i.e. could treatment ever reduce alcohol related crimes of violence and public disorder in anything like a comparable way?). The alcohol people are still interested in prevention and social marketing because some of the socially included people with alcohol problems may be amenable to prevention messages that would probably have much less resonance with the typical socially excluded heroin addict. The drugs treatment sector has made much progress in terms of political support and funding because our efforts demonstrably reduce acquisitive crime and improve community safety. Drug treatment provides these utilitarian benefits (crime reduction, community safety, prevention of the spread of BBVs etc) at the same time as it offers individual addicts routes to recovery that match their personal aspirations and ambitions as citizens. Alcohol and Drugs; we have a lot to compare, contrast and learn from.

Mark Gilman

I think the way forward with alcohol is to focus on the health gains. The calculations have been done, lots of money to be saved. The focus on prevention is not just sociologically inclined: there is good evidence for alcohol prevention in the form of brief interventions, NNTs (numbers needed to treat) are comparable to anti-smoking interventions.
This is not to say that crime would not go down too, if people were drinking less, but they will be disorder and violence crimes rather than acquisitive, still very visible gains, but possibly not as easy to do the sums.

Yes I think Susi's right about the health impact of alcohol interventions being the selling point, and from a health economics point of view, the potential to extend life and quality of life. So it's the very real financial savings that can be made from primary and secondary prevention strategies.

The trajectory of alcohol-related hospital admissions is almost too horrible to contemplate.
And given the ticking timebomb of HCV, I can't even imagine how NHS hepatology and gastro services are going to cope in the next 10 years and beyond.

Sorry, a bit Doomsday there, but it is Monday morning.
Simon

The real problems with alcohol in my mind were govt. led when they altered the licencing laws in ? 1989.
Alcohol has never been so easy to get hold of and pubs and clubs are open all hours now.

Or might it be partly the massive rise in inequality that took place from 1985 to the early 90s and seems to be linked to multiple problems from violence to obesity according to Richard Wilkinson on R4 this morning - you can listen again at http://www.bbc.co.uk/radio4/fa...l/starttheweek.shtml.

Price and potency are the 2 largest contributors to the problems now being experienced. Our Scottish cousins are to be congratulated on their attempt to take decisive action and use the levers at their disposal wisely and boldly.
The apologists from the trade were very poor but might untimately have some clout. As stock markets and pensions crumle on a daily basis we need something to ease the pain.
I am off to see my broker about some Weatherspoon shares,

[QUOTE]Originally posted by susi:
Or might it be partly the massive rise in inequality <snip>]

I think there is an issue about social inclusion and exclusion at work. Most of the people who use the drug treatment services that those of us on here, commission, work in, use and performance monitor/manage are populated by the socially excluded, marginalised etc. This can make it look like drug addiction and treatment in our western liberal democracy is primarily an "underclass" issue. Of course, we know that this is probably not the case and that addiction may recruit from across society. This might be particularly true for addiction to alcohol?

is this the sort of thing Mark Bellis of Liverpool JMU knows?

Yes. I would think it is core business for Mark Bellis and the guys at JMU. For me, it means things like social marketing messages may have some purchase amongst the middle class women drinking too much pinot grigio in a prosperous suburb whereas Know Your Limits might mean much less in a more deprvied area.

What's your take on the CMO Liam Donaldson's suggestion that we price alcohol up to 50p a unit? Having just seen yet another successfully stabilised methadone patient turn to a bottle of sherry a day, intoxicated, blurry and precontemplative, I have to say its an idea whose time has come. Ministers, and the PM speak of 'not punishing the responsible drinker', but surely the responsible drinker won't mind paying the princely £10.50 a week for his 21 units?

agree Susi, price is one of the best protectors against dependence so emphasising direct health again (in terms of reduced hospital admissions/treatment etc etc) are powerful arguments. I agree the class A to alcohol switch is unfortunately a common clinical dilemma. wider access to psychosocial interventions in such scenarios I guess the best way forward?

dont forget that there is a growing appetite for total abstinence based 12 step recovery

They'd better make it £50 a unit then - that should do the trick!

Price increases on cigarettes/tobacco have certainly had some impact on smokers like myself-I haven't given up but have cut down.

Public health tobacco controll includes prescribed substitutes and effective social marketing campaigns-any lessons for drugs and alcohol services?

Tony