Since the start of the COVID-19 pandemic, Dr Tony Rao has been tracking data on drinking patterns in lockdown. In this blog, he argues why now is the perfect moment for the government to introduce an alcohol strategy, with harm reduction at its core.
When I was a medical student in the 1980s, the idea of harm reduction never really filtered into our classrooms or clinics. That’s probably not surprising, as we’re taught to do doctorly things such as feel for an enlarged liver, detect the signs of alcohol withdrawal, and treat Wernicke -Korsakoff syndrome with high dose thiamine. All really important for when I was a houseman on a liver ward, where presentations with alcohol problems were commonplace. It was really all about diagnosis and treatment. That’s fair enough, as that’s where our skills lie. But what we didn’t really learn until we were fully registered doctors was how the way in which people present with the same underlying problems can be so different. There are so many different factors in the mix and we often need to make sense of how these all interact with each other.
Harm reduction is a concept that I still hadn’t heard about until I completed an MSc in Addictions as a consultant psychiatrist. I never fully realised that the all or nothing approach to medicine wasn’t just about successful treatment or “treatment failure”. Or about simply improving physical risk factors such as high blood pressure or raised blood sugar. Alcohol use disorders are very different, where the main challenge is to change drinking behaviour. Bring on harm reduction. We need to accept that for people who drink at levels that are harmful to their health, relationships or livelihood, many people find it difficult stop drinking completely.
The success of Dry January in giving people the opportunity to reflect on their drinking after a month without booze has brought huge benefits to many. But there are also many others, young and old, male and female, rich and poor, whose drinking has brought devastation into their lives. I’ve been tracking data on drinking patterns in England since the first lockdown, but what I found in my most recent analysis nearly made me fall of my seat. I calculated figures provided by Public Health England and applied it to population numbers and had to look at it several times before I could take it in. The number of people who drink at levels that suggest alcohol dependence – that’s the equivalent of over a litre of spirits, over five bottles of wine or 25 pints of beer a week – increased from 1.5 million to 2.5 million between September and December last year.
That’s an increase of one million people across all age groups – highest in the 55 to 65 age group – in just three months. There’s no doubt that stay at home messages were needed as a harm reduction measure in itself to reduce the spread of COVID-19 but the impact on heavy drinking seems to have taken its toll.
So what can we do now? This is an opportunity for a new alcohol strategy. With the re-launch of the All Party Parliamentary Group on Alcohol Harm, it’s the perfect time for the government to launch a strategy to tackle mounting alcohol harm. With alcohol costing NHS England an estimated £3.5 billion annually, our government must start to address the main aims of the Alcohol Charter – to improve support for those in need and also protect public health. The scope of this charter is immense and includes recommendations such as government funded public education campaigns, an increase in alcohol duty, improving identification and advice on risky drinking by GPs, better funded multi-agency treatment that also addresses age inequality and support for carers and those with accompanying mental disorders, labelling, marketing, lowering legal blood alcohol limits and licensing to name but a few.
To ignore the benefits of the alcohol charter at a time when a new alcohol strategy is paramount would be to look a gift horse in the mouth. The potential benefits to society will be immense. I just hope our government will push against what is an open door and move forward with an opportunity to improve the lives of people living with alcohol related harm. They all deserve better.
Written by Dr Tony Rao
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.