British drinking: a suitable case for treatment?

The rising consumption of alcohol per capita in Britain over the past 20 years has produced large increases in the prevalence of alcoholic cirrhosis, alcohol related violence, and heavy alcohol use, costing the British economy around £30bn ($55bn; €44bn) a year.1 About 7.5% of men and 2.1% of women in Britain are dependent on alcohol, among the highest rates in the European Union.2

Two papers in this issue show that two relatively brief psychosocial interventions—motivational enhancement treatment and social network therapy—are effective and cost effective in treating alcohol dependence, when delivered under routine clinical conditions in the NHS.3 4 The UK government could realise its stated aim of increasing access to effective treatments for alcohol dependence by investing in these interventions.

Britain also urgently needs to reduce the high rates of high risk drinking that produce dependence, health problems, and public disorder. Epidemiologists see the key drivers of rising consumption as the reduced price of alcohol, its increased availability, and its extensive promotion in British cities.5 6 These changes have resulted from the enthusiasm for deregulation that is shared by governments in most developed countries, now treating alcohol like any other commodity.

The UK government's new alcohol policy,1 which includes “partnership” with the alcohol industry, shows all the hallmarks of regulatory capture6 in that it embraces the industry's diagnosis and preferred remedies for the “alcohol problem.” The problem, in the industry's view, is a “minority” of drinkers who engage in antisocial behaviour and put their health at risk; the preferred remedies are public education about safe drinking, improved policing, better treatment for alcohol problems, and self regulation by the alcohol industry—the policies which evidence suggests are the least likely to reduce problem drinking.5^–7

The UK government has foregone the use of the most effective policy to reduce hazardous drinking: using taxation to increase the price of the beverages containing the highest concentrations of alcohol.5 It justifies this decision by saying that increased price has not been shown definitely to reduce harm due to alcohol,1 an assertion at odds with the views of the world's leading researchers on alcohol.5 8

The government has also rejected any policies that would reduce the availability of alcohol. Instead, it embraces the paradoxical idea that allowing drinking for up to 24 hours a day for seven days a week will reduce binge drinking and public disorder. It believes that, somehow, longer trading hours will help to create a continental drinking culture in Britain. This proposal has caused understandable consternation among British judges, police, the Royal College of Physicians, medical researchers, and alcohol experts.8^–10

Experience in Australia suggests that even a government bent on deregulation could do better.7 Over the past two decades Australia has expanded alcohol availability, liberalised trading hours, and not increased overall taxation on alcohol. In 1980-2000 in the United Kingdom per capita alcohol consumption increased by 31%, but in Australia it fell by 24%—as did many of the indicators of alcohol related harm that increased so steeply in the United Kingdom.7

Australia has imposed lower taxes on low alcohol (less than 3.8%) beer than full strength beer. Also, all states defined drink driving as driving with a blood alcohol concentration over 0.05% (rather than 0.08% as in the United Kingdom). Drink driving laws have also been enforced vigorously by well publicised, large scale random breath testing in the largest states. The immediate and sustained reduction in deaths and serious injuries from road crashes that followed the introduction of random breath testing in the largest Australian state ensured strong public support for continuing the policy.11 Low alcohol beer now accounts for 40% of all beer consumed in Australia.7

The UK government could avoid the worsening epidemic of public drunkenness by not increasing alcohol availability, by lowering taxes on beverages with lower alcohol concentrations, and by reducing the limit for blood alcohol when driving to 0.05%.

If the UK government remains deaf to the arguments of its critics, it should honour its promise to evaluate the effects of its policies. Then it would have the necessary evidence to drop policies that have failed and replace them with policies that have a chance of reducing (rather than merely preventing further rises in) alcohol related harm.