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Alcohol needs to be less affordable and less easy to buy if we are to save thousands of lives each year, says new guidance from NICE.

Around 1 in 4 men and women are currently drinking dangerous amounts of alcohol that are causing, or have the potential to cause, physical and mental damage. To help create an environment that supports lower-risk drinking, the National Institute for Health and Clinical Excellence (NICE) has published guidance today (2 June) outlining the most effective measures that can be taken to lower the risks of alcohol-related harm.

As well as the detrimental health consequences, there are a number of other knock-on effects that alcohol misuse can have, such as on antisocial behaviour, crime, costs to the NHS, relationship breakdown and work absenteeism.

Professor Mike Kelly, Public Health Director at NICE said:

“Alcohol misuse is a major public health concern which kills thousands of people every year and causes a multitude of physical, behavioural and mental health problems. What’s more, it costs the NHS over £2 billion annually to treat the chronic and acute affects of alcohol - this is money that could be spent elsewhere to treat conditions that are not so easily preventable.

“Based on the international evidence, it is clear that policy change is the best way to go about transforming the country’s unhealthy relationship with alcohol and prevent people from getting to the stage where they are drinking worryingly large amounts. Our guidance looks at a number of ways that the government can consider doing this, from reducing the affordability and availability of alcohol, to looking at how advertising affects children and young people.

“It is NICE’s job to improve the health of the population, and there is no doubt that if these measures are taken forward, that they will significantly decrease alcohol consumption and thereby offset some of the serious social, economic and physical health problems that arise as a consequence of drinking too much.”

Among the policy recommendations, NICE advises that:

• Alcohol should be made less affordable by introducing a minimum price per unit. This price should be regularly reviewed so that alcohol does not become more affordable over time.
• Alcohol should be made less easy to buy, for example by reducing how much individuals are allowed to import from abroad, or by reducing the number of outlets selling alcohol in a given area, or the days and hours that it can be purchased.
• Applications for new licenses to sell alcohol should be based on the number of outlets in a given area, the proposed business times and the potential impacts on crime, disorder and alcohol-related illnesses and deaths.
• “Protection of the public’s health” should be added to the current licensing objectives, as is already the case in Scotland. This would mean that premises would have a legal obligation to consider the health of their customers when selling them alcohol.
• The current advertising regulations should be strengthened to minimise children and young people’s exposure to alcohol products. A complete ban on alcohol advertising should also be considered to protect these high-risk groups even more, as is the case with tobacco products.

Professor Anne Ludbrook, Guidance Developer and a Health Economist said: “Alcohol is much more affordable now than it ever has been - and the price people pay does not reflect the cost of the health and social harms that arise. When it is sold at a very low price, people often buy and then consume more than they otherwise would have done. It is a dangerous pattern which many people have unknowingly fallen into.

“There is a strong body of evidence from around the world to show that making alcohol less affordable will reduce its consumption. This will in turn, improve the overall health of the population.

“NICE’s recommendation to introduce a minimum price per alcohol unit is a very targeted measure as it is most likely to affect heavy drinkers who typically purchase ‘cheaper’ alcohol products. Although many of us are able to enjoy alcohol responsibly, we are all affected by the small proportion of those that do not or cannot; for example by the level of disorder you see in our town centres on Friday and Saturday nights, or the associated costs to the NHS and other public services, as well as those who may be quietly drinking themselves into health harms at home. It is a national problem which we all need to face up to.”

In addition to the policy recommendations, NICE has outlined ways that public institutions, such as the NHS, local authorities, police, magistrates, schools and social care services, can improve how they identify adults and adolescents that may be drinking dangerous amounts of alcohol so that they can be put in touch with the relevant support if needed. Among these, NICE advises that:

• Local authorities should consider restricting applications for new alcohol-selling licenses in areas that are “saturated”, if the evidence shows that additional premises could adversely affect public safety, alcohol-related harm, crime and disorder.
• Sanctions, such as fixed penalties and closure notices, should be fully applied to all businesses that sell alcohol to those that are underage or intoxicated, as well as to those that import alcohol illegally. ‘Mystery shoppers’ have been proven to be an effective way of determining if businesses are doing the best they can.
• Healthcare professionals should use a certified questionnaire to ask their adult and teenage patients about their alcohol intake, for example during new patient registrations, when screening for unrelated health conditions, when treating minor injuries, and when advising patients about medication or sexual health.

Professor Eileen Kaner, Chair of the Guidance Development group and a Public Health Researcher said: “There is clear evidence from around the world that we are drinking much more than most other developed countries and the problem is apparent right across society, not just with our teenagers or with binge-drinking.

“We are constantly surrounded by various images of and opportunities to buy alcohol, from promotional offers in supermarkets to advertisements in the media. This encourages us to drink more than we otherwise would, sometimes without us even realising it.

“The guidance from NICE calls for GPs and other public service workers to ask some simple questions about people’s drinking habits as early as possible if they ever suspect that there may be a problem. This can help make people aware of the potential risks they are taking or harm they may be doing at an early stage. In addition, we are encouraging practitioners to give brief advice about practical ways of cutting down on heavy drinking. The earlier the problem is tackled, the more likely people are to change their behaviour.”

Ms Jayne Gosnall, community member of the guidance development group said: “My drinking problem crept up on me when I was going through a bit of a rough time. Rather than facing up to my problems I chose to drink by myself at home, which only made things worse. I constantly put myself at risk by forgetting to lock my doors at night or by accidentally injuring myself. Looking back I think that there were several ‘missed opportunities’, such as when I was in A&E following an accident, where someone could have asked me a bit more about my drinking habits and whether I was perhaps drinking too much. This might have made a difference and stopped things from getting as bad as they did.

“I hope this guidance from NICE goes some way to increase the opportunities that there are for people, like me, to think about how much they are drinking early on, before it potentially becomes a huge problem for them, their families, and others around them.”

Professor Ian Gilmore, President of the Royal College of Physicians and Chair of the Alcohol Health Alliance UK said: “The nation’s increasing addiction to alcohol is placing a huge strain on health services, costing the NHS over £2.7billion each year. This situation has to change. The NHS’s role should not just be about treating the consequences of alcohol related-harm but also about taking early action to prevent alcohol problems, and working in partnership with services in local communities to raise awareness. The government needs to confront the culture of low prices, non-stop availability and saturation advertising in order to make a difference and cut the amount we are drinking. I support this report from NICE, which presents a timely, evidence-based approach of how to prevent what is fast becoming a public health emergency.”

Professor Alan Maryon-Davis, President of the UK Faculty of Public Health said: “This is a very practical set of recommendations, based on solid evidence. We need to see this turned into action as soon as possible. The government should fast track a minimum price to stop the sale of ultra cheap alcohol. And we would like to see licensing authorities restrict the hours of opening for pubs and clubs in city centre trouble spots.”

2010/062 NICE recommends action to reduce alcohol-related harm