Home » Posts tagged 'alcohol'
Tag Archives: alcohol
Minimum pricing of alcohol: what’s the fuss?
Is alcohol perfectly harmless?
The Government has a very confusing narrative on when it decides to use “evidence” to make policy. We all know of things appearing in Government bulletins which are simply lifted out the glossies of management consultancy firms, which is sold as advertising patter. Last week, the Government justified – irrespective of Lynton Crosby – whether “standard packaging worked”, rather than whether “standard packaging did any harm”, because that’s what the Philip Morris New Zealand copy said. This afternoon, health groups have strongly condemned the government for failing to introduce minimum unit pricing for alcohol and substituting a series of measures to curb excessive drinking that they say will not work. They warn that more lives will now be lost, but it is not the first time that this Government has ignored the views of the medical profession. The complete disregard for the views of physicians still leaves a lump in many throats of those who have had to swallow the Health and Social Care Act (2012). Now, many are breathing in the latest Government toxic policy on public health, but trying desperately hard not to inhale. The Alcohol Health Alliance (AHA), which includes medical royal colleges and specialist doctors as well as campaigners, accused the government of buckling to pressure from the drink industry, which has fiercely opposed minimum pricing – a measure which is supported by doctors, children’s charities, pub landlords and the police.
I must admit that I have a conflict of interest, but I don’t think this makes me look at this issue particularly emotionally. I know that I am alcoholic, but I am one in remission. I have been in recovery for over six years. I think alcoholism is a good example of where the medical profession does not have all the answers, though the side effects of alcohol misuse affects every bodily system under the sun (for example peripheral neuropathy or gastritis.) It turns out that drug prescriptions to treat alcohol dependency in England has increased by almost 75 per cent in nine years, a health watchdog has warned. Almost 180,000 prescriptions were given to patients dependent on alcohol in 2012 compared to 102,740 in 2003, which, according to the Health and Social Care Information Centre (HSCIC), is the highest number ever recorded. HSCIC Chief Executive Alan Perkins said today’s report illustrates the impact of alcohol misuse on hospitals in England. The report ‘Statistics on Alcohol: England, 2013’ shows 315 prescription items were dispensed per 100,000 of the population in 2012 compared to 203 per 100,000 in the previous year. Dr Nick Sheron, Royal College of Physicians advisor on alcohol, said “The rise in prescriptions of drugs to treat alcohol dependency is indicative of the huge strain alcohol abuse puts on our society.” “The rise in alcohol addiction is being driven by cheap alcohol. A minimum unit price for alcohol would effectively tackle this problem.”
One of the many strands in this vital policy debate is whether citizens give a damn about the price of alcohol. One could argue that hardcore alcoholics like I was once don’t really care about the price of alcohol, because by that stage an alcoholic with severe dependence is not drinking alcohol for enjoyment, but to avoid withdrawal symptoms as a drug. A HRMC document entitled “Econometric Analysis of Alcohol Consumption in the UK” described that the demand for alcohol is influenced by a greater set of factors than many other consumption goods. The factors in the mix are intriguing, and also have a part to play in alcohol policy taken as a whole. As well as price and income, alcohol consumption is influenced by licensing restrictions, taxation, advertising restrictions, minimum age requirements, social factors, peer group pressure, habit formation, underlying health concerns, location, sex, age, religion, marital status, and so on. Cross?section analysis, as used in this study, is able to capture and control for this level of diversity. There is fairly conclusive and longstanding evidence that price has a negative impact on alcohol consumption in the UK. From this Table, one can also see that the general pattern is that beer is the most inelastic of the three main alcohol products.
Placing a minimum price on a unit of alcohol delivers health benefits much greater than those predicted by the UK government’s theoretical model, concluded a report by the independent UK Institute of Alcohol Studies recently, which decided to use empirical data from Canada, where minimum pricing has been in place for decades (Stockwell and Thomas, 2013). Official estimates of about 9000 alcohol related deaths annually are low as they exclude 4600 deaths from alcohol-related cancer and a wide range of alcohol-related injuries. UK alcohol consumption has risen in the last three decades, and is now 80% above the global average. More than half the alcohol sold in the UK is consumed above recommended daily limits. Alcohol is 45% more affordable than in 1980 and both men and women can exceed recommended daily limits for about /£1 if they purchase inexpensive alcohol from supermarkets or other outlets. The authors cited criticism of the Sheffield and Canadian research, much of it from commercial vested interest groups, has been inaccurate and misleading
It is interesting if one takes a comparative approach to alcohol policy. Most Canadian provinces have long exercised some form of government control over the distribution of alcohol through a mixture of government owned and privately owned outlets. Most provinces set minimum prices on a litre of wine, beer, and spirits. One province, Saskatchewan, adjusts minimum prices within drink categories according to alcohol content. The UK government has used the Sheffield alcohol policy model to predict effects of minimum unit pricing on consumption, health, and public revenue. In British Columbia the Sheffield model estimated that a minimum price per unit of $C1.50 (£1; €1.1; $US1.5) for all alcoholic drinks would reduce the number of wholly alcohol caused deaths (a category that includes alcohol poisoning but not cirrhosis) by 39 and the number of hospitalisations by 244 in the first year, with additional health benefits 10 years later.
However, the Institute of Alcohol Studies’ report cites studies published in Addiction and the American Journal of Public Health which found that a $C1.45 minimum price resulted in an estimated reduction of 92 wholly alcohol caused deaths and 1212 hospitalisations in the first year, with additional health benefits in chronic disease seen two years later (Zhao et al., 2013, Stockwell et al., 2013). Increases in the minimum price of alcohol in British Columbia, Canada, between 2002 and 2009 were associated with immediate and delayed decreases in alcohol-attributable mortality. By contrast, increases in the density of private liquor stores were associated with increases in alcohol-attributable mortality (Stockwell et al., 2013). A Can $0.10 increase in average minimum price would prevent 166 acute admissions in the 1st year and 275 chronic admissions 2 years later, it was further hypothesised. The authors estimated significant, though smaller, adverse impacts of increased private liquor store density on hospital admission rates for all types of alcohol-attributable admissions (Zhao et al., 2013).
The Institute’s own report cites evidence that heavy and problem drinkers are far more likely to seek out cheap alcohol and thus to be affected by a minimum price. Katherine Brown, the institute’s director of policy, said that the report would “give policy makers confidence that fulfilling the commitment to introduce this measure in the UK will deliver significant health and social benefits without unfairly penalising moderate drinkers or those on low incomes. The report comes as Scotland’s Court of Session struck down a challenge by the Scotch Whisky Association to the Alcohol (Minimum Pricing) (Scotland) Act 2012, which sets a 50p minimum price on a unit of alcohol (Christie et al., 2013). This meant that Scotland became the first place in the UK to introduce minimum drink pricing, after MSPs passed new laws. Under the plans, it was envisaged that the cheapest bottle of wine would be £4.69 and a four-pack of lager would cost at least £3.52. The move had won broad political backing, although Labour refused to support the legislation at the Scottish Parliament. The Alcohol Minimum Pricing Act, which aims to help tackle drink-fuelled violence and associated health problems, cleared its final parliamentary hurdle when MSPs backed it by 86 votes to one, with 32 abstentions. In a landmark ruling applauded by medical groups, a court has judged Scotland’s proposal to set a minimum price on a unit of alcohol as legal and compatible with European law. However, the Scotch Whisky Association and the trade organisation Spirits Europe, which have challenged the legality of minimum pricing, intended to appeal and were confident of success.
One suspects that this story is not over, yet, irrespective of the Government’s obvious turmoil over lobbying.
References
Christie B. Minimum alcohol price is compatible with EU law, says Scottish court. BMJ 2013;346:f2925.
Stockwell T, Thomas G. Is alcohol too cheap in the UK? Setting the case for a minimum unit price for alcohol. Apr 2013. http://www.ias.org.uk/uploads/pdf/News%20stories/iasreport-thomas-stockwell-april2013.pdf
Stockwell T, Zhao J, Martin G, Macdonald S, Valance K, Treno A, et al. Minimum alcohol prices and outlet densities in British Columbia, Canada: estimated impacts on alcohol attributable hospital admissions. Am J Public Health. Published online ahead of print April 18, 2013: e1–e7.
Stockwell T, Zhao J, Giesbrecht N, Macdonald S, Thomas G, Wettlaufer A. The raising of minimum alcohol prices in Saskatchewan, Canada: impacts on consumption and implications for public health. Am J Public Health. 2012 Dec;102(12):e103-10. doi: 10.2105/AJPH.2012.301094. Epub 2012 Oct 18.
Zhao J, Stockwell T, Martin G, Macdonald S, Valance K, Treno A, et al. The relationship between changes to minimum alcohol price, outlet densities and alcohol-related death in British Columbia, 2002-2009. Addiction, Volume 108, Issue 6, pages 1059–106.
If I could predict the future of my health, would I change my behaviour?
A major issue in economics certainly is how individuals cope with information. Much information is uncertain, so one’s ability to make rational decisions based on irrational information is a fascinating one. Predicting the future may be viewed as best kept as the bastion of astrologers such as Mystic Meg, but the likelihood of future outcomes is clearly of interest in the insurance industry. These decisions are not only helpful for people at an individual basis, but also hopefully useful for planning, rather than predicting, what is best for the population at large in future.
Angelina Jolie did not have cancer, but, in fact, like many women with breast cancer mutations, she had the radical surgery to lower her risk. She, at the age of 37, has described her decision as “My Medical Choice,” in an op-ed in the New York Times. She carries the BRCA1 gene mutation, which gives her an 87% risk of developing breast cancer at some point in her life. The abnormal gene also increases her risk of getting ovarian cancer, a typically aggressive disease, by 50%. To counteract those odds, Jolie wrote that she decided to have both her breasts removed. In 2010, Australian scientists found that women with the BRCA1 or BRCA2 mutations who chose to have preventive mastectomies did not develop breast cancer over the three-year follow-up. Since the genetic abnormalities increase the risk of ovarian cancer, women who had their ovaries and fallopian tubes removed also dramatically lowered their risk of developing ovarian or breast cancers. The ability of medicine to predict one day, with relative certainty, the likelihood to develop certain conditions is an intriguing way, and leaves the open the possibility of ‘personalised medicine’ on the basis of your own individual information. If you think the NHS is already overstretched, with A&E closures contributing to the ‘crisis’ in emergency health provision, then footing a bill for personalised medicine might be the ‘straw that breaks the camel’s back’. The idea that one day you can predict the likelihood of a person developing multiple sclerosis or Alzheimer’s Disease still intrigues neurologists.
This furthermore presents formidable challenges for the law. In recent years, governments have been embracing policies that ‘nudge’ citizens into making decisions that are better for their own health and welfare, including our own Government which has decided to ‘mutualise’ its own ‘Nudge Unit’. The European Commission has embraced this ‘libertarian paternalism’ in its review of the Tobacco Products Directive. Various people has recently explained that by introducing measures such as plain packaging and display bans, the European Union may be able to ‘nudge’ people into smoking less, whilst preserving their right to choose. After having relied on the assumption that governments can only change people’s behaviour through rules and regulations, policy makers seem ready to design polices that better reflect how people really behave. Inspired by “libertarian paternalism,” the nudge approach suggests that the goal of public policy should be to steer citizens towards making positive decisions as individuals and for society while preserving individual choice.
It’s likely that a ‘one glove fits all’ policy is not going to work. About a decade ago, I was surrounded in my day job by individuals with hepatic cirrhosis, requiring abdominal paracentesis to tap away fluid from their tummies. And yet being confronted with people yellow due to the build-up of bilirubin did not deter me one jot from being a card-carrying alcohol. I am not over seventy months in recovery from alcohol misuse, so this aspect of how people make decisions before being addicted intrigues me. I think that people genuinely in addiction ‘can’t say stop’, as they don’t have an off-switch; they lack insight, and are in denial, mostly, I feel from personal experience.
It’s also clear that there is a long-list of medical problems that cause someone to present to an A&E department aside from alcohol, such as a sore-throat, faint, dislocated shoulder, and so on. But alcohol is undeniably a big issue, so the question is a sobering one, pardon the pun. To what extent can we ‘nudge’ people out of alcohol-related illness? Commenting on the report out today from the College of Emergency Medicine, that highlights the pressures that Accident and Emergency (A&E) wards are under, Dr John Middleton, Vice President for Policy at the Faculty of Public Health, said:
“We quite rightly have high expectations of doctors and nurses working in emergency medicine, so it’s only fair that they get the support they need to do their jobs safely and well. One way to reduce the burden on Accident and Emergency (A&E) wards would be to tackle the reasons why people are admitted in the first place: in particular, alcohol. Given that drink related violence accounts for over one million A&E visits every year, we urgently need the government to be bold and introduce a minimum price per unit of alcohol. That would reduce the burden on overstretched hospitals and society as a whole.”
Nobody likes assessing risk, especially the consequences of an addict picking up/using again are potentially catastrophic even if in probability terms theoretically infinitesimally low. People who know about Taleb’s “Black Swan” work will know this well. And assessing harm has led others to be blasted in the public arena previously, for example Prof David Nutt who once compared the dangers of horse riding to the dangers presented by the major drugs of abuse. At a time when both the medical and legal professions at least think there should be an open debate about having ‘another look’ at the Misuse of Drugs Act (1971), hopefully a public can welcome a mature debate on this.
Even today, the news reports that introducing a law to force cyclists to wear helmets may not reduce the number of hospital admissions for cycling-related head injuries.Researchers said that while helmets reduce head injuries and should be encouraged, the decrease in hospital admissions in Canada, where the law is in place in some regions, seems to have been “minimal”. The authors examined data concerning all 66,000 cycling-related injuries in Canada between 1994 and 2008 – 30% of which were head injuries. Writing in the British Medical Journal, the authors noted a substantial fall in the rate of hospital admissions among young people, particularly in regions where helmet legislation was in place, but they said that the fall was not found to be statistically significant.
I suppose all political parties desire people with capacity to make decisions about their own lifestyle and healthcare, very much in keeping with the ‘no decision about me without me’ philosophy currently in vogue. If push came to shove, if I could predict the future of my health, would I fundamentally change my behaviour? Probably within reason, but the only thing which I am pretty certain about is having another alcoholic drink may lead to a pattern of behaviour that will ultimately kill me.
If I could predict the future of my health, would I change my behaviour?
A major issue in economics certainly is how individuals cope with information. Much information is uncertain, so one’s ability to make rational decisions based on irrational information is a fascinating one. Predicting the future may be viewed as best kept as the bastion of astrologers such as Mystic Meg, but the likelihood of future outcomes is clearly of interest in the insurance industry. These decisions are not only helpful for people at an individual basis, but also hopefully useful for planning, rather than predicting, what is best for the population at large in future.
Angelina Jolie did not have cancer, but, in fact, like many women with breast cancer mutations, she had the radical surgery to lower her risk. She, at the age of 37, has described her decision as “My Medical Choice,” in an op-ed in the New York Times. She carries the BRCA1 gene mutation, which gives her an 87% risk of developing breast cancer at some point in her life. The abnormal gene also increases her risk of getting ovarian cancer, a typically aggressive disease, by 50%. To counteract those odds, Jolie wrote that she decided to have both her breasts removed. In 2010, Australian scientists found that women with the BRCA1 or BRCA2 mutations who chose to have preventive mastectomies did not develop breast cancer over the three-year follow-up. Since the genetic abnormalities increase the risk of ovarian cancer, women who had their ovaries and fallopian tubes removed also dramatically lowered their risk of developing ovarian or breast cancers. The ability of medicine to predict one day, with relative certainty, the likelihood to develop certain conditions is an intriguing way, and leaves the open the possibility of ‘personalised medicine’ on the basis of your own individual information. If you think the NHS is already overstretched, with A&E closures contributing to the ‘crisis’ in emergency health provision, then footing a bill for personalised medicine might be the ‘straw that breaks the camel’s back’. The idea that one day you can predict the likelihood of a person developing multiple sclerosis or Alzheimer’s Disease still intrigues neurologists.
This furthermore presents formidable challenges for the law. In recent years, governments have been embracing policies that ‘nudge’ citizens into making decisions that are better for their own health and welfare, including our own Government which has decided to ‘mutualise’ its own ‘Nudge Unit’. The European Commission has embraced this ‘libertarian paternalism’ in its review of the Tobacco Products Directive. Various people has recently explained that by introducing measures such as plain packaging and display bans, the European Union may be able to ‘nudge’ people into smoking less, whilst preserving their right to choose. After having relied on the assumption that governments can only change people’s behaviour through rules and regulations, policy makers seem ready to design polices that better reflect how people really behave. Inspired by “libertarian paternalism,” the nudge approach suggests that the goal of public policy should be to steer citizens towards making positive decisions as individuals and for society while preserving individual choice.
It’s likely that a ‘one glove fits all’ policy is not going to work. About a decade ago, I was surrounded in my day job by individuals with hepatic cirrhosis, requiring abdominal paracentesis to tap away fluid from their tummies. And yet being confronted with people yellow due to the build-up of bilirubin did not deter me one jot from being a card-carrying alcohol. I am not over seventy months in recovery from alcohol misuse, so this aspect of how people make decisions before being addicted intrigues me. I think that people genuinely in addiction ‘can’t say stop’, as they don’t have an off-switch; they lack insight, and are in denial, mostly, I feel from personal experience.
It’s also clear that there is a long-list of medical problems that cause someone to present to an A&E department aside from alcohol, such as a sore-throat, faint, dislocated shoulder, and so on. But alcohol is undeniably a big issue, so the question is a sobering one, pardon the pun. To what extent can we ‘nudge’ people out of alcohol-related illness? Commenting on the report out today from the College of Emergency Medicine, that highlights the pressures that Accident and Emergency (A&E) wards are under, Dr John Middleton, Vice President for Policy at the Faculty of Public Health, said:
“We quite rightly have high expectations of doctors and nurses working in emergency medicine, so it’s only fair that they get the support they need to do their jobs safely and well. One way to reduce the burden on Accident and Emergency (A&E) wards would be to tackle the reasons why people are admitted in the first place: in particular, alcohol. Given that drink related violence accounts for over one million A&E visits every year, we urgently need the government to be bold and introduce a minimum price per unit of alcohol. That would reduce the burden on overstretched hospitals and society as a whole.”
Nobody likes assessing risk, especially the consequences of an addict picking up/using again are potentially catastrophic even if in probability terms theoretically infinitesimally low. People who know about Taleb’s “Black Swan” work will know this well. And assessing harm has led others to be blasted in the public arena previously, for example Prof David Nutt who once compared the dangers of horse riding to the dangers presented by the major drugs of abuse. At a time when both the medical and legal professions at least think there should be an open debate about having ‘another look’ at the Misuse of Drugs Act (1971), hopefully a public can welcome a mature debate on this.
Even today, the news reports that introducing a law to force cyclists to wear helmets may not reduce the number of hospital admissions for cycling-related head injuries. Researchers said that while helmets reduce head injuries and should be encouraged, the decrease in hospital admissions in Canada, where the law is in place in some regions, seems to have been “minimal”. The authors examined data concerning all 66,000 cycling-related injuries in Canada between 1994 and 2008 – 30% of which were head injuries. Writing in the British Medical Journal, the authors noted a substantial fall in the rate of hospital admissions among young people, particularly in regions where helmet legislation was in place, but they said that the fall was not found to be statistically significant.
I suppose all political parties desire people with capacity to make decisions about their own lifestyle and healthcare, very much in keeping with the ‘no decision about me without me’ philosophy currently in vogue. If push came to shove, if I could predict the future of my health, would I fundamentally change my behaviour? Probably within reason, but the only thing which I am pretty certain about is having another alcoholic drink may lead to a pattern of behaviour that will ultimately kill me.
It was honour to speak to a group of suspended Doctors on the Practitioner Health Programme this morning about recovery
It was a real honour and privilege to be invited to give a talk to a group of medical Doctors who were currently suspended on the GMC Medical Register this morning (in confidence). I gave a talk for about thirty minutes, and took questions afterwards. I have enormous affection for the medical profession in fact, having obtained a First at Cambridge in 1996, and also produced a seminal paper in dementia published in a leading journal as part of my Ph.D. there. I have had nothing to do with the medical profession for several years now, apart from volunteering part-time for two medical charities in London which I no longer do.
I currently think patient safety is paramount, and Doctors with addiction problems often do not realise the effect the negative impact of their addiction on their performance. No regulatory authority can do ‘outreach’, otherwise it would be there forever, in the same way that Alcoholics Anonymous or Narcotics Anonymous do not actively go out looking for people with addiction problems. I personally have doubts about the notion of a ‘high functioning addict’, as the addict is virtually oblivious to all the distress and débris caused by their addiction; the impact on others is much worse than on the individual himself, who can lack insight and can be in denial. Insight is something that is best for others to judge.
However, I have now been in recovery for 72 months, with things having come to a head when I was admitted in August 2007 having had an epileptic seizure and asystolic cardiac arrest. Having woken up on the top floor of the Royal Free Hospital in pitch darkness, I had to cope with recovery from alcoholism (I have never been addicted to any other drugs), and newly-acquired physical disability. I in fact could neither walk nor talk. Nonetheless, I am happy as I live with my mum in Primrose Hill, have never had any regular salaried employment since my coma in the summer of 2007, received scholarships to do my MBA and legal training (otherwise my life would have become totally unsustainable financially apart from my disability living allowance which I use for my mobility and living). I am also very proud to have completed my Master of Law with a commendation in January 2011. My greatest achievement of all has been sustaining my recovery, and my talk went very well this morning.
The message I wished to impart that personal health and recovery is much more important than temporary abstinence, ‘getting the certificate’ and carrying on with your career if you have a genuine problem. People in any discipline will often not seek help for addiction, as they worry about their training record. Some will even not enlist with a G.P., in case the GP reports them to a regulatory authority. I discussed how I had a brilliant doctor-patient relationship with my own G.P. and how the support from the Solicitors Regulation Authority (who allowed me unconditionally to do the Legal Practice Course after an extensive due diligence) had been vital, but I also fielded questions on the potential impact of stigma of stigma in the regulatory process as a barrier-to-recovery.
I gave an extensive list of my own ‘support network’, which included my own G.P., psychiatrist, my mum, other family and friends, the Practitioner Health Programme, and ‘After Care’ at my local hospital.
The Practitioner Health Programme, supported by the General Medical Council, describes itself as follows:
The Practitioner Health Programme is a free, confidential service for doctors and dentists living in London who have mental or physical health concerns and/or addiction problems.
Any medical or dental practitioner can use the service, where they have
• A mental health or addiction concern (at any level of severity) and/or
• A physical health concern (where that concern may impact on the practitioner’s performance.)
I was asked which of these had helped me the most, which I thought was a very good question. I said that it was not necessarily the case that a bigger network was necessarily better, but it did need individuals to be open and truthful with you if things began to go wrong. It gave me a chance to outline the fundamental conundrum of recovery; it’s impossible to go into recovery on your own (for many this will mean going to A.A. or other meetings, and discussing recovery with close friends), but likewise the only person who can help you is yourself (no number of expensive ‘rehabs’ will on their own provide you with the ‘cure’.) This is of course a lifelong battle for me, and whilst I am very happy now as things have moved on for me, I hope I may at last help others who need help in a non-professional capacity.
Best wishes, Shibley
My talk [ edited ]
"Britain's hidden alcoholics" by @campbellclaret. It made me cry.
This was an incredibly powerful programme presented by Alastair Campbell (@campbellclaret). Anne Robinson says she nearly died. I nearly did too – on June 1st 2007 I was admitted to the Accident and Emergency Unit of the Royal Free Hospital NHS Hampstead, having sustained an aystolic cardiac arrest and epileptic seizure. I then stayed in a coma for six weeks in ITU due to proven acute bacterial meningitis.
Nick Lessar, paramedic, remarked that he thought that people who’d fallen victim to alcohol excess on the streets of London were mainly professional people, and this observation apparently is confirmed by the Office for National Statistics. Alastair describes how he started off as a problem drinker, before he started drinking to excess. He described how felt he was good at hiding it, and indeed I have found from my own experience that alcoholics tend to become expert liars.
Like Alastair, I have never bought the argument that 24/7 style drinking works. My late father was the first to agree. Like Alastair, I also believe that this licensing is to be lame. I used to drink at home on my own, after a full day’s work; I don’t think as a professional I am the first or last to have done this. Furthermore, alcohol is cheap from supermarkets, so like as explained by Prof Ian Gilmore, former President of the Royal College of Physicians, proponent of the ‘Alcohol Health Alliance‘ I feel a safer environment was provided by traditional pubs.
Alcohol problems cost the country £2.7 billion last year. 41% of professional people apparently drink more than the recommended limit. My concern is that the legal and medicine professions are full of them. Many City firms are within a stone’s throw of pubs. Lawyers with problems need to know where to get help, and fast. 9,000 people a year die of alcohol-related disease.
One person describes that her life was “spiritually and morally bankrupt”. I recognise this aspect of many alcoholics.
I paid a very high price. Not only in terms of my working life so far, I ended up in a wheelchair. I learnt how to walk again, thanks to the wonderful help of the physiotherapists and occupational health therapists at the National Hospital for Neurology and Neurosurgery. I learnt how to speak again thanks to the wonderful Speech and Language Therapists there. My late Father witnessed the worst of it, but thankfully he lived long enough to witness the beginning of my recovery. And, for the record, I now walk and talk absolutely normally.
I have, originally from a wheelchair, completed my Bachelor of Laws. I then did a LLM by distance learning in international commercial law. Last year, I completed a MBA, and I am now doing the Legal Practice Course. I had a two hour interview with the Solicitors Regulation Authority in December 2010, having disclosed I had a previous problem with it. By that stage, I had been only 3 years in recovery. Now I am four years in recovery. I know that if I have another drink I’ll keep going, and I’ll be dead.
Drink does endanger work, health, relationships and their lives, as explained by Alastair. Like Alastair, I went to Cambridge, and my gut feeling is that alcoholism is far from simply only a working class problem. In fact, one might say that universities like Oxbridge have a formidable drinking culture, with numerous drinking culture and the notorious ‘Suicide Sunday’ at Cambridge in May Week. The professions need to have a strong attitude to getting professional away from harm’s way in being near the public. Someone though has to pick up the pieces to ensure that these ill people get help. I picked myself up.
Well, never mind, you live and learn. I’ve met, though, some wonderful people on the way, and they know who they are. Like Alastair, you spend ages pretending you’re not an alcohol, until you finally have to give up the pretence. I agree with Alastair’s Psychiatrist, though – I don’t think it’s safe for people like me to drink at all.
The author is the Shibley, President of the BPP Legal Awareness Society, a student society for all BPP students to promote the understanding of law and regulation to corporate strategy. He tweets at @legalaware.
Lawyers and alcohol
I have a huge interest in the effects of problem drinking and addiction to alcohol, and in recovery. However, a bit like my other interest disability, there’s a limit to how many ‘white elephants’ I can talk about in relation to the legal profession, otherwise the ‘white elephant’ in currency terms will become devalued. Notwithstanding that, lawyers who have a drink problem do need medical help, I feel. It’s probably true that the vast majority of lawyers and law students know how to have a social drink, and shouldn’t be unfairly stigmatised for doing so.
Like London buses, nothing was in eyesight, until several sightings came along at once recently for me. Alex Aldridge on Monday set the ball rolling with his article in the Guardian, “Law’s problem with alcohol is slowly being addressed – but is still hush-hush“. The article explains elegantly how drinking is indeed said to be part of the culture in deal-making particularly in the City, but also explains how there may be a spectrum of lawyers from ‘law anoraks’ who are driven by academic results to those with severe dependence problems. It is my belief that true alcoholics are those people who do not know how to stop at one drink, so will nearly always keep going until something catastrophic occurs. On Thursday, Paul Venton, Chairman of LawCare, wrote a truly terrific piece in the Law Gazette entitled, “A heartfelt thanks”. Paul writes, “On many occasions, the assistance we have been able to provide to those afflicted by the curses of drug or alcohol dependency, or the debilitating effect of stress in their lives, has avoided personal and practice tragedies and the wider ramifications they entail.”
I believe robustly that those with true dependency problems will need to spend a life in recovery for their own safety, but for individuals with mild problems more bespoke medical help may be suitable. This is one person’s view, and not advice to other law students or practising lawyers. On Wednesday evening, I was gripped by a lecture by Prof David Nutt, @profdavidnutt, an academic who was sacked as being the Government’s advisor on drugs by the last government but who is now Chair of the Independent Scientific Committee on Drugs. In a pleasant chat after the lecture, held at the Pitt Rivers Museum at the University of Oxford, I suggested to him that a team of his PhD students or postdocs should look at the frequency of ‘alcohol’ appearing in the Part II of death certificates in the UK, and examining whether this tallied up with the prevalence or incidence of alcoholism in vivo in the UK.
Prof Nutt interestingly provided that he had found the Liberal Democrats the most in line with his personal views about the tone of regulation. His lecture, chaired by Prof Guy Goodwin from the University of Oxford Warneford Hospital for psychiatry, described how the Misuse of Drugs Act 1971 was not ‘fit for purpose’, the Dutch cafe experiment, how the harm from alcohol was often much more than from other drugs, how alcohol abuse was globally a cause of disability according to WHO, how alcohol was recently not allowed even through necessity for medicinal purposes, the distinction between legalisation and decriminalisation (in the Q/A session afterwards), “equasy”, and how Francis Crick is alleged to have dreamt up the structure of DNA, amongst many other issues. It was obvious that Prof Nutt felt the debate about the regulation of drugs had been stifled in recent years, but strongly urged people to keep up-to-date with the latest developments on his blog, particularly since reports in the media were so unreliable.
Rehab
I did a period in rehab once. It didn’t work. I have been in recovery now for 45 months. You have to have to understand addiction of alcohol to make it work. Unless you have a willpower and fully acknowledge that alcohol addiction is a lifelong medical condition you have to learn to live with, you can’t make it.
I even tried equine therapy when my late father, my mum and I were really desperate. Don’t ask me what this involved!
Here’s the brilliant track from Amy Winehouse, “Rehab”.
The 12 steps of alcohol recovery
I personally don’t do the 12 steps programme for alcohol recovery, as they practise thoroughly in the Alcoholics Anonymous.
However, all I would say is: do whatever works best for you in recovery. In my recovery, I share some of the beliefs. In other words, you are genuinely powerless over the fact you cannot individually cope with alcohol. Many ‘normal’ people can cope – you are not one of them, if you are alcoholic. I have now been in recovery now for 45 months, and I am very open about it. I attend my recovery meeting mostly everu Tuesday in North London.
You cannot do it alone, but in a sense only you can totally cure yourself – this means a life-long programme of recovery. You have to let go, confront the issues, and live life in recovery – but it is an exacting and worthwhile process, and one which I continue to enjoy.
Indeed Christmas is a tough time for recovering alcoholics
Christmas is supposed to be a very tough time for recovering alcoholics. I must admit that I am extremely proud that I am now 42 months in my life-long recovery. It’s difficult, but waking up on the top floor of the Royal Free NHS Hospital having been in a coma for six weeks in 2007 had a lot to do with it. I think of my father being told the news that I was going to live, and that I had come round from my coma. At the time, he had no idea that I would have stopped drinking alcohol for good. He stood by me by thick and thin, including my Bachelors and Masters of Law between 2008 and 2010. I feel that by the end he was proud of me, but I felt dead myself thinking about his sudden death on 10th November 2010 due to a heart attack. I think of all the people and institutions who have disgusted me, but I think of the integrity and power of my father who were strong until the end, despite his own suffering. So – I didn’t think once about having a drink, although this is supposed to be the party season, but my mum and I (we live together in a small flat in Primrose Hill) think though about my father every single second. I hope you had a very nice christmas, and I wish you personally every success for a demanding 2011.
Best wishes,
Shibley
I am on
and
Shibley Rahman on why all non-prescription drugs are life-threatening to him, so he doesn’t need them
Drugs including alcohol and tobacco products are a major cause of harms to individuals and society. Some drugs are therefore scheduled under the United Nations 1961 Single Convention on Narcotic Drugs and the 1971 Convention on Psychotropic Substances. These controls are represented in UK domestic legislation by the 1971 Misuse of Drugs Act (as amended). Before 1971, the UK had a relatively liberal drugs policy and it was not until US influence had been brought to bear, particularly in the aforementioned circles, that controlling incidental drug activities was employed to effectively criminalize drugs us. Other drugs, notably alcohol and tobacco, have long been regulated by taxation, sales, and restrictions on the age of purchase.
On 3rd June 2007, I was admitted to the Royal Free Hospital at the end of several years suffering from a severe alcohol dependence syndrome 2003-2007. Alcohol treatment for me is now obligatory. I have been in recovery for 40 months, living a very fulfilled life in the abstinence of alcohol, and I now have insight into the disastrous effect it had on my personal and personal life. I was admitted to the Royal Free having sustained a cardiac arrest and an epileptic seizure, spent two months in a coma, but then emerged – not brain-damaged, but disabled.
I completed my postgraduate medical training as a physician in 2005. Whilst I am not a practising physician, I have passed all my exams that prove that I understand medicine, and alcohol-related medicine. However, I must admit to not understanding the impact of alcoholism until my recovery. I used to wake up in the morning, and have to have a ½ bottle of gin. I used to go to the news agents to buy alcohol at 11am in the morning, and I couldn’t function at all. I had lost my job in 2005 anyway, and got erased from the General Medical Register in 2006/7. The General Medical Council were aware of my problem as far back as 2003, but I was left on the general medical register until 2006 when I was provisionally erased. I resent this lack of treatment, but it was not for the General Medical Council to treat me under any legal obligation of ‘duty-of’care’. I would argue that they have some sort of quasi-moral one, simply because of the Hippocratic Oath which governs the behaviour of all doctors to patients, even if their patients are other doctors. Therein lies the conundrum of treatment for professionals – you don’t wish to admit you have a problem, and you don’t have insight anyway; obviously, you have nobody apart to blame, apart yourself, if you go down this route. In recovery, on the other hand, the paradox is that you certainly need the help of others, but you can’t make it on your own. Anyway, ‘every cloud has its silver lining’. I was able to complete both my Bachelors and (nearly) my Masters of Law, where my interests in law and philosophy have converged on the notion that legal responsibility is very hard to define where the extent of a defendant’s voluntariness has been compromised by mental illness. That issue is for another day but I have much enjoyed analyzing (and agreeing with) the arguments of LJ Sedley of the House of Lords (now the Supreme Court).
Enough about me suffice to say that I love my life, and indeed proselytizing about recovery to others. I am always taken aback by how common alcohol problems are, as a member of society not as a doctor, ahead of problem drinking or alcoholism. The vast majority of people are capable of being social drinkers, and do not benefit from interference with their lifestyles. I am different. If I have another drink, it will kill me, because I wouldn’t be able to stop drinking until I drop. I would just keep going on, and going, and going. I have seen others do it every night in Clerkenwell Road, vomiting in the streets, but they wake up the following with the hangover; some may even go as normal to work. I now detest this lifestyle. I used to be a ‘revolving door’ patient, but I don’t wish to pay Russian Roulette with my life. Last time I did, I woke up on the top floor of the Royal Free, having been written off by the superb NHS consultants, disabled, having received a catheter and tracheostomy, but alive.
I sent Prof. David Nutt an e-mail this morning. He is absolutely adored by his patients, and by all the national and international experts that I have ever met in addiction disorders. Genuinely, I find him a wonderful and inspiring man. I take what he says very seriously; he is often misquoted, and he makes clear that no drug is safe. If you’re the one in the million that reacts adversely, a mass of statistics won’t impress you particularly. Nutt had his latest paper published in the Lancet around midday today. Indeed, on the Centre for Crime and Justice Studies (UK) website which funded this study, Professor Nutt today is remarked to have said:
`No one is suggesting that drugs are not harmful. The critical question is one of scale and degree. We need a full and open discussion of the evidence and a mature debate about what the drug laws are for – and whether they doing their job?‘
There is no point us burying our heads in the sand pretending there is no problem as member of the Big Society. By August 2010, David Cameron deduced a problem with very cheap alcohol being sold by supermarkets which people were drinking before heading out for the evening. The House of Commons Health Select Committee and NICE have voiced strong support for minimum pricing. Hospital admissions due to alcohol have risen by 825 a day in five years to almost a million, researchers found today. The Alcohol Commission has recommended a ban on selling drink at below the “floor price” of the cost of production, plus the cost of duty and VAT. Recent data suggest that northerners were found to be the hardest drinkers but the most alcohol-related crimes were committed in London. (from the Liverpool John Moores University’s Centre for Public Health in the “Lape Report”).
There were 945,469 admissions to hospital for alcohol-related harm in England in 2008/09. The data from CIVITAS make staggering, and depressing reading, The overall annual cost of crime and anti-social behaviour linked to alcohol misuse is estimated at £8-£13bn a year. In 2004, the approximate figure had been £7.3bn. Thankfully, detoxification is available on reception in all local and remand prisons: during 2002-3, around 6,400 prisoners received alcohol detoxification and 7,000 combined drug and alcohol detoxification. Indeed, Alcoholics Anonymous run services in around 50% of prisons currently. The use of such drugs including might not only result in physical and mental harm for the user, but can also present great burdens to society, such as aggression, car accidents, poverty, job absence, and health-care costs.
Today, Professor David Nutt’s team published their latest findings on the relative risk of alcohol. Their findings supported previous work in the UK and the Netherlands, confi rming that the present drug classification systems have little relation to the evidence of harm. They accord with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy. The authors argued, to provide better guidance to policy makers in health, policing, and social care, the ‘harms’ that drugs cause needed to be properly assessed, but the authors readily admitted that a major issue is how you assees ‘harm’ in the first place.
Members of the Independent Scientific Committee on Drugs (ISCD) 1-day interactive workshop were invited to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals, whereas alcohol, heroin, and crack cocaine were the most harmful to others. Overall, alcohol was found to be the most harmful drug, with heroin and crack cocaine in second and third places. The correlations between the Independent Scientific Committee on Drugs (ISCD) overall scores and the present classification of drugs based on revisions to the UK Misuse of Drugs Act (1971) is 0·04, showing that there is effectively no relation. The ISCD scores lend support to the widely accepted view that alcohol is an extremely harmful drug, both to users and society; it scored fourth on harms to users and top for harms to society, making it the most harmful drug overall.
Different regulatory approaches have therefore been used to restrict the adverse effects of licit and illicit drug use, varying from punitive prohibition, to partial liberalisation, to full legislation of the drug market. An area of work which I will be followed in the near future is whether the behaviour of addicted individuals can be ‘incentivized’ – can an alcoholic be ‘nudged’ to give up under the right circumstances? Such libertarian paternalism is of course gathering some momentum in the US and here. Notwithstanding, experts have argued that overt and explciit criminalisation of drug use has low efficacy in reducing the prevalence of drug misuse, and even seems to promote petty and organised crime
As such, these new data provide an extremely valuable contribution for the re-evaluation of current drug classifi cation in the UK. A major point not addressed in the study, because it was outside the investigators’ scope, is polydrug use, which is highly prevalent in recreational drug users. The major funding must be surely that, for the discussion about drug classification, the two legal drugs assessed — alcohol and tobacco —score in the upper segment of the ranking scale, indicating that legal drugs cause at least as much harm as do illegal substances.
For me, it’s simple. I have never touched any drug apart from alcohol, but I can’t even risk having any of these drugs for the rest of my life, including alcohol or tobacco. For me – it’s simples – if I do, I will be dead!
Dr Shibley Rahman is happily in recovery for 40 months now, has done 2 books, nearly 2 law degrees, has become a company director and an Associate of the IoD as well as a FRSA, in that time.
