keith humphreys professor of psychiatry, stanford university school of medicine visiting professor...
TRANSCRIPT
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Keith HumphreysProfessor of Psychiatry, Stanford University School of
MedicineVisiting Professor of Psychiatry, King’s College London
Alcohol Research UK Conference 12 March 2013
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What is the Role of Science in Public Policy Formation?Can identify emerging problems of policy concern
Can determine whether policies are delivering their promised impacts
Can suggest new policies that could be tried
BUT cannot tell us what we care about as a society
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Why Be Explicit About the Values Basis of Public Health?
Being a scientist does not convey the right or ability to rule
It’s undemocratic and potentially dangerous for scientists to represent their values as proven facts
Public trust may be gained by values-based appeals
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Three Evidence-Informed Alcohol Policies That Will Promote Public Health and Public Safety
Mandatory sobriety for alcohol-involved violent offenders
Expansion of treatment and recovery for alcohol dependent people
Minimum unit pricing of alcohol
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Mandatory Sobriety for Repeat Drink Drivers in South Dakota
All offenders orientated to programme rules
Twice-daily breath testing or alcohol-sensing bracelet
Alcohol use or no show results in prompt arrest and certain, modest punishment (1 night in jail)
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Domestic Violence and Mandatory SobrietyImpact on arrests evaluated quasi-
experimentally as program was rolled out over South Dakota
Counties with the programme experienced a 12% reduction in repeat drink driving arrests
Counties with the programme also experienced a 9% reduction in domestic violence arrests
Kilmer, B. et al (2013). American Journal of Public Health. Jan;103(1):e37-43
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Current Status in the UK
Already in operation in Scotland
Programmes legally established in England and Wales as of 1 May 2012
But implementation has been slow
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Expanding Access to Alcohol TreatmentWell-validated psychosocial and
pharmacological treatments for alcohol use disorders are now available
Prior UK policy funded drug treatment disproportionately
Creation of Public Health England is an excellent opportunity to expand access to alcohol treatment
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UK Treatment Professionals Under-Refer to Recovery GroupsMultiple randomized clinical trials show
positive clinical benefit from facilitated access to 12-step groups
Yet many UK professionals are convinced that 12-step groups are rarely or never valuable
Professionals have a responsibility to educate themselves about the science and also to personally investigate (i.e., visit some open meetings)
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Timko RCT on AA/NA referral 345 VA outpatients randomized to standard or
intensive 12-step group referral
Higher rates of 12-step involvement in intensive condition at 6 month follow-up (82% located)
Over 60% greater improvement in ASI alcohol and drug composite scores in intensive referral condition
Source: Timko, C. (2006). Intensive referral to 12-step self-help groups and 6-month substance use disorder outcomes. Addiction, 101, 678-688.
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The Logic of Minimum Unit PricingHeavy drinkers spend about 80% less per
unit of alcohol than light drinkers
Consumption of high-strength, low-cost beverages is associated with health and safety damage from alcohol
MUP thus may generate health and safety gains despite applying to a small minority of beverages
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Sheffield Group Modeling of Annual Impact of a 50p MUP in England2930 fewer deaths
92,200 fewer hospital admissions
274 million GBP lower spendSource: Purshouse, R.C., Meier, P.S. et al. (2010). The Lancet, 375, 1355-1364
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Direct Evidence from CanadaBritish Columbia studied from 2002-2009
A 10% increase in average minimum price for all alcoholic beverages was associated with a 31.7% reduction in wholly alcohol-attributable deaths
The impact was evident despite concurrent expansion of private liquor stores in the provinceSource: Zhao, J., Stockwell, T., et al., (2013). Addiction. DOI: 10/1111/add.12139
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Other MUP issues in UK
Already the law in Scotland
“Save the pubs, support minimum pricing of alcohol”
MUP should be indexed to inflation
EU regulatory questions
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SummaryScience can help us make more public health-oriented
alcohol policy iff we openly choose that value framework
Mandatory abstinence programmes are now in the law of England and Wales and should be implemented
PHE should enhance access to alcohol treatment and encourage knowledge and respect for recovery organisations
A minimum unit price for alcohol would reduce the public health and safety damage of heavy drinking