The mainstream challenges of developing healthier alcohol

and drug policies and practice

Mike McCarron, The Scottish Association of Alcohol and Drug Action Teams

Scotland’s Futures Forum – 3rd April 2008

Global View

The Global Village proportionately reduced to 100 people includes:

 • 6 possessing 59% of wealth and living in USA• 80 living in poverty• 70 illiterate• 50 suffering hunger and malnutrition• 52 women and 48 men

Global Substance Use by Adults

• 50% Alcohol

• 30% Tobacco

• 5%   Prohibited drugs (inc 4% cannabis) • 0.6% Problem drug use is mainly in poorest

communities (as in Scotland)

Inter-Country Comparisons

Sweden

Tax rates Sweden:

Individual:

• Under 26000 - 31% 

• over 26000 51%

• over 40000 56%

• Employers Social Security contribution 32% of gross income

• VAT 25% Most services

Community Contrasts

Individual Situations

• “If there is less [food] I eat less.I have to feed the family first. Most days I don’t eat.The only place my diet will get me is death and is that really such a bad option?”

-Service User (SDF Gallery)

Structural Relative Inequality

Scotland’s Challenge

• Sizing the problem: alcohol-related deaths

Male liver cirrhosis mortality rates: Scottish rate = 2.5 times E&W rate

Sizing the problem: deprivation and alcohol

In Scotland 2005, men in most deprived areas 6 - 7 times more likely to die an alcohol related death

0

20

40

60

80

100

120

140

160

Least deprived 2 3 4 Most deprived

Deprivation quintile

Death

rate

per 1

00,0

00 p

op

ula

tion

Male

Female

Source: ISD Scotland based on GROS

Scotland: Some Promising Policies

New Futures Fund

10,000 Clients over 5 years in 70 projects, costing £34m (1,630 clients with drug problems in last two years)

– 75% reported increased self confidence and motivation– 50% thought their chances of getting a job had increased

– 21% went into a job– 12% moved into education or training– 14% joined a government employment or skills programme– 10% went into volunteering

Promising Policies

• Housing right for all by 2012• Unemployment analysis – Community Benefit

(Raploch) – apprenticeships (Glasgow)• Improving individual sense of wellbeing• Promoting “recovery”& essential services• Lower income proportionate increase• Early years prioritisation – kinship care

allowance

The Next Step

• 1998 “We want now and in the future to see deprivation given its full and proper place in all considerations of drug prevention policy, at both the local and strategic levels, and not let slip from sight” (ACMD, Drug Misuse and the Environment)

• 2008 From now on alcohol an drug policy and practice should be fully integrated within strategies and practice seeking to reduce poverty, multiple deprivation and social exclusion – and vice-versa

Because

A big reduction of inequality in Scotland would make a major

contribution to reducing the damage caused to its population by alcohol

and drugs by half by 2025