‘Dying for a drink’: New report calls for ‘professional optimism’ to support recovery from alcohol problems

SHAAP (Scottish Health Action on Alcohol Problems) has published a new report, ‘Dying for a drink’, following research commissioned by the Scottish Government.

The SHAAP report discusses alcohol deaths in Scotland and draws on interviews with those affected to highlight the personal tragedies that harmful alcohol use continues to cause, while also making recommendations for actions to reduce these in future. SHAAP also calls for more ‘professional optimism’, to recognise that people can recover from alcohol problems and to support that process.

The new SHAAP report draws attention to the fact that alcohol-related deaths remain significantly higher in Scotland than in England and Wales where death rates are high by international standards. It also points out that although there has been a downward trend in deaths since the mid-2000s this may now have levelled off. The two main causes of alcohol-related deaths in 2017 were alcohol-related liver disease (738 deaths, 60%) and mental and behavioural disorders caused by alcohol (321 deaths, 22%). Total ARDs in 2017 were 1,235. Alcohol-attributable deaths (AADs) include an appropriate proportion of a further 30 causes of death which are partially caused by alcohol. Using this wider definition, there were an estimated 3,705 deaths attributable to alcohol in Scotland in 2015.

The new SHAAP report also indicates that different sections of the population are harmed by alcohol in a range of different ways: The main causes of AADs for people under 35 are suicide, road/pedestrian accidents and poisoning. The main causes of AADs for people over 35 are alcohol-related liver disease, mental and behavioural disorders and neoplasms of the breast and oesophagus.

SHAAP notes that men are approximately twice as likely to have an alcohol-related death as women and this has remained constant over time. The impact of poverty is also highlighted: people living in the 10% most deprived areas are at least six times more likely to die because of alcohol use than those living in the 10% least deprived areas.

The qualitative part of the SHAAP study included interviews with individuals currently drinking excessively, those in recovery, family members and professionals working in this area. Key findings are that:

• Alcohol-related problems are symptomatic of many deep-seated and personal issues. The main reasons given by those continuing to drink and those in recovery were addiction taking hold; to gain confidence; deal with abuse as child; adult trauma; self-hatred; mental health issues and no longer caring for oneself. 
  
• User voices are both invaluable and necessary, and those with lived experience have to be a part of the conversation around strategy and service development.
  
• The steps towards recovery and sustaining recovery are about relationships and not doing this alone but with the support of others. Importantly, all people, at all levels in society, including though not limited to professionals, can play a powerful role in challenging stigma, showing care to help build hope, and demonstrating in daily actions the value of compassion and humanity.
  
• Alcohol harms are complex, affecting individuals and people around them. This research brings to light the shame and stigma families feel about dealing with this issue, the variability of service provision, and in some cases a lack of compassion and understanding they face, both by ‘society’ and professionals.
  
• Inequalities and a ‘Scottish drinking culture’ play major parts in contributing to alcohol-related deaths, according to professionals.
  
• Alcohol issues need to be addressed within a public health paradigm, i.e. at individual, social and societal levels.
  
• Resources invested ‘upstream’ in prevention will save money, and more importantly, lives in future.

Dr Eric Carlin, Director of SHAAP, who led the study said:
“The people we spoke to in this study told us that that we need to establish a continuous dialogue with those affected by alcohol problems, including drinkers and their families, to understand what social and health harms they experience. Their insights should inform strategies to prevent and reduce alcohol-related harms and early preventable deaths.‘Professional optimism’ in all public services should promote the idea that people can, and do, recover from alcohol-related problems, with support from their communities. All public services, including housing, welfare and employment services, should be alerted to the potential risks of harmful drinking, so that triggers for intervention are understood and support is embedded in service delivery. Working in collaboration, all public services, including housing, welfare and employment services, should be alerted to the impact of psychological problems, trauma and bereavement, on harmful drinking, as part of key training for all staff who have contact with the public. We also need to challenge stigma related to people who use alcohol harmfully, as it adds to the barriers that people face in accessing services. The potential contribution of assertive outreach services to supporting engagement in services should also be considered.Prevention also remains important. SHAAP has long been at the forefront of campaigning for policies to reduce and prevent alcohol harm from happening in the first place. The findings from this review underline the importance of continued support for policies to increase price, reduce availability and marketing in order to be effective in reducing overall population consumption and harms.”

Dr Peter Rice, Chair of SHAAP and part of the research team, said:

“Our hope is that this new SHAAP report further develops understanding of the individual and societal influences on alcohol deaths in Scotland and informs approaches to alcohol harm generally. SHAAP has previously drawn attention to the links between alcohol and cancers, alcohol and brain development and the need for an improved response to Alcohol Related Liver Disease. All of these areas are highly relevant to mortality from alcohol. This new report highlights the impact of alcohol on suicide in Scotland, especially in younger people and there need to be stronger links between the alcohol and mental health sectors in policy and practice.There has been progress in reducing alcohol deaths in Scotland over the past 15 years. While access to services is regarded as good by international standards, it is estimated that services meet at best 25% of the need. This study shows the importance of human relationships within services and in recovery communities. Recovery, which is often from a range of deep seated problems, is a process, not an event, and continuity of contact with trusted staff members and others in recovery is crucial. Services should organise themselves to ensure this continuity. People in recovery and families experience the same influences as the rest of the population in negative attitudes to alcohol problems, marketing of alcohol products and some of the ways in which alcohol is sold. They see considerable benefits for themselves in population level measures to tackle low price, easy availability and pervasive marketing. Scotland now has an active multidisciplinary alcohol research community. There is the capacity and ability for Scotland to have a model of continual evaluation, policy development and service improvement to continue to reduce alcohol deaths. We can learn from others and Scotland’s experience can continue to contribute to international best practice in tackling harms from alcohol. This is why information-sharing events such as the 8th European Alcohol Policy conference, which SHAAP is hosting on 20th and 21st November in Edinburgh are so important.”

For further information and/or interviews, please contact:
Dr Eric Carlin, Director, SHAAPshaap.director@rcpe.ac.uk  0131 247 3667, 0131 247 3665 and 0750 5081784.
Dr Peter Rice, Chair, SHAAPpeter.rice@nhs.net  0131 247 3667 and 07740 937732.