Damming the flood: 21 principles to underpin a new approach to alcohol

August 24, 2010

(Updated with additional references)
The past 50 years have seen the worst epidemic of public harm from a legal drug since the introduction of cheap gin in the 1700s (1, 2). Although alcohol intake has doubled in this period (3), alcohol related harms have increased many times more on account of the culture of heavy and, particularly, binge drinking that has developed.  There are a number of reasons for this epidemic. The major ones have been the last government’s policies of reducing the real price of alcohol (4) and increasing drinking hours (5), plus the massive increase in the marketing of alcohol in supermarkets, often as a loss-leader (6).  There has also been a marked growth in strong lagers and ciders of up to 8% alcohol content that appear designed to facilitate rapid intoxication rather than to satisfy palates (7).

Attempts to rectify this situation, such as the report by the Chief Medical Officer last year (8) and NICE this month that recommended pricing per unit of alcohol in drinks (9), and the Royal College of Physicians report the year before (10), were dismissed by government and the drinks industry as soon as they were published on spurious and intellectually dishonest grounds (see previous post Alcohol: the new opium of the masses?).  Thankfully we have a new government and one that in the run up to the election pointed out the issues especially of high strength ciders that have never been near an apple; some are a purely synthetic mixture of malic acid and alcohol! (11)  So what should the coalition do to reduce the harms of alcohol?  Here are my top twenty suggestions:

1.    Make alcohol a national health priority:  current estimates are that the damage from alcohol costs the NHS the order of £20bn per year and the violence it induces cost £7billion in police time.

2.    Tax according to alcohol content since alcohol is the dangerous drug in drinks. Everyone accepts the rationality of this between alcohol classes – e.g. sherry is taxed more than beer and less than spirits, so there is a precedent that could easily be brought into action. A can of 8% lager should cost twice that of a 4% one and 4 times that of a 2% one. This was planned by the last Labour government and the coalition missed a real opportunity to make a statement about alcohol harms by not increasing the tax in this way despite their manifesto commitment (12).

3.    Increase alcohol tax to bring the cost of alcohol in real terms back to where it was in the 1950s before the progressive rise in consumption started, i.e. gradually, say over 5 years, triple the price.  All available evidence shows that the price of alcohol determines use for almost everyone with the only possible exceptions being severely dependent drinker (13)s. The increased health burden of alcohol is largely driven by non-dependent drinkers so would be significantly reduced by an increase in price. I have estimated that the average taxpayer would save the order of £2,000 per year by the reduced costs of alcohol-related harms if we increased the price as suggested.  In the case of wine drinkers, only those consuming more than several hundred bottles a year would be worse off with this scheme, and they are drinking at a dangerous level anyway.

4.    Stop selling strong alcohol in supermarkets; use the Swedish model where only alcoholic drinks of less than 3% can be sold outside licensed shops that have more limited opening times than supermarkets (14). Supermarket alcohol sales are not only destroying lives but also public houses and other alcohol outlets where drinking is conducted in a social manner and where intoxication can be monitored and young people can learn to drink socially and more sensibly.

5.    Ban special discounting of alcohol in bars e.g. happy hours, all you can drink for £10 etc.

6.    Stop selling wine in larger 250 ml glasses that have crept up on use in recent years – we should go back to smaller glasses again.  For a medium size female, 5 large glasses of wine in one hour will lead to  a blood alcohol level of 300mg/% which is that needed to produce coma.

7.    Repeal the 24 hr licensing law so bars close at 11pm.

8.    Ban organisations such as Carnage UK that promote dangerous levels of drinking as entertainment (15).

9.    Make it a law that all alcohol outlets must sell non-alcoholic beers and lagers so that those who like the taste of ales can get it without the risk on intoxication.  Make these drinks be sold at below the cost of equivalent alcohol-containing ones and make it obvious that they are available.

10.    Enforce the law that makes serving drunk customers illegal in bars: have breathalysers in bars and clubs so that seemingly intoxicated people can be tested and denied more alcohol if they are above 150mg/%.

11.    Add warning notices to all drinks warning of the damage alcohol does, as with those on cigarette packets.

12.    Reduce the drink driving limit to 40mg/% to deter drink driving and hence reduce drinking. And if caught, get people properly assessed and repeal their licences if they flout DVLA guidance.  Encourage the wider use of alcohol detectors in cars.

13.    Invigorate the treatment of alcohol dependence by making alcohol a priority for the national treatment agency; encourage the use of proven treatments that reduce drinking and stop relapse.

14.    Provide incentives to the pharmaceutical industry to develop new treatments for alcohol dependence and its consequences.

15.    Encourage research into developing an alcohol alternative that is less dangerous, intoxicating and addictive than ethanol and for which an antidote or antagonist can be made available to prevent deaths in overdose.

16.    Educate from primary school age about the dangers of alcohol.

17.    Develop public campaigns to make alcohol unfashionable just as was done for tobacco.

18.    Ban all alcohol advertising as with tobacco.

19.    Ban all government supported organisations e.g. universities from having subsidised bars. Ban drinking games and pub-crawls in public organisations such as university sports and social clubs; remove financial support from clubs that allow these.

20.    Raise the drinking age to 21. When this was done in the USA in the 1990s it was estimated that over 170,00 lives were saved in road deaths (16).

Finally, a measure that could be a powerful tool in the implementation of the above would be to reduce the use of alcohol by politicians as it could distort their objectivity in law-making in relation to the harms of alcohol. Get them to openly declare any association with the alcohol industry. The government’s wine cellar should be closed and the subsidy of alcohol in the Houses of Parliament stopped. Somehow though, it seems unlikely that MPs would call time on that particular perk…

References:

1. The cost of alcohol related harm to NHS £2.7 billion at 2006/7  prices,  cost to Society  £17.7 to £21.5 billion.  (2008) Dept of Health
http://www.direct.gov.uk/en/Nl1/newsroom/DG_170745

2.Hospital Admissions linked to alcohol 65% increase over 5 years to 2008/9 (2010)
Data Dept. of Health
http://www.nwph.net/alcohol/lape
( lape =local alcohol profile England)

3/4. Institute of Alcohol Studies (2008)  “Alcohol: Tax, Price and Public Health”.  Institute of Alcohol Studies,
http://www.ias.org.uk/resources/factsheets/tax.pdf

per capita consumption of alcohol has doubled from 6.l per year in1960s to 11.5 l a year in 2000, price  (relative to income ) halved since 1960s

5. LicencingAct  2003 HMSO  –   commenced Nov. 2005

6. Bennetts,  R (2008) Use of Alcohol as a Loss Leader.  IAS briefing.
http://www.ias.org.uk/resources/papers/occasional/lossleading.pdf

discusses “pre-loading” with alcohol ( he suggests link with reduction in  “happy hours “)

7. Doward , J  (2010) Super Strength alcohol is killing more people than “crack” or heroin. Observer 29/08/10
http://www.guardian.co.uk/society/2010/aug/29/super-strength-alcohol-killing-homeless
not referenced, interview with homelessness workers

8. Donaldson, L  On the state of the Public Health  (2009)
http://www.gov.uk/en/publicationsandstatistics/publication/annualreports/DH_096206

good overview, discusses  concept of “passive drinking” cf smoking, minimum pricing ie 50p per unit of alcohol, per capita adult intake (England)  = 120 bottles of wine per annum
he says alcohol use is up 40%  from 1970s  ( NB see ref 3  ).

9. NICE  Alcohol use disorders, preventing the development of hazardous and harmful drinking.  (June 2010)  Public Health Guidance, 24

suggests minimum price per unit alcohol, reduce availability
states between 1980 and 2008 alcohol became 70% more affordable
lists Government initiatives since 2004

10.Royal College of Physicians, (2009)  Submission to Health Select Committee Enquiring into Alcohol
http://www.rcplondon.ac.uk/professional-issues/public-health/documents/RCP-HSCl/alcohol.pdf

11.refers to James Crowden who on his blog  www james-crowden.co.uk
explainshow super strength cider is made
author and poet, “expert “ on Cider

12. Not in Conservative Manifesto per se.  ( Oct 2009) Chris Grayling  (Shadow Home Sec.) proposed  in speech 1. significant tax increase on  “alcopops”, strong beer and strong cider, 2..supermarkets banned from selling below cost price 3 amuch tougher licencing regime

13. Pursehouse, Meier,P, Brennan,A, Taylor,K, Rafia,R,  (2010) Estimated effect of alcohol pricing policies on health epidemiological model. Lancet 375 (9723), 1355-64

14.  Swedish system for licencing alcohol.

http://www.Systembolaget.se

Alcohol is sold by state monopoly since 1955. Stated aim  “to reduce alcohol related harm by selling alcohol in a responsible way without profit motive”  (quote)

15 .www.carnageuk.com

16.Wagenaar, AC, Toomey,TL,  Effect of minimum drinking age laws. A review of the literature 1960-2000.  (2002) J of Studies on Alcohol,  suppl. 14:  206-22579 studies of MDLA (minimum legal drinking age) Conclusion  preponderance of evidence indicate found higher MDLA inversely related to traffic crashes  and amount of alcohol consumed.

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55 Responses to “Damming the flood: 21 principles to underpin a new approach to alcohol”

  1. Jackart Says:

    Ban this. Raise the price of that. It’s like NuLabour never went away.

    Progress economically means that everything (with the exception of Gold and Land) are cheaper relative to incomes than they were in the 50’s.

    I agree that pubs need to be able to compete with the supermarkets, but your proposals for more Government intervention miss the real problem of the late license laws: the need to provide ‘entertainment’ usually in the form of piped music at sufficient volume to cause people to shout increasing thirst….

    A quiet local cannot get a late lisence and still turfs you out at 11. Christ. Just leave poeple alone to have a pint or 3 in their local with their buddies!

    Raise the drinking age to 21. Are you quite mad?

    There will be a further fisking of this illiberal, draconian and new Labour “nanny knows best” rubbish on the blog.

    But this is seriously dissapointing in one whose views on decriminalsiation of illegal drugs are often sound.


  2. *sigh*

    What a load of nasty, authoritarian claptrap. Like every other lazy, unpleasant, illiberal dictator, you would rather punish everyone, rather than the guilty.

    Second, you should know—from the evidence—that most of your proscriptions simply won’t work. Has drinking markedly increased since 24 hour opening? No. Has violence increased? No.

    These two facts would imply that some people are always going to be idiots when they drink; why punish everyone else.

    Here’s another one:

    “Reduce the drink driving limit to 40mg/% to deter drink driving and hence reduce drinking.”

    Yawn. Both Finland and Sweden have a 20mg limit, and yet they both have higher levels of drink-driving than we do. In fact, Sweden has the highest proportion of deaths from drink-driving in the whole of Europe.

    I may fire into this tripe later on. But I’m not sure that I can be bothered: I have been fisking similarly misguided—and plain nasty articles—like this for over 5 years.

    DK

  3. Dan Gaston Says:

    Absolute rubbish. I don’t know about in the UK, but here in North America (and elsewhere) there is a proliferation of high alcohol content beers not because they are intended to “get you drunk quicker” but for palate reasons. Belgian barley wines have absurdly high alcohol contents and are chosen because the drinker likes that style of beer. They aren’t exactly the beer of choice (given their price and taste) for young people who just want to get trashed. The same goes for high hop content India Pale Ales and Imperial Pale Ales, doubly so for West-Coast style Double IPA’s. No one has yet figured out how to make an extremely hoppy beer with a low to moderate alcohol content that still tastes good. I’d love it if someone did (a local brewer I know is really trying), because then I could enjoy more than 3 at a time without getting drunk.

    As for raising the drinking age to 21. The only way this makes sense is if you decide that people are not adults at 21 after all. Change the driving ages and age of majority along with it. Otherwise you end up with the same bullshit situation as in the US, where young people are not-quite full adults under the law.

    A better approach would be to try and foster a healthy respect for alcohol (and by extension all drugs). They are something adults can enjoy without needing to binge drink and drink purely for the need to get drunk. Then again adults should be able to do what they wish. Make alcohol (or drug) impairment an aggravating factor in any and all criminal offences. Get in a fight because you were drunk or high? Worse punishment than if you were sober. Place real consequences on behaviour not make it difficult or extremely expensive for responsible people to enjoy.

  4. admin Says:

    Admin:
    We welcome open debate within the Comments section of Professor Nutt’s blog. Please refrain from promoting other blogs.

  5. Jackart Says:

    Admin: Standard practice in the rest of the blogosphere is to allow trackbacks. There’s a back link to this blog in the post in question. It is relevant – a direct response to this post.

    You’ll not win many friends or get readers with that attitude.

    I’ve removed the link from my blog. No readers coming from there any more. Anyway: the response to the nonsense suggested in the post.

    1 From whence these estimates? Anyone admitted to A&E with any alcohol in their blood, whether or not this had anything to do with their admission, just like Road Traffic stats?
    2 Why should a 4% can of lager cost twice as much as a 2% can? I can see the logic of a progressive taxation, but this would make wine, that facet of the Mediterranean cafe culture we’re all supposed to emulate, prohibitively expensive. He’s not thought this through.
    3 Everything except land, gold and whores are cheaper relative to incomes than they were in the ’50s. It’s called ‘getting richer’ and it’s a good thing, David. You stick to the psychopharmacology, and leave the Economics to people who understand it.
    4 Because problem drinking is UNHEARD OF in Scandinavia. Clearly we should emulate their drink policies.
    5 I’ve no problem with cracking down on establishments which cause a problem, and I’ve no doubt this correlates with happy hours, but it is unlikely that this correlation is perfect. Try enforcing existing laws before banning a perfectly reasonable marketing ploy by bar owners. How about enforcing the law about serving clearly intoxicated people? Wouldn’t that work…. Puritanism is the nagging fear that someone, somewhere is having fun. I think you just revealed that here, David.
    6 Oh for Pity’s sake. Where to start with this one. I’ve been to the pub with many, many ladies over the years, and I’ve often bought them large white wines in 250ml glasses. Not one, ever has ever slumped into an alcoholic coma. Perhaps you should stop adding the Rohypnol, or would that stop you ever getting laid?
    7 you miserable, bloodless Puritan. I would quite like to be able to stay in my local, drinking a few pints, chatting with my buddies until midnight on Friday nights, if that’s OK with you?
    8 If they cause a problem, why not enforce existing laws first?
    9 mmm. Alcohol free lager. Yes please! Not. Been tried. No-one likes it. This end up being a mandatory few bottles in the fridge, replaced only when they go out of date, and never, ever drunk by anyone. Just another silly, pointless law.
    10 This would go a long way to limiting the harm of binge drinking. Why not try that at #1 before banning stuff for those of us who don’t cause problems?
    11 Stop Nagging. We drink because its a pressured, unhappy society in part because people like David Nut think they can and it’s desirable to control the people.
    12 We’ve the safest roads in Europe, despite their being the most crowded. We’ve lower levels of drink driving despite drinking more than many others. Everyone should be copying us. Stupid idea.
    13 Get alchies to dry up and medicalise addiction. Sound point there, at #13.
    14 #14 can’t hurt either. What are the incentives: a tax break. Wouldn’t you see AIDs or Malaria as being more deserving though? Doesn’t this show warped priorities?
    15 I’m sure there are plenty of people who’d rather a line or two of coke than a pint of the Nutt’s gnat’s piss ‘ale’, but I suspect that’s not what you had in mind, is it David?
    16 Make alcohol glamorous for kids. Good Idea. What could possibly go wrong?
    17 None of the pretty girls I know smoke. Not one. NoSireee. Smoking isn’t fashionable. Not at all.
    18 Fine. Take money out of sport and new programming. All we’ll ever have on TV are American sitcoms. Good Idea.
    19 I’ll tell you what: You try and stop Exeter Agrics 2nd XV going on their annual pub golf tournament. How, just how will this be enforced?
    20 1. I dispute the figures. 2. It’s catastrophically illiberal. You can send an 18 year old to face AK47s in Afghanistan, but not let him face B52s in Bar Khyber? Madness. It’s madness in the USA, and it will be worse here. Why not go the whole hog an ban Alchol entirely. What? Oh.
    21 A populist swipe at politicians. Cheap.

    I can see why they fired you, Prof. Nutt.

  6. Duncan Stott Says:

    Many of these proposals are too authoritarian for my taste, but nevertheless I find this contribution useful.

    This is where the debate about all drugs should be: the amount of state regulation that is required around their supply.

    The debate around drugs (with the illogical exception of alcohol and tobacco) is currently around their legality. A grown up debate about the supply frameworks of a legal market will demonstrate what could be achieved with other drugs if they were legalised and regulated.

    Sadly the terms ‘grown up debate’ and ‘libertarian blogosphere’ are like chalk and cheese.

  7. Jackart Says:

    Duncan, (can I call you ‘Duncan’?) The odd naugty word offends your precious liberal-democrat ears does it? You can’t bear to be seen to agree with those Naughty, naughty boys over there…. I mean some of them even LIKE FPTP…

    The difference is we start with the position ‘prove that banning helps’ whereas you seem to start with ‘prove legalisation works’

    We’re arguing from different start points, not being childish…


  8. “Increase alcohol tax to bring the cost of alcohol in real terms back to where it was in the 1950s”

    Do you understand what ‘real terms’ means? Alcohol is already more expensive in real terms (ie. price has exceeded inflation). I think what you mean is you want it to be make it as expensive as it was in the 1950s relative to income. No thanks.

    This whole post is vile, ugly puritanism. Please go back to talking about narcotics.

  9. Duncan Stott Says:

    Yes, you can call me Duncan.
    No, swearing doesn’t offend me. It’s just counter-productive.
    No, I can bear to agree with you. I started my comment by saying most of Prof Nutt’s proposals were too authoritarian for me. That’s me agreeing with you.
    What has electoral reform got to do with this? (And why do libertarians like FPTP? It maximises the likelihood of strong government, and guarantees parties pandering to populist authoritarians.)

    I argue from the same starting point as you. You are seeking to find a difference where none exists. If there is a difference, it is because you don’t start from the position ‘prove that banning helps’; your position is that no ban can ever help, because individual liberty is sacrosanct.

    Don’t you agree that a shift in the debate away from ‘prohibition vs legalisation’ and towards ‘state regulation vs free market’ would be a shift in a libertarian direction?

  10. Adam Says:

    Could you give a reference for 1: current estimates of damage from alcohol. £27bn is almost incredible!

    I think the emphasis should be mainly on taxation: as with all drugs there should be pigovian taxes to counter any harm done. I agree that a few of these suggestions are too authoritarian.

    Education regarding the costs to the taxpayer seems to be lacking. If people knew how many hundreds or thousands of pounds it cost each of us… Maybe that could form a part of the warning notices.

    The call for breathalysers in bars is interesting though I can’t see it happening.

  11. Dave Says:

    Absolute rubbish. Have you ever been to scandanavia? Theirs is not the best approach to take. They have massive problems with bootleg booze and a pub culture that is to expensive to use often. Young folk drink purely spirits they buy duty free, and get absolutely smashed before they go out to save money. Furthermore, it has no effect on alcoholism as as see much more of it around the systembolaget than you ever do here.

    How can you not see how reducing the licensing hours just sends people home to drink what they want or makes them drink as much as possible within the time allotted. If you let people drink whenever they want, they will eventually learn to pace themselves, sending us back to defence of the realm act licensing hours is embarrassing, and mind boggling to tourists.

    And, minimum pricing. Absolute rubbish. Only someone middle class would ever suggest this. So, if your poor. Too bad. Shocking argument and it makes my blood boil every time i hear it.

    This post was like a manifesto for middle class puritan busybodies.

  12. Adam Says:

    A factsheet from the Institute of Alcohol Studies (link at my name) suggests that £3bn is the cost to the NHS in England so I’m still dubious of the £20bn figure. Law & Order cost is indeed at least £7bn and is broken down in that factsheet.

    But I’d like to say that I support what you’ve said. Evidence of effectiveness elsewhere should be considered but something needs to be done and Prof. Nutt shouldn’t be criticised for suggesting a variety of options.

    I only hope the government has the guts to do something that the public might not currently approve of (as with all evidence-based drugs policy). Would the public really be more annoyed by increased alcohol taxes than by job cuts and raised VAT? Probably! I think it would be idiotic not to do number 2.


  13. Professor Nutt,

    Not strictly relevant to this post but today I started to read the Home Office’s Drug Strategy consultation document and I was horrified:

    http://peterreynolds.wordpress.com/2010/08/24/home-office-drug-strategy-consultation-sham-and-deception/

  14. Anthony Says:

    “I only hope the government has the guts to do something that the public might not currently approve of (as with all evidence-based drugs policy).”

    I only hope the government does what they are electorally able to do under a democratic system. Otherwise, let’s just appoint an academic expert to each government department to replace the minister and scrap the elections.


  15. I’m disappointed with the lack of evidence behind some of the recommendations, given who’s making them. Some of them also seem utterly unworkable, such as banning large wine glasses.

    One item is missing from the list: Making other drugs available in bars / booze outlets. I would certainly opt for other chemicals over ethanol, thereby reducing my intake, but that’s currently not practical (or legal), so I’m stuck with the most harmful option.

  16. Simon Perry Says:

    Your desire to make another person’s decision whether to drink alcohol for them through taxation or other means can only come as a result that you believe you have made a better decision than that someone is capable of doing themselves.

    However, your argument is invalid because you have completely neglected one entire side of the decision making process.

    The decision whether or not to engage in any activity is one of cost vs. benefit. Your analysis looks only at the costs of alcohol, not the benefits.

    Analysing any activity on the costs alone will result in the decision to not engage.

    The decision whether or not to engage in alcohol consumption needs to weight the costs (health, financial cost, time) against the benefits (pleasure, relaxation).

    At present, you do not appear to have made an attempt to compare the costs to these benefits. Until you do so, you are in no position to advise, let alone dictate through taxation, what decision any individual should make.

    I should add that it is probably impossible to do this. Weighing up the benefits of pleasure against the costs of health is an individual, subjective decision. There is no one decision that will be correct for everyone.

    The only solution is to educate people about the costs, and allow them to freely make the decision on whether they are worth it.

  17. Jackart Says:

    Along the lines of Simon Perry’s comment above, the mortality of a tea-totaler doesn’t meet that of a drinker until the drinker is taking 60 units a week.

    There is plenty of evidence that the occasional couple of beers or Glass or two of wine in the evening is not just harmless, BUT GOOD FOR YOU.

    Binge drinking is a problem, but I would suggest reflects a stressful society in which Government seeks to control far too much of peoples behaviour, leaving people with the desire to get off their faces.

    LEAVE. PEOPLE. ALONE. FOR. A. BIT.

  18. James Phillips Says:

    Oh dear. Mr Nutt seems to have just turned to typical, mindless authoritarianism. I’m 18 and have never been out of control/heavily drunk on alcohol. I’m capable of responsible use, as are many, many others. This nonsense about raising drink age limits is just thoughtless solutions to complex problems. Does Mr Nutt have any EVIDENCE that higher drink age limits lower consumption in those age groups (look at france for a counter example)? He has shamefully resorted to the tactics of his opponents on drug regulation, as well as putting in his shameless plug for his own legal drug alcohol alternative which he does so frequently.

    Its a real shame to see David Nutt of all people make such an abysmal blog piece.
    I can summarise his thoughts:
    Ban ban ban ban ban.
    Worked a treat in prohibition.

  19. Chris Says:

    I’m sorry, Prof, but you clearly haven’t researched alcohol consumption statistics. If you had, you’d know that there isn’t a problem. Okay so we have a few thousand binge drinkers, but we have laws to deal with them. They can be arrested for their behaviour. It’s always been thus.

    As for making alcohol incredibly expensive, the smugglers and criminals will make a fortune. In any case, why should 99.9% of the population pay considerably more for the sake of a few head-bangers, who will not be put off anyway.

    And don’t come back with all that clap-trap about the cost to the NHS. The cost of the NHS is down to over-staffing and low productivity and not useage.

  20. Frank Says:

    From Transform’s Blueprint for Regulation: “For alcohol policy to have an effective future it is clear that potentially very unpopular decisions will have to be made that will involve increasing regulation and heavy restrictions on all aspects of marketing and promotions.”

    Making a consistent, rational drugs policy is going to require not just pulling ‘illegal drugs’ into regulation but also increasing the regulation of alcohol. People shouldn’t be criminalised for taking drugs (including alcohol) but it can’t be a free-for-all where no measures are taken to reduce abuse and no taxes are gathered to balance their costs to the taxpayer.

  21. Adam Says:

    Chris,

    I feel the need to reply to your above post in which you hypocritically make up your own statistics to fit your views.

    I refer you to the link at my name. For example, regarding there not being a problem, I could point to (in 2004) the 360,000 victims of alcohol-related domestic violence; the 4000 fatal acute incidents; the million children affected by their parents’ alcohol problems; 530 drink-driving deaths. As for costs, alcohol is responsible for a over a third of the Law & Order budget. And do you have any data to suggest that “over-staffing” is responsible for the billion pound cost of alcohol-related A&E and ambulance costs (not to mention the other billions)?

    These costs mean that the average taxpayer (even those that don’t drink) pays hundreds and hundreds of pounds to counter alcohol misuse. The report suggests that current alcohol revenue covers only around a third of taxpayer costs. Why not make those that drink the most ethanol pay more whilst everyone else pays less taxes overall?

    On smuggling: “It could be argued that the unwillingness to tax alcohol arises from the problem of smuggling and cheap legal imports from across the channel. However, a study specifically focused on this topic (Crawford et al. 1999) shows that the effects of smuggling and personal purchases are extremely limited and tend not to change demand sensitivity to price. Similarly in the years 2001-2005 personal imports (purchases done abroad by consumers) of beer have represented 2.34% of total purchases, 1.3% in 2005 (BBPA, 2006:23). Finally, we know that in 2003, the last available figure, the value of smuggled alcoholic drinks represented just 1.4% of the value of all alcoholic drinks consumed in the UK. On these bases it is hard to argue that personal imports and smuggling are a serious limitation to the powers of the UK government in taxing alcohol. Similarly we cannot argue that EU obligations limit this power. EU obligations merely prevent Britain from taxing wine in a discriminatory way.”

  22. Dokely Says:

    How anyone from Big Public Health can accuse anyone of intellectual dishonesty is beyond me. Just about everything published by this arrogant, mendacious and thoroughly corrupt alliance of pressure groups and meddlesome medics is of poor quality and economical with the truth. The comments above hopefully save me having to explain why. What is even more galling is that we are paying these people huge sums of money to achieve nothing but social division and distrust of government. How much longer will they go on lying at our expense? No wonder the suicide rates are so high in Scandinavia. My Nordic friends have been putting up with this crushing, autocratic, soul destroying nonsense for longer than the rest of us.

  23. Rap Scallion Says:

    Be careful, Professor. When you foment revolution, it may not be your enemies who lose.

  24. John Ellis Says:

    What! are people saying this is draconian and to harsh? I face prison and social persecution for my drug of choice thats draconian and harsh :).
    Within that the price rise after the break in consumption and price which became most evident around 1969 is perfectly reasonable. Why ? because those that choose to promote alcohol did it to cannabis so triple the price is good.

    If I choose to I can grow cannabis to a quality better than anything on the street. No tax little cost. I believe this used to be one of the mainstays of the alcohol users as well before it became fashionable to drink expensive branded(so it must be better) taxed alcohol. (mugs)

    The rules on alcohol need to be tightened and definitely removed from supermarkets. I was in ASDA wallasey today and they had alcohol on one side of the isle and children’s branded sweets on the other. My problem with this is that younger children will make associations especially brand associations when they are very young, which in turn will set a base for choice in later life.

  25. Greg Says:

    After reading this rubbish I need a drink. Now. Anyone know where I can get alcohol below cost-price?

  26. Roger Thornhill Says:

    @Duncan Stott “Sadly the terms ‘grown up debate’ and ‘libertarian blogosphere’ are like chalk and cheese.”

    Your attempts at blanket criticism says more about you than the “libertarian blogosphere”, as well as being condescending and priggish.

    Regulation is welcomed by incumbents, for they have the energy and resources to handle it, knowing that start-ups and new entrants do not. They also have the determination and smarts to face down and hold their ground against their opponents, something the faux Liberals lack in spades. Result: people get shafted, incumbents get undeserved rewards, innovators are crushed, Liberals think they rule the roost with their “grown up debate” but are, in fact, useful idiots addicted to compromise while Authoritarians get another click on their ratchet towards a ban.

  27. The Fyrdman Says:

    5 large glasses of wine in an hour may cause a coma? Well do me sideways! Your trying to tell us to ban the use of 250ml glasses because a woman who drinks almost 2 bottles of wine in an hour will pass out?

    Seriously Nutt do you think most women are so stupid that they don’t know what will happen when you drink so much wine in ONE hour? Or is it just poor women that you think are gibbering imbeciles and need your chivalric help to save them from themselves?

    If they are the type of woman who is determined to drink that much so quickly, do you think the size of the glass is going to stop them?

  28. Mark Butcher Says:

    I’m going to ask a very simple question: why do we care? I mean, who said the government has to care about how people choose to spend their lives. If someone chooses to spend their life smoking, having a beer and hates taking exercise (that about sums me up) then let them. I’m not saying government shouldn’t inform – it should. We should know of the dangers and then be allowed to get on with it. This nannying state and the view that ‘something should be done!’. So I again ask the question… why?

  29. Duncan Stott Says:

    That’s a nice rant Roger, and you make a good point about new entrants to the alcohol market. Do get back to me when your uncompromising attitude begins to have a shred of influence.

  30. jccoh Says:

    I still think the best thing would be an alternative to alcohol.I dont think people would accept such tight regulations on alcohol unless there was something in its place.If your synthetic alcohol becomes a reality then the alcohol problem could well take care of itself.

  31. Mark M Says:

    “Stop selling wine in larger 250 ml glasses that have crept up on use in recent years – we should go back to smaller glasses again. For a medium size female, 5 large glasses of wine in one hour will lead to a blood alcohol level of 300mg/% which is that needed to produce coma.”

    Of course it will – but it may surprise you to know that most people don’t knock back a bottle and two-thirds of wine in an hour. Mind, if that’s the rate you think people drink at then it’s no wonder you think there’s a drink problem. In fact, you’d do well to find anybody who would get through 5 large glasses of wine in an hour.

    Oh, and if we go back to smaller glass sizes then you know what’ll happen? People will drink MORE GLASSES OF WINE. If anything, large glasses would reduce the amount drunk, as people having had 2 glasses might think “no, I don’t want another one”, whereas someone drinking 125ml glasses might just feel like that 5th, because it’s not too much more.


  32. I’m surprised at the vitriol being expressed in these comments, considering the most vituperative of you seem to want more liberal drug policies and Nutt is a rare voice of (relative) reason, who eschews the moral panic for harm minimisation. He’s a doctor. It’s a no-brainer that for him its about health. Perhaps you could direct some of your ire towards Cameron and Clegg, who deserve it: http://peterreynolds.wordpress.com/2010/08/24/home-office-drug-strategy-consultation-sham-and-deception/

    For another view of this debate, read something I wrote back when the mephedrone panic was on, arguing that all drugs just be treated as chemicals and regulated according to toxicity. http://sirenofbrixton.wordpress.com/rants/drugsarentbad/

  33. Roger Thornhill Says:

    @Duncan Stott

    You get back to me when your compromising attitude has not give away the freedoms and rights of others.

    “A liberal is a man who will give away everything he doesn’t own”

  34. jccoh Says:

    Another comment from myself. I know Im going off topic here but has anyone been followimg the whole debate about electronic cigarettes in the uk and in the usa.The new models are proving quite successful and people are using them instead of cigarettes so what are both governments doing? They are trying to ban them of course.No tax revenue from them.Its the same with alcohol.I dont think the government really care what people drink as long as they are paying tax on it.Some people are giving prof Nutt a hard time on here but I think he is one of the few people who actually care about the health of the nation and he is obviously not in anyones pocket.He is the first person ever to stand up and tell it as it is with great personal cost to himself.So even if you dont agree with everyone of his suggestions-I still think people should support him in principle.

  35. cornyborny Says:

    Ha ha! “He is the first person ever to stand up and tell it as it is with great personal cost to himself.”

    If only. He is more like the ten billionth rent-seeking and UNELECTED ban addict to bravely call for our freedoms to be restricted in the name of some bs greater good. It’s like a never-ending torrent.

    N.B. Prof Nutt has shares in GlaxoSmithKline, the friendly neighbourhood pharmaceutical multinational.

  36. jccoh Says:

    So what if he has shares in Glaxosmithkline? I have a portfolio of shares spread across a few different places as do tens of thousands of people.What exactly is that supposed to signify? If I am getting this right Prof Nutt has shares in Glaxosmithkline. Hes working hand in hand with them to produce this pharmaceutical product called synthetic alcohol so of course the first step of his devilish fiendish plan is to bring down the alcohol industry.Well its entertaining and I love a good conspiracy theory as well as the next person but there is only one problem here.The breweries are the ones who are backing it. Dont believe me? Look at the blog archives.There is a blog titled HYSTERIA AND HUBRIS-LESSONS ON DRUG CONTROL FROM THE SCUNTHORPE TWO. In the 7th comment down prof Nutt says” The research on synthetic alcohol is ongoing and I have had interest from several brewers who feel that this may be the way forward in the long term.We are currently looking at candidate molecules and hope to begin some studies next year.” Anyway who cares if he makes money from it.Fortune favours the brave-thats the whole principle behind entrepreneurship.Alcohol has wreaked havoc in our society.I work in the frontline of an A+E department and the carnage is terrible to watch.Alcohol is killing Britain.If prof Nutt can come up with a safe alternative then hats off to him.Anyway its exciting.Beer has been around since the time of the mesopotamians so why not try something new? All the luddites who are shouting it down are just boring.On the downside I dont think all of Prof Nutts proposed restrictions would work.Britain is a nation of party animals who wont take too kindly to someone putting the brakes on.Just give them something safer to party on.

  37. admin Says:

    Admin:
    Cornyborny – Professor Nutt has never had shares in GlaxoSmithKline.

    To all commentators – please refrain from defamatory and abusive comments towards the author or those participating in the blog comments. Repeat occurences will cause the person responsible to be blocked from participating.

  38. jccoh Says:

    No shares in Glaxosmithkline.So another conspiracy theory bites the dust. When will people open their eyes and realise that prof Nutt is actually trying to help ordinary people?Reading some of these comments he must wonder why he even bothers.

  39. Filthy Says:

    admin says:
    27/08/2010 at 02:55 pm
    Admin:
    Cornyborny – Professor Nutt has never had shares in GlaxoSmithKline.

    Really? So can we expect a lawsuit against The Guardian?

    Drugs inquiry thrown into doubt over members’ links with manufacturers

    Two of the four CSM scientists, Michael Donaghy, a reader in clinical neurology from Oxford University, and David Nutt, professor of psychopharmacology at Bristol University, hold shares in GlaxoSmithKline, manufacturers of Seroxat.

    http://www.guardian.co.uk/society/2003/mar/17/mentalhealth.politics

  40. John Ellis Says:

    Filthy that was 7 years ago and does it really make any difference who was bought into what at the time. im quite sure that if you looked at the portfolios of most of government they would have dubious shares in all sorts of companies many would be against the interests of the parties involved.

    anyways all this mud slinging is boring and irrelevant to the subject matter at hand, unless that is you follow the clinical routes of alcohol use its damage and the total effect of dumbing down society.

  41. Filthy Says:

    John Ellis,

    Do Nutt’s competing interests matter? I don’t know.

    Is it relevant to mention that he had/has shares in Glaxo in reply to the admin of an ‘evidence-based’ site who says “Professor Nutt has never had shares in GlaxoSmithKline.”? I think so, yes.

  42. admin Says:

    Admin:
    Professor Nut does not and hsa not ever had shares in GlaxoSmithKline. He previously had shares in the Wellcome Trust but sold them some time ago.
    These allegations have been made before, presumably to try to discredit him, as here.
    Please keep comments to factual discussion rather than personal attacks.

  43. James Phillips Says:

    Admin: how about seeing Professor Nutt respond to the plethora of criticism that has come his way for this authoritarian trash he has written.

  44. Pete Brown Says:

    “Spurious and intellectually dishonest”? Physician, heal thyself!

    There’s no evidence to suggest increased hours of availability leads to greater alcohol misuse – indeed, all stats available from the NHS and ONS suggest – no sod that, PROVE – that since licensing hours were liberalised binge drinking, total alcohol consumption and alcohol related harm have all declined. By confusing on-trade licensing with the very real problem of cut price sales in supermarkets, you demonstrate a lack of understanding of your topic here.

    The real price of alcohol has NOT decreased – it has consistently increased ahead of the Retail Price Index.

    The alcohol induced health epidemic suffers from major miscalculation, in that it uses a figure where alcohol consumption is a present factor in hospital admissions, and is then used to suggest that alcohol is the primary cause of all hospital admissions quoted – a wilful confusion between correlation (eg generally unhealthy lifestyles, depression, mental illness – all of which may feature heavy drinking as one of several characteristics) and causation – alcohol consumption as the specific cause of hospitalisation.

    As for your points:

    1. If you actually look at that £20bn figure, the way it’s calculated is little better than the scribblings on the back of fag packet. It’s also disingenuous to quote the cost of alcohol to society without giving the corresponding benefits – such as the £8bn paid in duty by brewers every year, the £28bn contributed to the economy every year by the beer and pub industry (source: HMRC) and the general beneficial effect of a relaxing drink enjoyed by the vast majority of drinkers.

    2. Tax alcohol according to content – relatively, yes, but not on a ludicrous fixed scale

    3. Triple the price – by your own admission, this would penalise moderate drinkers and make no difference to those most in need of help. What a cruel and heartless approach. Look at what happened when they did this in Kenya in the early 2000s. Official beer consumption plummeted because people turned to illegal hooch. Alcohol related problems – and the cost to the country – soared. It doesn’t work.

    4. Stop selling strong alcohol in supermarkets – you cite the Swedish model. Have you ever seen Swedish binge drinkers? Again, all this approach does is denormalise alcohol and drive determined drinkers to illegal and more harmful spirits.

    5. Ban Happy hours etc – that already happened, months ago, with the implementation of the Mandatory Code – by the govt you say only made things worse.

    6. 250ml glasses – a fair point, but smaller glasses have to be available by law. ‘Banning’ them also makes no difference to home consumption – where most wine is drunk.

    7. Repeal 24 hr licensing – well, “24 hr licensing” doesn’t actually exist. But as all statistics a reduction in the problem since pubs were freed from all having to close at 11pm, I’d like to see one shred of evidence suggesting a return to the 11 o clock swill would result in less dysfunctional drinking. Even most police chiefs think staggered closing times are a good thing.

    8. Carnage UK? Yeah, fair enough. But it would be more effective to stigmatise them as the twats they are rather than martyr them by banning them.

    9. Mandatory low alcohol beers? Oh, come on! Have you tasted them?! All pubs already sell soft drinks which people are perfectly happy to switch to. Er… you have actually been to a pub, haven’t you?

    10. Enforce law about serving drunks. Well yes – the point being, it’s already law – it’s up to the police.

    11. Warning notices – alcohol is not the same as tobacco in that moderate consumption is actually beneficial to health (studies show moderate drinkers are healthier than teetotallers as well as heavy drinkers). Drinks packaging already carries information about units, and ONS data shows most people have a clear idea of what units mean and what their limit is.

    12. Drink driving limit – drunk driving fatalities are not cause by people who are slightly over the limit, but by people who have disregarded the limit and are many times over it. Lowering the limit wouldn’t make a blind bit of difference – it would just hurt already struggling country pubs.

    13. OK

    14. Fine – but have a clearer definition of what alcohol dependence is. Currently anyone who has more than two pints of beer in one day of one week is technically suffering from alcohol dependency.

    15. An alternative? An alternative what? A synthetic, psychoactive drug? Rather than a naturally occurring substance that we’ve been drinking for 10,000 years. What a bizarre idea.

    16. Educate from primary school – why? Anyway, figures show that under age drinking is consistently decreasing.

    17. Make alcohol unfashionable. Why? Refer back to point 11.

    18. Ban all alcohol advertising. There’s no link between advertising and problem drinking or under age drinking – despite millions being spent by health groups trying to prove one. Why shouldn’t drinks companies advertise? What exactly is the negative effect of drinks advertising that you’re asserting, and what evidence – that’s evidence, not opinion – do you have to prove that a ban would decrease problem drinking?

    19. Ban subsidised bars. Look, why not just come out and say you think we should have prohibition?

    20. Raise legal drinking age to 21. Talk to American teenagers – both those who drink and those who don’t drink – and tell me you still think this would be a good idea.

    This is twaddle. Neo-prohibitionist, reactionary, ill-informed twaddle that makes no use whatsoever of the available data on a subject clearly dear to Prof Nutt’s heart. Jesus, if an undergraduate student produced something with so little connection to the facts, they would rightfully be failed. For this to come from one of the supposed leading experts in the country underlines just how poorly informed and personal agenda-driven the anti-alcohol lobby is. Shame on you.

  45. Rachel Says:

    This is probably going to make me wildly unpopular, but I wanted to comment on #15 – the investigation into alternatives. There is actually a very similar drug to alcohol already out there – GHB is its street name, short for Gamma-Hydroxybutyric acid, but it has, as far as I know, been prohibited. Yes, it has an insidious reputation as a “date rape” drug, however, looking into it I could not find any verified reports of it actually being used as such (alcohol, on the other hand, is by far the most common date rape drug). Since GHB has similar effects to alcohol and is a liquid, it could feasibly be used as such, however, it is also because of these similar effects that it could be used recreationally (and in place of alcohol). It produces mild euphoria and lowers inhibitions. If you take too much of it, you pass out. Unlike alcohol, GHB does not inhibit respiration; as long as someone is placed in the recovery position, you will simply awake again after the effects have passed (unlike having to get your stomach pumped after too much alcohol). It produces no hangover, and its effects wear off quickly (within 1.5-3 hours). Too much just makes you sleepy, so it does not promote bingeing. It is also produced by your own body, so your body is not taxed in breaking it down and there are no toxins produced afterwards as with alcohol (and is probably why a hangover does not occur). Granted, it is not as pleasurable as alcohol and its soporific effects at relatively low doses (compared to that of alcohol) makes it unlikely to produce dependence.

    It also has many therapeutic potentials, such as a muscle relaxant (and in fact aids in childbirth), and has great potential to help those with sleeping disorders (it has a history of being used with much success in treating narcolepsy).

    Just thought I’d throw that out there. It is a drug that I think could be regulated properly for recreational use (i.e. all producers could dye it blue so as to make it difficult to spike someone’s drink unknowingly), and while it is not without its own potential harms, they seem to be less than those caused by alcohol. The main difficulty I would see in using GHB as an alternative to alcohol would be the fact that proper dosing would be more problematic.

    I would be curious to know what Dr. Nutt’s opinion on such an alternative would be.

  46. John Ellis Says:

    Pete Brown while i wont rubbish some of what you say throughout your points, I think you will find that its a different story per postal code.
    In the road next to me the special brew and vodka generally starts to flow around 9:30 am with all the young lads and various adults up and down the street congregating outside each others house. 4 out of 7 days will end up in a brawl.

    We welcome the rise in price of alcohol as it means that the drinking will slow down, as for them using other drugs in place of alcohol .. they already do mostly pills n powders a sub group methadone and heroin..

    if we have drunk alcohol for 10’000 years and because of this its okay to use then why are cocaine cannabis and opium all not okay? as these all have the same periods of use throughout our known history, or does ethanol have something special about it the others dont.?

    this one however really made me laugh.
    11. Warning notices – alcohol is not the same as tobacco in that moderate consumption is actually beneficial to health (studies show moderate drinkers are healthier than teetotallers as well as heavy drinkers). Drinks packaging already carries information about units, and ONS data shows most people have a clear idea of what units mean and what their limit is.

    can we have the studies please especially the healthier than tea drinkers one….

    Drinks packs should have pictures from A and E on them just as tobacco products have dissected body parts on. Alcohol is a drug people really dont care what it says on the Can apart from the proof age of alcohol contained.

    I would like to see alcohol classed alongside opiates, its just as harmful to the communities the users are in.

  47. paul Says:

    This blog needs to be peer-reviewed. What a lot of reactionary, ill-informed bollocks.

  48. Ian Says:

    Good post, but the raving comments only demonstrate how impossible it is to have a debate on the internet. Absurd, vituperative raging, god knows what they are like after a drink. the Prof has a lot of good ideas, shame the politicos won’t take the slightest heed.

  49. ETrickwe Says:

    The current bing drink culture can be attributed to one thing and one thing only: the human desire to be intoxicated, and alcohol being the only legal intoxicating substance (ignoring grey-area ‘legal highs’) decriminalization and/or legalization of, for instance MDMA or Cannabis would, in my opinion drastically reduce drinking for intoxication. Raising the age 21 would do nothing, as a 16 year old it is widely accepted for teenagers as young as 13 or 14 to be dangerously intoxicated on spirits at private parties, with much peer pressure to do so.

  50. Jonathan Bagley Says:

    Dear Prof Nutt,
    I would like to make three comments.

    First, alcohol consumpion has been decreasing since 2005 and last week a particularly large decrease was reported. Is it your view that this sort of decline wouldn’t continue without measures such as steep tax increases and stricter regulation?

    Second, I have worked at Colorado State University and the fact that only “three-two” (3.2% by mass) beer was sold outside of strictly controlled shops, open only to over 21s, did not prevent binge drinking among the students. In fact under 21s weren’t allowed in normal pubs.

    Third, when alcohol was more expensive, home brewing and wine making were very popular. Boots had a section devoted to it. Is a return to this desirable? The alcohol content of homemade wine and beer would be unknown much of the time. You mention Scandanavia, but although overall consumption is lower in Sweden, one third is classed as “unrecorded” – mainly moonshine I imagine. In the UK only a very small propotion is classed as unrecorded.

  51. Norwegian citizen living in UK Says:

    Some of these suggestions are good. The Scandinavian model has its’ advantages. However, restrictions do have unintended consequences. Let me sum up some that are common in Norway, which has already implemented some of what you suggest:

    – People stay at home longer and get very drunk before going out, or do not go out at all, because of the prices and restrictions.

    – Illegal and dangerous alcohol becomes more common.

    – Bars lose money and have to break the law to be able to stay profitable, attracting criminal elements.

    – More violence because the above mentioned drunk people that have been drinking at home gather in large crowds in a few bars for a concentrated period of time.

    – Restrictive policies reinforce the perception of alcohol as a drug, and reinforces binge drinking.

    – Norway and Sweden has a culture of never drinking with meals or on weekdays, and a culture of dangerous binge drinking on weekends. Norwegians and Swedes frequently never stop at one, two or three units, but have a culture of always binge drinking. Once they start, they do not stop, and this is the only culturally accepted use of alcohol.

    – Young people will buy illegal alcohol or steal alcohol from their parents.

  52. Norwegian citizen living in UK Says:

    Oh and I forgot, the law against selling alcohol to already intoxicated people in Oslo is frequently applied in a discriminatory way to people who are not drunk. For example, if you are just loud by nature, you could experience being denied alcohol so frequently that it makes you not want to go out at all. It feels rather ridiculous to be treated as a kid.

  53. Evidence Says:

    http://www.sciencedaily.com/releases/2010/09/100923162401.htm

    “Taken together, these two studies establish beyond any reasonable doubt that, as the price of alcohol goes up, alcohol consumption and the rates of adverse outcomes related to consumption go down,” said Wagenaar. “The strength of these findings suggests that tax increases may be the most effective way we have to prevent excessive drinking — and also have drinkers pay more of their fair share for the damages caused and costs incurred.”

  54. Morten Says:

    I doubt that increasing the age would affect drunk driving in the same way in the UK as in the states. Americans drive everywhere, and their public transport infrastructure is abysmal. In the UK, public transport is excellent and taxis are cheap and available.


  55. […] As the Prime Minister recently asked for minimum alcohol pricing proposals to be explored, these results are a timely indicator of the party’s position on the matter. It appears that current levels of regulation are considered appropriate by LDV readers, although admittedly there wasn’t a specific question relating to minimum alcohol pricing – it would be interesting to determine readers’ response to the current proposals (as advocated here by Ewan Hoyle), the Scottish minimum price policy that’s imminent, and the kind of proposals put forward by drugs expert Prof. David Nutt. […]


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