Getting away ‘Scot-free’ from alcoholism

Edinburgh, Scotland – Scotland has become the first place in Europe to prescribe a new drug that reduces cravings for alcohol.

Earlier this month, the Scottish Medicines Consortium, a body that approves drugs for use in the National Health Service, gave the go-ahead for doctors in Scotland to prescribe nalmefene, a drug made by Danish firm Lundbeck and designed to diminish the “buzz” drinkers get from alcohol.

Nalmefene will be targeted at people who are heavy drinkers, but not the most severely dependent alcoholics. The drug works by blocking reward centres in the brain that encourage drinkers to jaz drinking

In trials, men who normally drank eight units of alcohol a day and women who drank six a day halved their consumption over a six-month period when they took the drug.

The decision to prescribe nalmefene free of charge by the National Health Service reflects a growing concern about Scottish drinking habits and their effects on social and economic well-being.

Scotland has one of the highest levels of alcohol consumption in the world. Among Scottish men, the alcohol-related death rate is twice that of the rest of the UK. Drinking costs the economy an estimated £3.6bn ($5.75bn) in everything from lost productivity to increased spending on health care and criminal justice.

‘It causes so much damage’

“We have a massive problem with drinking,” says Gillian Bell, spokesperson for Alcohol Focus Scotland. “We accept excessive drinking as the norm, but we shouldn’t because it causes so much damage. Alcohol does not just affect the person who is drinking, it affects society as a whole.”

[Nalmefene] represents a new option for treating some people with alcohol dependence by helping them to cut down their drinking.

– Jonathan Chick, consultant psychiatrist at Queen Margaret University Hospital

The devolved Scottish government, which has responsibility for the country’s health policy, hopes that nalmefene will help to tackle alcohol abuse. The decision to prescribe nalmefene, which is taken as a tablet before drinking, has been widely welcomed by Scotland’s medical community.

“I am pleased that Scottish patients will have access to nalmefene, which represents a new option for treating some people with alcohol dependence by helping them to cut down their drinking when they may not be ready, or have no medical need, to give up alcohol altogether,” said Jonathan Chick, a consultant psychiatrist at Queen Margaret University Hospital in Edinburgh.

Peter Rice, the chairman of Scottish Health Action on Alcohol Problems (SHAAP) and a former chairman of the Royal College of Psychiatrists in Scotland, told Al Jazeera he believes the drug will be “a useful addition to the options we have to offer patients”.

Scotland was the first place to introduce routine screenings for alcohol abuse. Now all patients must complete a form about their drinking habits. The programme has allowed doctors to identify a quarter of a million problem drinkers over the last four years, in a region with just over five million people.

Rice said the success of nalmefene will depend on whether doctors use it alongside psychological and personal care. “The evidence base and effectiveness of the brief intervention is better-established than it is for the medication. The medication needs to be seen as working in conjunction with the intervention, the simple advice from the doctor. I would expect that it won’t be just doctors reaching for their prescription pad,” Rice said.

‘The wrong approach’

Drinkers in Glasgow, Scotland’s largest city, were less optimistic about the drug’s potential. “It’s the wrong approach. If someone is an alcoholic, surely the thing to do is to is to make them stop, not encourage them to drink less,” said Josephine, one of a handful of afternoon drinkers in the Vale, a bar near Glasgow’s Queen Street train station.

A chef in a city centre restaurant, Josephine said drinking is a way of life for many, particularly in the hospitality sector. “Everything revolves around alcohol. Staff night’s out, you are brought to the pub. At Christmas you don’t get a cash bonus, you get £20 ($32) in drinks tokens.”

Her friend Maria noted that Scotland’s drinking culture is “very different” from that in her native Canada. “People back home will maybe plan once a month to go out drinking. Here it is every weekend.”

William Smith, who has run the Vale for almost 20 years, said medication to prevent people from drinking too much is “pointless”. “This isn’t the answer. If people want to drink, they’ll drink. They’ll get up in the morning and say ‘I’ll drink’ or ‘I’ll not drink’.”

Instead, Smith believes the Scottish government should be focusing on the problem of young drinkers. “That is where I would be starting … Nobody is going to give [nalmefene] to a 12-year-old in a [housing] scheme in Glasgow. It seems to be me that this thing is aimed at the wrong people.”

Minimum prices

While alcohol consumed in pubs and clubs has fallen by 34 percent in Scotland since 1994, the amount of alcohol bought to drink at home rose by 45 percent over the same period. In an effort to stem the flow of cheap booze, the Scottish government last year passed legislation introducing a minimum price of 50 pence per 10 millilitres of alcohol.

But the measure has yet to be implemented, following a court challenge launched by the Scotch Whisky Association and two other trade bodies, spiritsEUROPE and the Comité Européen des Entreprises Vins, which represent European spirits and wine producers.

Minimum prices are “the most important thing” to reduce drinking in Scotland, argued Rice. “If we don’t have price controls and we got back to the alcohol price wars of three or four years ago, that would undo a lot of the good work done in interventions and other areas.”

The effects of alcohol abuse are all too evident in Scotland, from the street drinkers to the over-zealous revellers in city centres on weekends. Alcohol branding is ubiquitous, too, appearing on everything from the shirts of popular football teams to the names of summer music festivals.

“Drinking is accepted as part of everyday life,” said Bell, the Alcohol Focus Scotland spokesperson. “But the alcohol industry are very good at making it feel like part of everyday life.”

This piece originally appeared on Al-Jazeera


Calling Time on Arthur’s Day

There’s a growing backlash over an event dreamed up by the ad men to celebrate Guinness that could see its focus move from drink to the arts, writes Peter Geoghegan.

A couple of years ago I went to Galway for a wedding. I arrived on a wet Thursday night with the wind whipping off the Atlantic Ocean, but it seemed the entire city was out on the town, swaying in the streets or bulging out of the myriad pubs. Even by the less than abstemious standards of “the City of the Tribes”, this was a big night.

I’d no idea what the party was for. “Have Galway won the All-Ireland?” I asked, somewhat tongue in cheek, at the reception in my hotel. “No, it’s Arthur’s Day.” I was handed a leaflet featuring a picture of a pint of Guinness, a slogan about celebrating “great people who make things happen” and the logo of Diageo, the international drinks giant that now owns Guinness.

Arthur’s Day, basically a marketing gimmick to mark 250 years since the first pint of Guinness was brewed in Dublin, is now in its fifth year. Yesterday at 17:59 – the year of the company’s establishment – people raised pints of Guinness in pubs in over 40 countries around the world, including Jamaica, Malaysia and, of course, Ireland. As part of the event, Diageo paid for secret free gigs at around 500 venues across Ireland by a host of international and national groups, including Biffy Clyro and the Manic Street Preachers.

Arthur’s Day has provided something of a fillip for hard-pushed Irish publicans – despite the national stereotypes, pubs in Ireland are closing in record numbers in the face of the massive downturn in the country’s economic fortunes – but the backlash has been building, especially this year. And Ireland’s writers, singers and artists have been in the vanguard of the anti-Arthur’s Day brigade.

“Has there ever been a scam like Arthur’s Day,” columnist Eamon McCann wrote in the Belfast Telegraph recently, “as contemptuous of the people it targets, as disrespectful of the culture and especially of the music it misuses to make its play, as depressing in the extent to which the people made fools of simper with pleasure and cry out for more?”

Actor Gabriel Byrne was, if anything, even less sympathetic to the marketing men’s cause. “The idea that people go out and get absolutely pissed on a day that’s made up by marketing guys – that’s a cynical exercise in exploitation in a country that has a huge problem with binge drinking,” said the Usual Suspects star.

This year, Arthur’s Day seems to have hit a nerve with a country jaded with ad men and increasingly aware of its own alcohol excesses.

Government statistics show that Irish households last year spent 7.7 per cent of their money, or €6.3 billion, on booze. That’s double what is spent on clothing and more than €2,100 per adult.

Ireland tops the European league table in terms of binge drinking, according to a 2010 Eurobarometer survey. The study found 44 per cent of Irish people said they had consumed five or more drinks in a single sitting over the previous 12 months. The EU average is 29 per cent.

Arthur’s Day has quickly become the apotheosis of Irish binge drinking. An even-boozier version of St Patrick’s Day – if such a thing can be imagined. Statistics suggest alcohol-related ambulance call-outs increase 30 per cent on Arthur’s Day. No wonder, then, that a boycott was called for by Irish medical professionals. “Alcohol is more affordable than ever. Alcohol is more acceptable than ever. Alcohol is more available than ever. We need measures to address this epidemic. Where does Arthur’s Day fit into all of this?” said Dr Stephen Stewart, director of the Centre for Liver Disease at the Mater Hospital in Dublin. Cirrhosis of the liver is reaching epidemic proportions across Ireland, particularly among younger people.

Alex White, Ireland’s deputy health minister, recently described Arthur’s Day as a “pseudo-national event”. The Irish public would seem to agree. A poll on a leading Irish radio show found 74 per cent of listeners opposed to the day. “They shouldn’t call it Arthur’s Day. They should call it Vomit Day,” Aisling Fitzsimons told reporters.

Fitzsimons, a 50-year-old manager of a convenience store, said she regularly had to hose down the footpath outside her business after alcohol-fuelled weekend excess. Hungover workers cost Ireland €3.7bn annually.

Among the loudest voices against Arthur’s Day has been singer-songwriter Christy Moore. In a scathing song – released yesterday – he dubbed it an “alcoholiday”.

“Diageo Diageo have mounted a Crusade/ Creating Arthur’s Day they’ve suckered us into their charade/ Start ‘em off on alco-pops tastes just like lemonade/ Get ‘em into the hit while they’re young and none the wiser,” he sings on Arthur’s Day.

Diageo, however, has maintained that Arthur’s Day is all about promoting the arts. “Ultimately, it’s about bringing pints of Guinness, music and the pub together,” said Peter O’Brien, corporate relations director at Diageo, western Europe.

“I think that’s a very unique festival. Christy Moore is entitled to write a song, and that’s fine. I completely disagree with him and I’m fairly certain that the thousand of musicians who are playing and enjoying themselves, and getting good employment on Thursday, would likewise disagree with him.”

In the face of continued cutbacks to the arts budget, Diageo, through its Guinness brand, has begun to play an ever-increasing role in funding the Irish creative scene. As well as the singers and musicians paid for during Arthur’s Day, a scheme called the Arthur Guinness Projects provides money for artists. But in stepping into the funding hole left by the Irish state, Diageo has also created a wonderful marketing opportunity for themselves – and sparked question marks over the commitment of the government in Dublin to tackle Ireland’s drinking problem.

The Irish Cabinet is still considering whether to follow Scotland in imposing minimum pricing on alcohol. Restrictions on advertising and event sponsorship have all been mooted, but for now the iconic Guinness logo still adorns everything from sports jerseys to advertising hoardings.

Diageo responded to some of the criticism it received this year by saying that it would pay for an additional police presence on the streets for last night’s Arthur’s Day celebrations. But the long-term future of Ireland’s new “pseudo-national event” is unclear. The company says that it is keeping an open mind on changing Arthur’s Day next year to focus less on pubs and pints, and more on the arts, but also insists that nobody is being forced to drink when watching musical performances.

But this year’s backlash against Arthur’s Day suggests a growing disquiet among many about the relationship between Ireland, its national drink and its drinking culture.

The Guinness Storehouse in Dublin is the country’s most popular tourist attraction. The iconic image of Barack Obama’s visit to Ireland was the president supping “the black stuff”. Even the Queen and Prince Philip watched a pint settle (though neither drank it).

A Diageo spokesperson might have unwittingly stumbled on the cause of his company’s Arthur’s Day woes when he said that Irish society had “started to question our relationship with everything: the [Catholic] church, big business, politicians. And we’re questioning our relationship with alcohol”. About time, too.

This column originally appeared in the Scotsman September 26, 2013.