Transcript Two successful approaches to substance

Alcohol Research UK Conference 12 March 2013
Keith Humphreys
Professor of Psychiatry, Stanford University School of Medicine
Visiting Professor of Psychiatry, King’s College London
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
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
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
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)
Domestic Violence and
Mandatory Sobriety
 Impact 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
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
Expanding Access to Alcohol
Treatment
 Well-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
UK Treatment Professionals UnderRefer to Recovery Groups
 Multiple 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)
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.
The Logic of Minimum Unit Pricing
 Heavy 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
Sheffield Group Modeling of Annual
Impact of a 50p MUP in England
2930 fewer deaths
92,200 fewer hospital admissions
274 million GBP lower spend
Source: Purshouse, R.C., Meier, P.S. et al. (2010). The Lancet, 375, 1355-1364
Direct Evidence from Canada
 British 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 province
Source: Zhao, J., Stockwell, T., et al., (2013). Addiction. DOI: 10/1111/add.12139
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
Summary
 Science 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