I will talk briefly about solutions, which is more where we come into the picture. Our expertise is in providing health care to people with mental health problems, and alcohol impacts greatly on these people. We see many people with alcohol related problems. It is important to point out that the introduction of public health measures is critical to reducing problem alcohol use. We welcome the publication of the alcohol Bill today, but it possibly does not go far enough. There are many proven international measures which reduce problem alcohol use. If we accept that Ireland as a society has a serious problem with alcohol, we need to look seriously at the introduction of such measures.
We have listed them in order of proven effectiveness, which may be surprising to people because it is not intuitive. Random alcohol breath testing is the most proven measure for reducing problem alcohol use, followed by lower blood-alcohol levels for drivers. Our blood-alcohol limit at 80 mg, together with that of UK, Cyprus and another country, is the highest in Europe. The blood-alcohol limit in other member states has been reduced to 50 mg. We would be very supportive of a reduction in the limit that applies here. Strong arguments from publicans and others have been put forward to the effect that reducing the limit might affect the fabric of society because people would not be able to go to the local pub and have a drink. In truth, there is no reason somebody cannot drive, if they need to, or otherwise make their way to a pub, have one or two drinks, spend a few hours and go home. There is a strong lobby to encourage people to drink much more than that and that is problematic.
Reducing the availability of alcohol is also a key measure. Some measures towards that have been published today in terms of off-licence hours being reduced and supermarkets and garages being required to have alcohol in a separate area to ensure there can be more regulation as to who buys it. These places are selling alcohol in a way that it can be bought by under-age drinkers. There is inadequate enforcement of the law in that respect. Increasing taxation on alcohol is a well proven measure which reduces alcohol use. We have to be aware that alcohol is currently at its most affordable level ever because of increased income and the fact that, relatively, prices have not increased.
Advertising and promotion restrictions constitute a difficult topic. We have extremely lax advertising regulations on alcohol in this society. In France, for example, one cannot advertise alcoholic products on television. One can only advertise them in the written media by showing a picture of the bottle. One cannot show a glamorous model drinking. Even though people consume alcohol a lot in French society, they do not have the same degree of alcohol-related problems that we have. A statutory code of practice on alcohol advertising is essential.
At the bottom of the list, but also very important, is education. There is not as much proof of its effectiveness but it is clearly important to educate young people about alcohol-related problems. As regards developing alternatives, it is also important to provide young people with other things to do - alternatives to drinking high alcohol content beers and so on.
We have also included a slide about interventions that do not work. As regards the designated driver campaigns, our feeling is that the message going out is that if people have somebody with them who is going to stay sober, they can get completely trolleyed. I do not think that is helpful because it conveys the message that a person does not have to take any responsibility for their own state of sobriety if someone is going to drive them home. I do not think that is an effective public health measure.
Advertising self-regulation has not been effective. On the one hand we have industry ads on the radio saying "Drink sensibly", while at the same time the same industry is promoting crates of beer at all-time low prices in every available outlet. It does not make sense. The industry should be made to be more responsible as regards promotion and advertising.
I will now move on to how one can treat alcohol problems and how we have traditionally done it in this country. It has traditionally been very poorly organised - a hotchpotch of voluntary organisations such as Alcoholics Anonymous, Sr. Consilio's organisation in various parts of the country, hospitals such as the St. John of God Hospital and St. Patrick's Hospital, which offer alcohol programmes for people with private health insurance, and the Rutland Centre. For the vast majority of the population there have been psychiatric hospitals. Traditionally a lot of people have gone into psychiatric hospitals with alcohol problems. It is Government policy but it does not make sense. In our experience, admitting somebody with an alcohol problem to a ward environment where, in the main, people are being treated for conditions like schizophrenia and bipolar disorder, does not address their problem. The Vision for Change document, which is Government policy, makes clear that alcohol problems will no longer fall within the remit of mental health services, except where there are co-morbid mental health problems such as depression or anxiety disorders. We need to recognise it is a wider problem than that.
It is important to identify the problem and address it earlier, before it gets to the point where people are admitted to psychiatric hospitals. Hence, services need to be organised so that they allow for the problem to be recognised and addressed earlier. Public awareness is a key point - awareness of what problem drinking is. It is not the severe alcohol dependency that we have traditionally recognised as problem drinking. If somebody is coming in on Monday morning boasting about having had 14 pints the night before, falling over and not being able to find their bedroom, that is not something one should be boasting about in Irish society, but at the moment it is.
We should be training professionals to recognise and manage the problem. When I say professionals, I am talking about everybody - teachers, prison officers, employers - anybody in any walk of life who has contact with people so they can recognise the problem early and be able to go some way towards addressing it.
Screening is important. A study has been published by colleagues of ours, John Sheehan and Ronan Hearne, which examined how often alcohol problems were picked up in an accident and emergency departments. We know that about half the cases in accident and emergency departments, particularly at the weekends, are alcohol-related, but less than a third of them, 30%, were picked up by doctors. Only a small proportion were referred on for appropriate treatment. We are not picking the problems up, partly because everybody is working flat out, they are too stressed and do not have readily accessible services to refer to. If people do not think they have something they can do for somebody, there is a kind of nihilism about bothering to pick it up. Research has shown, however, that even telling somebody "You're drinking too much. Drink caused you to be here today. You should think about cutting back. Here is some information", has been proven to be effective in reducing a person's alcohol intake over the following six months. That has got to be done.
The next slide is a pyramid showing how alcohol services should be organised for people who are drinking at a hazardous or harmful level, by having easily accessible and available brief interventions, advice and counselling at primary care level. More extensive services should be available for severe alcohol-prelated problems up to and including residential services. At the moment there is no real organisation at primary care level for alcohol-related problems.
We want to get to these problems early in a primary care setting. If we get them early there is much less impact on society and on the individual's subsequent health. We are trying to implement the primary care strategy at present by setting up primary care teams. Part of that strategy is to include addiction counsellors as part of those primary care teams. In the first instance, people presenting in all sorts of primary care settings need to have their alcohol problem identified. Primary care settings do not just include GPs, but also other areas where people might have their health problems identified. Accident and emergency services are probably the biggest area in which we are not addressing this problem. In units all around the city and country, people are presenting night after night having had all sorts of alcohol-related problems, including fights and falls. Such people are stitched up and sent home, yet nobody is asking "Are you going to do something about your drinking?" That is partly because people do not recognise it as being within their accident and emergency remit. It is important, however, to have professionals working in accident and emergency units who can deliver simple advice and information.
Following studies in London, they developed a test called the Paddington alcohol test. It takes one minute. Somebody presenting in certain situations is essentially asked two questions and gets a leaflet with information. Even that reduces drinking.
It is important to put the resources into accident and emergency departments to address alcohol-related issues when they arise. Very often that is the only opportunity we will get before that person is much more severely dependent on alcohol.
There are other areas where people might have particular needs. People in prison should have their addictions, including alcohol, attended to. Alcohol tends not to be considered as much a problem as perhaps heroin in prisons but often people going to prison have very severe alcohol problems. It is important the homelessness services have the resources to address alcohol-related problems. Perhaps there should be particular services for groups such as Travellers and asylum seekers which might not find it easy to access primary care health facilities. The specialist settings, such as mental health services like ours, general hospitals and drug treatment services, all need to address alcohol problems as part of what they do because there is a huge overlap.
Different treatment is required for different types of drinking. People who hazardously drink, that is, perhaps having 14 pints every Friday and Saturday night, need brief advice telling them they are drinking too much. Even that can help them to reduce the amount they consume. Counselling is required for people who engage in harmful drinking. Harmful drinking means not only harming one's physical or mental health but also harming one's family and society in terms of crime. Dependent drinkers, who are very physically dependent on alcohol, need a more comprehensive package which includes the availability of detoxification with medication such as Librium and specialised addiction counselling up to and including residential care.
Residential treatment is really only available in the private and voluntary sectors at present. It is not necessary in most cases. Most cases can be dealt with on an outpatient, community basis. There is as good an outcome if somebody can address his or her problem on an outpatient community basis as there is if he or she is in an inpatient setting, even though traditionally we think that somebody addresses his or her alcohol problem by going into hospital and getting dried out. Very often that only results in a person being dried out in order to leave and do the same thing again. It feeds into a dysfunctional cycle and the person does not actually address the problem.
I refer to the steps to be taken to address this. The public health measures are the critical way forward. The strategic task force on alcohol made all these recommendations which need to be implemented, as they are all sensible. In the primary care and other health care settings I mentioned, there should be screening, brief advice and education from professionals whose job it is to address alcohol problems and access to more specialised addiction counselling and detoxification, as required.
The last slide I have states: "Time for action, no more reports." It suggests there is a need for an office that involves everybody along the lines of the Office for Tobacco Control, to deal with alcohol. Many Departments have an interest in alcohol, including the Departments of Justice, Equality and Law Reform, Finance, Education and Science, Health and Children, Community, Rural and Gaeltacht Affairs, Social and Family Affairs and Transport. With so many Departments with an interest in one area, perhaps there is a need for a joined up task force. We came up with a slightly tongue-in-cheek acronym - bureau for alcohol regulation - but perhaps we can come up with a better one than BAR. The strategic task force's recommendations should be implemented.
