A NEW APPROACH: A STRATEGIC FRAMEWORK TO TACKLE ALCOHOL MISUSE
30. We want Scotland to be a place where alcohol is enjoyed responsibly and where all the people of Scotland contribute effectively and realise their potential as individuals, families, communities and as a country. We are clear that the scale and extent of alcohol misuse in Scotland requires a concerted, effective and proportionate response from Government and from our partners to tackle it.
31. Previous interventions have tended to target particular groups, such as those with alcohol dependency or young people, and over-relied on the promotion of general health information and education campaigns. The World Health Organisation ( WHO) has stated that alcohol interventions targeted at vulnerable populations can prevent alcohol-related harm, but that policies targeted at the population as a whole can have a protective effect on vulnerable populations and reduce the overall level of alcohol problems. Action on a wider scale, both population-based and targeted to particular groups, is now required. A new approach is needed to rebalance Scotland's relationship with alcohol and the question is not whether to act, but how extensive our actions should be.
32. There is no single, simple solution. An effective alcohol policy is one that encompasses a range of interventions (including regulatory measures, support and treatment interventions and changes in culture and attitudes) delivered via a comprehensive strategy aimed at the whole population with particular targeting for high-risk groups. Where possible, we have drawn on the international evidence base to identify those measures which offer the greatest chance of success. For example, a WHO review of 32 alcohol strategies and interventions found that the most effective alcohol policies include alcohol control policies, drink-driving countermeasures and brief interventions for harmful and hazardous drinkers. For other measures, such as education in schools, public service announcements and voluntary regulation by the alcohol industry, it was difficult to find a direct positive effect on drinking patterns or problems and therefore, they recommend that these measures feature only as part of a more comprehensive strategy. 35
33. Where we know there is significant risk of harm and we are clear about what we are trying to achieve, we should adopt a precautionary approach and act. By carefully monitoring and evaluating the effectiveness of our interventions in reducing alcohol-related harm, not only for their overall impact but also for their potentially differential effects on different groups in society, we can adjust them as necessary over time. We know, for example, that there is general evidence that regulatory, structural or fiscal interventions at the level of a whole population (such as smoking bans, drink drive legislation, increasing price of alcohol) can have a greater impact on reducing health inequalities than information-based approaches. 36
34. Based on our knowledge and understanding of alcohol misuse, its drivers in Scotland and of the interventions which are likely to be effective, this Government considers that sustained action is required in four areas:
- reduced alcohol consumption;
- supporting families and communities;
- positive public attitudes towards alcohol and individuals better placed to make positive choices about the role of alcohol in their lives;
- improved support and treatment.
Within our 'Framework for Action', starting on page 16, we outline proposed measures under each of these headings.
Wider Government Contribution
35. These measures will not be taken in isolation. Action is already underway which will contribute more widely towards tackling both the underlying causes of, and the negative effects resulting from, Scotland's complex relationship with alcohol. The Government Economic Strategy ( GES) sets ambitious targets for increasing sustainable growth and recognises that improving health and well-being are critical to achieving this. Beyond this, we recognise the importance of early intervention as the key to achieving a range of social policy objectives. As a result, we recently published a joint policy statement, with COSLA, on 'Early Years and Early Intervention', 37 focussing on support for families and young people, while the Ministerial Taskforce on Health Inequalities report 38 identifies action to tackle the underlying causes of inequality. Our recent discussion paper on tackling poverty, inequality and deprivation also strengthens this approach. 39
36. We are currently reviewing the national antisocial behaviour strategy to identify where it can be strengthened and improved and to enable stronger community involvement. The review will consider the use, effectiveness and range of existing measures available to local agencies to tackle antisocial behaviour. The findings of the review will be reported to Parliament by the end of 2008. Also, given the clear links between the causes and consequences of drug and alcohol consumption, our recently published drugs strategy 40, with a renewed emphasis on recovery, also forms part of the wider picture.
37. We are determined to provide the necessary leadership, but we cannot deliver the long-term sustainable change required alone. It is essential that we work in partnership with a wide range of other bodies and groups such as local government, NHS Scotland, the police, the third sector and the alcohol industry. Only by doing so can we change Scotland's relationship with alcohol for good and ensure that we use our resources effectively to address the problems we are facing today.
38. Of particular importance is our new relationship with local government, following the agreement of the concordat in November 2007, which includes an agreement to work together to develop policy. We recognise the crucial part they play in delivery given their responsibility for providing services to those affected by alcohol misuse, for ensuring community safety and for education.
39. NHS Scotland has a unique role in intervening early with those who are at increased risk of developing health problems as a result of alcohol misuse, or supporting and treating those who are already experiencing such problems, whether through GPs or through hospital-based services. Third sector organisations are also key in providing prevention and support services.
40. Alcohol and Drug Action Teams ( ADATs) bring together the key partners, including local authorities, NHS Boards and police, in a given geographical area. They have a pivotal role in identifying local priorities in relation to alcohol and drugs and in providing strategic co-ordination of prevention and treatment activity at a local level. As part of the on-going ADAT delivery reform process we would expect ADATs and their members to build stronger links with community planning partnerships, ensuring better coordination of wider issues relating to alcohol.
41. For most (if not all) local authorities, police and fire and rescue services, working together as a community safety partnership, misuse of alcohol has been a constant factor. The issue of alcohol-related disorder whether in city centres or elsewhere particularly at busy periods has always attracted considerable planning and resources as local partnerships attempt to manage and contain any associated violence and disorder. A key link here is to licensing boards which have responsibility for implementing the Licensing (Scotland) Act 2005.
42. The alcohol industry is key in shaping the market and public perceptions of alcohol. The Scottish Government and Alcohol Industry Partnership ( SGAIP) has already worked on a number of successful initiatives around promoting responsible drinking and we look forward to working with the Partnership, and other stakeholders, in taking forward the proposals contained within this document.
Measurement Of Success
43. While our approach is based on the best available national and international evidence of the effectiveness of harm reduction interventions, it is crucial that we evaluate and review how and to what extent we are achieving our desired outcomes. NHS Health Scotland and the Scottish Government, working closely with the Alcohol Evidence Group ( AEG), will develop a comprehensive monitoring and evaluation framework to measure how the actions we put in place today contribute to reducing Scotland's alcohol misuse problems tomorrow. Where gaps in our knowledge exist, it will be the role of the AEG to consider how these gaps can be bridged. The group oversaw the publication of the Scottish Alcohol Research Framework in July 2007, and continue to monitor the progress of key research projects set out in it and to identify priority areas for new research. Annex D sets out a number of key alcohol-related indicators which we believe will help us to evaluate our performance.