4. Purpose and intended effect
4.1. In June 2008, the Scottish Government issued the consultation paper Changing Scotland’s relationship with alcohol: a discussion paper on our strategic approach  , which set out the scale of the alcohol misuse problem in Scotland, the Scottish Government’s approach to tackling it and a range of proposals aimed at reducing alcohol-related harm, drawing on the best available international evidence. Responses to this consultation are available on the Scottish Government’s website  .
4.2. The Scottish Government published its response Changing Scotland’s Relationship with Alcohol: A Framework for Action  on 2 March 2009. This identified that sustained action was required in four areas:
- reduced alcohol consumption;
- support for families and communities;
- positive public attitudes towards alcohol and individuals better placed to make positive choices about the role of alcohol in their lives; and
- improved support and treatment.
4.3. Scotland’s alcohol strategy sets out over 40 actions aimed at addressing alcohol-related harm, with minimum pricing a key component of that approach. The actions set out in the Framework reflect the need for a whole population approach to tackling alcohol misuse – an approach which recognises that, as a country, we need to drink less, as well as to drink more responsibly. Scotland’s alcohol strategy is closely aligned with the World Health Organization’s ( WHO) Global Strategy to reduce harmful use of alcohol  , and also WHO’s approach of placing affordability alongside availability and attractiveness as the three key areas for effective prevention. Affordability focuses on pricing measures, including minimum pricing.
4.4. Considerable progress has been made on implementing key aspects of the Alcohol Framework, including:
4.5. Investment of £689 million since 2008 in tackling alcohol and drug misuse, with the bulk of this funding (£628 million) going directly to NHS Health Boards for use in line with local priorities identified by Alcohol and Drug Partnerships ( ADPs). ADPs were established in 2009, and bring together local partners which include health boards, local authorities, police and voluntary agencies. They are responsible for developing local strategies and commissioning services which meet the needs of local people.
4.6. The commencement of the Alcohol etc. (Scotland) Act 2010  in October 2011 contained measures such as banning quantity discounts and restricting alcohol promotions in off-sales premises. The quantity discount ban stops off-trade retailers discounting alcohol based on the volume of alcohol sold, such as ‘buy one, get one free’; ‘three for the price of two’; ‘three bottles of wine for £10’; and ‘buy six, get 20% off’, and has been associated with a 2.6% reduction in consumption  . A similar ban on promotions in the on-trade was introduced through the Licensing (Scotland) Act 2005.
4.7. NHS Scotland has delivered over 753,000 alcohol brief interventions ( ABIs) to individuals who are drinking at a level that is endangering their health, to help them cut down.
4.8. Refreshed advice for parents and carers  was published in January 2011. This provides information and supports parents and carers to talk to young people about the effects of alcohol consumption. It also encourages adults to reflect on their own consumption.
4.9. Improved substance misuse education in schools through Curriculum for Excellence. Good practice guidance has been developed for practitioners and commissioners, based on a literature review taken from international evidence on the prevention of drug and alcohol misuse ‘ What works in drug education and prevention’ (Scottish Government, 2016)  . We are now aligning the interventions we directly support with this evidence, and good practice guidance will provide valuable advice on evidence-based approaches to drug and alcohol education and prevention.
4.10. Working with industry partners on joint initiatives to promote responsible drinking, such as increasing the availability of 125ml wine measures in the on-trade, and encouragement of safer drinking environments through initiatives such as Best Bar None.
4.11. Since 2008, committed £92 million to CashBack and other community initiatives, funding community activities and facilities largely for young people. This has delivered nearly two million free, positive and healthy opportunities and activities for young people. Projects range from diversionary work to more long-term potentially life-changing intervention projects, which aim to turn an individual’s life around and provide the opportunity of a positive destination such as employment, education or volunteering. CashBack helps to build better, safer, healthier communities, improving facilities, running projects that would not have existed otherwise and giving our young people something positive, purposeful and constructive to do. In addition, our CashBack partner Scottish Sports Futures deliver Jump2It – taking health and wellbeing messages into primary schools covering areas such as alcohol awareness, knife crime, bullying, etc. The programme is supported by inspirational sporting role models who will help to communicate the key messages to 10,500 young people over a three-year period. Action for Children deliver CashBack Positive Choices Plus, which provides intensive 1:1 mentoring and group work to those young people furthest from the work force. The programme includes themed sessions and guest speakers focusing on topics such as relationships, alcohol and managing money.
4.12. Worked to improve the early identification and assessment of children affected by parental substance misuse issues ( CAPSM). We published Getting our Priorities Right  , which provides a best-practice framework for all child and adult service practitioners working with vulnerable children and families affected by problematic parental alcohol and/or drug use. In addition, we are currently undertaking a Child Protection Improvement Programme.
4.13. Increased awareness of, and improved diagnosis and support for, Fetal Alcohol Spectrum Disorder ( FASD) which is the leading known preventable cause of permanent learning disability worldwide and is caused by maternal use of alcohol during pregnancy.
4.14. Reduced the drink driving limit from December 2014 to 50mg of alcohol per 100ml of blood (it was previously 80mg, and remains so in the rest of the UK), with equivalent changes to the limits for alcohol in breath or urine, bringing Scotland into line with the majority of other European countries.
4.15. Tackling alcohol-related violence through initiatives such as the Mentors in Violence Prevention programme and Medics Against Violence.
4.16. The final report and recommendations ( Quality Alcohol Treatment and Support  ) from the Scottish Ministerial Advisory Committee on Alcohol Problems ( SMACAP) Essential Services Working Group were published in March 2011. This led to the development and publication of The Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services  to ensure anyone looking to address their alcohol or drug use receives high-quality treatment and support that assists long-term, sustained recovery and keeps them safe from harm. The Principles are central to implementation of our Quality Improvement Framework for drug and alcohol treatment and recovery services. In 2016, we commissioned the Care Inspectorate to undertake a programme of work to provide an evidence-informed assessment of local implementation, measurement and quality assurance of ADP and service compliance with the Principles. The Care Inspectorate has now finalised publication of their national report in relation to a programme of supported self-assessment. The supported self-validation has provided a national picture of how the Quality Principles are being implemented, provided detail on the extent to which service-users’ own voices are incorporated into service design, delivery and evaluation, and worked to strengthen a culture of continuous improvement and quality assurance, ultimately improving the experience and outcomes for people towards achieving their own recovery journey. The Care Inspectorate report noted that the majority of ADPs are actively embracing and working towards implementing the Quality principles, though this was variable across the country. It also identified a positive shift towards a recovery philosophy. The Partnership Action on Drugs in Scotland ( PADS) Quality and Consistency group is now moving this work forward by operationalizing the principles, developing the workforce and integrated service models of delivery.
4.17. Although not a specific commitment within the Alcohol Framework, the HEAT  (A11) drug treatment waiting times target was expanded to incorporate alcohol in 2011, and this has evolved to become the present NHS Local Delivery Plan Standard  , one of a set of performance standards agreed by the Scottish Government and the NHS. Performance on alcohol treatment waiting times has consistently exceeded the national standard of providing treatment within three weeks for 90% of individuals.
4.18. The Scottish Government commissioned a monitoring and evaluation programme of the Alcohol Framework, which was independently undertaken by NHS Health Scotland  . It consisted of several independent assessments from the Monitoring and Evaluating Scotland’s Alcohol Strategy ( MESAS) programme with the final report being published in March 2016  . The report demonstrates the successes of the Framework and makes recommendations for future improvements. In addition, the Alliance for Useful Evidence Four Nations Report, published November 2015  , compares alcohol policies across the UK and shows that Scotland has the strongest approach to evidence-based policies in the UK.
4.19. A refreshed Alcohol Framework will be published in 2018. It will build on the progress already made and retain the focus on evidence-based policies. The four key themes will remain: 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; and improved support and treatment.
4.20. These measures are not being taken in isolation. We recognise the need to tackle the underlying causes of poor health and social disadvantage in Scotland, and as such our alcohol strategy is aligned with initiatives across the health, young people, education, justice and economy policy portfolios. The outcomes we seek will only be delivered through close partnership working – including the NHS, Police Scotland, local ADPs, the voluntary sector and the alcohol industry.