Behind The Medical Headlines

Alcohol and its problems - Scotland's Licensing Bill

• Dr EB Ritson, Consultant Psychiatrist and Vice President Medical Council, Edinburgh, Scotland

Summary

Concern about alcohol abuse and it adverse health effects on health, the family and society has increased in Scotland in recent years following an increase in alcohol-related ill health and disorder. In response to this situation a new Licensing Bill has been introduced. In this article Dr Bruce Ritson reviews Scotland’s record on alcohol and the aims of the new Licensing Bill.

Declaration of interests: No conflict of interests declared

Humans have long sought relaxation, pleasure, relief from stress, and escape from misery in psychotropic drugs. Public concern tends to focus on the drama of street drugs such as heroin, cocaine and marijuana, while pressure groups have focussed on, and increasingly curtailed the use of, nicotine, at least in the Western world. Alcohol, by contrast, is widely used and widely misused, and an affluent UK population wants easier access to it. Simultaneously, there is increasing concern in the UK about levels of alcohol consumption and the damage that is causing.¹ A Bill before the Scottish Parliament aims to square the circle of easier use while limiting abuse, and the background to this Bill should be of general interest.

The new Licensing Bill

The Licensing Bill² currently before the Scottish Parliament arose from the recommendations of the Nicholson Committee (2003).³ Contrary to some reports, the Bill does not recommend 24-hour opening of public houses – indeed it specifically states that there should be ‘a presumption against it’, but it does open the door to longer hours and it is likely that alcohol will become increasingly available.

Licences

The proposal is for two forms of licences: one for premises where alcohol is sold and the other for the licensees who operate the premises. The rules will encompass off-sales (shops) as well as on-sales (public houses). Those wanting licences for premises will have to declare their intention concerning the size and character of their premises, staffing and their hours of opening, and these have to be agreed by the Licensing Board. These Agreements will have to conform to Licensing Boards’ policies and accord with guidelines set out in the Bill, these being that licensing should be mindful of the need to prevent crime and disorder, promote public safety and public health, and protect children from harm.

Regulation

Inspectors (Liquor Licensing Standards Officers) will monitor compliance in individual premises. Licences may be revoked if the principles are ignored. In extreme cases, this could lead to immediate closure of the premises. The proposed legislation contains checks and balances designed to promote the social use of alcohol and curtail disruptive drinking and drunkenness, for instance by banning irresponsible promotions such as ‘happy hours’ and strengthening the complaints procedure for the local community and other interest groups. Licensing Forums will advise and challenge the Board on local concerns. A national Licensing Forum is also envisaged which will oversee and review progress and national guidelines. Doctors should ensure that health interests are represented at all levels.

Past experience; future hope

No society permitting the use of alcohol has yet managed to regulate alcohol use in such a way as to maximise the freedom of the individual to drink while limiting the ill-effects of alcohol abuse. The sale of alcohol in public houses (pubs) in the UK is regulated by Licensing Laws, and the Scottish Parliament now regulates alcohol sale in Scotland. The Licensing Bill currently before the Scottish Parliament is the first review of Scottish licensing since 1976 which came from the report of the committee chaired by Dr Christopher Clayson (former President of the Royal College of Physicians of Edinburgh who died, aged 100, earlier this year). The Clayson Committee sought to liberalise the opening hours of Scottish pubs, and through this sought to ‘change the character of Scottish pubs and reduce the pressure to drink’. It introduced ‘extensions’ to permitted opening hours for pubs, but did not envisage the extent to which this provision would become routine in many parts of Scotland.

Although many would agree that the character of Scottish pubs has changed, the hoped-for impact on the pattern of drinking has not occurred. Extended hours are more likely to be taken advantage of by those who are already heavy drinkers than utilised by tourists enjoying a late glass of wine after an evening concert. The new Licensing Bill currently before the Scottish Parliament seeks to liberalise further Scotland’s pub opening hours. However, will liberalising Scotland’s licensing laws increase an already worsening level of harmful drinking in the country? And will the new opportunity for longer opening hours be taken up by the drinks industry, and will this have serious health consequences?

Factors determining alcohol consumption

International evidence suggests that increased availability of alcohol is associated with increased consumption and increased harm of various kinds.⁴ Consumption in the UK has increased by 23% in the past ten years. Price in relation to disposable income is a major factor influencing consumption and there is evidence that a price rise has most impact on the heaviest drinkers rather than on those who drink moderately.⁵ Factors that increase availability include price in relation to disposable income (alcohol was 54% more affordable in 2003 than in 1998), number and accessibility of liquor outlets, hours of opening and enforcement policy in respect of licensing laws including underage purchasing. Recent trends in Scotland do not offer much comfort to those who see the new Licensing Bill as having a beneficial effect on drinking habits and the level of problems could well worsen.

Scotland’s record

Scotland’s health record in relation to alcohol is very disturbing.⁶ The cost to the Scottish Health Service of alcohol-related problems was £110·5 million in 2002/03. There has been a threefold rise in alcohol related deaths since 1980. Over that time, alcohol-related deaths have risen from less than 1 in 100 to 1 in 30 of all deaths in Scotland. People living in the most deprived areas were nearly four times more likely to die of an alcohol-related death than those in the least deprived areas. Between 1997/98 and 2003/04 admissions to hospital for alcoholic liver disease rose by 41%, and alcoholic-liver disease is now the main reason for referral for liver transplantation in Scotland.

The acute effects of intoxication are well known to the staff of Accident and Emergency (A&E) Departments; accidents, violence and the destructive consequences for the quality of family life and the health of children. One in eight violent incidents occurs in or around pubs and clubs.

Binge drinking is not a new phenomenon. In common with many other North European countries, this has been our style of drinking for hundreds of years. However there has been an alarming increase in binge drinking in recent decades, particularly amongst young people and women. Approximately two in five men and one in seven women in Scotland drink alcohol hazardously.

Turning to the youngest age groups, 67% of 13-year-old boys and 69% of 13-year-old girls report having drunk alcohol. The proportion of 15-year-old boys reporting drinking in the previous week rose from 30% in 1990 to 40% in 2004. Over the same time, the proportion of 15-year-old girls reporting drinking in the previous week rose from 25% to 46%. The majority of children who drank alcohol also reported having been drunk. Scotland has one of the worst records in Europe for binge drinking amongst 15 to 16 year olds.⁷

Could the new Bill work?

Once in force, the Act will provide opportunities that could reduce alcohol-related harm as well as the risks that go with increased availability. There are elements of the Bill that could be extremely positive, such as the introduction of server training, the curtailment of price cutting promotions (happy hours), and constraints on the over-provision of licensed premises. The medical profession has a responsibility to ensure that the balance favours health, and we must identify individual and public health consequences of alcohol misuse as early as possible and alert Licensing Forums to these trends.

References

1. Academy of Medical Sciences. Calling Time: the Nation’s Drinking as a Health Issue. London: Academy of Medical Sciences; 2004.
2. The Licensing Bill Scotland
3. The Nicolson Committee. Review of liquor licensing law Scotland. Edinburgh: Scottish Executive; 2003.
4. Babor T et al. Alcohol – No Ordinary Commodity. Oxford: WHO / Oxford University Press; 2003.
5. Kendell R, Ritson B, Roumanie M. Influence of an increase in excise duty on alcohol consumption and its adverse effects. BMJ 1983; 287:809–11.
6. ISD Scotland. Alcohol Statistics 2005.
7. Hibell B et al. The ESPAD Report: Alcohol and other Drug Use among Students in 35 European Countries. 2004.