Déjà vu? Opportunities and obstacles in developing alcohol policy in English prisons

Under the new Alcohol Harm Reduction Strategy for England published by the Prime Minister's Strategy Unit in 2004, there has been an increasing focus on crime and public order issues and alcohol-related harm experienced by 'vulnerable' or 'at risk' groups. Prisoners have been identified as a vulnerable group who have high rates of dependence on alcohol and problems with alcohol-related offending. In late 2004, the Prison Service launched its first alcohol strategy. Based on an analysis of key policy documents, official enquiries and research, this paper explores how the 'problem' of alcohol can be defined within the prison setting and the issues it raises for both the individual prisoner and the institution. It examines the lack of policy and strategic direction prior to the publication of the new prison alcohol strategy and the possible reasons for the complacency around alcohol in prisons in contrast to illicit drugs. The paper critically assesses the new strategy in relation to the testing and treatment initiatives proposed and the lack of research and resources underpinning them. There is a real risk that the strategy will fail unless adequate resources are forthcoming to expand treatment provision. Given the neglect and complacency around alcohol, policy champions or policy entrepreneurs are needed to lobby for funding and keep the prison alcohol issue on the policy agenda.     

Producing the ‘problem’ of new psychoactive substances (NPS) in English prisons

BackgroundThere has been a significant change in the types of substances consumed within English prison settings in the last eight years. There have been particular concerns regarding the acceleration in the use and availability of New Psychoactive Substances (NPS), mainly synthetic cannabinoids. Although NPS were identified as a ‘problem’ in prisons in 2011, government responses emerged only in 2015. As yet, there is no overarching policy document or strategy for dealing with NPS. This paper analyses the various strands of the response to NPS in prisons published from January 2015 to December 2016.MethodsDrawing on Bacchi’s ‘What’s the problem represented to be’ framework, the ways in which the NPS ‘problem’ in prisons has been represented is analysed through a number of related policy texts including press releases, new legislative and regulatory measures, government documents and training package.ResultsFrom the various measures introduced to deal with the ‘problem’, NPS use is produced primarily as a law, order and control ‘problem’ requiring regulation, penalties and control, rather than a ‘demand problem’ calling for prevention, education, treatment and harm reduction or a ‘regime problem’ demanding greater emphasis and resources for purposeful activities such as education, training and work opportunities. This problematisation of drug use in prisons has a history dating back to the 1995 prison drug strategy and has become entrenched and reproduced within policy development over time.ConclusionThe law, order, and control problematization blames the volatility of the substances and the individual prisoners who use them as key factors contributing to the current prison crisis, rather than as consequences of the wider practices, cultures, contexts, and conditions. Multiple representations of the problem of NPS in prisons are needed in order to address the regime and structural issues which lead those imprisoned to use substances.     

Children's alcohol initiation: An analytic overview

Many parents support the ‘supervised introduction’ of alcohol to children. While initiation to regular alcohol consumption in early adolescence has been linked with alcohol-related problems in adult life, the findings from these studies cannot be extrapolated to early childhood. The definition of initiation to alcohol in early childhood is often not reliable and there is a dearth of research regarding the impact of the broader social and cultural context where initiation may occur. Whilst parents need to be supported to make decisions that are informed by ‘evidence’, policymakers need to be mindful of the role of ideology in policy development and the potential differences in risk factors for initiation to alcohol and the misuse of alcohol.     

Gender,intoxication and the developing brain: Problematisations of drinking among young adults in Australian alcohol policy

In this article, we draw on recent scholarly work in the poststructuralist analysis of policy to consider how policy itself functions as a key site in the constitution of alcohol ‘problems’, and the political implications of these problematisations. We do this by examining Australian alcohol policy as it relates to young adults (18–24 years old). Our critical analysis focuses on three national alcohol policies (1990, 2001 and 2006) and two Victorian state alcohol policies (2008 and 2013), which together span a 25-year period. We argue that Australian alcohol policies have conspicuously ignored young adult men, despite their ongoing over-representation in the statistical ‘evidence base’ on alcohol-related harm, while increasingly problematising alcohol consumption amongst other population subgroups. We also identify the development of a new problem representation in Australian alcohol policy, that of ‘intoxication’ as the leading cause of alcohol-related harm and rising hospital admissions, and argue that changes in the classification and diagnosis of intoxication may have contributed to its prioritisation and problematisation in alcohol policy at the expense of other forms of harm. Finally, we draw attention to how preliminary and inconclusive research on the purported association between binge drinking and brain development in those under 25 years old has been mobilised prematurely to support calls to increase the legal purchasing age from 18 to 21 years. Our critical analysis of the treatment of these three issues – gender, intoxication, and brain development – is intended to highlight the ways in which policy functions as a key site in the constitution of alcohol ‘problems’.     

Alcohol policy and harm reduction in Australia

With consultations having been held across Australia this year as part of the process of developing a new National Alcohol Strategy, it seemed timely to invite my colleagues from the National Drug Research Institute who are experts in the alcohol field to write this Harm Reduction Digest. The authors have canvassed a range of alcohol policy options and discussed their effectiveness in reducing harm for what is arguably Australia's number one drug problem. Australia's response to alcohol and other drug problems has, historically, been based on ‘harm minimization‐incorporating supply reduction, demand reduction and harm reduction’. At this time where the policy options for alcohol are being set for the next 5 years in a climate of ‘small government’, removing restrictions of ‘fair competition’ in business and a belief in the free market, what does the research have to say about recommended policies and strategies to reduce alcohol‐related harm?     

Punishing parents: Child removal in the context of drug use

New amendments to child welfare policy in New South Wales turn a spotlight on parents who use drugs and raise concerns about adequate provision of services for families facing issues with alcohol and other drug use. Sections of the new legislation are explicitly focused on parents who use illicit drugs, expanding the reach of child protection services over expectant parents during pregnancy. This targeting of women who are ‘addicted’ highlights the ambiguous scientific and moral attention to drug use in pregnancy. It also raises practical questions about the potential for the legislation to increase stigma towards drug use and disproportionately affect vulnerable and disadvantaged families. [Olsen A. Punishing parents: Child removal in the context of drug use. Drug Alcohol Rev 2015;34:27–30]     

Producing the vulnerable subject in English drug policy

The concept of vulnerability is now deeply embedded in English drug policy, influential in governing practices such as prevention and treatment activity but yet to be subject to critical scrutiny. In this article, we offer an appraisal of the vulnerability zeitgeist in contemporary drug policy, drawing upon insights from similar endeavours across a range of policy areas to consider the underlying assumptions and various effects of this conceptual logic. Using an approach to policy analysis which supports the questioning of deep-seated assumptions and implications of particular representations of ‘problems’ in social policies (often referred to as the ‘What’s the Problem?’ [WPR] approach, Bacchi & Goodwin, 2016), we analyse the 2017 Drug Strategy to facilitate a close perspective on the texture of governance in relation to people who use drugs in England. We explore how vulnerability and drug use are in Bacchi’s (2018; 6) terms ‘problematized’ and ‘made ‘real’’ as a specific kind of phenomenon, drawing attention to the presuppositions and potential effects of being labelled (or not) as vulnerable. We argue that alongside bolstering targeted support, the current problematisation of vulnerability in English drug policy supports the operation of subtle disciplinary mechanisms to regulate the behaviour of those deemed vulnerable, underplaying the role of material inequalities and social divisions in the unevenness of drug-related harms. We then use the WPR approach to guide a discussion of the burgeoning multi-disciplinary literature on vulnerability, exploring orientations and effects of alternative representations of the ‘vulnerable’ drug users. Producing the ‘vulnerable’ subject in these alternative ways creates a different and deeper understanding of the ‘problem’ and consequently its ‘solutions’, allowing more space for human agency to be considered and directing attention beyond drug policy towards tackling the diverse multiple social marginalisations which make some people more likely than others to experience drug-related harms.     

Alcohol and drug treatments in Australian correctional services

A comprehensive literature review on the subject of drug and alcohol treatments in correctional services reveals the size of the drug and alcohol problem within the prison population and reconfirms the positive correlation between drugs, alcohol and criminal activity. Disturbingly few comprehensive ongoing assessment and treatment services are available for the prison population. Special drug and alcohol-related issues such as HIV and hepatitis B infection, and high drug-related post-release prisoner mortality rates demand an urgent review of the policies and procedures concerning the assessment and treatment of drug and alcohol problems in correctional facilities.     

Effects on Alcohol Consumption and Alcohol Related Harm of a Community-Based Prevention Intervention With National Support in Sweden

Background: In order to strengthen local alcohol prevention work in Sweden the Swedish government has for the past almost 15 years commissioned the Public Health Agency of Sweden to initiate a series of community-based alcohol prevention projects. The latest of these, labeled local development with ambitions (LUMA), included 25 municipalities in Sweden. Objectives: Aim of this study is to examine if LUMA municipalities that received financial support, with requirements, increased local alcohol prevention and if alcohol consumption and harm declined. Methods: Twenty-five Swedish municipalities that received financial support aiming to strengthen local alcohol preventing activities (intervention group) were compared to municipalities that did not receive such support (control group, N = 224), before, during, and after the intervention period. Two composite measures of policy and activity were created and used. The composite activity measure includes seven activity indicators and the composite policy measure includes six policy indicators. Harm measures have been selected based on several recommended indicators for monitoring alcohol, tobacco, and other drugs in Sweden. A fixed effects model was used to analyze data. Results: The results reveal that prevention activities increased and several alcohol-related harm indicators were reduced in intervention municipalities (LUMA) compared with in control municipalities. Conclusions: It seems as if financial support, combined with specific requirements and support from the regional and national level, can stimulate local alcohol prevention activities and have a significant effect on alcohol consumption and alcohol-related harm. Similar evaluations in other countries would be of great value for assessing the generalizability of findings.     

“Undisciplined” drinking,multi-sectoralism and political power: Examining problematisations in the Botswana alcohol policy

The Botswana government has recently ramped up efforts to control alcohol consumption through various measures. These include the alcohol tax levy, reduction in trading hours for bars and other licenced premises and increased penalties for alcohol-related road offenses. Whilst these efforts have recently received considerable attention, the processes of alcohol policy development remain unknown and understudied. In this paper, I examine the alcohol policy processes in Botswana using What's the Problem Represented to be (WPR), a poststructural analytic approach that emphasises problematisations in policies. Drawing on alcohol-associated policy documents, I identify two key problematisations that relate to, (1) an emphasis on an “undisciplined” drinker, and (2) an appeal to an internationally-endorsed multi-sectoralism. I explore these problematisations as political formations and periodise them to the year 2008 when they were canonised. I argue that “undisciplined drinking” and an internationally-endorsed multi-sectoralism neglect the social and cultural contexts of drinking, pathologise drinking and do not consider other forms of knowledge. Unmaking current alcohol policy representations is needed to allow for the ‘emergence’ of alternative conceptualisations of the alcohol ‘problem’ in Botswana.     

Experience of harm from others’ drinking and support for stricter alcohol policies: Analysis of the Australian National Drug Strategy Household Survey

BackgroundPrevious research indicates that those who have experienced alcohol-related harm from others are more likely to support stricter alcohol control policies. This study investigates the association between types of harm experienced because of others’ drinking and support for stricter alcohol control policies.MethodsData from 20,570 Australians aged 18 and over who completed the 2013 National Drug Strategy Household Survey was used. Questions about experience of alcohol-related harm from others – being put in fear and abuse (verbal or physical) – were asked. Support for stricter alcohol control policies was quantified by a mean policy support score across 18 alcohol policy questions.ResultsTwenty seven percent of respondents reported harm from someone’s drinking. Respondents who were put in fear had a higher level of support for stricter alcohol control policies than respondents who were not harmed (p < 0.001), regardless of whether they were abused or not. Conversely, respondents who experienced abuse but were not put in fear did not significantly differ in their support for stricter policies from those who experienced no harm.ConclusionIt is the apprehension of harm (i.e. having been put in fear), and not the experience of harm itself (i.e. abuse), which is related to people’s support for stricter alcohol policies. These findings suggest that perceiving others’ intoxication as dangerous to oneself may motivate support for stricter alcohol policies.     

Trusting and misleading. Parents’ and children’s communication and negotiation about alcohol as described by teenagers

Background: Typically, research on parents’ and children’s interactions around alcohol issues focuses on how parenting styles and parents’ examples affect teenager’s drinking habits. In this paper, we approach the theme from the youngsters’ perspective. We ask how teenagers describe the interaction on alcohol-related issues with their parents and how they would like their parents to act during these interactions.

Data and methods: The article applies the concept of trust, which is seen as a feature connecting all kinds of communities, and especially families. We pay attention to whether alcohol issues challenge trustful relations and give rise to contradictions and complications in the interactions between parents and children.

Results: The analysis shows the ways how trust is maintained and challenged in teenagers? accounts of communication regarding alcohol with their parents. It also shows that although trust is tested in several ways, it is essential for teenagers. Even though teenagers tell how they can mislead their parents by using strategies that challenge trust, they nevertheless highlight the importance of trusting ties with parents. Teenagers do not exclude their parents from alcohol-related discussion but expect rules, communication and authority from them. Our data suggest that teenagers also want to protect their parents from disappointments caused by their own actions.

Conclusions: A trusting parent–child relationship, based on dialog rather than opposition, seems to play a significant role in guiding teenagers’ alcohol-related attitudes and practices.     

Depictions of alcohol use in a UK Government partnered online social marketing campaign: Hollyoaks ‘The Morning after the night before’

Aims: This study analysed the depiction of alcohol in an online government partnered social marketing campaign: Hollyoaks ‘The Morning After the Night Before’. This was a new initiative, providing Internet-delivered episodes of a popular terrestrial drama targeted at young people.

Methods: All the 12 episodes were coded for visual representations of alcohol, drinking acts and alcohol effect references. The drinking setting, point in time, type of alcoholic beverage consumed, drinker's demographics, effects/consequences of drinking, and official and unofficial responses to alcohol consumption and related harms were also coded. Audience comments were then categorized according to their content in order to gain an insight into viewers’ thoughts regarding the campaign.

Findings: A wide variety of data is reported. Most representations of alcohol were positively framed, and were depicted without immediate consequence. No explicit sensible drinking messages were included in the episodes. Analysis of viewer feedback indicated a lack of awareness of the intentions of the campaign and little discussion of alcohol-related issues was generated. In contrast, viewers seemed to reject the depictions of alcohol portrayed, and identified with, or admired, the central characters. Further analysis indicated little coherence between alcohol framing in the online campaign and representations in the terrestrial TV series.

Conclusions: This article uses the example of KYL/Hollyoaks to draw attention to the emergent use of the internet and other new media in health promotion. New media provides creative new opportunities to engage young people with health-promoting messages. However, although new ways of delivery are important they should be part of a co-ordinated and internally consistent campaign, present realistic depictions of alcohol use, and be based upon clear evidence-based principles.     

Local action to prevent alcohol problems: Is the UK Community Alcohol Prevention Programme the best solution?

Increasing evidence indicates that the UK has a serious alcohol problem. This crosses many patterns of drinking and all ages, whereas the public debate about alcohol tends to focus almost exclusively on binge drinking and on young people's alcohol-related anti-social behaviour. This paper addresses the interventions and policy developments currently implemented in the UK to reduce alcohol-related anti-social behaviour. There are two main approaches: a national (England) change in the licensing laws; and local harm reduction projects seeking to effect change independently of central Government initiatives. This paper describes the critique currently mounted against the expected efficacy of new licensing laws and describes the theoretical and practical developments of some local prevention initiatives that are part of the United Kingdom Alcohol Prevention Programme (UKCAPP), funded by the Alcohol Education and Research Council (AERC). Although it is too early to draw conclusions as to the effects of either of these developments, initial reports suggest that changes in the licensing regime have not yet created the increase in alcohol-related problems some commentators have argued would occur; and the local prevention initiatives have led to the formation of extremely strong community partnerships, with a range of innovative and integrated actions to tackle alcohol-related anti-social behaviour. Fundamental criticisms of both the new licensing laws and the National Alcohol Strategy remain, however. Even if the above interventions lead to reductions in alcohol-related anti-social behaviour, it is not clear how they might deal with the rising levels of alcohol-related health harms reported within the UK. Nevertheless, the community partnership approach may be the best possibility for dealing with at least some of the alcohol-related problems caused by the rise in availability and accessibility of alcohol within the UK.     

A study on effectiveness of local alcohol policy: Challenges and solutions in the PAKKA project

To an increasing degree, alcohol policy and prevention in the Nordic countries is expected to be carried out on the local level as the free-trade agreements and international harmonization of alcohol taxes and regulations are limiting the scope of traditional national alcohol policies. In recent reviews on the effectiveness of alcohol political interventions the recommended strategy for local communities is to combine community mobilization with various types of environmental strategies focused on the supply of alcoholic beverages. The PAKKA project continues the international tradition of research on community-based prevention of alcohol-related harms. In this paper we discuss the challenges and solutions of evaluating community-based prevention projects, using the recently started ‘PAKKA’ (Local Alcohol Policy) project as a concrete example. The PAKKA project relies on a mixed-intervention strategy attempting to change the local social, economic and physical environment related to risky and under-age drinking. In measuring the project's effectiveness a quasi-experimental research design is used. In our research design we have had to tackle three interconnected problems: the problems of causality in a multi-component population level study, the problem of generalizability and the complex role of the researcher.     

Canada's new federal 'National Anti-Drug Strategy': an informal audit of reported funding allocation

BackgroundWhile there is mounting international acceptance of harm reduction approaches and growing support for policies that balance enforcement with more health-focused interventions, in many settings these developments are not reflected in policy. In October 2007, the Canadian federal government launched a new $64 million dollar ‘National Anti-Drug Strategy’ in which two-thirds of the new monies was reportedly directed towards drug prevention and treatment initiatives.MethodsHowever, contrary to the impression left by a host of federal politicians, including the Prime Minister, that this new strategy was investing significantly in drug prevention and drug treatment, this analysis finds that when base funding is considered additional monies provided through the new federal National Anti-Drug Strategy only marginally shifts the allocation of funds within each category.ResultsSpecifically, law enforcement initiatives continue to receive the overwhelming majority of drug strategy funding (70%) while prevention (4%), treatment (17%) and harm reduction (2%) combined continue to receive less than a quarter of the overall funding.ConclusionThese findings suggest that the Canadian government is failing to invest resources in evidence-based drug policies.     

“I think we should all be singing from the same hymn sheet” – English and Swedish midwives’ views of advising pregnant women about alcohol

Abstract

Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives’ attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n?=?7) and Örebro County, Sweden (n?=?9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional’s role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives’ attitudes around risks with prenatal alcohol use.     

Harmonising alcohol consumption,sales and related outcomes data across the UK and Ireland: an insurmountable barrier to policy evaluation?

Abstract

There is a need to ensure public health policies are robustly evaluated to establish their benefits and harms on the population and subgroups. We aimed to assess the comparability of Northern Ireland (NI) and Republic of Ireland (RoI) alcohol-related data to determine their suitability for evaluating the effectiveness of alcohol policies on alcohol consumption, sales, and related outcomes. A comparability analysis of NI and RoI alcohol-related hospital admissions, deaths, consumption, sales, and crime administrative and survey data was undertaken. Data sources were compared, where applicable, in terms of coding systems, population coverage, definitions, quality, response/completion rates, and question similarity. The NI and RoI consumption and sales data were found not to be comparable enough for use in a natural experiment study; comparability for hospital admission data was acceptable. Key barriers to comparability included variations in population coverage and lack of overlap in questionnaire topics. Data access issues made it difficult to fully determine data comparability for alcohol-related crime and deaths. By contrast, NI alcohol-related data were more comparable with other UK countries, making comparisons for the purpose of policy evaluation possible. RoI would benefit from identifying another economically and culturally similar country with comparable alcohol-related data.