alcohol

A recent piece highlighting the difficulty of getting help when we have both mental health and alcohol or other substance use problems attracted insight with sources spanning from Glasgow to Tauranga. Below is a lightly-edited selection.

“I’d say this isn’t ‘becoming’ the norm, I heard this in the field ten years ago regularly and it has never changed,” Michael Pearson, counsellor at Bristol University, UK.

“This article raises a very real problem and one that I did not realise was an international problem. It is things like this that cause my team and I to want to be identified as alcohol and drug workers rather than anything else. People need Hope and that is what we try to provide,” Darryl Wesley, The Salvation Army, Bridge & Oasis, Tauranga, New Zealand.

“All the evidence suggests that the best approach is to treat both in parallel. The fact that it’s so difficult for service users to get the help they need borders on criminal.” Norman Beecher, Kensington and Chelsea Recovery Care, London, UK.

“I come across this all too much in my work! While I understand that sometimes you have to remove substances to find out if certain mental health is triggered by these, what I know works from experience, is a joined up approach to mental health and substance use. It has far better lasting outcomes for people I’ve worked with,” Nicole Cooper,

a recovery facilitator at Bracknell Forest Council, UK

“A lot of services unwittingly provide care, treatment and support to people with a dual diagnosis, because it wasn’t identified as an issue. The problem comes when it is identified as an issue that clinicians lose confidence in their ability to provide care, treatment and support to a person who needs assistance,” Stephen Mihaly, director of nursing at The Endoscopy Centre, Melbourne, Australia.

“This has been an issue for my entire career in community services of over 20 years. Every conference I go to will have a well researched piece on why holistic no-wrong-door treatment services are what’s needed – yet still it doesn’t happen,” Xenia Girdler, working in education and training at Welways, Melbourne, Australia.

“With all the money and focus that was done some 11 years ago with Dual Diagnosis and State and Fed initiatives—this seems to now have gone backward. It is so disappointing.” Renee Hayden, CEO of HealthCare, Melbourne Australia.

“This is a very, very big issue. A new set of recruits with knowledge of both would really help. The amount of people pushed from pillar to post because they have both mental health and dependency issues. We have had dual diagnosis’s workers that seemed to have achieved nothing. It either gets dismissed as the dependency or the dependency needs to be dealt with first before we can do anything. And, when people get frustrated, upset and exhibit any anger they are often told to leave, ‘we will not tolerate that behaviour’ Despite the person clearly being unwell and desperate for help.” Mark Masterson, carer, UK.

“As someone with lived experience I lived with the problem of not qualifying for mental health support because of my addiction. The addiction services I did go to actively discouraging me from going to mental health services, despite clearly having both issues. There used to be a very strong division between the types of services which led to people like me falling between the cracks. I did end up focusing on abstinence from my addiction first and years of therapy through those services. I did truly believe that the symptoms I was experiencing (that I later realised were mental health related) to stop once I was abstinent. Of course that didn’t happen and I walked an exceptionally risky path and ultimately ended up in mental health clinical services anyway

There has been a lot of work in New Zealand to work towards that and in the clinical mental health and alcohol and other drug (AOD) clinicians work closely together. I was fortunate to work together with mental health teams which had AOD clinicians as part of their multi-disciplinary team  All clinicians were expected to be able to work with people with both mental health and/or addiction problems. In many ways that worked well especially when it came to sharing experience and knowledge of either area of speciality. So that was real progress in the teams, however, one other concern I had was the division of the people themselves who would really benefit from having both issues looked at, who really didn’t want that. Shame and stigma have a lot to do with that and historical cultures of being labelled as having one or the other issue and often people didn’t think kindly of people in the other group. A lot of stigma and discrimination. It’s changing, slowly. So there is hope of change,” Louise Windleborn, consumer and peer advisor, Wellington, New Zealand.

“I hate the fact this happens. I’m currently working in mental health and am told all the time by my bosses that if there is any hint that a person is using substances we have to signpost them out because ‘we don’t work with people who drink/use drugs’. It frustrates me so much; I’ve worked in a rehab centre where we did treat both the substance use and the underlying mental health issues that were frequently present and I just don’t see why we can’t have more joined up working in order to actually help people,” said a psychological wellbeing practitioner in the UK’s NHS.

“I can understand why stretched mental health services retreat behind this sequenced assessment of need. But then it’s more than a big ask for people who by definition can’t always organise their own wellbeing to fit themselves into service criteria for treatment. Arguably, service design provokes crisis level needs that can’t then be deferred. The treatment gap also shifts the cost of unmet needs onto emergency and criminal justice services. That’s not exactly a cost saving or a social investment either. Sad for the lives and communities in the middle of this,” Dave Chung, a social worker in Doncaster, UK.

“Important but so sad that we’re still where we are. When I was managing the Angel Drug Project in the late 1990s we almost never had a client we couldn’t work with and hopefully help. For me,  the term ‘dual diagnosis’ often told more about how services were configured and the inadequacy of that for all people who were having substance use problems than anything else,” Eric Carlin, a public health and alcohol policy expert currently working at the WHO, based in Glasgow, Scotland. ■

UK release, July 2nd; certificate 12A

I hoped Another Round, an international Oscar winner about alcohol, might at least be entertaining, despite some obvious flaws. But I was disappointed.

I am no film critic, but I believe etiquette demands some positives at this point. The film is well made, well acted and shot, and there are moments of real pathos and extended periods of the bleak sadness that Scandinavia is so good at.

The lasting sadness, however, is that all this undoubted artistic skill and talent was employed in exploring alcohol through an idea even its own supposed inventor, psychiatrist Finn Skarderud, says was no more than an offhand joke.

There is also a Smirnoff vodka bottle put in the hands of photogenic lead actor Mads Mikkelsen, who just happens to also be the face of brewer Carlsberg. It is hard to imagine either appear accidentally or without conditions attached.

The premise is, some tell me, not even an original joke, but an oft-repeated psychiatrists’ common room gag, made funny mainly because it is obvious nonsense. The idea is, I should say, we are born with a deficit of 0.05% of alcohol in our blood.

The film cracks on, nonetheless, making this patently phoney idea its intellectual cornerstone. The audience is thereby invited to suspend their disbelief for a large chunk of a rather plodding 2.5 hours of image after image superficially “proving” the theory.

And for about two-thirds of the film things go swimmingly. Four grouchy middle-aged Danish men start teaching tiddly, perform like champs and generally regain their lost mojo. “All fired up and relaxed at the same time,” as one puts it.

Predictably, enough, they up the dose. But only after they reach more than double the 0.05% “deficit” does it go horribly wrong. No matter that it is a daft idea to depend on alcohol to do your job from the start, particularly if you look after kids.

But it is good, one might argue, that the film goes on to disproves its own crackpot theory in the tragic ending. Well, it does, sure, but [unapologetic spoiler] a few shots later alcohol is the catalyst of the final euphoric scene.

The film also does things like making Churchill’s notorious heavy drinking an unarguable endorsement of a liberating habit. It also fails to mention that Ernest Hemmingway’s alcohol drinking was life threatening for decades. Yada yada.

“Misuse of drugs must be infrequent and should not be glamorised or give detailed instruction,” is among the conditions of the UK’s 12A certificate, and films must not promote dangerous or anti-social behaviour.

There is a tragedy, sadness and a bit of sanitised puking, but these do not outweigh the impression left by the far longer sections in which we watch male role models experience a quasi-scientific miracle, reprised at the end.

In the closing scene Mikkelsen’s dour history teacher has a post-funeral pick-me-up enabling him to dance with the kids like it was 1999, before flinging himself fully-clothed off a jetty in a final alcohol-fuelled flourish.

There is a great film to be made about alcohol, about its real effects, dramas, humour, confusions and contradictions. This, sadly, is not it, and despite its many troubling flaws it seems likely to fill the niche for years to come. ■

Alcohol share prices in the US are far stronger than before the covid-19 slump struck with the US Alcoholic Beverages/Drinks Index up a fifth over the full year, having almost halved in February (see chart).

A share price rise needn’t necessarily indicate an expectation of higher profits or revenue. It could be a “flight to safety”, where people make more reliable bets in crises, which is why gold prices go up.

Interpreting share movements is a matter of speculation. This interpretation would indicate the US financial market expects alcohol to fair relatively well and is willing to bank on it. ■

The heaviest drinking households bought 17 times more alcohol than the lightest drinking ones at the start of the covid pandemic, a study says, helping to explain record high levels of alcohol-induced death.

The polarisation of alcohol consumption found between the top and bottom fifth of households in the UK is likely one reason why there was a 19% rise in alcohol-specific deaths in 2020, reaching the highest level for 20 years.

The US saw an even bigger alcohol-induced death surge in 2020 Alcohol Review revealed last month (see chart). The CDC has since confirmed the 26% rise that year and now also estimates a similarly high level for last year.

The increase in US deaths has so far attracted scant public attention or research. But it is likely the lifestyle changes and stress of the covid crisis saw heavier drinkers in both sides of the Atlantic increase their intake to deadly levels, just as this research suggests they did in the opening phase of the covid crisis in the UK.

Late last year around 30% more people in England said they drank more than the official low risk guidelines of 14 units (140ml) a week compared to before the covid crisis, said a Office for Health Improvement and Disparities survey.

“It is also likely that reduced access to care and treatment during covid contributed to an increase in alcohol-related deaths,” said lead author Professor Peter Anderson of Newcastle University when asked if other factors played a part in the UK. 

Households in the more socially disadvantaged locations of northern England bought more alcohol. The pattern in Scotland and Wales was “less pronounced”, possibly because they have minimum alcohol pricing policies, the study says. 

 “This suggests that a focus on policies to reduce high levels of drinking are even more important in extraordinary times, such as those we’ve seen since March 2020,” said Professor Anderson from Newcastle University.

“By failing to implement minimum unit pricing as part of its plans for public health, England is now falling further behind the rest of the UK in the race to tackle alcohol harm,” said Professor Sir Ian Gilmore of the Alcohol Health Alliance.

The research is a joint project between Newcastle University and the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria. 

The study used retail data from Kantar WorldPanel for 30,000 UK homes for six years to 2020. ■