Examination of witnesses (Questions 630
- 639)
WEDNESDAY 28 FEBRUARY 2001
DR LAURENCE
GRUER and DR
MARTIN PLANT
Chairman
630. Good afternoon, gentlemen. Could I welcome
you to this session with the Committee. Can I, first of all, apologise
for the fact that we did overrun on our two previous sessions,
it is always a problem when you have three different sets of witnesses.
I do thank you for your forbearance. Can I ask you to introduce
yourselves to the Committee?
(Dr Gruer) I am Dr Lawrence Gruer, a consultant in
Public Health Medicine with the Greater Glasgow Health Board.
(Dr Plant) I am Dr Martin Plant, I am a sociologist
and I am Director of the Alcohol and Health Research Centre in
Edinburgh.
631. We will not detain you longer than necessary.
I do hope that the questions we ask you will stress the importance
we place on this particular aspect of the inquiry. At this stage
in the proceedings are there any brief submissions either of would
you like to make to the Committee or would you prefer to go through
the structured agenda?
(Dr Plant) May I just say, very briefly, that there
is a huge amount of interest in alcohol. The great majority of
people in the Scotland drink and their drinking is moderate most
of the time and it is either harmless or beneficial most of the
time. From the point of view of science one of the difficulties
is thatmany of the harms are pretty much intangible, in the sense
that you cannot calculate them or they never have been calculated,
and many of the benefits are so obvious we simply take them for
granted. The main problem we have in Scotland is we are a group
of northern European countries where we tend to concentrate a
lot of our drinking into a Friday night and a Saturday night and
thereby lies 60 per cent of what we are all concerned with.
632. Are you saying we should drink on a Sunday
morning?
(Dr Plant) In some respects that would be better.
Mr Clarke: Can they afford that?
Chairman
633. I think we all recognise what you say,
most of us to do drink responsibly most of the time, but some
of us err occasionally. Can I begin by asking you about alcohol
abuse, the Greater Glasgow Health Board has come up with some
terrible statistics in relation to Glasgow. It is estimated that
30,000 males drink twice the recommended weekly limit. Excessive
drinking is responsible for between 20 to 30 per cent of acute
hospital admissions. General Practitioners see around 4,700 people
with severe drinking problems every month. Do you believe that
the situation in Glasgow with regard to the health impact of alcohol
misuse is different from that found elsewhere in Scotland, or
the United Kingdom for that matter? (Dr Gruer) The first
thing I would say is that from the data that we have got the health
problems related to alcohol have been worsening steadily over
the last 20 years or so, not just in Glasgow but in the whole
of Scotland, and there are indicators in the whole of the United
Kingdom. That is borne out by alcohol-related deaths and admissions
to hospital where there is an alcohol tag put on the diagnosis
and on conditions like alcohol-related brain damage. The figures
for Glasgow generally are worse in virtually every area than for
the rest of Scotland but I think the most telling analysis is
where you look at what sort of people are getting alcohol-related
problems. The strongest link that we can find, and it is very,
very strong indeed, is with levels of socio-economic deprivation.
If you compare in Glasgow the most affluent parts and the most
deprived then you are six times more likely to die of an alcohol-related
problem in the most deprived areas, you are ten times more likely
to be admitted to a general hospital with some sort of emergency
admission for alcohol and you are nine times more likely to be
admitted to a psychiatric hospital if you live in a deprived area.
In certain age groups, like the 50-59 year old age group for men,
you are well over 20 times more likely to be admitted if you live
in a deprived area than in an affluent area. The same applies
across the whole of Scotland. I think one of the main reasons
why Glasgow stands out compared with the rest of Scotland is that
Glasgow has got a far higher proportion of people who live in
deprived areas than the rest of Scotland. If you compare like
deprivation in Aberdeen or in Lothian or in Glasgow you get the
same sorts of levels of alcohol-related harm. I think that is
the main reason why Glasgow seems to stand out.
634. Can I ask you how much the health board
spends on alcohol-related problems?
(Dr Gruer) I cannot give you a precise figure because
so much of it is part of the normal weave of health service provision.
As you said, maybe something like 20/25 per cent of hospital admissions
have an alcohol-related component, a huge proportion of GPs' work
is dealing with people who have some sort of drinking problem,
so the large expenditure on alcohol-related problems is hidden.
The amount of money we spend on specific alcohol-related services
is of the order of £2 million or so. I can give you precise
figures if you wish in a further written submission.[7]
635. That would be helpful.
(Dr Gruer) What I would say is that although there
has been this steadily worsening trend in alcohol-related problems,
there has been very, very little additional investment in alcohol
treatment services not just in the Greater Glasgow Health Board
area but throughout Scotland over the past 20 years or so. That
is in fairly stark contrast with the situation regarding illegal
drugs and the treatment of drug misuse other than alcohol.
636. My final question is to both of you and
it is a two part question. Is it possible to identify what type
of person is most likely to drink too much? Are you able to give
us any advice or information as to whether the different kinds
of alcohol, ie beer, wines and spirits, cause different problems?
Is someone who has an alcohol problem just as likely to be a beer
drinker, a spirit drinker or a wine drinker, or is there a difference
between the different types of alcohol and the effects on people?
(Dr Plant) First of all, there has been a big search
for the alcoholic personality. There has been an enormously expensive
American study to find out the extent to which it is genetic and
the conclusion really is that there is not any identified alcohol
dependent or drug dependent personality. The genetics project
suggested that genes only explain two per cent of all the possible
issues. You can have the genes and live in Saudi Arabia and perhaps
not develop a drinking habit or an alcohol problem. You can have
the genes and if you live in a society where people drink a lot
you are much more at risk. As far as the kind of person who is
concerned, there is no doubt at all that if you come from a family
where people either drink a lot or do not drink at all, you are
more likely to finish up landing into alcohol problems. A big
study of teenagers in Europe that was released last week suggested
that teenagers who drink heavily are more likely to come from
families where their parents simply don't know how they spend
their spare time. As far as different kinds of alcoholic beverages
are concerned, overwhelmingly alcohol is alcohol is alcohol. It
is a myth that spirits are more dangerous than wine or more dangerous
than beer, what really matters is how much alcohol people consume.
In fact, the main influence on the kinds of problems people get
into is the pattern of their drinking. In Scotland we have two
distinct patterns. We have the traditional pattern of cramming
down a lot of alcohol in a short session, particularly at the
weekends, which seems to come with acute problems: public nuisance,
accidents, injuries. At the same time we have an increasing trend
for some people to spread their drinking throughout the week,
which is almost certainly why there has been a rise in alcohol
dependence and liver cirrhosis.
637. Thank you. Dr Gruer?
(Dr Gruer) I would not add much to what Martin has
said there but I think one factor which influences whether people
get into drinking problems are the circumstances of their lives.
You often find that people begin to drink much more heavily in
situations of stress where they have got serious problems that
are besetting them and if alcohol is the available way of relieving
that stress then a certain proportion of people will get into
difficulty. Precisely why they do is very difficult to determine.
It may be something to do with your family antecedents, sometimes
it may have something to do with your make-up. I think there is
a large proportion of people who potentially could develop drinking
problems and only a proportion do, but that proportion can vary
according to the circumstances they are in at the time.
638. Do you agree with Dr Plant's comment that
alcohol is alcohol is alcohol and there is no difference between
the different types of beverages?
(Dr Gruer) I think pretty much. Obviously it is the
way you drink it that has such a crucial effect. Taking a few
slugs of whisky can make you more inebriated suddenly than, say,
taking two per cent shandy, it will be a long time before you
get inebriated.
Chairman: You have both stimulated my colleagues,
almost everybody wants to pick up on what you have said. Before
they do, can I apologise to both of you because I have to leave
and I will ask Mrs Adams to take the Chair.
(In the absence of the Chairman, Mrs Irene Adams was called
to the Chair)
Miss Begg
639. A couple of things. First of all, you made
the close link between alcoholism and deprivation and you also
said that the levels of alcoholism are going up. Why is that?
Is that because levels of deprivation are going up or is alcohol
cheaper in relative terms because incomes have also risen?
(Dr Gruer) It is undoubtedly the case that over the
last 30 years or so the availability of alcohol has increased
dramatically and we are all aware how easy it is to get alcohol
virtually 24 hours a day throughout Scotland and that was not
the case 30 years ago. Relative to people's incomes, alcohol has
tended to decrease in price. The figures for the amount of alcohol
that people are drinking on average seem to have been relatively
steady, so far as official figures go, over the last 20 years
or so, but they did rise quite substantially between the end of
the Second World War and the 1970s. I think one factor is there
are now a lot of people around who are in their middle age and
are getting older who have actually been drinking quite substantial
quantities of alcohol through most of their adult lives and they
are now beginning to show the damage in terms of effect on their
livers and their brains and so on. One factor that accounts for
this rise is that there is now a large number of people who have
been drinking for a long time and they are showing the signs of
it. I think at the younger end of the market with young people
there does seem to be more of a trend for young people, teenagers
and the like, to be drinking dangerously at an earlier stage.
That was certainly borne out by the survey that we carried out
with general practitioners in Glasgow in 1997, half of whom said
that in the last five years they had seen more problems with teenage
drinking in their patients. This is also borne out by the particular
figures for admissions to hospital for teenagers which have been
going up more sharply than the rest of the population; still quite
small numbers but quite worrying.
7 Note by witnesses: During the current financial
year, Greater Glasgow Health Board will have spent an estimated
£2.42 million on specialist treatment services within the
NHS and via voluntary and private sector services. Back
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