Health Committee - The Government's Alcohol StrategyWritten evidence from Mentor (GAS 40)


Mentor welcomes the alcohol strategy, including the introduction of minimum unit pricing, but would like to have seen a more comprehensive approach to preventing the harms of alcohol misuse among young people.

We are concerned not only that evidence-based programmes are failing to reach scale, but also that school health education is given a low priority and the quality of delivery is highly variable.

Universal alcohol misuse prevention programmes in schools have been shown to have an impact on alcohol use as well as other drugs such as tobacco and cannabis.

The approaches which appear to be most effective are those based on social influences and life skills, for example Life Skills Training and Unplugged.

Interventions which are not alcohol-specific but focus on children and young people’s attachment to school (eg Good Behaviour Game) or personality type (eg Preventure) can also be effective in reducing alcohol misuse.

Economic modelling suggests that programmes do not need to have dramatic impacts on behaviour to be cost-effective when delivered universally.

1. Introduction

1.1 Mentor is a UK charity which believes that prevention is better than cure. We focus on protecting children from the harms caused by drugs and alcohol through evidence based programmes and interventions, inspiring them with choices to achieve their best as individuals and citizens, and working in partnership with schools, parents and carers and communities.

1.2 We support the move towards minimum unit pricing (MUP), which we expect to be an effective environmental intervention. The table below sets out the expected impacts if set at 40p and the considerably greater impacts of a 50p minimum unit price.1

Negative outcomes averted per year



Hospital admissions (first year)



Hospital admissions (after 10 years)



Deaths (first year)



Deaths (after 10 years)



Violent crimes



Crimes (total)



1.3 We also welcome the focus on parents, since they have been shown to have a strong influence over young people’s decisions about drugs and alcohol. We are glad that earlier guidance from the Chief Medical Officer on young people’s drinking is reinforced. The strategy also promises social marketing for young people which will support parents to have a real impact on their children’s behaviour. We hope that this will be implemented in a way most likely to achieve behavioural change and recommend that the government looks at evidence suggesting that using a “social norms” approach (stressing the positive behaviour of the majority) can be effective.2

1.4 However, the government’s alcohol strategy falls short of the comprehensive, evidence-based prevention strategy for young people that the scale of the problem requires. “Comprehensive” means prevention that works: across different settings (schools, families and community); for children and young people of different ages and at different levels of risk; and at different levels (changing the environment, increasing knowledge and understanding, and developing skills and values). “Evidence-based” means based on the knowledge we currently have about what works, but also implies continued investment in building that knowledge base.

1.5 The main gap that we identify in the alcohol strategy is universal school-based alcohol prevention, based on developing young people’s skills as well as their knowledge and understanding.

2. Harms and Costs of Alcohol Consumption by under-18s

2.1 Alcohol consumption in excess is a problem across society. However, regular drinking in adolescence carries particular risks and costs, both for the individual and for the wider community. Although the proportion of young people who drink has fallen in the past decade, there is still cause for concern. A quarter of 12 year olds have had an alcoholic drink. By the time they are 15, almost a third say they have drunk alcohol in the past week, consuming an average of 14 units in that time. One in ten say they have been drunk at least three times in the past month.3

2.2 Drinking too much can put a young person in hospital. In England, in 2007–08 over 7,600 under 18s were admitted to hospital for conditions directly related to alcohol, almost all alcohol poisoning and/or acute intoxication.4

2.3 Lowered inhibitions also lead to risky behaviour. The 2007 ESPAD survey of 15- and 16-year-olds found a quarter (26%) of teenagers from the UK had had an accident or injury as a result of alcohol use. Also, 12% had performed poorly at school as a consequence of alcohol use; 17% had got into a fight; 15% had got into trouble with the police; and 11% had engaged in unprotected sexual intercourse.5

2.4 Young people’s drinking aged 15 to 16 results in 195,000 accidents and injuries a year and costs the NHS over £4 million a year through attendance at A&E alone. 6 Around 80,000 violent offences and 27,000 property-related offences were carried out by under-18s and directly attributed to drunkenness.7

2.5 Other impacts of early alcohol consumption are less immediate, but still worrying. Heavy drinking in adolescence can interfere with normal development of the brain, liver and bones and affect hormone levels.8 Studies estimate that the probability of alcohol dependence can be reduced by 10% for each year drinking onset is delayed in adolescence.9

3. The State of School-based Prevention

3.1 The alcohol strategy identifies schools as having a vital role as promoters of health and wellbeing in the local community. However, this role is currently not being used to full advantage.

3.2 Ofsted’s 2010 report on PSHE found: “Lack of discrete curriculum time in a quarter of the schools visited, particularly the secondary schools, meant that programmes of study were not covered in full. The areas that suffered included aspects of sex and relationships education; education about drugs, including alcohol; and mental health issues that were not covered at all or were dealt with superficially.”10

3.3 In many schools, PSHE education is taught by non-specialists. Unsurprisingly, the Ofsted report cited above found better quality teaching from teachers trained in PSHE.

3.4 As outlined below, there is a growing evidence base for classroom-based drug and alcohol prevention. However, these are currently very little used in the UK, while a significant proportion of drug and alcohol education uses approaches which are not believed to be effective. A recent EMCDDA review found that across Europe, personal and social skills training programmes have not increased, while interventions with little evidence of effectiveness continue to be widely provided: information days about drugs; visits of police officers or other external visitors to schools; and information about the risk of alcohol without skills training.11

3.5 Mentor is concerned that with a lack of guidance for schools in how to commission effective alcohol prevention, approaches can be taken which are counterproductive, for example seeking to scare pupils into taking healthy decisions or staying within the law. A cost-benefit analysis of the Scared Straight programme (which seeks to shock young people out of anti-social behaviour) estimates that for every £1 spent on delivering the programme society has to pay an additional £32.69.12 We are aware of at least one UK charity using what appears to be this approach that claims to have reached 100,000 pupils in the last year.

3.6 Outside lesson time, school based primary prevention spending for children and young people was £143 million in 2006–07. This included £17 million for the National Healthy School programme, which has since been cut.13 Direct services to pupils included routine medical checks, sexual health advice and family planning, smoking cessation and substance misuse advice and support.

4. Effective School-based Interventions

4.1 Rigorous evaluation of the research base, for example through Cochrane reviews (a gold standard in public health research), shows that developmental programmes in schools can have a measurable impact, reducing harmful drinking, smoking, and cannabis use. A 2011 Cochrane review of universal alcohol prevention programmes in schools concluded “Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game.”14

4.2 Life Skills Training and Unplugged have a similar approach, often described as life skills. They provide information about drugs and alcohol, in particular correcting misperceptions about how common and acceptable substance misuse is among the young people’s peer group (normative education). They also teach interpersonal skills to help handle realistic situations where alcohol or drugs are available, and to improve resilience in pupils.

4.3 Interventions which are not alcohol-specific but focus on children and young people’s attachment to school can also be effective in reducing substance misuse. The Good Behaviour Game (GBG) is one example, explained in more detail below.

4.4 The programmes so far mentioned are all school-based universal primary prevention programmes. There are also promising approaches targeted at higher-risk groups. For example, Preventure is a programme which focuses on addressing specific personality elements (impulsivity, sensation seeking, anxiety sensitivity, and depression proneness) which in different ways increase the likelihood of early-onset substance misuse and other risky behaviours. Lessons are delivered to sub-groups of pupils identified as high-risk personality types.

4.5 The vast majority of the research evidence for alcohol misuse prevention comes from the United States, where implementation of universal school-based programmes is much further advanced, and more randomised controlled trials have been carried out. There is an urgent need to expand the evidence base in the UK. We welcome the work that the Centre for Analysis of Youth Transitions is doing, both in making information about evidence-based youth programmes more easily available, and in helping programme developers collect better evidence.

5. Cost-benefit Analysis

5.1 The cost-effectiveness of the programmes described is increased because they have a wider focus than alcohol. Reductions in tobacco and cannabis use have been demonstrated, and some evaluations have also found impacts on educational achievement and anti-social behaviour.

5.2 On the evidence so far, it appears that universal drug and alcohol prevention programmes do not need to have dramatic impacts to be cost-effective. For example, modelling for NICE concluded that if an alcohol misuse prevention programme in schools cost £75 million and achieved at least a 1.4% reduction in alcohol consumption amongst young people it would be a cost-effective public health intervention.15

5.3 A study on cost-effectiveness by the US Department of Health and Human Services concluded that national implementation of an effective programme which cost $220 per pupil could in the long term save $18 for every $1 invested.16

5.4 The Social Research Unit at Dartington are carrying out detailed cost-benefit analysis of a range of children’s services interventions in a UK context: the latest reports are available from

6. A Case Study: The Good Behaviour Game

6.1 The GBG is a way of managing class behaviour during lessons by dividing young children into teams which during short periods of the day are given the chance to earn prizes and praise by keeping to simple rules for good behaviour.

6.2 A trial in Baltimore showed a 50% reduction in the likelihood of later drinking problems at follow-up aged 19 or 20. The programme had other pro-social benefits; reducing the chances of drug dependence, dropping out of education, and antisocial behaviour, particularly among boys. A feasibility study of the GBG in the UK with six primary schools in Oxfordshire has shown promising results with regard to behavioural impact.17

6.3 Economic modelling by the Washington State Institute for Public Policy estimated every dollar spent on the GBG resulted in total benefits valued at $31.18 In a UK context, the Social Research Unit recently estimated a more conservative benefit-cost ratio of £8.26 for every £1 invested.19

7. Implementation

7.1 Mentor’s Chief Executive is co-chair of the Education Committee for the Department of Health’s Responsibility Deal. This offers a valuable opportunity to assess the impact that some of the programmes described above can have in the UK. However, it is clearly not the role of the alcohol industry to fully fund appropriate health education and prevention. If these programmes are cost effective and attractive options to policymakers we would want and expect them to be funded by the state.

7.2 If the Committee would like more information on any of the points raised in this submission, we would be very glad to provide it.

May 2012

1 Purshouse, R, et al (2009). Modelling to assess the effectiveness and cost-effectiveness of public health related strategies and interventions to reduce alcohol attributable harm in England using the Sheffield Alcohol Policy Model version 2.0. NICE

2 Perkins, H W (ed) (2003). The Social Norms Approach to Preventing School and College Age Substance Abuse. John Wiley & Sons

3 Fuller, E (ed) (2011). Smoking, drinking and drug use among young people in England in 2010. Health and Social Care Information Centre,

4 Donaldson, L (2009). Guidance on the Consumption of Alcohol by Children and Young People. Department of Health

5 Hibell B, Guttormsson U, Ahlström S, et al (2009). The 2007 ESPAD Report: Substance Use Among Students in 35 European Countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs

6 Jones, L, Stokes, E and Bellis, M (2007). A review of the effectiveness and cost-effectiveness of interventions delivered in primary and secondary schools to prevent and/or reduce alcohol use by young people under 18 years old. Addendum: Additional economic evidence preparend for the Public Health Interventions Advisory Committee (PHIAC). NICE

7 Jones, L, Stokes, E and Bellis, M (2007). A review of the effectiveness and cost-effectiveness of interventions delivered in primary and secondary schools to prevent and/or reduce alcohol use by young people under 18 years old. Addendum: Additional economic evidence preparend for the Public Health Interventions Advisory Committee (PHIAC). NICE

8 Donaldson, L (2009). Guidance on the Consumption of Alcohol by Children and Young People. Department of Health

9 Grant, B F, Stinson, F S, & Harford, T C (2001). Age of onset of alcohol use and DSM-IV alcohol abuse and dependence: A 12 year follow-up. Journal of Substance Abuse, 13, 493–504.

10 Ofsted (2010). Personal, social, health and economic education in schools. Ofsted.

11 EMCDDA (2012). EMCDDA trend report for the evaluation of the 2005–12 EU drugs strategy. EMCDDA

12 Social Research Unit (2012) Investing in Children, Youth Justice


14 Foxcroft, D and Tsertsvadze, A (2011). Universal school-based prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews

15 Nherera, L and Jacklin, P (2009). A model to assess the cost-effectiveness of alcohol education developed for NICE public health guidance on personal, social, health and economic (PSHE) education. NICE

16 Miller, T R and Hendrie, D (2009). Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration.

17 Chan, G, Foxcroft, D, Coombes, L and Allen, D (2012). Improving child behaviour management: An evaluation of the Good Behaviour Game in UK primary schools. Oxford Brookes University and Oxfordshire County Council

18 Washington State Institute for Public Policy (2012). Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. Washington State Institute for Public Policy

19 The Social Research Unit at Dartington (2012). Investing in Children: Early Years & Education.

Prepared 21st July 2012