Getting away ‘Scot-free’ from alcoholism

Edinburgh, Scotland – Scotland has become the first place in Europe to prescribe a new drug that reduces cravings for alcohol.

Earlier this month, the Scottish Medicines Consortium, a body that approves drugs for use in the National Health Service, gave the go-ahead for doctors in Scotland to prescribe nalmefene, a drug made by Danish firm Lundbeck and designed to diminish the “buzz” drinkers get from alcohol.

Nalmefene will be targeted at people who are heavy drinkers, but not the most severely dependent alcoholics. The drug works by blocking reward centres in the brain that encourage drinkers to over-indulge.

In trials, men who normally drank eight units of alcohol a day and women who drank six a day halved their consumption over a six-month period when they took the drug.

The decision to prescribe nalmefene free of charge by the National Health Service reflects a growing concern about Scottish drinking habits and their effects on social and economic well-being.

Scotland has one of the highest levels of alcohol consumption in the world. Among Scottish men, the alcohol-related death rate is twice that of the rest of the UK. Drinking costs the economy an estimated £3.6bn ($5.75bn) in everything from lost productivity to increased spending on health care and criminal justice.

‘It causes so much damage’

“We have a massive problem with drinking,” says Gillian Bell, spokesperson for Alcohol Focus Scotland. “We accept excessive drinking as the norm, but we shouldn’t because it causes so much damage. Alcohol does not just affect the person who is drinking, it affects society as a whole.“

The devolved Scottish government, which has responsibility for the country’s health policy, hopes that nalmefene will help to tackle alcohol abuse. The decision to prescribe nalmefene, which is taken as a tablet before drinking, has been widely welcomed by Scotland’s medical community.

“I am pleased that Scottish patients will have access to nalmefene, which represents a new option for treating some people with alcohol dependence by helping them to cut down their drinking when they may not be ready, or have no medical need, to give up alcohol altogether,” said Jonathan Chick, a consultant psychiatrist at Queen Margaret University Hospital in Edinburgh.

Peter Rice, the chairman of Scottish Health Action on Alcohol Problems (SHAAP) and a former chairman of the Royal College of Psychiatrists in Scotland, told Al Jazeera he believes the drug will be “a useful addition to the options we have to offer patients”.

Scotland was the first place to introduce routine screenings for alcohol abuse. Now all patients must complete a form about their drinking habits. The programme has allowed doctors to identify a quarter of a million problem drinkers over the last four years, in a region with just over five million people.

Rice said the success of nalmefene will depend on whether doctors use it alongside psychological and personal care. “The evidence base and effectiveness of the brief intervention is better-established than it is for the medication. The medication needs to be seen as working in conjunction with the intervention, the simple advice from the doctor. I would expect that it won’t be just doctors reaching for their prescription pad,“ Rice said.

‘The wrong approach’

Drinkers in Glasgow, Scotland’s largest city, were less optimistic about the drug’s potential. “It’s the wrong approach. If someone is an alcoholic, surely the thing to do is to is to make them stop, not encourage them to drink less,“ said Josephine, one of a handful of afternoon drinkers in the Vale, a bar near Glasgow’s Queen Street train station.

A chef in a city centre restaurant, Josephine said drinking is a way of life for many, particularly in the hospitality sector. “Everything revolves around alcohol. Staff night’s out, you are brought to the pub. At Christmas you don’t get a cash bonus, you get £20 ($32) in drinks tokens.”

Her friend Maria noted that Scotland’s drinking culture is “very different” from that in her native Canada. “People back home will maybe plan once a month to go out drinking. Here it is every weekend.”

William Smith, who has run the Vale for almost 20 years, said medication to prevent people from drinking too much is “pointless”. “This isn’t the answer. If people want to drink, they’ll drink. They’ll get up in the morning and say ‘I’ll drink’ or ‘I’ll not drink’.”

Instead, Smith believes the Scottish government should be focusing on the problem of young drinkers. “That is where I would be starting … Nobody is going to give [nalmefene] to a 12-year-old in a [housing] scheme in Glasgow. It seems to be me that this thing is aimed at the wrong people.”

Minimum prices

While alcohol consumed in pubs and clubs has fallen by 34 percent in Scotland since 1994, the amount of alcohol bought to drink at home rose by 45 percent over the same period. In an effort to stem the flow of cheap booze, the Scottish government last year passed legislation introducing a minimum price of 50 pence per 10 millilitres of alcohol.

But the measure has yet to be implemented, following a court challenge launched by the Scotch Whisky Association and two other trade bodies, spiritsEUROPE and the Comité Européen des Entreprises Vins, which represent European spirits and wine producers.

Minimum prices are “the most important thing” to reduce drinking in Scotland, argued Rice. “If we don’t have price controls and we got back to the alcohol price wars of three or four years ago, that would undo a lot of the good work done in interventions and other areas.”

The effects of alcohol abuse are all too evident in Scotland, from the street drinkers to the over-zealous revellers in city centres on weekends. Alcohol branding is ubiquitous, too, appearing on everything from the shirts of popular football teams to the names of summer music festivals.

“Drinking is accepted as part of everyday life,” said Bell, the Alcohol Focus Scotland spokesperson. “But the alcohol industry are very good at making it feel like part of everyday life.”