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Alcohol Misuse (Scotland)

Volume 976: debated on Friday 21 December 1979

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2.22 pm

I wish to turn to another kind of vat—that concerned with the drink industry in Scotland. It is a very seasonal debate in the sense that at this time of the year there is likely to be a substantial increase in the number of accidents on the roads consequent on drunken driving. I wish to direct my attention to the question of alcohol abuse.

It is commonly agreed that this is one of the most worrying social problems in Scotland. Although not a teetotaller, I approach the subject with a degree of care because I do not want to appear to be moralising in any sense. Alcohol abuse is a disease rather than an evil, though it is probably a combination of both. If those who make and sell alcoholic liquor had to rely solely on the patronage of people like me, they would quickly be bankrupt. But like other drugs and poisons—we have earlier today had a debate on drug addiction—the consumption of alcohol in moderation can be a pleasant and harmless social habit, but, consumed in excessive quantities, can have serious and even fatal effects in terms of health and in other ways.

The results of excess consumption are reasonably well known and are publicised in various documents. The 1976 annual report of the Scottish Council on Alcoholism and the 1976 survey conducted by Mr. S. Dight for the Scottish Office entitled "Scottish Drinking Habits" indicate a problem of disquieting proportions.

I want to refer particularly to the document "Responding to Alcohol-Related Problems in Scotland—The Development of Services" by the Scottish Council on Alcoholism. It gives some illuminating and frightening facts on the matter. I should express publicly my thanks for the diligence of the council in presenting its case in moderation. It is a very constructive case which I hope the Scottish Office will study carefully so as later to present, in the form of a White Paper or in some other way, its considered view on how it will deal with the council's recommendations.

The report emphasises that the available statistics are not comprehensive enough and that, in so far as they are available, they are likely to underestimate the problem. Many people—and some of us know some of them—will tend to conceal their illness, or their disease or whatever one calls it, out of a sense of shame or a feeling that a moral stigma attaches to it.

Many of the consequences of abuse are very difficult to quantify. For example, one cannot quantify the amount of human suffering within the family and, still less, within the nation. The economic cost to the family and to the nation are also impossible to quantify accurately. The social cost—the increased demands on local and national health services, on other social services, on the police, on the district nurse and the GP, all of whom are involved—is also impossible to quantify.

Before any of those costs can be quantified, it is essential to define the problem. One starts with a difficulty: how is alcoholism defined? I do not know what the Under-Secretary's alcoholic intake is. I guess that a couple of doubles would see him on his back. The definition in the 1978 DHSS report entitled "The Pattern and Range of Services for Problem Drinkers" is
"any person who experiences social, psychological or physical problems as a consequence of his or her own repeated drinking of alcohol".
In trying to quantify the problem, the Scottish Council on Alcoholism, in its report, estimates that in 1975 between 75,000 and 112,000 of the adult population of Scotland—that is a very wide range—were problem drinkers, the great majority of them being males.

On 12 November my right hon. Friend the Member for Glasgow, Craigton (Mr. Millan) asked the Secretary of State for Scotland a question which resulted in a written answer which appeared in columns 472 and 473 of the Official Report of that date. It referred to the difficulties of definition, but the figures given were derived from the number of deaths from cirrhosis of the liver adjusted to take account of the proportion of such deaths not derived from alcohol. On that basis it was estimated that the number of alcoholics in Scotland in 1957 was 81,000 and in 1977 110,000. That is roughly a 36 per cent. increase in the past 20 years.

In a written answer on 31 October 1979 relating to England and Wales, it was estimated that 740,000 people had a serious drink problem, although it was impossible to say how many of them should be regarded as alcoholics, however defined. It can be fairly confidently asserted that the seriousness of the problem is greater north of the border than south of it.

The Scottish council also showed that there were regional variations. This is an interesting factor. In a distilling area 10 per cent. of the working population aged from 18 to 65 had a problem of alcoholism. The report discusses various facets of the problem. For instance, in 1975, of the acute male medical admissions to hospital as a whole, in Glasgow 25 per cent. had an alcohol problem, and in 19 per cent. of the cases the admission was either directly or indirectly due to alcohol or its effects.

It is suggested by the figures that in 1974 182 male and 124 female alcoholics committed suicide. In the same year between 395 and 1,087 discharges from hospital were due to cirrhosis of the liver. Other statistics show a close co-relation between alcoholism and the incidence of road accidents and accidents in the home and place of work. Indeed, in this morning's newspaper there is a report of a speech made by the Minister of Transport indicating that every year 1,200 people die on the roads in car accidents directly as a result of excessive drinking. One in five of all road deaths is due to this cause.

Blood alcohol levels in excess of the legally permissible limit were found in over 40 per cent. of the patients admitted with head injuries to the Western infirmary in 1974. The prosecutions for drinking and driving in Scotland in 1975 were 798 per 100,000 vehicles licensed compared with an average of 372 in Great Britain as a whole.

I turn to another facet of the problem—crimes of murder. The Minister is a lawyer and he will know these cases inside out. The crimes of murder are a small part numerically of Scotland's crime, but they receive great attention. They are extremely costly to investigate and prosecute through the due processes of law. In the study of 400 persons charged with murder in West Scotland between 1953 and 1974, it was found that 58 per cent. of the male accused and 30 per cent. of the female accused were intoxicated at the time of the offence. Nor is the role of alcohol limited to the assailant. It was concluded by the Scottish council that alcohol was the cause of the crime in 54 per cent. of the victims of male accused and 32 per cent. of the victims of the female accused.

Here I should like to make a political point. The facts to which I referred put into perspective the rather squalid campaign conducted especially by the former Member for Glasgow, Cathcart for the return of capital punishment as an effective deterrent to the crime of murder. The Minister must know what a nonsense that was in the context of alcohol. If one is drunk when one commits, or is a victim of, a murder, it is no deterrent.

I now turn to the harm caused within the family by excessive drinking. Maternal alcoholism, for instance, is literally a mortal danger. The children of chronic alcoholic women have a perinatal mortality rate of 17 per cent. compared with 2 per cent. in non-alcoholics. In addition, a further 26 per cent. of alcoholic women give birth to children with the foetal alcoholic syndrome characterised by abnormalities of the development of the brain and heart, retarded post-natal growth and many other developmental abnormalities. Thus complications occur in 43 per cent. of pregnancies of alcoholic women. Some years ago I chaired a Select Committee on battered wives. It is well known that battered children and battered wives are often the direct consequence of excessive alcohol consumption.

I now turn to the broader costs of alcoholism in Scotland. The Scottish council estimated that the average alcoholic employee cost his company £600 a year in terms of substandard work performance. It gave a rather startling figure, which I think is probably grossly exaggerated. I do not know how the council obtained the figure. It said that the bill for the whole of Scottish industry could be as much as £35,000 million to £50,000 million in lost production per year. I find that incomprehensible. I looked up the figure for the total GNP for the whole country. I find that it is about £163,000 million. The Scottish proportion of that would be about one-tenth, or £16,000 million. I find it difficult to associate that figure with the figure quoted in the council document.

However, the cost must be substantial and must be eliminated. By any standard the cost of living with this problem and tolerating it is horrendous, exceeding many times over, I suspect, the total cost of the entire National Health Service in Scotland and getting near, in the United Kingdom context, to exceeding the total cost of the national defence bill. Yet the amount spent on combating the problem is ludicruously small.

I hope that the Minister will give us an indication of the public expenditure on combinating this problem—I appreciate the difficulties—so that we may contrast it with the figures and facts that I quoted. I should also like to contrast it with what the Exchequer draws in tax on alcoholic liquor. In 1975–76 the Exchequer took in duty on liquor £1,561 million. Last year, 1978–79, the figure was £2,339 million. The Government have an enormous vested interest in the drink trade. I speak of all Governments. They receive such an enormous amount of revenue from it that they shrink from doing much to damp down the demand for alcohol. There are powerful vested interests at work in this area. The drink trade spends far more on advertising its wares than probably any other industry. The advertisements are romanticised; they connect drink with the young. It is time that the Government pursued much more vigorous policies against this kind of pernicious advertising.

The Government are exercising their minds on related subjects. According to press statements this morning, they intend to tackle football vandalism and hooliganism and vandalism in a wider context. Many of those problems are related to excessive drinking, especially among young people. Unless we tackle the problem at the root, the results will not be adequate.

The problem is vast, and little has been done by successive Governments to resolve it. As the Scottish council points out, the services for alcoholics have grown up in a haphazard fashion, unplanned and largely as the result of the zeal of voluntary bodies with inadeqate resources. I hope that the Minister will spell out what is being done and what the Government intend to do in schools and youth clubs, and how they will encourage local authorities to mount a campaign to root out the problem. What will be done in concert with the churches? What will the Government do to extend the use of television films and radio talks? A massive poster campaign, for instance, could be initiated by the Government to spell out the evils and the dangers of this habit. They should clamp down in a negative way on the advertisements allowed to the drink trade all over the country.

Nothing less than a Royal Commission is required to deal with all aspects of this problem, which is costing us dearly as a nation in terms of human misery, vast losses of national wealth and countless unnecessary deaths. If we cannot have a Royal Commission, the new Select Committee on Scottish Affairs might set up a Sub-Committee to prepare a report and ascertain the scale of the problem and its human and economic cost.

I did not initiate this debate in a moralising spirit and I hope that I have not taken that tone. However, no one can derive much pleasure from citing a few facts of a tragic state of affairs. If it only incites the Government a little to show greater willingness and determination to tackle the problem, the purpose of the debate will have been well served. It is in the wider national interest that it should be tackled with much more vigour and determination than have been shown up to now.

2.42 pm

The whole House should thank the hon. Member for Fife, Central (Mr. Hamilton) for raising this subject, particularly at this time. Obviously, as he said, with the onset of Christmas and new year, it is probable that the consumption of alcohol will substantially increase, which on past experience means that the related problems will increase.

I am sure that the hon. Gentleman will agree that it is right to use this opportunity, and any opportunity, to urge people in Scotland and elsewhere to recognise that, while there is no objection to the normal responsible consumption of alcohol, they should whenever possible ensure that their consumption, particularly at this time of the year, is sufficiently limited to avoid serious problems. In particular, alcohol consumption by those who intend to drive should if possible be completely constrained. At least, the problem is one of stomach ache: at worst, it is one of heartache, not only for those injured but for their families and the whole of the community. One cannot emphasise too strongly the need for restraint.

The hon. Member rightly stressed that he was concerned with the problem not only at this time but throughout the year. Such evidence as we have suggests that the problem is, if anything, more serious in Scotland than elsewhere in the United Kingdom. No one wishes to dispute or disagree with the right of members of the public to consume alcohol in a social way. Like the hon. Member, I have occasionally done so, to almost the same extent as he is prepared to admit to.

No one suggests that that is anything but a natural part of social intercourse. But the hon. Gentleman is also right when he says that the problem over the past 20 years has seriously deteriorated. What is particularly alarming is that the problems of excessive alcohol consumption have got worse among young people.

The hon. Gentleman mentioned the reply to a recent parliamentary question which estimated that the number of alcoholics in Scotland increased between 1957 and 1977 from 81,000 to 110,000. A sad and difficult aspect of the problem is that, however one approaches it, the statistics are not encouraging. From 1965 to 1976, the numbers admitted to hospital for alcoholism or alcoholic psychosis rose by 102 per cent. Deaths from cirrhosis in the same period rose by 45 per cent. and established deaths from alcoholism in Scotland rose eightfold. That is serious evidence, particularly when one considers that the number of drunkenness offences and drink and driving offences recorded over the same period were also on the increase.

This problem is not peculiar to Scotland. There have been equally distressing increase elsewhere in the United Kingdom, in Europe, behind the Iron Curtain and in the Third world—but that can be of little comfort to those concerned with the problem in Scotland. The hon. Gentleman referred to the report of the Scottish Council on Alcoholism published only in November, which is under active consideration by the Scottish Office. It was a generally useful and responsible report, which has highlighted a number of the serious difficulties.

In one respect, even at this stage, one can make a slight criticism of the fact that the report perhaps did not adequately describe some of the useful and important work which is already being done in Scotland. One can approach this matter under three headings—prevention, treatment and education. Prevention in the Scottish Office is essentially the responsibility of the Scottish Health Education Unit, which has for some time been pursuing objectives similar to those proposed by the Royal College of Psychiatrists in its report on alcohol and alcoholism. The unit has published a self-monitoring scheme to promote responsible attitudes to drinking by encouraging the public to monitor their own drinking levels and recognise where such drinking is causing problems.

The aptly named "dying Scotsman" cartoons in the daily press draw attention to the type of problems created by excessive drinking. Some recent television advertisements have been carefully researched and designed to attack the cultural image of drink which was referred to by the hon. Member.

The Scottish Health Education Unit has also sponsored a great deal of research into the development of attitudes among children aged between 6 and 17 in order to try to identify in what way education, particularly health education, in schools could be geared to warning youngsters of these dangers.

When it comes to training, it is perhaps sad that the report of the Scottish Council on Alcoholism did not mention one of the most interesting new developments—the opening of an alcohol studies centre at Paisley college of technology financed by the Scottish Home and Health Department. That is not only an innovation in Scotland; it is also probably unique in Europe. The centre's main aim is to provide advanced multi-disciplinary courses for those who come into contact with problem drinkers—social workers, nurses, doctors, policemen, clergymen, prison officers and others.

The first yearly course attracted 10 applicants from a good range of disciplines and next year's course is already well subscribed. The course has been approved by the Central Council for the Education and Training of Social Workers as a postgraduate training course. The alcohol studies centre also has it in mind to provide short courses of varied duration for those who in the course of their work must deal with problems arising from the misuse of alcohol—such people as doctors, nurses and others involved in accident work.

I want also to pay tribute to the Scottish Council on Alcoholism itself. Over the years it has played an important part in providing counselling through its 23 local councils and in all the manifest good work that it does to try to concentrate the public's attention on this problem.

Treatment is essentially a problem undertaken in the National Health Service, either in psychiatric hospitals or in special units in general hospitals. At present there are three units with a total of 54 beds identified as alcohol treatment units. However, I do not suggest that that is the total amount of activity in respect of people with these problems. The vast majority of them are dealt with in the general wards of hospitals, and one can see from the statistics an indication that, in 1976, 4,096 persons were admitted for alcoholism or alcoholic psychosis to the various hospitals.

Tribute should also be paid to the very important and useful work done in the voluntary sector. The Salvation Army, the Cyrenians and the Talbot Association have for many years put in a great deal of work which quite often has not been realised by the vast majority of the public. There are 23 residential homes in Scotland for recovering alcoholics, with 270 places. All but one of these have been provided by voluntary organisations. There has been a great deal of excellent work which we should recognise.

The Scottish Council on Alcoholism indicated in paragraph 5.8 of its report that a first step had not in its view been taken by most social work departments. It suggested that social work departments were not properly recognising the extent of the problem and responding to it. In some ways, this is an unfair charge to level against the local authorities. I have before me copies of very detailed and comprehensive reports prepared by Lothian regional council and Strathclyde regional council, the two largest regional authorities in Scotland, which deal with alcohol related problems and seek to promote useful solutions to deal with them. Strathclyde regional council has set up an officer-member working group which has reported on ways of implementing many of these proposals. The regional council recently appointed a principal social worker whose sole responsibility is the problem of addiction. That indicates the attention which local authorities are paying to the difficulties.

The hon. Gentleman raised the very important issue of the overall cost of alcoholism to the community. He said that very substantial sums of money were involved. He referred to the estimate in the report of the Scottish Council on Alcoholism which pointed out its view of approximately £600 per worker and then went on to speculate that the total cost to the community was between £35,000 million and £50,000 million. I think that the hon. Gentleman may rest assured that that must be a typing mistake. My own modest arithmetical exercise suggests that if the figure was correct it would imply that there were at least 58 million alcoholics in Scotland. That amounts to about 12 times the total population, and I think that it is a suggestion which can be dismissed easily. Clearly, it is a typing mistake. However, one should not jest too much, because the sums involved are very substantial.

In England and Wales an estimate has been made of a cost resulting from alcoholism of between £430 million and £650 million. This covers four main areas of cost—lost output, the cost to the Health Service, material damage, and police, prison and administrative costs. Taking Scotland's share of the overall population of the United Kingdom, it can be seen that the sums for Scotland are equally large in terms of money and resources which the community cannot afford to lose.

The hon. Gentleman referred to the link between alcohol and crime. He is right to suggest that a very substantial amount of crime, especially amongst young offenders, is linked to problems of alcoholism. He will be aware that in the Criminal Justice Bill, published this year, the Government put forward specific proposals dealing with football hooliganism, a very high proportion of which is linked with alcohol which is taken on to the terraces and consumed, resulting in antisocial and other forms of undesirable behaviour. The Government's proposals resulting from the work done by the Committee chaired by the hon. Member for Glasgow, Queen's Park (Mr. McElhone) have been put forward as a serious attempt to ensure that this aspect of the problem is at least improved. I hope that the hon. Gentleman and his colleagues will feel able to support the Government on this.

The hon. Gentleman also commented on the extent of the dependence of all Governments on alcohol as a source of revenue. Clearly, this is a problem. It also creates a slight paradox. The hon. Gentleman might not be aware of it, but, if anything, alcohol is relatively cheaper today than it was 15 years ago. Over the period from 1964 to 1979, the retail price index has gone up by 280 per cent. However, the cost of whisky has gone up by 141 per cent. Relatively speaking, therefore, it is 37 per cent. cheaper today than it was 15 years ago. Beer has gone up by 240 per cent. and, therefore, is 10 per cent. relatively cheaper than it was then.

Is the Minister undertaking, therefore, that the Chancellor of the Exchequer will put that right in April?

This is exactly my point. The hon. Gentleman said how unfortunate and perhaps how unsatisfactory it was that the Government should be able to rely so heavily on the taxation of alcohol and, therefore, that the more alcohol was consumed, the more revenue they received. However, simply to put up rates of tax on alcohol makes the Government, if anything, even more dependent on that source of income in years to come. Obviously, my right hon. and learned Friend the Chancellor of the Exchequer will have to come to his decision, and it is not an issue in which I am privy to his views. But it is a serious problem, and it is not perhaps widely realised that, relatively speaking, alcohol is cheaper today than it was 15 years ago. This may be one reason why consumption has increased over that period.

The hon. Gentleman referred finally to advertising. This is a problem about which the Government are concerned. Such evidence as we have from Scandinavia, for example, does not suggest in any firm way that restrictions on advertising have a significant effect on the amount of sales. The hon. Gentleman will remember that Scottish Television was on strike for 11weeks and that there was no advertising of any kind on television during that period. So far as we are aware, that had no significant effect on the level of sales in Scotland during that period. For some time there has been a voluntary ban on the advertising of spirits on television. As yet there is no clear evidence of what effect that is having on sales by those who sell these products. However, the Government accept that we cannot be complacent. It is a matter which is kept under constant review. Both the IBA and the Advertising Standards Authority have codes of practice on these matters. The codes have been strengthened recently, and that is to be welcomed.

The hon. Gentleman did not refer to it, but I am sure that he will not mind my saying that the problems of drinking and driving are also of serious import. The Blennerhassett committee which reported in 1976 put forward a series of recommendations. The hon. Gentleman will be aware that yesterday a consultative document was published by my right on. Friend the Minister of Transport. We hope that that will be responded to by the various interested bodies and lead to useful changes.

In conclusion, I thank the hon. Gentleman for raising this issue. I emphasise that it is an issue that the Government consider to be of supreme importance, especially in Scotland where the problem is greater than elsewhere in the United Kingdom. Much of great value is being done at present. The recommendations in the report contain a number of additional proposals. They are being considered by the Scottish Office, and we hope to be able to indicate which of the proposals can be translated into action in as short a time as possible.

I hope that the hon. Gentleman feels reassured that we recognise the problem. We hope to build on the work that has been done by previous Governments over the years.