The Panorama programme “Dying for a Drink” reminds us of the dreadful increase in liver damaged patients over the last 10 years. The programme showed us graphic images of the horrors of disease due to severe jaundice and liver failure. The escalating harm is not only a product of today’s negative drinking culture but also yesterday’s.
The producers didn’t make this very clear, but there has been a doubling of consumption over the past 40 years. For every pint our grandparents drank – we have two! So given the fact that the greatest increase in alcohol consumption has been in the last 20 years – the problem of alcoholic liver disease is only going to increase as time catches up with our country’s drinking epidemic.
Although the programme makers mentioned a slight decrease in alcohol consumption over the last couple of years, this is likely to be explained by the increase of bootlegged booze rather than any cultural shift. The real news for the next generation is that throughout the last decade, the number of drunk children admitted to hospital has risen by 40%. These are the liver damaged patients of tomorrow.
Alcohol abuse in Scotland
And what about Scotland? The programme focused on the problems in England, but Scotland has already had its diagnosis. Peter McCann, Chairman of Castle Craig – who has been studying and comparing the Scottish and English addiction landscapes for the past 25 years spoke to me about the figures in Scotland that show a trebling in chronic liver disease over the past 15 years. In fact as a rule of thumb, Peter McCann believes that when it comes to alcohol – whatever problems England are having – Scotland’s problem are consistently 60% worse.
It is clear that change is going to have to be dramatic. Peter McCann has long offered such a solution – slap another £10 tax on a bottle of whisky. Yet, remarkably, Gordon Brown in all his years as chancellor and Prime Minister, suppressed even tax increases on alcohol in line with inflation, meaning that in real terms alcohol became cheaper. The programme also showed how the new government is falling into the lap of the drinks industry, the same way that all other governments seem to do.
Politics and the drinks industry
Unsurprisingly the drinks industry is employing the same pernicious argument of the past 30 years – blaming “minority groups” who are spoiling the fun for the rest of us. Yet in Scotland, enough recorded alcohol is sold each year to allow every single adult over 16 to exceed their recommended weekly limits. Despite this the drinks lobby insists that voluntary measures from retailers are what is required – and quite shockingly the government swallows this.
It is disheartening that Alcohol Concern and other medical voices and charity groups are being ignored. They must be sick of being wheeled in to give the same advice to ministers before being routinely ignored. They are perfectly correct to repeat the mantra of “price, marketing and availability”. These are the only variables that can be altered by the government to bring alcohol sales and consumption under control. But we also need a shift in public tolerance to drunkenness. It is still an offence to be drunk in a public place – but it’s a tolerated offence – by publicans, the police and by the public as a whole who see drunkenness as more comic than tragic.
Tough message for patients
Away from the politics and back to the hospital wards, there is a tougher line that medics could be taking. We heard one doctor in the programme tell his patient that “if you keep going like this then eventually you could kill yourself.” From another patient we heard that his doctor had told him, “you are dying.” It is clear which is the stronger message – and the programme demonstrated a fact that that many working in the field know – which is that those very hard words such as, “You will be dead within a year,” or “you are killing yourself,” – are often the clincher – the trigger words that people need to hear before really changing their habits.
So, in order to get sober – there has to be a radical message to patients. But it also follows that if patients are to stay sober then there has to be a radical change in their lifestyles. And so it was sad to see one of the patients , following his liver transplant , was back in the pub with his friends. He was drinking a pint of orange juice – but how long will it be before he’s drinking beer again? Experience suggests this is inevitable. Elsewhere in the programme we heard nothing about any effective support services for the liver damaged patients being discharged from hospital.
Alcoholic liver disease
This is another untold story. Liver specialists, gastroenterologists and others in the medical field need to appreciate how the disease of addiction links in with alcoholic liver disease. A lot of their patients will be alcoholics and any form of treatment that doesn’t begin with addressing their underlying addiction will most likely be futile. The human body – and most especially the liver – has a remarkable ability to recover provided the patient remains abstinent and forgoes all alcohol, and this is where addiction treatment centres such as Castle Craig have a role to play.