ALCOHOL
labelling restrictions are due to be enacted in 2026 , two key parts of the PHAA are yet to be commenced . These are section 18 , covering ads in publications , and section 13 , which places restrictions on the actual content of ads . And it ’ s the latter that the industry are ‘ ferociously ’ resisting , says AAI .
This is because it ‘ restricts the contents to facts , stripping out the industry myths which are used to recklessly promote consumption ,’ and , again , requires the inclusion of health information and warnings . ‘ But even if they were published tomorrow , what happens is they have to go to the European Commission and there ’ s a process to be gone through there ,’ she says . ‘ So we ’ re still a very long way off get getting that done .’
‘ Look at the number of children right now living with a parent with an alcohol problem . A quarter of the adult population in Ireland grew up with alcohol harm in the home ...’
REGULATION DILUTION Is she worried that industry pressure will mean that when they do finally come into force they ’ ll end up being watered down ? ‘ That ’ s always the concern ,’ she says . ‘ But I ’ d say the industry game at the moment is to delay them as much as possible .’ The problem with this is that everything – the labelling regulations , the content regulations – is designed to work together . ‘ They complement each other and should be brought in at the same time . It ’ s just desperately frustrating because , among other things , what you could see happening is people saying , “ so did it make any difference ?” And we ’ re saying the whole thing is meant to act as a package – it ’ s not that this is the magic bit and that bit is something else . It ’ s designed to work together , so it ’ s undermining the legislation to be doing it in these bits and pieces , without a coherent path .’
JOINED-UP THINKING Speaking of a coherent path , AAI and others have also been lobbying for the establishment of an Office for Alcohol Harm Reduction in the hope of creating that oft-cited but usually mythical thing , ‘ joinedup government ’ – on this issue at least . ‘ We need people who have the time and resources to be firstly gathering the information that ’ s needing to be looked at , different policy options , and most of all to be coordinating it across government . Because what we see all the time is we have the Department of Health who are seeking to reduce alcohol use , and then we have a multitude of other departments which act contrary to that – for example proposals from the Department of Justice to increase availability through longer licensing hours .
‘ So we ’ re very keen on this idea of an alcohol office , of needing people with fresh thinking ,’ she continues . ‘ We need to be looking at things like internet marketing , we need to be looking at other harms and harms to children in particular . Look at the number of children right now living with a parent with an alcohol problem . A quarter of the adult population in Ireland grew up with alcohol harm in the home , and it carries a devastating impact . Think of the costs of that alone – individual costs like mental and physical health and wellbeing – but also on an economic basis . It makes so much sense to look at all of this in the round .’ DDN
THE FRIEND THAT WON ’ T LEAVE
Breaking someone ’ s close bonds with alcohol is no easy matter , Dr Roger Prudham told an audience of GPs
The ‘ really dramatic increase ’ in deaths from alcoholic liver disease represented an ‘ incredible explosion ’ in the toll on the population , Dr Roger Prudham , consultant gastroenterologist , told the recent RCGP and AP conference , Managing addictions in primary care . His chart showed the burden of disease from alcohol dwarfing that of hepatitis B , hepatitis C and metabolic dysfunction-associated steatohepatitis ( MASH ). ‘ Yet the allocation of resources for alcohol doesn ’ t match that epidemiology ,’ he said .
Signs of liver disease in the hands , jaundice , gynaecomastia , ascites , hepatosplenomegaly , abdominal wall varices , oedema , and encephalopathy were all things to look out for during assessment . ‘ But you may have nothing at all , or you may look perfectly fine because the liver is an incredibly forgiving organ – it doesn ’ t give you any pain or discomfort .’
Importantly , that first conversation needed to be ‘ brutally candid but also kind and non-judgemental ’. He encouraged asking specific questions – ‘“ What do you drink ?” “ How many bottles / cans a day ?” “ How many times a week do you buy that ?” “ Does that include what you drink at the pub ?” – instead of “ How many units do you drink ?” When you get into those specific questions , people find it much more difficult to prevaricate .’
Lifestyle advice included a gradual reduction in alcohol consumption , withdrawal support ( community-based where possible ), chlordiazepoxide to manage withdrawal , thiamine and multivitamins , and nutritional support . Prudham advocated vigilance for worsening oedema , encephalopathy , jaundice , bleeding , and fluid balance and added , ‘ I also think it ’ s sensible to think about alcohol addiction as a disease , not to make a moral judgement or to think that somehow somebody is defective if they ’ ve got an alcohol-related problem , because it ’ s a very seductive drug , it ’ s universally available , and it ’ s socially accepted everywhere .’
For medical interventions in primary care , he advised spironolactone and furosemide to help mobilise oedema , low sodium , and lactulose for treating encephalopathy . But what really worked was ‘ probably not the medicine ’ but ‘ a brief intervention , a word from a healthcare professional when you ’ re going from 30 to 40 units a week ’.
He believed minimum unit pricing , cognitive behavioural therapy and a multidisciplinary approach were all effective , alongside finding something else to do – ‘ Boredom , I think , is the biggest promoter of recidivism ,’ he said . ‘ You ’ re going to need something to replace the alcohol .’
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