ALCOHOLISM (SCOTLAND) (Hansard, 11 December 1972)

§ Mr. Alex Eadie (Midlothian)

In the British Journal of Addiction a very scholarly article on alcoholism in Scotland, written by J. Warder and C. Ross of the MRC unit of the Edinburgh University Department of Psychiatry, stated that judged from the number of deaths from cirrhosis of the liver the World Health Organisation had placed Scotland in the middle range of 30 countries ranked in order of the incidence of alcoholism.

The authors went further in the article to show the marked difference in the incidence of alcoholism in Scotland compared with England and Wales taken together. Compared with England and Wales, first admissions for alcoholism in Scotland are seven times as high for men and five times as high for women. First admissions for alcoholic psychosis are three times higher for men but there is an equal number of admissions for women. The proportion of alcoholic admissions of all admissions to mental hospitals is higher. Alcoholics constitute 31 per cent. of total admissions in Scottish mental hospitals and 7 per cent. in English hospitals.

I am initiating the debate because of the serious nature of alcoholism in Scotland. It could fairly be described as one of the curses of our country or as a national galloping unhappiness. The magnitude of the problem was recently stated by one of our national newspapers, which gave figures which as far as I know have not been challenged. It said that in Scotland one family in 10 had a drink problem, that one in 50 males were alcoholics and that of all alcoholics one in five were women. Alcoholism is now the third highest cause of death. As a nation we shall have taken leave of our senses if we ignore the implications of these startling figures which in most cases portray human misery, degradation and ruin.

At regular intervals the nation is made aware of the startling increase in all facets of crime—theft, rape, murder and violence. Ways of deterring such acts are suggested. How great is the influence of alcohol in these sometimes terrible acts? In the priorities for finding deterrents to 195 such crimes, where does the question of alcoholic drink come?

We must understand that alcoholism is a disease. That is accepted by medical opinion. It is no use just thinking that it is the result of the irresponsibility or the misdemeanours of the individual sufferer. That attitude will lead only to hopelessness and despair, when hope of a cure could be given to many, but it depends on how we as a nation are seized of the urgent need to deal with the problem.

In the light of the known facts, what steps do the Government propose for giving hospital treatment to alcoholics? How many hospital beds are available, and what are the out-patient facilities for specialist treatment?

I am not unmindful of the difficulties of the Minister in replying to this question, because alcoholism is the hidden disease, the disease that places the patient outside society like a leper. He is placed there by a society which, by its accepted social customs, with drinking in pubs and clubs and at parties, has encouraged the problem. It is a sad reflection that the man who does not drink is considered a bore, unmanly and not to be entertained, yet the alcoholic is also shunned. Thus we have the stigma and the emotive words "drunk" and "Skid Row", which bedevil the approach to the disease, causing frustration and anger to all who work with the problem and also causing the patients and their families to deny and hide the problem until very often it is too late to help them.

This came to me very graphically at a medical conference on alcoholism in Edinburgh in March 1971, which I attended by invitation of the Govern-. ment. The wife of an alcoholic there outlined her family's problem in strict scientific terms, without false emotionalism. She told how the love relationship was destroyed in every sense between herself and her husband and she spoke of the loss of jobs, the destruction of her home and how she herself turned to alcohol.

We all welcome the recent formation of the Scottish Council for Alcoholism, which I understand was born out of the initiative of Glasgow and Edinburgh in amalgamation. The fact that the Secretary 196 of State for Scotland has his own representative on the council is additionally welcome. But can the Minister give us some information tonight about a radio interview with a representative of the council, who stated that the council had been invited to some secondary schools to help in the drink problem, which was by far a bigger problem than drugs?

The Government must have been aware of the problem from a report on alcoholism by the Medical Council on Alcoholism as far back as 29th July 1970, when it reported: Today the potential teenage drinking problem is much greater not only in this country but throughout the world and should give more cause for alarm than drug addiction which concerns only a small percentage of the young, despite alarums in the Press, on television and in the House of Commons. What steps are the Government taking to stop our young people being corrupted and cursed in this way?

I have very little time tonight to deal adequately with the problem, but I must find time to attempt to define an alcoholic. I find that the most generally accepted definition is that laid down by the World Health Organisation: Alcoholics are those excessive drinkers whose dependence upon alcohol has attained such a degree that it interferes with their bodily and mental health, their inter-personal relationships and their smooth social and economic functioning or who early show signs of such developments. Alcoholics, therefore, are sick people.

It is essential to understand that alcoholism and drunkenness are two different problems. Nor are all excessive drinkers alcoholics—although excessive drinking over long periods can and will cause physical and mental damage. I suggest that the facts disclose that alcoholism is not confined to one class. No figures are available for Scotland, but the Institute of Directors, to use its unsympathetic phrase, admits that it "boots out" seven or eight people a year.

I should like to quote from an article on alcoholism by Richard A. Parry in the Scottish Medical Journal. Under a subheading The 'character' of the drinker", Mr. Parry says: Alcoholism does not occur in 'bad' people rather than in 'good" people, or in 'irresponsible' rather than 'responsible' people. Some people who become addicted are highly 197 respected members of society and most pass unrecognised by their friends and workmates. It is true, of course, that some very irresponsible individuals become addicted; but this type of personality must not be regarded as a paradigm for alcoholics as a whole. I have endeavoured to try to work out what the problem costs us in Scotland in money terms in industry. I estimate that it costs us at the very least £10½ million. I base my estimate on the Report on Alcoholism by the Medical Council on Alcoholism in 1970 which estimated that the cost to industry could be a minimum direct sum for Britain of £30 million a year, to which must be added an indirect cost of £75 million. Therefore, I assert that I am more than generous in my estimate for Scotland for 1972.

I do not have today's figures in relation to what the Government in Britain receive in tax from the sale of liquor, since they grossly under-estimate the position, but the rate of tax realised in 1969 was some £777.7 million a year. We must add to that sum the tax on the profits from the liquor industry, plus income tax from the individuals employed in the industry—an estimated figure of at least £700 million. We arrive at a figure—under-estimated—of at least £1,500 million received by the Government from the liquor trade generally. It is a bad bargain when we consider that the economy of Britain loses over £100 million per annum.

I want to put a question to the Minister who is to reply. It is generally admitted that medical research into alcoholism is greatly hampered by lack of funds. Has any consideration been given to levying additionally to give, for example, about £500,000 for medical research?

I want to say a word or two particularly on television advertising. As I have stated, I welcome the fact that the Secretary of State for Scotland has a representative on the new Scottish Council for Alcoholism but I must state my disappointment when I put down a Question to him last month asking his representative to inaugurate a discussion on television advertising, because I believe that advertisements of the type which we are getting are insulting to the people who devote so much of their time to 198 trying to deal with the problem. The advertisements are couched in the irresponsible. They infer "If you want to get on and be pals with the 'birds', drink a particular brand of liquor". It is an obvious double catch for the girls. The advertisements say "If you want to be a man, and some kind of superman at that, drink a particular brand of liquor". The Minister cannot be happy about this kind of advertising corruption, and I hope that he will explain why his right hon. Friend the Secretary of State conveys the impression that we should not discuss it. Industry in general must obey certain codes of practice and there is no reason why the brewers or their representatives should be treated differently.

In preparing this speech I discovered that the last Government report on the subject was the report of a working party on 12th June 1970 which was captioned "Habitual drunken offenders". It had very limited terms of reference and was oriented mainly to England and Wales and did not deal specifically with alcoholism. I mention it because it contains a great deal of information on the effects of alcohol. I noticed that there was an observer on the working party, Mr. D. J. Cowperthwaite, from the Scottish Home and Health Department, and oral evidence was given by two representatives of Glasgow City Police and the principal probation officer in Glasgow. I wonder where the rest of the authorities on Scotland were. Perhaps the hon. Gentleman can tell me, because Glasgow is not the only city with an alcohol problem.

Since I knew that I was to have this debate, the Erroll Report on Liquor Licensing has been published. We understand that a Scottish report on the same subject will be with us early next year and that it is, we are told, to follow the same pattern. It will be called the Clayson Report. I do not have time to make any detailed comment, but in the Erroll Report the extension of opening hours for drinking has been suggested in an argument to curb drunkenness; to cater for consumer demand it is recommended that the age of 18 years be reduced to 17 years for the purchase and consumption in bars of intoxicating liquor, and that the admission of children under 14 years into certain parts of the premises should be considered. It is ridiculous to suggest that this is all that 199 the Erroll Report deals with, but there are aspects of the report which will create great controversy and which should be put up for public discussion if the Scottish report is to follow the same pattern as the Erroll Report.

In any discussion which takes place in a Scottish context it must be remembered, regrettable as it may be, that the problem of alcoholism is worse in Scotland than it is in England and Wales, according to the available statistics. I have refrained from making too much mention of such bodies as Alcoholics Anonymous. I am sure that they will not take it as a non-recognition of their selfless devotion towards assisting in solving a problem of whose effect we all seem to be painfully unaware. I hope that I have in a very small way opened what must be a continuing debate on one of Scotland's great problems.

§ The Under-Secretary of State for Health and Education, Scottish Office (Mr. Hector Monro)

It is clearly right that the hon. Member for Midlothian (Mr. Eadie) should have raised this subject tonight. I am grateful to him for his support on this subject over many months. I am also grateful to those hon. Members on both sides of the House who have stayed here to listen to the debate.

The Government have been making a determined effort to increase awareness of the reality of the problem in Scotland and anything, such as this debate, that helps to increase that awareness is helpful. It is only by greater public understanding that there can be mobilisation of the resources and effort on the scale needed to make an impact on the amount of human misery suffered by alcoholics and their families.

Alcoholism is still widely misunderstood. It is too readily confused with various kinds of anti-social behaviour in which excessive drinking often plays a part. But the disease of alcoholism must be kept quite distinct from casual drunkenness, football hooliganism or other forms of destructive, malicious or merely foolish behaviour.

200 Alcoholism is an illness and sufferers from it need treatment and support quite different in nature and degree from the drunken offenders or experimenters with drugs. I want to make it clear that at present alcoholism in Scotland is a much more serious problem than drugs.

The hon. Member mentioned the Clay-son Committee. As he is aware, the licensing laws of Scotland are now under careful scrutiny by the Clayson Committee whose report is expected early in the New Year. It has been a difficult and contentious task and personally I am not surprised that it is running a little behind the Erroll Committee on licensing in England and Wales which reported last week.

Liquor licensing has functions other than the prevention of alcoholism. I have no doubt, however, that the Clayson Committee will carefully consider the possible link between changes in the law and the prevalence of alcoholism. Without wishing to anticipate the Scottish conclusions, I have of course taken careful note of chapter 3 of the Erroll Report and of the comment in para. 3.31 that very considerable changes would be required to make any significant impact on the problem of alcoholism.

We must not expect the disease to be cured by legislation. There are four aspects to treatment—the parts played by hospitals, the voluntary organisations, the health education unit and research. Treatment of alcoholism is provided in nearly all mental hospitals in Scotland and two hospitals, the Royal Edinburgh Hospital and the Southern General Hospital, Glasgow, have special units with 18 and 15 beds respectively.

Over the last few years admissions for alcoholism to mental hospitals and the psychiatric units of the general hospitals have increased appreciably. In the five years from 1967 to 1971, admissions of men rose from 2,469 to 2,888, an increase of 17 per cent., while admissions of women increased relatively much more from 434 to 756, a startling increase of 74 per cent. Beds are available for emergency treatment and the problem is getting alcoholics to go to hospital and to take the chance of a consultant's help.

The hon. Member mentioned outpatients. Most of the facilities are used for following up those who have had 201 more intensive care in the hospitals. About 60 per cent. of the cases I have mentioned are readmissions and we must take those into consideration when looking at the overall total. Although hospital admissions for alcoholism are clearly no more than the tip of the iceberg, the upward trend may reflect an actual increase in alcoholism and not merely a greater readiness of alcoholics to come forward for treatment. Some support for this view is provided by the number of deaths certified as due to alcoholism. For the last four available years, 1968 to 1971, these have been respectively 32. 32, 55 and 51, which shows that the trend is upwards.

I pay tribute to the social workers, who are very much involved in treating the alcoholics and helping their families. We are calling for plans from the social work departments which will include facilities for helping alcoholics, and we expect them shortly. Edinburgh Corporation has already planned a hostel for alcoholics in the Grassmarket, and this should be a valuable introduction.

I also pay a warm tribute to the voluntary workers, because without their special contribution we should be in serious difficulties. Perhaps the best known body is Alcoholics Anonymous, but a wide range of organisations is concerned and these have gradually formed themselves into regional councils on alcoholism in Glasgow, Edinburgh and Tayside, and are now in the process of combining to form a Scottish Council on Alcoholsm, which it is hoped will be representative of all the organisations in the field.

As evidence of the Government's support of the aims of the new Scottish Council, a grant of £6,000 has been given for the current year to help in its organisation and to enable it to further the work of its constituent bodies. I have great hopes for this council and I wish it great success. We have also had good relations with the National Council on Alcoholism, the United Kingdom body, and we contribute £1,000 a year to it, particularly with a view to making possible the employment of an industrial organiser.

Research is most important in the long term and many fields require intensive study. Only recently has it begun to 202 attract suitably qualified workers. There is now a marked increase in interest, and the Scottish Hospitals Endowments Research Trust has received £5,000 a year from the Distillers Company to help in five projects at present under way in Scotland which are studying issues of direct relevance to alcoholism. Recently, Distillers made a further grant of £73,000 to establish a research unit in Glasgow. Many of these issues will be discussed at a conference on alcoholism in March.

The rate of progress this year gives me confidence that the impetus will be maintained, and it is much faster than was forecast in Glasgow last March.

But besides the studies on behalf of the Health Education Unit by Strathclyde University, to be published next month, particularly concerned with young people, there is much awareness, particularly among universities, that this problem needs active support.

I should like to say how active the Director of the Health Edacation Unit has been in holding conferences. With a grant of £15,000 he has brought this problem to the forefront in Scotland. I am grateful to hon. Members on both sides—including the hon. Member for Glasgow, Provan (Mr. Hugh D. Brown), who is present tonight, and who went to a conference on the Continent—for bringing home to the people of Scotland the seriousness of this problem.

Because alcoholism is so deeply ingrained a problem, because Scotland has, for whatever reason, been less successful than other societies in coming to terms with alcohol, it is easy to feel unnecessarily despondent about the efforts being made to combat it. We are trying to tackle this subject with vigour and determination.

There must be no question of complacency. The evidence is unmistakable of the enormous cost of what is perhaps the dominant social problem of the present time, far more serious, I would say, than drugs. It is not only the burden of serious disability of individual sufferers, often leading to total failure. The disruption of family life and the destruction of friendships—the statistics imply that one family in 10 in Scotland has an alcoholic member—also makes the search for new and increasingly effective 203 methods of treatment, rehabilitation and support one of the undoubted priorities of our health and social services.

We must all recognise that not enough has been done. We intend to see that alcoholism is not in the future, as it has 204 so often been in the past, a neglected, under-rated and almost unmentionable subject.