§ 4.23 p.m.
§ LORD SOPER rose to ask Her Majesty's Government whether they will:—
- (1) give figures showing the incidence of alcoholism in Great Britain and Northern Ireland;
- (2) give a comparison of these figures with those of other European countries and of the United States;
- (3) state what facilities are available for the treatment of alcoholics in this country;
- (4) state whether they have any plans for the extension of these facilities.
§ The noble Lord said: My Lords, there is widespread feeling, amounting in many quarters to conviction, that the problem and evil of alcoholism is grave and is increasing. I believe that to be true, and 1401 I have some first-hand evidence to support that belief. But it may be in your Lordships' minds that a Nonconformist minister with a tradition somewhat addicted to teetotalism may not be the most appropriate person to raise this question without, incidentally, raising questions as to whether I am afflicted with typical ecclesiastical exaggeration and also a kind of sentimental fanaticism about the problem.
§ I agree that it may well be considered that ministers of religion tend to see more sinners in their congregations than are actually present. John Wesley himself on one occasion said that he saw 25,000 people in Gwennap Pit, in Cornwall. Those of your Lordships who are aware of the location and size of this open-air forum will know that they could have been accommodated there only in layers, and I am quite sure that Wesley was very largely exaggerating the number. Your Lordships may equally think that there is exaggeration in the numbers which will be given of the actual incidence of alcoholism in this country. It is with that prudent thought in mind that I have so framed the questions as to evoke what specific statistics are available in the reply which my noble friend will no doubt given later, and I shall therefore restrain myself from giving any more statistics than I feel are absolutely proper to the arguments I hope to develop.
§ In the second place, I am quite sure this is not a matter to be treated as an aspect of teetotalism or as an opportunity for evangelical fervour on behalf of total abstinence. If I may remind your Lordships of the nature of alcoholism, it will quickly dispose of any temptation so to do. Alcoholism is a specific disease, a stress disease. It is accompanied by physical changes in the victim and, of course, is characterised by compulsive drinking on the part of the victim. It is not a process whereby a man continues to drink because he wants to, or because he has a strong desire so to do: it is a condition of compulsive drinking in which he drinks because he has to.
§ I would delay your Lordships a little to look into the causes of this alcoholism, if I may, and what I have just said indicates one regulative feature of that inquiry. There are those for whom alcoholism is the terminal stage of "a 1402 rake's progress". There are those who have deliberately used their opportunities of freedom until those opportunities of moral freedom have long since passed out of their own control.
But there are more circumstantial reasons why alcoholism is now prevalent, and they have only ancillary relationships to moral questions. It is contended by some, such as those in the Carter Foundation, that one of the prime causes of alcoholism is the kind of society in which so many alcoholics are to be found. I will quote two short sentences from their most admirable document:
The major contributory factor to the increasing percentage of alcoholics in our population is the ever more complex industrial and social framework in which we live. It is an inability to come to terms with this complexity which causes most alcoholics to take their first drink.
Whether that last part of the sentence is completely accurate I am not sure. But I would submit to your Lordships that it is true that in a society which is increasingly complex, and, I would add, is largely secular, there are to be expected greater degrees of frustration, and of psychological frustration in particular; and it is no passing comment to remind oneself that the absence of religious faith, or even, indeed, of religious taboos, has not a little to do with the inability of many people to-day to sustain the strains of a modern so-called civilised society. For it is true, I suggest, that the taboo which is the product of religious superstition may, in this field, be as effective as a moral principle generated by religious faith. Those props and buttresses have largely disappeared, and it is in that regard that the society in which we live contributes to the incidence of alcoholism.
§ There is no doubt at all—and the evidence that comes to us from across the water and France is here most declaratory and impressive—that alongside the so-called affluent society has come a very much larger option in the matter of diet and drink, and a larger assumption on the part of many people that drinking is a social pleasure and a social activity to be repeated frequently during the day. This is why, during the last legal processes in France which led to new constitutional enactments, bistros and estaminets have now been prohibited alongside railway stations and bus 1403 stations, precisely because there is overwhelming evidence in France of the incidence of alcoholism among adolescents of sixteen and over who have been habituated from their earliest age to repeated intakes of alcohol and a variety of those intakes every day. And it has been not only drinks between meals, but drinks between drinks, which have largely aggravated a problem which in itself was sufficiently large to be admonitory and serious.
§ Furthermore, we are confronted with, and I think afflicted by, an advertising campaign which is as assiduous as it is basically unscrupulous. I make no bones about it: I regard the general use of advertisement by the drink trade as unscrupulous; and when it is accompanied by all the blandishments that can be brought into it through television to-day, and when we are invited to think the only proper activity for young people, particularly if they want to be virile, is to be constantly taking in alcohol, I am not surprised that many of those young people in this country become addicted to it, and that this is one of the subsidiary, although not necessarily important, causes of alcoholism as we now have to face it.
§ What are the effects of alcoholism? I would not have your Lordships believe that I speak without some little authority on this matter. Not that I presume to know technically, and from any standpoint of medical competence, but because, having run a couple of hostels for some years for male and female alcoholics, I know these facts to be substantially true. First, alcoholism is a personal tragedy for those who suffer it; and, secondly, it is almost incurable. In fact, the optimum is a protracted convalescence; there is no such thing as an absolute cure for alcoholism. Furthermore, of those who are alcoholics, so the best evidence I can obtain suggests, only about 20 per cent.—and that is probably an optimistic figure—are cured, despite the efforts made to succour them.
§ Secondly, no one can underrate, and no one would want to underrate, the misery and wretchedness caused in the households of those who are alcoholics, and particularly those who are female alcoholics. This is a secret vice or affliction, and those of us who have made 1404 some attempt to provide domestication hostels for women alcoholics know now something of the profound difficulty, first in getting at the evidence, and secondly of providing such accommodation and friendliness and medical treatment as may be of use. There can be little doubt that the statistics which have been previously advanced (I think it was in 1956), that one in ten alcoholics are female, are inaccurate. The suggestion is now that the proportion is much more like one in three; and that may not be due to the fact that there has been an increase in the number of women alcoholics—although there may have been—but probably because many have been hitherto undetected, and controlled experiments are still few and far between.
§ Those who would look at this problem from the economic and social standpoint may like to remember that it was the father of the noble Lord, Lord Stamp, who, in giving evidence before a Royal Commission on drink not many years ago, calculated that about 13 per cent. of the total productivity of a community was impaired, if not destroyed, by intemperance. Of course, some of that was drunkenness, and that is not the same as alcoholism; but a great deal could be regarded as statistically accurate of the kind of society in which we live to-day. Those who would attempt to assess the moral and spiritual loss to the community by reason of alcoholism and what it does to people, fine and splendid and useful people, would also want to calculate something of the material loss to that community caused by the varied impacts of alcoholism on efficiency and health, and would also want to reckon, in conjunction with this calculation, the tremendous cost it now presents to a civilised society, as we claim ours to be.
§ My Lords, it is because I would see something done, and I am sure your Lordships want to see something done, about this growing serious disease that I would turn your attention now to what seem to me the areas in which the attempt to answer this problem has to be sought. There is wide need for publicity and there is wide need for teaching, both to adults and in schools. I pay my tribute to the National Council for Alcoholism, and I should like to see it supported and its effectiveness increased. I am quite sure that there is a flippant, stupid and very 1405 often senile, attitude to alcoholism, which is something between a giggle and a guffaw. I have no doubt there are many people who would regard alcoholism as a comic joke, until they see, as I saw a fortnight ago, a boy of fifteen who was a confirmed alcoholic.
§ I believe that there is profound need for what is best called an information centre (one of which has already been set up in Liverpool and one, for which I shall be responsible, that is to open next Monday in Kennington) where those who are afflicted with this disease, or those who are friends or neighbours or the relatives of such, may find an opportunity of gaining what information is now available and profiting by the kinds of treatment which have only recently come to the fore and become established and clinically operative.
§ Thirdly, there is one outstanding problem in any treatment which is offered to an alcoholic, and it is precisely this. Unless you can provide some suitable arrangements whereby he will find it possible to use what little moral power he possesses to take advantage of these treatments; unless you domesticate him in circumstances in which it will be congenial to take these treatments—and some of them are unpleasant, like apomorphine and (what Hansard joyously called last time "anti-boost") antabuse; unless you can provide some hostel, some friendship, some friendly place where he will be at home, then it is highly unlikely that he will take more than the first dose. It is because there is this peremptory need for the setting up of hostels in which those who can be treated will, in fact, have the encouragement so to be treated, and will in some measure co-operate with this treatment, that I hope my noble friend will say something about the tremendous need for hostel accommodation for those who are afflicted with this disease.
§ Finally, I am advised that it is within the general view of Her Majesty's Government that in the general framework of the Welfare State, and in the particular framework of the Health Service, there should be greater efforts to deal with and make provision for dealing with this evil of alcoholism. That I most heartily welcome. I am well aware of the fact that the British Medical Association and the Magistrates' Association have hitherto 1406 regarded what is provided as grossly inadequate. I am sure they would agree, that the Government itself would agree, that if this particular evil is anything like as grievous as I have been presumptous enough to suggest it is, what has as yet been provided is grossly inadequate. I hope, therefore, that when the reply is given to my questions there may be some strong indication that within the framework of the Health Service, within the framework of the Hospital Service, within the framework of the general practitioner's area of influence and opportunity, there may be a deeper awareness of what this problem is and a greater utilisation of the methods, some of which have already been tried and not found wanting, but found useful and, in some cases, curative.
§ I should not have ventured to raise this problem in your Lordships' House had I not, in the process of my own pastoral duties recognised it, and been forced to recognise it, as of profound seriousness and it is in no mood of undue solemnity that I have come to the conclusion that in many respects what my doyen, John Wesley, said on another matter is also true of this: in the matter of alcoholism, "There, but for the grace of God, go I."
§ 4.39 p.m.
THE LORD BISHOP OF CHESTER
My Lords, in view of the passage of time it may be necessary for me to leave the debate in order to fulfil an unavoidable evening engagement, before the noble Lord has replied. If so, I hope he will accept my apologies, for I intend no discourtesy. All of us who are interested in the problem of alcoholism will be grateful to the noble Lord, Lord Soper, for tabling the Question that stands in his name, and I hope that, in consequence, the noble Lord who answers will be able to give us a clear lead in the policy of the Government for dealing with this problem, and also information of realistic plans for extending the means for fighting this major social evil.
In the debate in this House on the Welfare Services in April of last year, I endeavoured to set before the House the facts concerning the disease of alcoholism. The noble Lord, Lord Soper, has spoken from his own experience of these matters. I will not weary your Lordships by going over the same ground, 1407 but I wish to draw your Lordships' attention to two aspects of the matter which I suggest merit our close attention.
As with so many matters of public concern, alcoholism is being tackled by a partnership of statutory aid and voluntary service. A great step forward was taken when the Ministry of Health published their Memorandum H.M. (62)43 on the hospital treatment of alcoholism. That Memorandum was published three years ago. I understand that in the 15 Regional Hospital Boards there are now 11 clinics, 3 of which are in London, dealing with alcoholics. I hope that the noble Lord in his reply will be able to tell us the extent of the response by hospital authorities to the commendation which is made in the Memorandum. Has there been a growing readiness to provide facilities for the treatment of alcoholics? Is the Minister satisfied with the developments which are taking place? And what plans has the Ministry to extend the opportunities for advice and treatment?
On the voluntary side much is being done, mainly at the instigation of the Churches, to help alcoholics. One can think of the work of the Church Army and the Salvation Army, the Reginald Carter Foundation, the Anglican Community at Spelthorne St. Mary for women addicts, and the work of the noble Lord, Lord Soper, at the West London Mission. Alcoholics Anonymous is doing splendid work in bringing the techniques of group therapy to the problem, which is so important. The National Council on Alcoholism, through its work in London and at various centres in the Provinces, is providing information centres at which the alcoholic may be directed to the people and the places where he can find the assistance he needs. These voluntary services are vital, but they are having a very hard time to survive financially.
The treatment of the alcoholic, as Lord Soper has said, s not a matter which evokes much popular appeal. Those who are approached are apt to shrug off the request for aid by asking why they should help those who, by their self-indulgence, have got themselves into the state. The remedy, they suggest, is in their own hands—let such people take a grip on themselves, lay off the bottle, and all will he well. But such a reply is all too readily made, and it betrays an ignorance 1408 of the nature of alcoholism and of the manner of its incidence. Alcoholism is a disease, compulsive in nature, incurable in so far as no alcoholic can ever again take alcohol with impunity, but responsive to treatment.
A person becomes an alcoholic, as Lord Soper has said, for a number of complex reasons, many of which cannot be labelled as unadulterated human weakness. Emotional shock, undue stress, fear, disappointment, anxiety—all of these emotions and many others may set a person off on the road which will lead to the slavery of alcoholism. It is not merely a question of lack of self-control, a condition which may be recovered by an effort of the will; it is an insidious disease requiring the most skilled understanding, research and treatment. I hope that, as a consequence of this debate, there may be a greater understanding of this terrible scourge of alcoholism, and that word may go out from us to charitable foundations, to industry and to all others who can give, calling upon their readiness to help.
What we are asking, at its lowest, is self-help, for industry must lose many millions of pounds through lost man-hours and decreased efficiency. It would do itself a good turn if it were to invest in the efforts being made by voluntary agencies to understand and to stem the incidence of alcoholism. But, as well, I hope that the Government will show themselves ready to give more help financially than they do at present. In Canada, Australia, New Zealand and the United States of America, a great deal of Government assistance is given to the various national councils of alcoholism. No such help is given in this country.
And yet it may be pleaded that those who are trying to deal with the problem in this country have a special claim upon State aid, since not only does the State receive vast revenue from duty on alcoholic beverages, but it is itself in the drink business. It owns some 200 licensed premises in Carlisle which, so I understand, produce a profit of some £200,000 per annum. In Scandinavian countries, where there is a State monopoly of the manufacture and sale of alcoholic beverages, a proportion of the profits are ploughed back into research into alcoholism and education of the public. I suggest that Her Majesty's 1409 Government should follow this example. The National Council in this country is doing important and essential work on most tenuous financial resources. Unless help comes, it may well have to cease its work. So that I hope the Government will supply the means whereby it may carry on.
My second point is more specific and concerns the work which can be done among alcoholics in prison. It has been encouraging to read recently that Her Majesty's Government are deeply concerned with this aspect of the problem. Speaking on June 8, Miss Alice Bacon, Minister of State at the Home Office, spoke of the special treatment for alcoholics at Wandsworth, Pentonville, Grendon, Wormwood Scrubs, Holloway and Wakefield Prisons, and of plans to extend the units for treatment. I hope, therefore, that there will be further experiments, especially in open prisons where alcoholics may live a more natural life than they do in a closed prison while receiving treatment for their condition.
In this treatment it will be very desirable to call upon the help of outside bodies. I understand that Alcoholics Anonymous have branches in a number of prisons. I would also draw attention to the work being done in Gloucester Prison by the field officer of the National Council of Alcoholism. I understand that the value of his work has been generally recognised. The N.C.A. hope that this experiment may be regarded as a pilot scheme which might be repeated where it has other information centres—in Cardiff, Liverpool, Glasgow and elsewhere. But this can be done only if financial help is forthcoming. Indeed, the Gloucester scheme is in danger of closing because the necessary support is not available. Here is another instance of valuable work which is in jeopardy for lack of money.
Those who are battling to get alcoholism recognised as a disease which needs extensive research and treatment are fighting an uphill battle in the face of a great deal of discouragement. It is noteworthy that many who are in the forefront of the movement are themselves ex-alcoholics, who know from their own experience the misery and degradation of the condition in which at one time they 1410 found themselves and the relief of discovering places and people who offer sympathy and treatment. They deserve far more help from society than they are getting at present. Measured in terms of lowered efficiency, lost man-hours, broken homes, harmed children, hospital treatment, imprisonment, society is paying a heavy price, both financially and morally, for this vicious cancer of alcoholism. Those who are striving to awake the public conscience and to aid the sufferer look to the Government to help them in their quest. I trust that their requests will not be in vain.
§ 4.50 p.m.
§ LORD TAYLOR
My Lords, I once had a French general-practitioner friend who was much mystified by the English disease of the nervous breakdown. He said, "We do not have this in France. En France c'est l'alcoholisme." This is, indeed, a very true observation. My noble friend Lord Soper, and the right reverend Prelate, both say that alcoholism is a disease. Well, it is of course a disease, but it is really only a symptom of a disease and the size of the symptom—the amount of alcohol consumed—is very largely determined by social factors.
My noble friend Lord Soper said that alcoholism was a product of a complex industrial society. I just do not agree with him. Alcoholism was a terrible curse in the 18th century, and it was very largely got rid of by raising the price of gin. It was pretty bad before the first world war and it got steadily less, so far as we can ascertain—and it is very hard to ascertain—in the years succeeding the first world war. It has only started to rise again in the past few years, in so far as we can ascertain, but, as I said, it is very hard indeed to ascertain what the true figures are. We get figures for acute drunkenness, and it is probable that figures for acute alcoholism follow the same sort of line but way below, because acute drunkenness is a fairly common phenomenon and alcoholism is not so common at all.
My noble friend Lord Soper said that alcoholism is a personal tragedy and almost incurable. The right reverend Prelate said the same thing, though he was a little more optimistic. I entirely agree with my noble friend Lord Soper. One tries to be optimistic, and sometimes 1411 one can be, but it is a personal tragedy and the problem appears to be so enormous because, when one faces a case, one is so often facing that case for life. It goes on and on and the social problem is there. The family is broken up, the family is reunited again, and for years and years social workers spend hours and hours struggling. The hospitals struggle to help these people and it really is a personal tragedy of major dimensions, but in terms of numbers of people afflicted it is, so far as I can see, comparatively small.
Of course, we must distinguish between drunkenness and alcoholism. I happen to think that drinking is a very good thing. I am all for alcohol properly used. I think it is one of the Lord's blessings, if the two reverend gentlemen will allow me to say so. I think He made the stuff; in fact I know He did, because I read my Bible.
§ LORD SOPER
My Lords, may I interrupt my noble friend? It is true that Paul advocated taking a little wine for thy stomach's sake, but the best exegesis suggests that he meant rub it in.
§ LORD SOPER
My Lords, on that occasion 153 gallons were apparently contrived by a so-called miracle. I think it would be preferable, exegetically again, to regard that as an active parable.
§ LORD TAYLOR
I am perfectly prepared to take that one literally. I am very interested as to what my noble friend Lord Champion is going to say when he comes to answer Lord Soper's extremely difficult statistical question. First of all, the disease is not notifiable; and, secondly, even if it were, as the right reverend Prelate said, it is often concealed for very long times indeed, for years and years. Quite often it is only when someone who has been living alone dies and one discovers all the bottles hidden in the room that the whole awful problem is unearthed.
Thirdly, there is the great problem of definition and degree. I think we can leave out acute drunkennesss. This is not really alcoholism. This is almost its 1412 own punishment, in my limited experience, and if occasional it is not a very serious thing unless one happens to be in charge of a car. But if there is a rise in acute drunkenness, it is fairly safe to assume that there is also going to be a parallel rise in alcoholism, and I think that this is occurring now. I am not quite sure that compulsion is such an important element in the definition as the effects of that compulsion. One knows a number of people who feel a compulsion to have a glass of sherry before dinner, or even a compulsion to have a glass of bitter with their lunch, and yet they go on throughout their lives none the worse for this.
What is wrong, I would suggest, is consumption in such quantities as to lead to loss of efficiency in working or earning, or to disturbance of family or social life, or damage to the drinker's physical and mental health. Those are the criteria which are given in what is probably the best textbook of psychiatry in Britain, and I think that they are probably right, but that condition takes a considerable time to develop. Signs that alcohol has got a real hold on one are morning drinking, apart from the immediate pre-lunch drink, and repeated black-outs with loss of memory. Those two signs are pretty bad.
I have been trying to think what would he the best source of information to get the true incidence of alcoholism, and I reached the conclusion that probably good general practitioners who really know their patients and their families are about the best people to give this information. I asked seven of them how many alcoholics they had in their practices. They were all medium-sized town practices, and the total number of patients covered by these seven was 18,880. The total number of known chronic alcoholics among these nearly 19,000 people was five. In other words, this gives a national figure of 15,000 to 20,000 chronic alcoholics. I suspect that this is pretty near the truth, although I am not absolutely certain. But I want to emphasise that this is an appallingly serious problem, even if the figure is only that, because these people are mostly addicts for life.
THE LORD BISHOP OF CHESTER
My Lords, the noble Lord will know that there is a formula known as the Jellinek 1413 formula, which has been applied to this country and which suggests that there are 400,000 alcoholics at some stage. Also, would the noble Lord not agree that the general practitioner probably hears of only the very serious cases and that even they are reluctant to go to him?
§ LORD TAYLOR
My Lords, I do know about the Jellinek formula and I just do not believe it for a moment. I just do not believe that there are 400,000 alcoholics. This would mean that in every doctor's practice—and there are 18,000 or 19,000 general practitioners—instead of there being about one known alcoholic, there would be about 40 alcoholics. A general practitioner who visits a patient's home gets a pretty shrewd idea whether there is an alcoholic there. It is a fairly obvious situation once the disease has declared itself, and I just do not believe these enormous figures.
§ LORD ILFORD
My Lords, I wonder if the noble Lord will allow me to ask him a question? Does he include among his alcoholics those who drink methylated spirits?
§ LORD TAYLOR
Yes, my Lords, I most certainly would include methylated spirits drinkers. But here again I do not know the figures, because they are a very peculiar, small—I must not say small, but they are a very special group of people, usually living in a small series of "Skid Rows", as it were, or their equivalent. But this is the best figure I can give. I dare say that it is too small, but I am giving it as a corrective, or am trying to give it as a corrective, to the very large figures which have been stated and which I just do not think are true.
I admit at once, of course, that it is incredibly difficult to obtain good figures. As I would emphasise again, each of theses people represents a continuous problem over so many years, so that, if the number is not 100,000, it may seem like 100,000. It certainly follows that the need for facilities for treatment in every hospital region is very real, and I would echo the right reverend Prelate's plea for the support by the Government of the voluntary agencies, which have done, and are doing, a tremendous work. Here again, I would support the noble Lord, Lord Soper, even though I do not know 1414 how many people he has to deal with. I am absolutely certain that the work of both these voluntary agencies, and of Alcoholics Anonymous, is quite invaluable.
I want to make only one more point, my Lords, and this is far more important than any statistics I may have given: it is one practical word about cause and prevention. The most important single factor, so far as we know, is not mental make-up but the price of alcohol in relation to the average income. If the average income rises without a corresponding increase in the price of alcohol, alcoholism will increase, and vice versa. It is as easy as that. Alcoholism is a disease of an affluent society, and, if we wish to prevent it, we shall just have to make sure that taxation of drink increases step by step with the increase in available spending income. Otherwise, I am afraid, we are certainly going to get more alcoholism—and the lesson of that is obvious.
§ 5.3 p.m.
§ LORD ARWYN
My Lords, my interest in this matter was aroused by an industrial doctor and some tragic experiences within my own circle. I speak as another Member of your Lordships' House who can see danger signs which can disrupt our economic life. The loss to industry due to the consequences of alcohol has been estimated (we are bandying figures about, I agree, but this is the situation, so far as I can find out) at at least £30 million a year. Industry is therefore now becoming fully awakened to the dangers from the consequences of alcoholism. It affects every stratum. The primary reasons, as we know, are varied. Once the borderline is crossed tragedy seems inevitable. There are indications when the danger point is reached, but each of us is reluctant to call attention to a weakness in another, especially if we have ourselves been guilty in condoning by participating in heavy drinking bouts on convivial occasions.
Figures can often mislead, but the lowest published estimate of the number of alcoholics in this country is 300,000, and the highest 500,000. Add to these the families and others concerned, and we get a million people involved already. Alcoholism becomes more common as affluence grows; and, if we accept the 1415 figures for different States of the U.S.A., which show that the richer the State the higher the rate, then I think we are getting somewhere. The State of California now announces that one in sixteen adults is an alcoholic. A State official has said that their schools should seriously consider whether teaching schoolchildren about the danger of excessive drinking might have to take priority over the teaching of English literature. And if we take our lowest estimate, 300,000, this is twice the total of our university population.
My Lords, that which can start as a slight psychological disturbance can end as a chemical disease. There are stages, from the social drinker to the vagrant alcoholic. The vast majority of us are able to exercise sufficient control, and we hope we shall always stay in the category of the occasional social drinker—the first stage, and the least harmful. The second stage is the habitual social drinker, who spends regular, if not most, evenings in pubs, clubs or some other place of a convivial character. He has a need to relax and forget his worries, and finds that this is the easiest way. Such as he could rather easily progress (or I should say degenerate) to the third stage.
Then we enter the real danger zone. The third stage is the man who, in varying degrees—and perhaps to an unexpected degree—is becoming dependent on alcohol. He can still run a big business (I have met such men: we have had them occasionally in our own organisation) and maintain his self-respect, because society to-day is widely alcohol dependent, and to a degree which we are not willing to admit. This is the dangerous stage. This man is no longer drinking to ease his tensions but because the chemical process in his body demands more and more alcohol, This stage requires serious medical attention because the fourth stage is just over the borderline to complete alcohol dependence and complete addictive drinking. The irreversible chemical process is reached at this stage, and it is now not only advisable but absolutely essential that he should seek medical treatment.
My Lords, this fourth stage is bad enough, but it is not the last. There is still the last, where a man's whole 1416 life falls to bits, his personality seems to change, he suffers an acute guilt complex, he becomes a liar, he seeks escape in fantasy, and he can only hope and pray for a miraculous cure. Such a man is suffering from a terrible disease, and is in need of all the professional skills which can help to rehabilitate body, mind and soul. It is not a subject for jokes: the alcoholic is far from being that often portrayed in our minds as the poor drunk in the gutter.
Alcoholics are increasing in industry, from the boardroom to the shop floor. We also have the "Skid Row" alcoholics in the big cities. The case histories of many who exist in various hideouts and bombed sites are, I think, impossible to describe here in your Lordships' House. One thing is certain: we should be guilty of inhuman cruelty if we did nothing about their plight, or "passed by on the other side", leaving the problem to the desperate efforts of too few voluntary workers, dedicated medical men and the Churches.
My noble friend Lord Soper is asking the Government what they are going to do about it. There is no immediate panacea. We must consider a long-term programme, including education. We could even start in the primary schools, where the foundations of character are so often laid. If the pattern of a child's attitude towards religion can be influenced by religious teaching at an early age, surely it is possible to extend this to an attitude towards the dangers of excessive drinking, the physical as well as the moral dangers. The curricula of health education should include explanations to children, in a level-headed way, that there is little or no harm in occasional social drinking in which they will probably indulge when they grow up. But we have to destroy completely the idea that excessive drinking, like excessive cigarette smoking, is a manly feat; and we must teach them, too, that hospitality which encourages intoxication is not always sinecere and could be humiliating. Our present attitudes and ideas require revising.
My Lords, experience in industry and in medical research proves that most employers have little warning of the danger to their own businesses of the existence of this disease among the staff—and I have personal experience of that 1417 —until it is too late. The damage to a firm is the consequence of throwing a trained man on the scrap heap, perhaps having to pension him off, while hiding the facts of his illness. We have no information of the annual loss to industry of highly-skilled operatives and executives. In Scandinavian countries and in America, firms have introduced well-thought-out company policies. A man who is showing symptons of alcoholism can go to the manager and ask for help, knowing that he will be offered treatment rather than dismissal. It is cheaper to restore a man to health than to lose his skill. We need an investigation into the relationship between alcoholism and absenteeism and between alcoholism and industrial accidents. Instead of allowing men in industry to hide the disease until the disintegration is obvious, we must remove all fear of asking for help. A programme of education in industry on the consequences of this disease is as important as is education for prevention of industrial accidents; and it needs to be as persistent, if not more so.
One cannot sidetrack the problem of the Skid Row vagrant alcoholics, lying out like animals on bombed sites or other hiding places. Society's response to this problem is apparently to give a man short stays in a prison cell. It is not impossible to find cases of men who have been in prison 100 times on charges varying from begging or vagrancy to drunkenness. What is the purpose of the 101st imprisonment? It is no good saying that these men are merely vagrants; they are suffering from the same disease as are some members of respected professions and executive industrialists. They are also chemically dependent on alcohol.
Which Government Department is going to accept responsibility?—or is there to be a constant passing of the buck between the Ministry of Health and the Home Office? Can either Ministry produce evidence of action on this particular problem? Alcoholism is, in part, a mental disease. It is not a departure from our principles to see that there may be a case for compulsory treatment. But—and this is the point I want to underline—it is going about things utterly the wrong way to tackle the problem from the point of view of stiffer laws. First we need facilities for those who want help; 1418 and then we can see the size of the residuum. My information is that the majority of these vagrant alcoholics, if offered proper help, will accept it; and they are sophisticated enough not to regard a reception centre or a short stay in the general ward of a large mental hospital as "proper" help.
The National Council on Alcoholism, a voluntary organisation, have been doing stalwart work for two or three years. But are they receiving any Exchequer support? Other countries have their national councils, and the trend is for Governments to realise the enormous good being done and the need for financial aid if these voluntary bodies are to give their utmost towards preventing the disease from getting into an unmanageable state. A recent editorial in The Lancet notes the efforts which are being made by a particular London suburb to treat alcoholism as a community health problem. Cannot such commendable ventures be encouraged in other parts of the country?
My Lords, we have had this opportunity in your Lordships' House to draw attention to this problem, and I feel sure we cannot be content to let it rest. Whether we are talking about the incidence, the cause or the treatment of the disease, one important fact constantly recurs—the need for research. We need to know more, not only that alcoholism may, if possible, be prevented, but that when it does occur it can be effectively treated. We want further research into causation. How much research is there going on in this country? What backing are the Government giving to research? Is there any centre in this country at present where a permanent research team, directing skilled energies to these questions, is being supported? We ask that this serious disease must be taken seriously. Doctors and research workers must be provided with adequate facilities. The National Council on Alcoholism is striving hard and needs financial support. The Ministry of Health has encouraged the setting up of specialised alcoholism treatment units by each Regional Board. In 1963, 851 alcoholics were treated; in 1964, 1,110. Those in the Ministry who have guided this endeavour are to be congratulated on making the initial breakthrough; but we must regard it as a beginning.
1419 For instance, if a general practitioner in London wants a patient admitted to one of the units, is seems likely that his patient will wait for one or two months before even being seen for assessment. Out-patient and follow-up services are grossly insufficient—and this is not the fault of the staff; it is just the lack of financial support. Do these units admit "Skid Row" alcoholics, for instance? There is an appalling shortage of rehabilitation hostels; and treatment, once started, must be continued. Are there plans for supporting more hostels in the country, or are we to depend on the valiant, self-sacrificing efforts of Alcoholics Anonymous?
My Lords, we cannot look back upon the past efforts as having been anything like sufficient, or as likely to become so unless we are determined to tackle the problem with the seriousness it demands. It has to be tackled on the national level and on the local level. The Camberwell Council on Alcoholism has given an excellent lead in showing what can be done at local level. But too little is being done. Our approach must not be overemotional; but every effort of Alcoholics Anonymous, the Churches, the voluntary bodies and the dedicated medical men is needed. The Government should give the problem the priority which it demands by authorising an immediate general review of the whole situation, with particular emphasis on the question of proper coordination between Ministries. Or we may, sooner than we think, find ourselves, like the State of California, having to face the problem of one in sixteen of our adults being classified as an alcoholic.
§ 5.19 p.m.
§ LORD SEGAL
My Lords, I feel that I have very little right to intervene at this stage of the debate because, unfortunately and very much to my regret, I was compelled to miss the two opening speeches. For this I should like to apologise to my noble friend Lord Soper and to the right reverend Prelate the Bishop of Chester. But I should like to make a few very brief remarks at this stage in connection with No. 4 of the list of queries which my noble friend Lord Soper has put to the Minister who will be replying on behalf of Her Majesty's Government.
May I ask my noble friend Lord Champion when he replies to the debate 1420 to state whether the Government have any plans for extension of the existing facilities? Perhaps he will refer particularly to the extension of these facilities on behalf of the extreme cases of alcoholism, many of them utterly beyond the reach of medical aid. One of the tragedies of the extreme alcohol addict is that, unlike the drug addict, who is always within reach of medical help, often he does not call on medical aid until he is in the last stage of alcohol addiction.
My noble friend Lord Taylor gave statistics of the number of alcoholics on the lists of various doctors in the National Health Service. There are in addition the extreme alcohol addicts who refuse to see a doctor and who are in such a stage of utter hopelessness that they are almost beyond the reach of medical help. Cases have been brought to the notice of the Ministry of Health where doctors have visited such people and referred these cases at once as beyond assistance. It is in such extreme cases that so litttle can be done.
My noble friend Lord Arwyn spoke of the toll of cases of alcoholics who have received repeated sentences of imprisonment. In some ways they are among the more fortunate of the extreme cases of alcohol addiction, because as soon as they enter prison they are admitted to the prison hospital and compelled to undergo, if not some form of medical treatment, at least some form of careful supervision. One of the terrible tragedies of this group of cases is that these people suffer first from an initial phase of euphoria that is followed by a feeling of utter dejection and misery and self-abasement which is almost incredible to realise until one has come up against it. That is why during this debate I felt somewhat allergic to the statistics which have been quoted. In essence this is not a problem of statistics at all. It is a problem of individual human tragedies, and none of us who has seen these cases can feel other than that some special provision ought to be made for these people, who are quite beyond the reach of institutional treatment, who are quite beyond any means of rehabilitation, who are almost literally out of contact with human kind.
I should like to ask the Minister whether the extension of these facilities may not include assistance for the extreme 1421 cases of alcoholism; people who live in solitary misery, cut off from medical aid and who desperately need some sort of human contact. For them treatment and rehabilitation is out of the question. Equally, admission to any residential centre is out of the question. These are people whose first need is for some human contact in the form of a social visitor or worker. I can think of no better instance than some of the workers in homes about which my noble friend Lord Soper has spoken. Such workers might visit the homes of these people, these extreme cases of alcoholism. Even though so little may be done, the mere fact of a human contact would be the first stage towards lifting them out of the utter degradation in which they find themselves. I again ask my noble friend when he replies to the debate to state whether any plans have been made for the extension of these facilities to those unfortunate beings in the last stages of alcoholic addiction, and beyond the reach of rehabilitation and medical help, but who are still desperately in need of human contact.
§ 5.25 p.m.
§ LORD LEIGH
My Lords, I rise this afternoon with considerable diffidence. It is only the second time that I have had the temerity to address your Lordships, and, kind as you were to me on the first occasion, I know that your patience cannot last forever, and so I will be as brief as I can.
Anyone who urges the Government to provide further facilities for the treatment of alcoholics, particularly at this time when our hospitals are so full, and when rebuilding programmes are being carried on (and when there are too many sick persons, or their relatives, chasing too few beds), must contend with three obstacles. The first is that there are still many people, even in the medical profession, who are not prepared to admit that alcoholism is a disease. Secondly, the image of the alcoholic in the public mind is not a pleasant one. Thirdly, owing to past tragedies and the ignorance of most of us—and this includes the sufferer and his relatives—we feel that the matter ought to be hushed up. This is perhaps the greatest difficulty of all to overcome.
1422 Regarding the question of whether alcoholism is a disease, I think that noble Lords who have spoken have convinced your Lordships that it is. After all, the ordinary heavy drinker can stop if it is worth his while to do so, if he has enough at stake. The compulsive drinker would give anything to be able to stop, but without help he cannot do so. He suffers the mental agony of realising that he is gradually losing his self-respect, the trust and affection of his family, and probably also his job; yet he is literally powerless to stop. A man would not go on doing that if he could stop. We have heard that nearly all the North American States, and the European countries and the Dominions, provide substantial help in various ways towards the solution of this problem. They are amply repaid financially, as well as on the score of human happiness.
This leads me to the second difficulty, the image of the alcoholic in the public eye. He is thought of as a pathetic "down-and-out", appearing monthly, if not weekly, in the magistrates' court; or as a discharged prisoner who, as soon as he is let out of gaol, goes off and steals in order to get alcohol again; or possibly as the motorist who is had up for manslaughter. They are the alcoholics who come into the public eye. But for every one of them, there are thousands who, if they are lucky, do not figure in the Press at all. The loss through sickness and absenteeism caused to the country and the lack of mental efficiency is incalculable. A retired doctor, who is, I suppose, the greatest living authority on the subject has written—and the order is his, not mine:Members of the Judiciary, politicians, brewers, bankers, lawyers, members of the Armed Forces and ministers of religion have all sought my help.My Lords, a very large proportion of alcoholics are normally intelligent and often very charming people, and in every other way are worthy to resume their ordinary life. Their recovery, after all, affects not only themselves but their families. I venture to think that an extra bed for an alcoholic may mean a vacancy in a ward for nervous breakdowns and may certainly mean one or more in the casualty clearing ward for road accidents.
The third difficulty is the conspiracy of secrecy which bedevils the whole problem. 1423 In nine cases out of ten, the arch-conspirator is the sick man himself. I believe that, fifty years ago, to suggest at a medical school that alcoholism was a disease would have been laughed to scorn; and this tradition has died very hard in this country. The general public, not unnaturally, take theft attitude from the medical profession, and he would be a bold man who would confess to being an alcoholic. He will do anything but become a normal drinker. The thought of life without alcohol is so appalling to him that he simply dare not confess that he is an alcoholic, because he knows what the cure is—total abstinence. And this has a great deal to do with this secrecy. We have heard that the World Health Organisation has said that out of 33 million of our population who drink, they reckon that there are about 412,000 alcoholics. Other people say that there are more. Anyway, there is a very considerable number: and eleven special units, with 257 beds, seems poor provision for dealing with them.
The noble Lord, Lord Soper, stressed the need for education in this matter, and mentioned the work of the National Council on Alcoholism. This is a body of dedicated men and women who aim, first, at educating public opinion that this is a disease and not a vice—that a man should no more be ashamed of being an alcoholic than of being a diabetic; and, secondly, at creating centres at which advice is given to the alcoholic and his relatives and he is told where to go and what to do. They have about five such centres, and they need many more. Birmingham, for instance, has none. There are difficulties about telling an alcoholic where to go, because it is months before he can get a bed; and, although this disease is curable, there is a point of no return, which a man may easily go over during his months of waiting. And this is, of course, an extremely serious matter.
I would ask Her Majesty's Government to hear these facts in mind, when weighing the claim of alcoholism on the many other calls on the National Health Service. I would further ask them to give an adequate grant to the National Council on Alcoholism, under whose aegis all the other bodies working in this field will be gathered together, so that some- 1424 thing really constructive can be done to make this country in some way on a par with most other countries. I thank your Lordships for your kind indulgence.
§ 5.35 p.m.
§ LORD HILTON OF UPTON
My Lords, I rise to make a brief intervention in this discussion. As a fellow Methodist, I should like to thank my noble friend Lord Soper for introducing this subject, which I regard as a very important one, and to assure him of my full support. Early in this century we heard a lot about the Nonconformist conscience. I am glad that my noble friend has shown to-day that the Nonconformist conscience is very much alive. It cannot be denied that excessive drinking is responsible for a great deal of trouble among the citizens of this country. Open any daily newspaper and see the number of cases in which people before the courts, for driving offences or for crime, attribute to drink the fact that they are in the dock. I recall a pathetic case, which came before a court of which I was a member, of a man who had given his life to public service and was just about to retire and was before us on a serious charge of embezzlement. With tears in his eyes, he said, "This would never have happened but for the drink". I am sure that every noble Lord in the House to-day can recall similar cases.
It has already been said that drinking is on the increase at the present time, and I was glad to hear most of the speakers say that more is now being done about it. My noble friend reminded us of the hostel, for which he is going to be responsible, which is being opened within the next few days. I am sure that we are all glad that more is being done to treat the unfortunate victims of alcoholism, and that we all hope these efforts will be successful. I believe in the old saying, Prevention is better than cure. One thing that alarms me is the tremendous amount of money being spent on advertising beer and strong drink. I was going past a hoarding the other day on which there were six giant posters and three of them were advertising some sort of drink—and each one was better than the other!
I am all in favour of giving more and better treatment to those who suffer from this disease. Many people are concerned because we spend so little on trying to find out the cause of cancer. Yet here 1425 is a disease of which we know the cause and we do little about it. I should like to see more money spent on the prevention of this disease. If this Government would allocate more money to educating people, especially our young people, on the dangers of strong drink, I believe that it would be money well spent. I hope that my noble friend who will be replying to this debate will give serious consideration to this problem, and, in particular, to trying to prevent people from becoming alcoholics.
§ 5.40 p.m.
My Lords, I am glad that the noble Lord, Lord Soper, raised this question in the House to-day. In fact, it is almost worthy of a bigger debate on a Wednesday afternoon instead of at the tail end of Business on a Thursday. But when the rapprochement between the Methodists and the Church of England comes to pass, I shall beg leave to opt out of Lord Soper's version of the miracle of Cana. I am no teetotaller. Alcohol is very pleasant, but it is most insidious when human nature is weak, and it is all too easy to slip down the slippery slope. In the last century, at the time of Hogarth, we were an appallingly drunken country. That was remedied by putting up the price of spirits, but up to the First World War we were a pretty drunken country. That is when the pubs were open all day, and it was DORA and the war taxes which turned us into a great deal more sober country.
To-day the affluent society is introducing new temptations. The ratio of the price of drink to wages, so far as I can see, has in some respects never been more favourable to the drinker. For instance, there is a particularly insidious, and perhaps succulent, form of alcohol known as a British-type wine, and the ordinary working man can buy more than a bottle of this for one hour's labour. I do not know when in our history it was possible to buy so much oblivion at so small a time of labour.
The I.T.A. and the B.B.C. should, I think, be approached by the Government to try to give a little less alcoholic a view of life than they tend to do. I have noticed that, whenever a play comes on which purports to picture a home of any affluence, the play is one long booze. It is, of course, a distorted view of life which is held by people who perhaps do 1426 not live in those particular circles. But it should be corrected. It is roughly on a par with a story that one of my aunts used to tell me. She was travelling in a train in the East Riding of Yorkshire with an old farmer, and he got to discussing the Peerage. He said, "They are a drunken lot, those Lords." She, being a daughter of one who happened to be a parson as well, pulled him up and asked why. He said, "They've all got a cellar, and who would stop at a glass when he could get a bottle?" Those are the views of a certain section of the populace as to what goes on in the more affluent circles. All the plays shown on B.B.C. and I.T.A. of this kind have fallen into that trap, and they should be pulled up by the Government.
I am sorry to say that in trade and commerce to-day the habit seems to be spreading that it is impossible to do any business except over a considerable meal and quite a lot of drink. This certainly did not apply between the wars.
This question of drink is a national danger, as the noble Lord, Lord Soper, has pointed out, for all who are not strong minded. We can take the example of France. France was always held out to us as a place that had no laws restricting the sale of liquor and very small taxes and the people there were never drunk. Only in recent years has it been discovered that, instead of being drunk, they all have cirrhosis of the liver; and they are trying to do something about that. The danger signals are there for modern society to see, and we must he on our guard.
§ 5.45 p.m.
§ THE MINISTER WITHOUT PORTFOLIO (LORD CHAMPION)
My Lords, this has been an extremely interesting debate on a worthwhile and highly important question. Following the opening remark of my noble friend Lord Soper, who told us that ministers of religion tend to see a large number of sinners in the congregation before them, I was going to say that I was not sure I could draw any conclusions from the fact that all the speakers so far, with the exception of the noble Lord, Lord Leigh, have come from behind me; but the balance has now been restored by the worthwhile intervention of the noble Lord, Lord Hawke.
1427 My noble friend Lord Soper has asked some specific questions, and so have other noble Lords. But before turning to those questions, may I say that I am personally grateful to my noble friend for giving us this opportunity of debating a subject which, rightly, nowadays attracts a good deal of public interest and concern. The questions raised and the observations made by my noble friend and other noble Lords seem to me all to reflect the modern view, that alcoholism is a disease and requires medical treatment. I thought that the noble Lord, Lord Leigh, was going to dissent from this point of view when he started, but he clearly came round to an acceptance of it before he finished.
A lot has been said about the origins of this disease. The fact is that we do not know very much about the origins. The causes are generally thought to lie partly in social conditions, and partly in personality. But the fact that it is so widely acknowledged is in itself an important advance in the treatment, and to some extent, perhaps, in the prevention. I am sorry to have to say, as other noble Lords have said, that the need for treatment is not always recognised by the alcoholic himself, by his family or by the general public. We all know that alcoholism, if allowed to run its course without treatment, can lead to permanent physical or mental damage, to the break-up of families, to serious social problems and to many a private tragedy.
I turn now to the first question asked by my noble friend Lord Soper. He asked for figures showing the incidence of alcoholism. My noble friend Lord Taylor has pointed to the difficulties here, but has himself given us some interesting figures resulting from his private researches. I am afraid the fact is that there are not reliable figures for the country as a whole, and certainly no figures that our medical advisers would accept as reliable. The difficulty is one of definition and identification. Noble Lords may be interested to have what is undoubtedly the most widely accepted definition of an alcoholic, and that is the definition used by the World Health Organisation. It is as follows:Alcoholics are those excessive drinkers whose dependence on alcohol has attained such a degree that it shows a noticeable mental 1428 disturbance of and interference with their bodily or mental health. Their inter-personal relations and their smooth social and economic functioning also show prodromal signs of such development. Therefore they need treatment.Unfortunately, this definition does not get over the administrative difficulty of distinguishing the alcoholic from other heavy drinkers who may not be victims of the disease. There are, of course, the heavy drinkers who have not yet reached the stage—and who may never, in fact, reach it—when they would come within the definition of the World Health Organisation. And there are also, of course, many alcoholics who themselves are quite unaware of their condition—the fact that they have arrived at this stage. They may have no desire at all for treatment, and may fail to present themselves to the health and welfare services that are available.
Field surveys on a national scale, aimed at getting full information about the incidence of alcoholism, have not taken place, for the reason I have given. An inquiry of this sort would be a most difficult, expensive, and probably unrewarding undertaking. There have, however, been studies of the incidence of alcoholism in small areas. These are more practicable, and two are known to be in progress at the present time, one in South London and the other in Cambridge. There may be others, such as that mentioned by my noble friend Lord Taylor, and it is possible they may produce pointers to the incidence nationally. I hope, too, that we shall get some useful information about alcoholism among the "down-and-outs" from the current survey of single homeless persons which is being carried out by the National Assistance Board, with the help of the Ministry of Health and other Departments.
We sometimes hear—and I have heard mention of it to-day—of the World Health Organisation's estimate of the incidence of alcoholism. A World Health Organisation Report of 1951 contained estimates based on the formula of Dr. Jellinek. His formula was apparently derived from records of death from alcoholism and cirrhosis of the liver. The Report said that estimates based on statistical studies were available only in Switzerland and the United States, and that the figures for England and Wales were hardly better than a guess. No 1429 estimates were given for Scotland and Northern Ireland. For what they are worth, the alcoholism rates for 100,000 adults estimated at that time were, in England and Wales, 1,100; Switzerland, 2,385, and the United States, 3,952. Estimates were given for eleven countries, and England and Wales were shown to be the second lowest. Having given those figures to the House, I am bound to say that Dr. Jellinek himself, and others later, decided that his formula was not satisfactory outside the United States, and should be replaced by field surveys. I have already explained why a nation-wide survey would present serious practical difficulties.
The only other information of this sort that I am able to give the House relates to inquiries conducted among general practitioners about the incidence of alcoholism, so far as it came within their knowledge. Parr carried out an inquiry in this country in 1957. His figures for England and Wales were only about one-ninth of those estimated by Dr. Jellinek. A similar survey was carried out in Scotland in 1963–64 by the College of General Practitioners. This was at the request of the Scottish Standing Medical Advisory Committee, and the results will be published shortly. They may give us some clue, certainly so far as Scotland is concerned, and some idea, perhaps, so far as England is concerned—because I cannot imagine that in this matter there is any great difference between Scotland and England and Wales.
We are on much firmer ground—perhaps I should say a little firmer ground—when we come to hospital treatment. The number of admissions to hospital for alcoholism and alcoholic psychosis has increased considerably over recent years. In England and Wales, it has gone up from 775 in 1953 to 5,536 in 1964; in Scotland, from 732 in 1956 to 2,188 in 1964, and in Northern Ireland from 315 in 1959 to 791 in 1963.
The proportion of the population who receive in-patient hospital treatment for alcoholism or alcoholic psychosis is higher in Northern Ireland than in Scotland, and higher in Scotland than in England and Wales. Admissions in 1962 for each of the three countries respectively were approximately 5, 3 and 1 per 10,000 of the population. It does not follow at all that the incidence of alco- 1430 holism is in the same proportion. It is true that the effective demand for treatment often rises as facilities develop. We cannot say how far these increases in hospital admissions are attributable to such a factor: they do not prove that alcoholism is on the increase. Nevertheless, I am quite sure that every noble Lord here would agree that they give us cause for concern, and I can assure noble Lords that the Government are keeping the situation under review. Later on I shall come to some other steps that the Government are taking.
Finally, I ought to give such figures as are available of the convictions for drunkenness offences. The figures, which are for England and Wales only, increased steadily from 53,000 in 1954, to almost 84,000 in 1962. But they dropped to 83,000 in 1963, and to 76,000 in 1964. Frankly, I do not know what the explanation of this trend may be. It does not follow that fewer people are getting drunk. It may well be that there are other duties being placed upon the police which causes them to look with a kinder eye on the drunk, or they may not have time to deal with him. But in this instance it is true that the figures do not necessarily provide a guide to the incidence of alcoholism; for although alcoholism in this country normally involves drunkenness, not all drunks are alcoholics. Nor, I fear, does the total consumption of alcohol necessarily provide a guide. The consumption in this country has increased substantially. For example, the consumption of spirits went up by 60 per cent. between 1954 and 1963. But this figure, like the others I have quoted, falls short of answering the question which my noble friend Lord Soper has put.
My noble friend Lord Taylor, and the noble Lord, Lord Hawke, rather suggested that in this matter there was a definite and understandable relationship between the affluent society and drunkenness. The noble Lord, Lord Taylor, suggested that we ought to raise the prices, and that this would prevent alcoholism. My Lords, prices have gone up pretty steeply in the period between 1954 and 1963, but it may well be that the relationship between wages and the price of drink has, in fact, enabled more people to participate in drink. It is a point. But I am fairly sure of this; that no 1431 Government will tackle the job of curing alcoholism by putting up the price of liquor deliberately in order to achieve what I would regard as a wholly desirable end, although I like a drink occasionally.
§ LORD TAYLOR
My Lords, surely my noble friend must admit that it was done in the late eighteenth century by a Government with great courage, presumably, when they started taxing gin.
§ LORD CHAMPION
Yes, my Lords; but surely the simple fact there was that the people who were drinking gin were pretty well the lowest, the very poorest types, and a small increase in the price of gin made it quite impossible for them to buy it.
§ LORD AMULREE
My Lords, must we not be careful that we do not confuse drunkenness with alcoholism? The two things are really quite different, but this does seem to me to be one of the things that has caused a certain amount of confusion during this debate.
§ LORD CHAMPION
My Lords, I was under the impression that I had made that point, but if I had not already said it I was about to do so.
In short, the sort of answer the noble Lord, Lord Soper, would like is not available. Of course that means that I am unable to go on to answer his second question, which calls for international comparisons based on statistics showing the incidence of the disease. With regard to the figures that I gave previously, of the United States of America and Switzerland, we do not accept that worthwhile conclusions can be drawn.
I must therefore now go on to the noble Lord's third question, which is about the facilities available for treatment. I think there are three points which need to be made at the outset when we talk about facilities for the treatment of alcoholism. First, there is no monopoly—and we do not want to set up one—of the way it should be treated or by whom it should be treated. Hospital treatment, either as an in-patient or as an out-patient, is of course very important; but a valuable contribution can be made by family doctors, local health authorities, and the voluntary bodies. Secondly, the treatment of alcoholism calls for the co-operation of the patient and must be on a voluntary 1432 basis if it is to succeed. The will to be treated and to persist in treatment is the basic requirement. I am afraid this is not always realised by those who are inclined to advocate compulsion in this field.
Thirdly—and here we have to acknowledge that there is a barrier that the advance of medical science has so far been unable to surmount or circumvent—most experts consider that a recovered alcoholic is always at risk, and local studies have shown that a high proportion of patients do indeed relapse. This was a point, I think, very well stressed by the noble Lord, Lord Soper. In England and Wales most alcoholics in the past have been treated in psychiatric hospitals or departments with specialised facilities; this is still the position to-day. But in 1962 the Minister of Health commended to the hospital authorities the advice of his Standing Medical and Mental Health Advisory Committees, which had been endorsed by the Central Health Services Council, that so far as possible treatment should be given in special units; and progress is being made in this direction.
At present there are twelve units (not eleven, as I think was mentioned by the noble Lord, Lord Leigh, and the right reverend Prelate) which are divided in this way: ten of the hospital authorities have units, two of them having two each, bringing the total to twelve. There are still five which do not have these special units. As the noble Lord, Lord Leigh, said, the twelve units have some 270 beds in all.
Hospital authorities were asked at the same time to tell family doctors, local authorities and other interested persons about the hospital facilites available, so that they could refer cases to hospital, where appropriate.
In Scotland and Northern Ireland all treatment is given in psychiatric hospitals and departments, and each country has also established one specialised treatment unit run on an experimental basis. Then there are the local authorities, who also have a very important part to play. The staff of local health authorities may become aware of alcoholics who have not sought treatment, and they advise them to consult their general practitioner. Local health authorities may themselves provide services for the care and after-care 1433 of psychiatric patients, including alcoholics, and co-operate with the voluntary organisations in making information available about statutory and voluntary services in the locality. The noble Lord, Lord Soper, spoke of the need for the expansion of local authority accommodation. As local authorities expand and improve their facilities for the care and after-care of the mentally ill, additional hostels will be provided and will be available to alcoholics, as well as to other mentally ill persons.
Turning to the voluntary bodies, of these perhaps the best known is Alcoholics Anonymous, which has described itself as a fellowship of men and women whose primary purpose is to stay sober and help other alcoholics to achieve sobriety. The only requirement for membership is the desire to stop drinking. We have heard something of their excellent work this afternoon. The National Council of Alcoholism also makes an important contribution. The Council are concerned only with alcoholism as a disease, not with propaganda against drinking in general. They are concentrating their efforts on collecting and publicising information about alcoholism, helping and encouraging alcoholics to obtain, and to persist in, treatment and after-care, and emphasising to the bodies responsible for providing medical and social services the importance of making adequate provision for alcoholics. The Council have four information centres in England, and last October they opened one in Glasgow. We welcome the information given by the right reverend Prelate about this body; about the steps which he and the organisation have taken to combat this evil.
The noble Lord's last question was about plans for extending facilities. In England and Wales these plans take the form mainly of projects for more special units in hospitals. Some of the plans are only in the earliest stages, but seven additional units are envisaged, with about 100 beds in all. As I said just now, when talking about Scotland, this will be considered in relation to that part of the country after the report of the special sub-committee has been considered.
My Lords, in all this—and this is always the difficulty of Government, the difficulty of the Minister of Health, the 1434 difficulty of the regional hospital authorities and local authorities—the problem is that of weighing the needs of alcoholics against the other urgent claims on the services and the money available to these authorities. When I last spoke on a health subject from this Box the subject was cervical cancer. I felt at the end of that debate that the hospital authorities should drop everything and concentrate their money and efforts on taking smears and trying to prevent that horrible disease. To-day, at the end of this debate, I feel that we should drop a certain amount of what we are doing in that field in order to concentrate more on alcoholism. The job of Government, the job of the other authorities involved, is to provide a balance, and this is always difficult.
Noble Lords have raised a number of other points. The right reverend Prelate and almost every speaker suggested that the Government should do very much more. The right reverend Prelate asked whether we are doing enough to support the work of the National Council on Alcoholism in prisons. The Government appreciate the valuable work which the National Council are doing among prisoners, particularly in Gloucester Prison, and the Home Office are in touch with the National Council about the possibility of a grant to help this work. I hope that this will give some satisfaction to the right reverend Prelate. I also hope (and I dare say there are some who are Members of this House) that the brewers, distillers and others concerned will note what the right reverend Prelate said about some contributions to the work of these incomparable people, people who are trying to do a first-class job of work in this field.
There are also branches of Alcoholism Anonymous in a number of prisons, and special treatment units have been set up in Wandsworth, Pentonville, Wakefield, Wormwood Scrubs and Holloway. I hope noble Lords will notice that a new experiment is being tried in which prisoners sentenced for drunkenness in the London area are sent to an open prison, Spring Hill, in Buckinghamshire. It is near the psychiatric prison at Grendon, and Grendon's medical and other facilities will, of course, be available. It is hoped to identify those who need treatment and to arrange for continuation of treatment 1435 after release from prison. Liaison is maintained with welfare workers outside the prison, in order to make suitable aftercare work available.
Again, there is the question of a national project. The noble Lord, Lord Soper, made reference to this in the debate on community care last July. Perhaps it would be of general interest to the House if I explained briefly how we on the Government side view this. I understand that in many of the cities of the U.S.A., and also in Holland and several other countries, the services connected with alcoholism are administered centrally. We have no intention of setting up a new central body or national board to deal with this narrow responsibility. We think that in this country the services concerned, the hospital, local health authority and the general practitioner services, which form an integral part of the National Health Service, are the right people to tackle this job and that it ought not to be carved out or hived off to some new organisation.
§ LORD ARWYN
My Lords, may I interrupt the noble Lord? Does that mean that the Government are not in favour of a research unit?
§ LORD CHAMPION
Although I am going on very much too long (I am sorry about this, but there is a deep interest in this matter), I have a considerable amount to say, but I am going to touch on the very important point which the noble Lord, Lord Arwyn made about research.
There is, of course, the problem that has attracted a good deal of interest and sympathy, the problem of the crude spirit drinker. He is, of course, a chronic alcoholic, but so far down the slope that treatment is exceptionally difficult. He is usually unwilling to accept treatment or to co-operate with the statutory authorities, which makes it difficult, if not impossible, to bring to bear the range of local health and welfare services available. His condition may warrant compulsory admission into hospital under the Mental Health Act, but continued detention will not usually be justified once the patient has sobered up and dried out. This is the problem highlighted by the noble Lord, Lord Segal. Once he has dried out, sobered up, and becomes what appears 1436 to be mentally stable again, out he goes and again he is on the slippery slope because very few of these people are willing to continue as informal patients.
The noble Lord, Lord Arwyn, in a striking speech, which was listened to by the House with rapt attention, appealed for more research and employer participation in the prevention of excessive drinking. He pointed to the fact that this can have a serious effect on the national economy as a result of the loss of the services of men in their jobs, as well as to the fact that so often this starts in the social round, in which perhaps the higher executives and directors particularly participate—this business of not being able to sell unless you sell over liquor, and that is an important point. I would say that his appeal that employers should participate in this job of trying to prevent alcoholism is one that ought to be considered by every employer in this country. Some research into the causes and treatment of alcoholism is being done at hospitals and in universities. I understand that the Medical Research Council are not at present conducting research into alcoholism. It is, of course, open to researchers to seek grants for their work from the usual statutory or voluntary bodies which support medical research generally or, more particularly, research in the mental health field.
The noble Lord, Lord Hilton of Upton, and the noble Lord, Lord Hawke talked about advertising and education. I have some little doubt whether much good would be likely to be done by advertising, or by using television in this job of education, because I remember what has happened following the advertisements about cigarettes and cancer—remarkably little, so far as I can tell. So I have some doubts about whether we can do very much here.
I come to my final point, and I am sure your Lordships will be glad of this. There are, as the House has seen in the course of this interesting debate, many questions to which no answer can be given, at any rate, in the present state of our knowledge. But I think we have to persist in our search for the answers. I would certainly wish to assure the noble Lord, Lord Soper, and the House, that the Government are far from being complacent about the measures that have 1437 been taken to tackle the serious problem of alcoholism, and our policy will certainly be to try to improve the existing services. But I hope we can all take encouragement from the fact that this subject has been debated to-day in a spirit of sympathy and understanding. This is the approach which one may hope to see becoming more widespread, both among the families and friends of those who suffer from alcoholism and among the general public. Perhaps to some extent our debate will have been such as to give a lead and perhaps some encouragement in wider circles to all those who feel that this evil ought to be ended as soon as is humanly possible.
§ LORD SOPER
My Lords, I may be out of order in saying this, but I should like to say, "Thank you" to my noble friend for what he has said. I am indeed grateful to him.