ALCOHOLISM

HL Deb 19 March 1975 vol 358 cc775-819

4.34 p.m.

The Earl of KIMBERLEY rose to draw attention to the growing problem of alcoholism in this country, the increasing number of man-hours lost to industry thereby, and the shortage of health and social service facilities to deal with the problem; and to move for Papers. The noble Earl said: My Lords, the subject of the debate this afternoon has been shrouded in mystery for many years, largely through the ignorance and misunderstanding of the general public. I feel that it should be a non-Party debate. I hope that by the end of it we shall have cleared the air considerably, and recognised many of the problems that exist. I feel sure your Lordships will bear with me while I briefly describe what an alcoholic is not. However, I must add here that whenever the term "alcoholic" is referred to this afternoon, it refers to either sex.

My Lords, for many years, the alcoholic has been drawn as a character on a bomb site with a bottle of "meths" stuck in his pocket. He has been ridiculed on the stage as the proverbial drunk with a red "hooter" propping up a lamp post, as someone everyone laughs at. He has been described as a person lacking in moral fibre, who has no will-power. For many years, metaphorically he has been swept under the carpet and not admitted to by any of his family, because of the stigma attached to Ms so-called weakness. How wrong this conception is!

My Lords, the alcoholic suffers from a very severe illness, both mental and physical. It is a progressive illness, often taking from eight to 15 years fully to manifest itself. Due to the inadequate knowledge of the family and of the general public with regard to this illness, the alcoholic gets progressively more ill, fighting with his family, thereby putting an excruciating strain on his nearest and dearest who, for the sake of peace and quiet, by all the wrong methods try to stop him from drinking, usually with disastrous results. In the end, either he dies, or ends up in an insane asylum as a vegetable.

He will go out with the best intention of having only one or two drinks. When he sets out on a social occasion, it is his avowed intention that that is all he will have, but as soon as he has had them, he cannot help himself and usually ends up by getting hopelessly drunk. If the family have no drink in the house, he will wait in agony for the pub to open. He will wake up in strange rooms, in strange towns, wondering how he got there. He will steal money from his wife's purse. The wives of alcoholics are forced to go out to work to pay the rent and keep the family. After a period of time, the alcoholic completely disrupts his family life, his social relations, and invariably loses his job. His mental and physical condition is so affected and weakened by the continuous use of alcohol that every-thing is neglected except the procuring of more alcohol.

My Lords, the problem of the alcoholic is not only in his physical being, but also in his mind. If asked why he went out on a "bender", he will give you any of 100 excuses. Women alcoholics have exactly the same problem. Why they drink is rather irrelevant, although it has been ascertained that many women start drinking through loneliness and boredom. Their husbands do not understand why they do not join a bridge club or do charity work. The husband is often envious that the wife has no work to do, and, in the end, all this leads to is that they grow more and more incompatible, and the woman alcoholic continues down the same slippery path of despair and self-destruction. Alcoholism is the fourth biggest killer in this country, coming closely after heart disease, cancer and tuberculosis. The alcoholic does not necessarily die directly through cirrhosis of the liver, but, perhaps, in a motor accident, or he can set his house on fire, commit suicide, get run over, and so on.

Should any of your Lordships think that alcoholism is not an illness, in 1952 the World Health Organisation stated that it was. The stigma that is quite unjustifiably attached to alcoholism often pre-vents him from admitting that he is one, let alone allowing himself to consider treatment. I must point out here that a drinking alcoholic is partially insane, and cannot fight this terrifying addiction and craving without help. He is one of the most unfortunate and lonely characters in the world today. Practically everyone is against him, and few understand him. He has got himself into a condition and situation from which he can find no escape, except to continue drinking in order to anaesthetise himself from all the problems both large and small, from which he thinks he cannot escape.

If anyone in this Chamber thinks I have exaggerated, I would assure them that, if anything, I have done the opposite. I speak from experience, as I am myself a recovered alcoholic. I would add here that I do not preach teetotalism. I have no desire to stop anyone drinking socially. For the alcoholic to recover, he must not drink at all. The percentage of recovered alcoholics who have managed to drink socially again is absolutely infinitesimal. That is why it is no good sending an alcoholic to a treatment centre for a week or so, after which time he has dried out and feels physically well again— so well that on his release he goes straight out and drinks again. To enable recovery to be successful there is a vast amount of after treatment and care necessary.

My Lords, what is the size and extent of this problem in our country? The official estimate is around 400,000, but this figure is of only the known alcoholics. It is probably only the tip of the iceberg, as today the figure of hidden alcoholics is certainly very much larger. I could go into many more details, numbers and statistics at great length, but should any of your Lordships like any further information on those figures I will be only too happy to try to supply them after this debate.

We must remember that the alcoholic affects not only his whole family but other people, such as his general practitioner, the police, magistrates, publicans and so on. Therefore, conservatively, over 2 million people have direct con-tact. The problem is increasing rapidly. Between 1958 and 1973, the number of convictions per year for drunkenness rose from 75,000 to 99,275. This represents an increase of about 25 per cent. per 10,000 people in the population aged fifteen years and over. The biggest percentage increase occurs in the under-eighteen year old convictions—1,880 in 1966; 4,725 in 1973—which is very alarming. I realise that many of those convicted are not alcoholics, but a large percentage are, or are potential, alcoholics. Dr. Glatt, one of the great medical experts in the world on alcoholism, published a survey in 1967 of two London courts and, if this survey was projected nationwide, out of 70,000 males convicted for drunkenness 17,500 were convicted once, 7,000 were convicted two or three times and 10,500 were convicted four or more times. From this it can be seen that the drunkenness pattern of today will reflect the trend of tomorrow's alcoholism.

My Lords, I think it would help if I gave a few figures on the increased alcohol consumption in this country, and I will break it down into three sections. Beer consumption in 1951–52 was 25½ million barrels; in 1974 it was 39 million barrels. Wine consumption in 1951–52 was 17 million gallons; in 1974 it was 87 million gallons. Spirits consumption in 1951–52 was 9½ million gallons; in 1974 it was 33 million gallons. The dramatic rise in wines and spirits is even more disturbing when one realises that the greatest increase has occurred in the last three years; namely, 80 per cent. for wine and 66 per cent. for spirits. In fact, wine consumption has increased in the last year by 5 per cent., and although the more expensive wines have decreased, possibly due to the extra taxes imposed by the Chancellor, cheaper wines have taken their place. These figures speak for themselves.

Today in England and Wales 91 people per 1,000 exceed 15 centilitres of pure alcohol per day, and can therefore be classified as problem drinkers. Deaths from cirrhosis of the liver increased by 33 per cent. between 1962 and 1972. The admission rate in hospitals has increased in the last few years, but this is not a good guideline because it does not reflect the increase in beds which have been made available, coupled with the decrease which has occurred in the stigma attached to alcoholism whereby more alcoholics have come forward. Nevertheless, admission rates have increased from 2,400 in 1960 to 10,000 in 1972. I hope now, my Lords, that you will all agree that the growing rate of alcoholism in our community cannot be disputed.

I will now come to the cost to industry through loss of man-hours. It is very difficult to produce exact figures for the number of man-hours lost, since so little research has been done. But I am certain that it would pay a handsome dividend to the Department of Health and Social Security, as well as to the Department of Employment, if an inquiry into this problem were set up. It was found in 1968 in one Scottish company that the overall incidence was 14 per cent. According to Dr. Glatt, those in industry particularly prone to alcoholism are top executives, publicans—who, incidentally, have the highest rate of cirrhosis of the liver and mortality from it—journalists, the shipping industries, coalmining, steel-workers and show business. Taking into account the number of people with drinking problems in our community, the con- servative estimate that industry loses only £105 million a year is obviously very much an underestimate. Dr. Glatt estimates that with the sickness benefits, social security, loss of efficiency in a work force of 250,000 problem drinkers, the loss is at least £250 million annually.

My Lords, we must rid ourselves of the completely false picture that the aver-age alcoholic is unemployed and unemployable. In fact, during the last six months the information centre of the National Council on Alcoholism helped 435 people, of whom 70 per cent. had full-time jobs. Quite soon after the onset of the illness the alcoholic becomes less efficient, less productive, less co-operative. His ability to establish relationships, both at home and at work, deteriorate. For years he works below his potential, and therefore the economic cost of absenteeism, accidents, loss of years of training for a responsible post, should be costed.

In 1967, some very revealing figures on alcoholism in British industry were published. Out of 300 alcoholics inter-viewed, it was found that 66 per cent. were frequently late for work, 40 per cent. were absent on Monday mornings once or twice a month, 21 per cent. were absent on Monday mornings more than once or twice a month, and the time lost by an alcoholic per year was 86 days. The alcoholic also sometimes works under the influence of drink, and it was found out that 88 per cent. usually drank before coming to work, 62 per cent. sometimes took a bottle to work with them, 12 per cent. did this every working day, and 90 per cent. sometimes drank throughout the day. It was found that 11 per cent. of accidents occurred through drinking at work, and 33 per cent. of those interviewed considered that drinking might have been responsible for some such accidents.

My Lords, what has been done in the United States? Over 300 major companies have alcoholic programmes, and these include Dupont, Eastman Kodak, Allis-Chalmers, the Bell Telephone Company and many others. Ford and Heinz prohibit the use of alcohol in their canteens and dining rooms. Dupont apply shock treatment. Employees are aware that their jobs are in jeopardy unless they take the treatment, and the Dupont figures of recovery are 65 per cent. successful. Most of the major firms in the United States use constructive coercion. The principles of constructive coercion are very simple. The motive for the employee to keep his job provides the coercion needed. The company has a desire to rehabilitate rather than sack the employee, which is constructive. Inefficient and unproductive work occurs early in alcoholism, thus providing early diagnosis. Most United States companies have recovery rates between 70 and 90 per cent. Even if rehabilitation fails, many companies give a disability pension to the alcoholic, if he has been with them a long time. Experience in the United States has shown that treatment is not the problem, but identification is.

It is interesting to note that in 1968 constructive coercion was tried by the Glasgow Council on Alcoholism, but it failed because top executives denied that there was a problem. In seven years we have come a long way. Just because if failed the first time, that is surely not sufficient reason for not trying again. I have said that we think alcoholism costs industry at least £250 million a year. Unfortunately, most companies—and the Institute of Directors and the trade unions —are still not keen to discuss the alcoholic problem. Why not? I would suggest that it is probably through ignorance and also through insurance difficulties.

If a company retains an alcoholic after treatment, and an error is made, usually the insurance company is most unsympathetic. This discourages firms from re-employing alcoholics. It is high time that British industry and the trade unions examined this long neglected area. Alcoholism is a modern major health hazard to industrial life and it would be of great benefit to industrial and commercial firms if they would encourage early detection of problem drinking. As we all know, prevention is much better than cure; but prevention must commence when the problem is a social one. It must not be left until it has become a medical disease.

We must educate our doctors to a much greater awareness of the problems, particularly with teenagers. We must educate our managers and directors to diagnose and begin to use constructive coercion. All these endeavours are much easier in large firms where separate medical care is available. In small firms it is more difficult. So it is important that the general practitioners should establish two-way communication with managers of small firms. Let us remember that as well as the economic cost there is also the humanitarian cost to our society.

During the last 13 years, the Department of Health and Social Security has made a great contribution towards the treatment of alcoholism. But, nevertheless, there is still an acute shortage of such facilities. In its Memoranda of 1962, 1968 and 1973, the Department has shown great awareness of the need to provide medical and social services to deal with the problem. It has recognised the need for more hospital units, counselling and information centres, hostel accommodation and for more staff and training facilities.

But the services are still inadequate, probably for the following reasons. The provision of facilities leads to a greater demand. Educational programmes have begun to diminish the stigma of alcoholism and, therefore, more sufferers are coming forward. There are more alcoholics today and, lastly, there is the difficulty of persuading local authorities, the social services, and Area Health Authorities to support financially community-based services for the alcoholic.

The DHSS, realising the difficulty of persuading public opinion to recognise the problem, in 1973 sent out a circular. It read: The reluctance of public opinion to recognise the scale and nature of the problem in their midst is well known, and it would be unrealistic to expect rapid unaided development of community provision by statutory or voluntary bodies on the scale which is needed to meet the needs of the alcoholic community at large.

People working with alcoholics are hampered and frustrated by the lack of agencies to refer to. I am convinced that the benefit that could be gained by putting some of our resources into the primary and secondary prevention of alcoholism would soon outweigh the capital spent on these services. Statutory bodies working in close co-operation with voluntary bodies could provide a powerful breakwater in preventing and cushioning the worst manifestation of alcoholism. We must find an earlier method of diagnosis.

Industrial personnel and medical officers have a tremendous role to play here, as well as the health visitor and the GP. It has often been said that the ordinary GP ignores the problem of alcoholism. In some instances, unfortunately, this is correct, but in the last two or three years I have noticed a much greater awareness of the problem by the GP. There is also this point: May not the general practitioner be much more willing in his practice to identify alcoholics if he knew that he had the facilities for treatment and after-care available in his area? A campaign run by the North Eastern Council on Alcoholism for the last three months of 1974 produced 924 inquiries, and the majority of these were at a relatively early stage in their drinking. The campaign would have been much more successful, however, had there again been more facilities available to cope with the number of cases that presented themselves.

My Lords, I should like to suggest a few ideas for your Lordships' consideration. There should be many small centres run by local authorities. At present, only the GP is available; and as I have said, he is sometimes ill-informed, has no time and is too busy to concern himself with such a complex and time-consuming problem. Local authorities should teach social workers about alcoholic problems and have at least one who specialises in this illness. These services should be well-publicised by advertisements in the local Press and in telephone directories under "Alcoholics' Information Centre" and not left to a sub-heading under "Local Government". Where regional councils already exist this is done.

There is the problem of after-treatment follow-up. Alcoholics often have no one to turn to, and consequently often re-lapse. This follow-up treatment is vital if the initial treatment is not to be wasted. Virtually the only after-treatment ser-vice currently available is Alcoholics Anonymous. This society does a tremendous amount of good but it is not suit-able in every case. Last, but not least, is the importance of help to the alcoholic's family. Some treatment centres try to help, but often do not for lack or short-age of staff. As I have said, in the last few years the number of hospital beds has grown, but the waiting list has grown too. There is the greatest difficulty in getting an alcoholic into a detoxification centre as many hospitals cannot be bothered with it. Unfortunately, the more alcoholics we find, the more hospitalisation will be needed. However, improved community services would allow many people to be treated at home, so leaving hospital beds available for the worst cases.

To sum up, we must inaugurate a primary prevention programme by educating the public on the dangers of excessive drinking and to where it may lead. I am happy to learn that the National Council on Alcoholism, the Medical Council on Alcoholism and the National Association of Youth Clubs are attempting to institute an educational programme on this subject. Also, the Medical Council on Alcoholism is about to research the attitude of English schoolchildren to alcohol and their different drinking pat-terns. An educational programme of this magnitude would, however, require considerable expenditure.

I should like to end with a suggestion as to how some of this money might be raised. In 1973 the British public spent just over £4,000 million on alcohol, and in that same year the drink industry spent £38 million on advertising. The Customs and Excise duty collected by the Government was £954 million and the VAT received was about £350 mil-lion, making a total that the Government received of just over £1,300 million. There should be added the tax on company profits, which in 1970 was assessed at £76 million, and no doubt it is higher today. Surely a society which has a tax revenue of nearly £1,400 million a year could contribute a greater sum than it does to all those services which seek to reduce the ever-growing disaster of the alcoholic problem in our country. My Lords, I beg to move for Papers.

5.1 p.m.

Lord HUNT of FAWLEY

My Lords, I thank my noble friend Lord Kimberley for initiating this debate. I should like to ask your Lordships to consider, first, how old is this problem of alcoholism and how can we learn from the past. Fermentation processes leading to the formation of alcohol must have been taking place long before man appeared on this planet. When he did arrive, it could not have been very long before he discovered its remarkable qualities, and it is likely that for ten of thousands of years he enjoyed its good effects and suffered from its hangovers. It has been one of the best tranquillisers we have ever had, and it is still. Not long ago we heard of a doctor who put a little port wine into almost every bottle of medicine he dispensed; but that was before the National Health Service.

We were fermenting grapes thousands of years ago. Genesis Chapter IX, verses 20 and 21 tell us: And Noah began to be an husbandman, and he planted a vineyard: And he drank of the wine, and was drunken; and he was uncovered within his tent". The Old Testament contains more than 200 references to alcohol, of which some 40 describe its ill-effects. In Britain, mead made from honey, ale and cider were drunk in our earliest pubs before the Roman Conquest, and the Romans brought us wine. In 1700 the population of Britain was about 5 million and we are told that 12 million barrels of beer were brewed each year. Whiskey was soon afterwards introduced from Ireland, we are told, and not many years later gin was so cheap and plentiful that it caused a great deal of trouble for a long time, until reviews of the licensing laws, punishment for drunkenness and disorderly conduct, taxation and an increase in the price of liquor all helped towards an improvement. So we know that the problem of alcoholism is by no means a new one.

In ancient times alcohol was comparatively difficult to make and keep. Now it is easy to obtain and store; it is widely advertised; some of it is made to taste delicious and it is considered to be almost essential for most kinds of entertaining. In this country now the per capita consumption of alcohol is rising. Most people up and down our occupational and social scales take an innocent drink from time to time and the old sayings, "As sober as a judge", and, "As drunk as a lord", are no longer always applicable.

Our problem now is that apart from an increase in harmless, well-controlled social drinking, there are many indications that excessive drinking is on the increase, too. In many countries—and we are by no means the worst of them— it is a growing problem and a most serious matter, because it will almost surely get worse unless it is treated energetically. We are told by the Department of Health and Social Security that we have now probably about 400,000 people in Britain who have a serious drinking problem.

A rising consumption of alcohol may, by itself, mean only that more people can afford to have a glass of wine, beer or spirits with their dinner in the evening, but we know that magistrates are punishing more people for drunken-ness and for being drunk and disorderly. For the Metropolitan Police District, the figures for 1972 and 1973 were 44,203 and 45,107, respectively. The figures for 1974 are not yet avail-able. There are many driving offences, more than before, involving alcohol. Alcoholics Anonymous is having to in-crease its number of meetings; more alcoholics are being admitted to psychiatric hospitals; more deaths are attributed to alcoholism, and we are told that more women and teenage children are taking to the bottle in a big way, with their drunkenness offences increasing more quickly than those of the general population, a matter about which the Clayson Committee expressed the gravest concern two years ago.

In British industry it has been estimated that 5 per cent. of the work-force have drinking problems, with an annual financial loss from absenteeism, lowered quality of work, cost of medical treatment and so on of perhaps £300 million. In the alcohol industry itself, £1,700 million is invested and 90,000 people are employed. There are more than 130,000 places in England and Wales for the retail sale of intoxicating liquor, which produces more than £1,000 million in taxation annually, which is about 6.5 per cent. of the total revenue from all sources. The latest information I have been given is that about £50 million is spent on advertising liquor each year.

All this is a measure of the immensity of the problem we have to face. Between 1960 and 1970 alcohol consumption in Britain is said to have increased by 43 per cent., which the author of an article in a trade magazine described as "eminently satisfactory". From a business point of view this remark was correct. In the context of what we are discussing tonight, it could be considered almost irresponsible. An alcoholic is difficult to define and more than 100 definitions have been put forward, from the light-hearted quip that an alcoholic is anyone who drinks more than his doctor does, to the rather long definition of the World Health Organisation, which is: Alcoholics are those excessive drinkers whose dependence on alcohol has attained such a degree that they show a noticeable mental disturbance or an interference with bodily and mental health, their interpersonal relations and their smooth economic and social functioning; or who show the prodromal signs of such development. They therefore need treatment. Even with that detailed definition, some people disagree. It is a matter of opinion, too, sometimes as to when a person may be said to be drunk, from the wedding guest who, after a few glasses of champagne, laughs too loudly or slurs his speech a little when toasting the bride, to the cabbie who was picked up from a gutter outside a pub in Smithfield and brought unconscious on a stretcher to hospital when my father was a house surgeon and whose friend, a brewer's drayman who accompanied him, was heard to mutter, "'e's not prop'ly drunk: I saw 'is ears twitch."

I have been asked this evening to discuss the problem of alcohol in Britain at the present time from the point of view of a practising family doctor. It has been estimated that each general practitioner in this country has between 10 and 40 alcoholics in his practice, depending on where he works. Some of them are hidden alcoholics of whose intake of intoxicating drink he is ignorant and of whom Dr. Rodney Wilkins made such a careful study. Every alcoholic has an individual problem, everything to do with alcoholics is equivocal and it is dangerous to generalise.

There are four phases in the development of a chronic alcoholic addict, phases which shade imperceptibly into one another. First, there is the stage of the moderate, controlled social drinker like most of us in the greater part of our country's population. We do not want to give it up, but nor do we want to increase our consumption. Secondly, there is the stage of the heavy social drinker who, for a long time, notices no ill effects from his excessive intake of alcohol. He may be a great leader or senior executive who is under tremendous pressure and stress connected with his work. The tranquillising effect of alcohol may keep him going, and he may feel that he would be worse without it.

Then, thirdly, there is the stage of the heavy problem drinker who may imbibe up to 15 or 20 drinks a day, starting with a double vodka at breakfast, but who can still control to some extent the amount that he takes, though he begins to notice some ill effects—physical, mental or moral problems for which he, his family, a friend, his employer or one of his workmates may seek help from his doctor. These ill-effects include sleepless-ness, irritability, aggressiveness, impairment of memory, blackouts, personality changes, plausibility, unreliability and refusal to take responsibility leading to a breakdown in family relationships. They may also include neglect of children, loss of job, dishonesty, perhaps leading to criminal acts, severe depression even leading to suicide and increased liability to ordinary injuries. Road accidents are common, too, and there is a bewildering diversity of other problems including digestive upsets, heart disease, strokes, cirrhosis of the liver with accompanying portal hypertension and internal haemorrhages, pancreatitis, lowered resistance to infections such as pneumonia or tuberculosis, obesity, lack of vitamins, peripheral neuritis, morning tremors helped only by an early drink or delirium tremens.

My Lords, no one has improved on Shakespeare's description of the effect of alcohol on sexual performance, Macbeth says, It provokes the desire but unprovokes the performance. A patient may go to his doctor complaining of any of these symptoms and, unless the doctor is of a suspicious nature, he may not appreciate that the underlying cause is alcohol. It has been described as the "great deceiver". The doctor finds it easier, more tactful and kinder to say to such a patient, "You have a drinking problem" rather than, "You are an alcoholic".

My Lords, the fourth stage is that of the chronic alcoholic addict which may take 10 to 20 years to develop and in which the patient has lost all control of his alcoholic intake—a "man or woman broken by alcohol"—and this condition may lead to a very severe mental illness. Of the estimated 400,000 people in Britain who may have a drinking problem, possibly about one-fifth are in this most serious stage of chronic addiction. As a family doctor, one sees some patients who really want to be cured because they know that alcoholism is ruining their lives or those of their families, or is spoiling their careers. A strong motivation for cure is an enormous help towards successful treatment. As a family doctor, one would like to help all alcoholics, but some are hopeless and do not want to be cured. With these, one may have to admit defeat and cut one's losses.

Some patients are even proud of the amount that they drink. Not long ago, I took one to a specialist to whom I said, "This man claims to have drunk half to three-quarters of a bottle of whisky every day since 1920." The patient sprang to his feet and said, "That is absolute nonsense: it was 1919! " When trying to help a difficult patient like this, I have often been told, "You're wasting your time with that fellow"; but even with the worst of them one may be able to help a little, even if it is only by persuading the patient to reduce his intake, or by supporting his family in some way. It is always worth while trying and an occasional success is an encouragement to do one's best for someone else.

My Lords, we must remember that nearly all doctors now consider alcohol-ism to be a progressive illness, not a sin or something which is due to lack of moral fibre. We must also remember that it does respond to treatment. But the saying "Once an alcoholic, always an alcoholic "is true. The majority of doctors think that a cured alcoholic addict should , never drink again. Such a patient may relapse after quite a small amount of alcohol, even after a long time, and the only drink that matters is the first. General practitioners with proper training are in a unique position. They can do an enormous amount in their surgeries and in their patient's homes towards prevention, diagnosis, drying-out or detoxifica- tion, which can sometimes be done at home in about two weeks. They can also help with the rehabilitation and after-care of alcoholics.

From the patient's point of view, the three main stages are acceptance of the diagnosis, withdrawal from alcohol and, probably, permanent abstinence. Family doctors have a great many people to help them in this. Their "back-up team", as it has been so well called, consists of members of the patient's family who themselves often need treatment for anxiety, his friends, nurses, counsellors, health visitors, social workers and others, people from the local health authority, psychiatrists—particularly those who specialise in the psychiatric treatment of alcoholism—probation officers, industrial medical officers, the police, magistrates and the clergy.

There are also a great number of organisations, both statutory and voluntary, which are ready to help the alcoholic. First, there is the Department of Health and Social Security, which has shown a great interest in this subject during the past 13 years, since Sir Keith Joseph and, indeed, his predecessor Kenneth Robinson took the initiative, and, also the very great deal that Dr. Alan Sippert has done recently. The Department has given generous support, advice and financial assistance to very many organisations which are helping alcoholics. They include the Royal College of General Practitioners, the BMA, the Medical Council on Alco-holism (with its educational activities including films, its research, its library, its valuable information centre and its Journal of Alcoholism). There is also the National Council on Alcoholism—a lay body with wide influence throughout the country and many branches with counselling services—several local councils on alcoholism, and the Alcohol Education Centre at the Maudsley Hospital which is helping to train those who are professionally associated with alcoholics. Then there is Alcoholics Anonymous, with more than half a million members throughout the world, which for 40 years has been doing an enormous and splendid job in the after-care and rehabilitation of alcoholics, the Church's Council of Healing, the British Council of Churches the Salvation Army and the Church Army and many other organisations, including Al-Anon, Al-Teen (which helps young people), the Helping Hand Organisation, the employment medical advisory ser-vices and the National Association of Youth Clubs.

In the hospital treatment of alcoholics, all general hospitals play a part, especially in the treatment of accidents and of all the physical complications of alcoholism that I have mentioned. The 152 mental hospitals in England and Wales admit about 8,000 alcoholics a year. We have 20 special alcoholic treatment units with more than 400 beds. There is at least one such unit for each Regional Hospital Board and others are being planned. In this work, which Dr. Max Glatt has done so much to develop in the last 23 years, full withdrawal and aversion treatment are practised. Group therapy sessions are held and, after six to eight weeks, it is claimed that 40 per cent. of the patients are off alcohol and another 25 per cent. have improved.

There are considerable advantages in treating alcoholics in groups, living in communities, rather than scattered throughout several hospitals, though some people feel that the cost-effectiveness of special alcoholic units is doubtful and that alcoholics are better treated at home or in a general ward. Much depends on the ability of the doctor in charge. There are also very many hostels of different types—some day centres, a new alcoholics recovery project and detoxification centres, many of them partly financed by the Department of Health and Social Security. A walk-in advisory service is sometimes preferred by the drunken down-and-out vagrants who are but a small proportion of the total of our alcoholics. The police and other people are beginning to appreciate that these people, who have been aptly called "revolving door alcoholics"—like the man who has been charged 174 times for being drunk and disorderly; "It was my birthday, your Honour", he often used to say—are more often medical problems than criminal ones. When they collapse in the street they should perhaps be treated as would epileptics or diabetics who fall about, rather than putting them repeatedly into prison or fining them. To take them to court frequently seems to many to be a waste of time for the police and the magistrates, and hope-less for the patient.

In conclusion, my Lords, may I say that I am sure you will realise that much is already being achieved in Britain to help these unfortunate people suffering from alcoholism. But there is a very great deal still to be done to solve this very serious social problem. While more and more alcoholic drinks are being made, advertised and sold every year, it is hard to expect our already strained medical and social services to catch up with the prevention and treatment of the harm that they do. Education is the key —to persuade people, especially the young ones, through their parents, school-masters and others, to be moderate in what they drink, and to teach all those who are in contact with alcoholics how best to make the right early diagnosis and to care well for these patients in a closely integrated comprehensive service.

The Medical Council on Alcoholism is organising a whole-day symposium at the Royal College of Physicians in May for medical students from all medical schools in England, Wales and Scotland, which has the warm approval of the deans despite their already overfull curricula, It is hoped to make this an annual event. We cannot forbid the manufacture, advertisement and sale of alcoholic drinks, although it would be a great help if these could be reduced in some way. We remember the horrors of the prohibition experiment in the USA. We should be a dull lot if we never took any risks, and never ate or drank anything that might harm us.

For someone over 70 it does not matter all that much if he chooses to shorten his life a little by overeating, oversmoking, taking no exercise, or by overdrinking. Treatment of his illness may cost the country something, but so will his old age pension and benefits if he lives longer, and also his terminal illness. But for teenagers and young adults it is vital that they do not ruin their lives with drink, and everything possible must be done to help them. The great need is not only for more alcohol treatment units, more hospital beds and shorter waiting lists but, even more important, for more doctors, social workers, health visitors, counsellors, rehabilitation and follow-up experts and other personnel properly trained to deal with this difficult and enormous problem. Good follow-up and rehabilitation are vital. Much more money is needed, too, and also more research into many aspects of this subject, especially into the relative values of treatment at home, in-patient, out-patient and day-patient treatments. Future research may reveal some way of reducing the toxic effects of alcohol, so that it does less harm than at present to our bodies and minds.

Finally, my Lords, may I quote one sentence from what was said nearly two years ago by Admiral Sir Dick Caldwell, Executive Director of the Medical Council on Alcoholism: Alcoholism is a subject as fascinating as it is sombre … there is an immense scope for work, for education, for research and, indeed, for deep thought for all of us who have any interest in this challenging and yet desperately serious affliction ".

5.25 p.m.

Lord SOPER

My Lords, I am sure the whole House will be grateful to the noble Earl, Lord Kimberley, for once again practically ventilating this important subject. May I specially thank him for the informed sympathy with which he described the condition of the alcoholic. A matter which has probably been some-what neglected in previous debates in your Lordships' House—and it is worth putting on Record—is that those who have had some contact with alcoholics will recognise what an amiable, decent and kindly folk they are compared with others who suffer from social diseases or, in fact, from personal imperfections. It did me good to hear the noble Earl, Lord Kimberley, describing so sympathetically a nice group of people, which makes it all the more tragic that they are so often ruined through alcoholism. I am also deeply grateful to the noble Lord who has just spoken, alike for his temperate and for his very well-informed contribution to a debate on a subject which requires the expertise to which he particularly was able to address his remarks.

I agree with him in his morphological digression as to the emergence of alcohol and also to his very brief reference to the danger of quoting scripture in order to defend any position in this field. I remember on one occasion, when I was preaching in favour of temperance, being contradicted by a man in a crowd. He said that Paul said: Take a little wine for thy stomach's sake. That is in the Bible and of course he did, but Paul meant rub it in—but this man was not prepared to accept that interpretation. I was able to quote another passage from the Old Testament, from Proverbs, to the effect that: Wine is a mocker. Strong drink is raging for at the last it biteth like a serpent and stingeth like an adder ". He said he had been looking for that kind of stuff for the last ten years.

I think it is not improper to introduce into a sombre discussion the warning that we must not be too solemn about it. May I derive two comments from an experience which was mine on 21st January 1971 in your Lordships' House when it was my opportunity to introduce an Unstarred Question on the topic of alcoholism? I remember two reactions to it, one on the part of certain Members of your Lordships' House—and I do not unduly blame them—who thought that this was a spin-off from fanatical teetotalism for the purpose of the total elimination of alcohol as the Devil in solution.

There is a perceptible difference, as I have learned between the teetotal proposition, to which I am personally committed, and this problem of alcoholism which is separate and distinguishable from the problem of total abstinence in itself. The other reminiscence which I cull from that occasion is, I think, more serious and is more than a justification for the raising again of this problem today. I asked in the Unstarred Question, "What is the number of alcoholics in this country at the moment?" The Government did not know, and although the noble Lord said he might make a guess, he was prudent not to engage in that exercise. But a number of other contributors to the debate professed their own knowledge of these matters. In their judgment the number of alcoholics ranged from some-thing like 35,000 to, perhaps, 120,000. As a matter of fact, partly by the stimulus of that debate and partly for other reasons, it was then known to those who had taken the trouble to find out that the number was much more likely to be 300,000 discovered alcoholics—and that was almost a male calculation.

Something that has happened, and was referred to specifically by the opener of this debate, is that the problem has increased and the number has grown, and whether it is 400,000 or 500,000 it is an intolerable figure. I would draw some inferences from what has happened since 1971, in an experience which is person-ally mine, in endeavouring to provide some help for alcoholics in various institutions for which I am responsible. The first is that a great many more people are today aware that this problem exists. I would here draw a very gentle lance with my noble friend who introduced the debate, that there are fewer people today who have the same allergy against any confession of alcoholism. There are more who are likely, in a more enlightened atmosphere, to recognise that they are alcoholics, and not to be ashamed of something which, though it is not entirely a matter of the mind or the body, is an illness, as has been correctly stated this afternoon.

My Lords, I beg to offer one comment here. I cannot accept the proposition that it is purely and simply a disease. I think it would be totally wrong to exclude the moral element. Emphasising, as we must, the physical and mental condition, recognising that it is an illness, it would be quite wrong to exclude from the general diagnosis, and indeed, much more, the prognosis, the moral element. I may come back to that a little later. Secondly, a very large scale change has taken place in the attempted treatment of alcoholics, so far as I am aware. Whereas antabuse and various other medicaments, nauseating in their immediate impact and calculated to facilitate the drying out process, are much more current and much more clearly advocated, there is increasing evidence that the psychological approach —the approach of companionship—and the recovery of a sense of significance, and the breakdown of the sense of alienation, are far more potent medicaments and far more potent methods of therapy.

Since 1971 there has been a vast in-crease in the type of advertisment directed specifically to young people. Those of your Lordships who watch television will be left in no doubt that the main point of attack is made to those who are young. Your Lordships may have seen pictures of a father leading his son along a road to the local pub and warning him that it is time he grew up and become a social drinker. Your Lordships will probably recognise the advertisement which asks, "What's your right arm for?", as if the obvious answer is continuously to raise it in the intake of alcohol. I abominate this kind of advertisement, and I entirely agree with the last speaker that whatever may be the frailties which are permissible in relative old age, it is a matter of total and absolute wickedness to encourage susceptible youth to believe that their maturity and virility must be accompanied by regular drinking in public houses. If there were, in addition to this, an anathema for which I would be pre-pared to accept full responsibility— though I am more concerned with bene-dictions—I should say: To hell with the beer can! I am sure that the capacity to go on your way carrying your beer can with you, and to become more or less bottled in the process is not only restricted to those people who do it in single bad companies, but has a very great deal to do with the rowdiness, evil behaviour and danger on the football terraces.

There is, at the same time, a recognition that whereas alcoholism is a social disease and has to be treated not as some mere delinquency for which a process of moral assertion is required, there are many kinds of alcoholics for whom a process that will be effective must be carried out in a number of stages. There is obviously the first stage of drying out the alcoholic at the point of his alcoholic dereliction. There is the second stage in which the alcoholic can be, either at home or in some kind of hostel or house, induced to recover something of the sense of belonging which he has lost, something of the sense of moral opportunity for which he finds it impossible at that stage to mobilise. This must in itself be part of a process which goes further.

I quite agree with the noble Earl, Lord Kimberley, that in many cases the alcoholic has broken up a home to which he can return; and domestic therapy is preferable. In the hostels for which I am responsible, the average age of the alcoholic has come down in four years from 45 to 35. I want to speak on behalf of those who have nowhere to go and who cannot be permanently hospitalised in a hostel, but who, sooner or later, will require protective and supported living, if they are to become the permanent convalescents, which is probably the best one can hope for many of them. There is no such thing for many of them—as I think the noble Lord who preceded me would probably agree—as a total cure, but a permanent and uninterrupted convalscence depends on a quality of supported living in which they will have the opportunity, when they are in danger or where they are sorely tempted, of recourse to someone who will help them and tide them over their periods of acute temptation.

This raises all kinds of practical problems and I will concentrate on some of the opportunities which I believe ought to be seized. I readily agree that Governments of the day have made considerable progress in this field, but that progress is insufficient. Speaking as I do for a penurious and yet, at the same time, I think, worthwhile attempt to help alcoholics back to a reasonable state of social fitness, I believe we need much more money. In particular, we need a third-stage opportunity of occupying and of using premises where reference can be made by those who are seeking information, or who, at a time of stress, would want to find a friend; and, at the same time, an opportunity of housing single alcoholics—many of them youngsters— who otherwise would drift upon the tide and quickly become delinquent, or end up on the rubbish heaps, as many of them do.

There are in this country something like 800,000 unoccupied houses. There are at least 100,000 unoccupied premises and dwellings in the county of London, and every night there are 2,000 homeless youngsters who sleep rough, if they sleep at all. Of this figure, it has been calculated that perhaps 800 or 900 of them are to some extent alcoholics, who have drinking problems, who are drunkards— and I am not specifying the various areas in which one can differentiate in this complicated field. I wish to put a point to the Minister who is to reply, and I know that I can count on his consideration and sympathy in this matter. I believe that there is currently in another place a Bill which would provide for the requisitioning of property in the private sector which has been vacant for six months. Further, in the Housing Act 1974 there is a provision where local authorities can, through housing associations, provide money for the rehabilitation and the resettlement in houses, which could be so repaired and improved, of considerable numbers of those who today go through the first stage—which we provide for them—of the drying out process, and who are then for some time encouraged into a better state of social awareness and social belongingness in the second stage hostels, such as St. Luke's Hostel, for which I am particularly responsible.

But after that, what do you do? They cannot be expected to face up to the rigours of a society in which they start with the understandable and terrible handicap of having nowhere to go, and probably having so alienated their loved ones or their friends and relations as to be more or less on their own. Not only do we want more money—I put in a plea for that—but I am quite sure that it is the voluntary organisation committed to this three-stage kind of rehabilitation programme which can offer the liveliest hope for certain groups among the alcoholics. I earnestly ask the Minister what more can be done, recognising as I do, that it is a state of financial extremity in which I make this appeal. Nevertheless, I believe that what we try to do now will be immensely strengthened if we ran go on to provide some kind of supported housing for recovered alcoholics.

May I now return to one of the matters the noble Earl, Lord Kimberley, referred to in his speech and to which I believe great attention should be paid. It is true that the loss to the community of man hours of productive capacity is very large and deplorable. The father of the noble Lord, Lord Stamp, between the wars gave evidence to a Royal Com-mission on Alcoholism that, economically speaking, the total loss to any community from alcohol in general and alcoholism in particular was 13 per cent. I do not know the accuracy of that statement. It would not surprise me if it were an understatement today. There is another aspect of this loss which I think is even more deplorable. I believe it to be true that many of these alcoholics are fine people who have lost the sense to be line; who are intelligent people who have lost the ability to be intelligent; who are companiable people and good parents who have lost their capacities in these fields. That, in my judgment, is a much greater loss to the community— particularly at a time when family ties are being stretched and are ever more needed.

Therefore, my Lords, I want to finish by once again making an observation that I am sure your Lordships will take in the spirit in which I offer it. It strikes me as extraordinary that, wearing the collar that I do and representing the faith of the Christian religion, I find practically no reference to the therapeutic value of religion. I hear a great deal about the psychological values which can be attached to this problem; and I must say that I think that psychologists are much better at diagnosis than at treatment. I hear a great deal of the necessity for educational facilities and for teaching the young to recognise the truth when they see it; but would it not be at least arguable that the greatest social voluntary organisation in the community is still the Church, if only it would do its business, and that, in fact, although it may be arguable that reformation is the good advice which no alcoholic can accept, it is probably the right time of the year as well as an eternal truth to say that resurrection is the good news which the Christian Church ought to be proclaiming and which indeed the fellowship of the Christian Church and the offering of companionship and help, intelligent, informed and vigorous help, to the alcoholic is probably the finest answer that can be made to a problem? It is a problem about which I know a considerable amount, which I feel deeply about and on which I am more than grateful if, out of another discussion this afternoon in your Lordships' House, something will be done to bring these alcoholics back to the life to which they can contribute and in which their happiness can be shared by those who love them; so that their future may be a contribution to the community in which they live.

5.45 p.m.

Lord LEIGH

My Lords, when the noble Earl, Lord Kimberley, asked me if I would speak in this debate I agreed rather hesitantly, particularly as I knew he would say first everything that I wished to say. That he has done except, I think, for one point. I am told that there is a coloured administrator in one of the new African countries who has three files on his desk: "In", "Out", and "Too difficult". I believe that this question of alcoholism has been in the "Too difficult" file for far too long. It is nice that at least it is on the top of the "In" file this afternoon. We have heard from the noble Lord, Lord Hunt of Fawley, a doctor; and we have heard from the noble Lord, Lord Soper, a minister of religion, but I should like to speak as one closely connected with one of the regional information centres and, therefore, more or less in the front line.

The centre caters for a manufacturing city with a population of 300,000 and a county with a population of 470,000. The county comprises three boroughs, two district councils and two health areas. Except for a 14-bed treatment centre— not a detoxication centre—the regional centre is the only place to deal with that population of 470,000. The work is done by a dedicated voluntary treasurer, who is not a reformed alcoholic, and an executive director, equally dedicated, who is a reformed alcoholic. He works night and day; he is called out to the local hospital; he is never off the job; and I think he is grossly underpaid.

This centre has been operating for five and a half years during which the expenditure has been a mere £33,122. That has been paid as to 61 per cent. by voluntary effort on the part of the council who runs it, 16½ per cent. from the Department of Health and Social Security and—and here is the interesting part—12 per cent. from local authorities and 10½ per cent. from industry. The town is a big manufacturing town.

The Department of Health and Social Security in a Circular of May 1973 to local authorities says: Information centres lie within the sphere of responsibility of both Area Health Authorities and social service authorities who should not hesitate to use their grant-giving powers to help them. I believe that in this county with two exceptions, that message has been to a large extent ignored. In the case in point, two of the three borough councils have produced nothing; the county has produced £250; of the Area Health Authorities, one has produced £100 and the other £50.

One feels that the local authorities must be encouraged to give more help; one feels that industry—after all, it is in their interest—must be encouraged to help us more. But I think that our big lack— the money may come in; one hopes so —is in men. I was delighted to hear the noble Lord, Lord Hunt of Fawley, say that the General Medical Council are to run a one-day course on alcoholism; because I am informed that in the teaching hospitals in general very little attention is paid to this all-important subject; yet it is said to be the third highest cause of premature death. I do not believe the ordinary general practitioner has the time (or, if he has the time) the inclination to deal with the alcoholic. Any form of treatment must take a considerable time and I do not think one can blame the general practitioner because often he has more important things to do. But from the medical profession we do need leaders in this field because, after all, the problem is not entirely in the psychological field and there is a lot of ordinary medicine connected with it. But whoever deals with alcoholics must be a specialist, and until there is some urge among medical students to take up this subject I am afraid we are not going to get any great lead from that profession. Whether such an urge might be helped by a financial incentive, I do not know: I take it that the pay structure of the medical profession is rather a difficult subject.

Another point is that in the information centres and other places in which alcoholism is dealt with, there are very few men; there is no training and no financial incentive. They have to be dedicated men, and the ex-alcoholic is far and away the most likely person to be dedicated to the cause. He knows the full horror of the situation because he has suffered it himself. If there could be some kind of training school for people, particularly ex-alcoholics, who wish to take up this work, and if there could be some decent remuneration available when they have finished their course, this would be a great step forward.

5.53 p.m.

Lord AMULREE

My Lords, my noble friend Lord Kimberley and other noble Lords who have spoken tonight have made most of the points I had intended to make, so I shall be able to make my speech a little shorter than it would otherwise have been. There are just a few points which I should like to make, partly on the medical side and partly on the general educational side.

The first thing we really need to know is: what is the cause of alcoholism and where do alcoholics come from?— because the popular feeling is often that they are the tipsy kind of person from the Registrar-General's fifth social class; they are the people we see lying in the street, and so on. Certainly that type of person forms a proportion of the people we see—and the noble Lord, Lord Soper, will know a great deal more about this than I do—but most of these people do not come from that walk of life and, therefore, a great deal of research needs to be done. We also need to know whether the disease is primarily psycho-logical or physiological. It is probably a mixture of the two as many things are, but that is something which, again, we need to know a great deal more about

I am certain that the general practitioner should be the main instrument in the care of these people. It is important that he should be encouraged to think about alcoholism more than he does now. There are a number of com-plaints about which people see their doc-tor—simple things like gastritis, for instance—but if the doctor is aware of the fact that alcoholism may be at the back of such complaints or symptoms, it might be possible to detect far more alcoholics at an earlier stage than at present. It must never be forgotten that, fundamentally, the alcoholic is a sick person, and quite a number of general practitioners—as I am sure the noble Lord, Lord Hunt of Fawley, will agree —do not know how many alcoholics they have in their practice. When they do know I think the bulk of them become extremely sympathetic and co-operative in their care of the alcoholic. Of course, one comes across one or two doctors like the one I saw quoted in a book the other day, who thought that alcoholics were " a confounded nuisance" and would therefore have nothing to do with them ; but this is a relatively uncommon attitude.

One of the troubles about my profession is that we do not get taught about alcoholism as students; we do not come across it at all. Therefore, I am very interested to see that the hospital where I was for a long time on the staff is now running a course under Doctor Glatt, who is one of the great experts on alcoholism in this country. I am sure it will be very successful and very popular. Furthermore, there is a body which may be known to some of your Lordships, of which I have spoken on previous occasions. It is called the London Medical Group and gives lectures on a large number of subjects to medical, nursing and other students. The lectures are purely voluntary and the students go in their spare time. The lectures drawing the biggest crowds tend to be those on alcoholism, given by people who know what they are talking about. So it shows that the ordinary medical student is keen to learn more about this problem, and I think we may find in time to come that the practitioners will take more interest in it and know more about it than they do at present.

The dreadful fact about alcoholism is that it is now spreading to the young, so that it involves a large number of people in their 'teens or twenties. I saw that in a big centre at Nottingham 30 per cent. of the patients were under 30. That is an extremely frightening state of affairs, because alcoholism is, broadly speaking, a treatable disease; but the objective of the treatment has to be complete and total abstinence. Some National Health Service hospitals give group therapy courses, which are very successful and do a great deal of good. Of course, it is probably better if the patient can obtain individual psychotherapy, but that is extremely expensive and rather difficult to come by, because the number who give this treatment successfully is not large. When we are referring to treatment we must not speak about the " cure " of alcoholism ; we should speak about "recovery" from alcoholism, because it is a disease which cannot be cured. One may think one can turn to social drinking after treatment, but I am certain this is not so. It is said that for the alcoholic one drink is too many, and I am sure that that is true. There may be the occasional case where alcoholism can be cured, but it is extremely uncommon.

Quite a number of units are now working under the Health Service for the treatment of these cases. I have worked out the number as about 20 or 21, and the total number of beds is about 450. One of the biggest units is that run by Dr. Glatt in Middlesex, where I think he has about 70 beds. I am told there is quite a long waiting-list, because people telephone or get in touch with him from places a long way from Middlesex because of the general shortage of places. I think one can say that the first six months after treatment are the really difficult and critical months. That is when relapses occur. Some of those who relapse have a curious conviction deep in their minds that they could cope with drinking after all if they tried once again. But of course they find they cannot, and so they relapse and the whole of the treatment has to be restarted.

However, no matter who these people are, they need a great amount of support and co-operation from their general practitioner, from the various social workers, health visitors and such people who can encourage and assist. One must refer also to the enormously important work done by the voluntary bodies. I was pleased that the noble Lord, Lord Soper, referred to them. I know of one place which is run by the Church of England in Central London where a great deal of good rehabilitation work is done. Here I am sure the Churches and voluntary organisations can contribute a great deal. Whether they can cope with treatment for people who are far gone and need to be in hospital, I do not know, but they can certainly carry out a great amount of supportive treatment, and a great deal of preventive work, too.

Finally, one comes to the question of the people who work in industry. I was very interested indeed to hear about the work in the United States of constructive coercion. That seemed to me to be most important. At the present time, one trouble is that if a person tries to obtain a job when he has been an alcoholic and has recovered, he finds it very difficult unless his medical history is kept carefully concealed. One would like to see this situation changed and improved and a more enlightened point of view taken. Furthermore, if an alcoholic is in a job why should he be dismissed? He is probably someone of relative seniority; he has probably had a good deal of experience and training Would it be not only far cheaper for the business but more humane to rehabilitate him and let him continue doing his work, rather than give him the sack and his cards and tell him to go away and find another job, which would probably be enormously difficult to do?

My Lords, these are just a few of the points I wanted to bring out. I am extremely sorry that the noble Lord, Lord Porritt, President of the Medical Council on Alcoholism, could not be with us tonight. He wanted to be here to speak, but told me he had another engagement. My observations tonight come partly from what he has told me and partly from what I have been told by the Medical Council on Alcoholism, so I feel that they have had something to do with what has been put to your Lordships.

6.6 p.m.

Lord ST. JUST

My Lords, we have had a very clear picture given from various sides of your Lordships' House concerning the whole problem of alcoholism, especially from the medical profession, as well as from that great expert on this subject, the noble Lord, Lord Soper. Might I say that I agree especially with one thing he said. I remember that some years ago in your Lordships' House we had a debate on drug addiction. We got on to talking about the question of heroin addiction, and, quite rightly, the most sombre and terrifying results were spoken about from every side of the House, especially from the medical profession, and the possibilities of any cure. At the conclusion of the debate, I was taken to the Guest Room and introduced to two nuns who had for many years been running a drug addiction centre near Reading. They assured me—and I am quite certain they were telling the truth—that they had had total cure of heroin addiction, mainly in the period of follow-up after the medical cure itself had ended. There-fore we know how essential is the spiritual side of these matters.

May I congratulate the noble Earl, Lord Kimberley, on giving a very graphic description of the alcoholic and of the total despair he experiences. This is no doubt one of the greatest problems to be overcome. I have spoken to many experts about this condition, and basically the alcoholic must be removed from society for a period of time and put into a unit or a mental health hospital where experts can treat him. As has already been said today, probably the treatment will consist of very little physical treatment. I believe the medical profession are getting away from this now. Perhaps after the drying out period the alcoholic will be given a considerable number of vitamin injections. But the most important factor is likely to be endless group therapy—prob-ably four days a week—under a psychiatrist who will help him to readjust to normal life again in the future.

Quite rightly, much has been said this afternoon—and it has been referred to in so many debates in your Lordships' House—about the problem when a person leaves hospital; about his need to readjust to life, and how local authorities can help. There is little need for me to add anything at all about this. The problem is recognised on every side of the House and a solution must slowly be worked out. I should finally like to say that I entirely agreed with what the noble Lord, Lord Amulree, said concerning the medical profession and training in teaching hospitals. I know that it sounds rather a cheek for me as a lay person to say this, but I have seen a lot of mental illness in my life. I am quite convinced that a great deal must be taught in the teaching hospitals, so that the general practitioner, who is the person who has to look at this problem, will channel off patients at the right time.

If I may, I will end with a small point which I do not expect the noble Lord to answer now, because I gave him no previous warning. Some time ago we read in an American report the horrifying fact that it had been found that the babies of mothers who were drug addicts suffered from withdrawal symptoms, especially at birth. Is the noble Lord able to tell us whether he has any indication that in children born to alcoholic mothers there are any symptoms, whether metabolic or other symptoms, which appear during the first few weeks after birth?

6.11 p.m.

Lord SANDYS

My Lords, as another layman in this very complicated and difficult field, I am very glad to have been here to have had the pleasure of listening to the speech of the noble Lord, Lord Soper, especially when he referred to the Book of Proverbs which says that drink biteth like an adder and stingeth like a serpent", because it was my first experience in this field that exactly this happened. Also, I was very glad when the noble Lord, Lord Soper, in closing, offered help to the alcoholic, because that was impossible in this particular instance.

May I be allowed to refer to an occurrence which took place a long time ago when I was serving in Germany in the winter of 1950. It was a very cold winter and our tanks had to be replenished and protected against frost with ethylene glycol. Most unfortunately, a quantity of this fluid fell into the hands of a per-son who was subsequently discovered to be an addict. He mixed a little of the ethylene glycol with German gin called Steinhager. It had the most devastating results. Unfortunately, the medical officer was not available sufficiently early with a stomach pump, and I regret to inform your Lordships that it was a fatality. Here is an instance where the lay person, who ought to be sufficiently well-informed on alcoholic substances and their power to destroy the human body, should have known some first aid in order to be able to deal with the situation. I was not involved personally in this occurrence. However, it took place in a unit with which I served and the powerlessness of the individual concerned to do anything about it struck me very forcefully.

I believe that the conference which was referred to earlier in the debate by the noble Lord, Lord Hunt of Fawley, is a lesson in public education which every-body should welcome. As a layman, I feel that I am not well equipped to speak about clinical matters, but I should like to refer to some research which I have carried out.

May I draw the attention of the noble Lord, Lord Wells-Pestell, to the role of the Government in combating alcoholism, especially in regard to the laws of past Governments and the errors made by past Governments, because there is a long and chequered history of Government action. May I begin with one of the greatest errors made by any British Government in this field—though perhaps that point is disputable—in an Act, passed in 1690, which prohibited the importation of wines and brandy from France. It had the al-most immediate effect of stimulating illegal and illicit stills and the production of gin which used a method which had then recently been discovered by a Dutch-man in Leiden.

I think that the noble Earl, Lord Kimberley, referred to a population here of 5 million in 1700. In the first decade of that century, the production of gin rose to 20 million gallons. The noble Earl and your Lordships will probably agree that this is a staggering figure, if we assume that at that time the Board of Trade was remarkably ill-placed to cater for either the legal or the illegal production of spirits. Throughout the eighteenth and nineteenth centuries, successive Governments passed legislation; but undoubtedly the real difficulty occurred much earlier when prohibition caused the situation to get completely out of hand.

One can learn from the past; certainly one can learn from the recent past. With that in mind, my noble friend Lord Erroll of Hale took up a Report of a Depart-mental Committee on Liquor Licensing in 1972. The noble Lord, Lord Shepherd, served as one of the most prominent members on that Committee. At that time, there was definite recognition of the rising overall consumption to which the noble Earl, Lord Kimberley, referred. The graph shows pictorially what is happening, and paragraph 3(17) says: The picture we get, particularly over the last 20 years, is of rising overall consumption, accompanied by increases in alcoholism death rates and in offences of drunkenness all of which are, however, still below the peak levels reached towards the end of the last and the beginning of this century. Paragraph 3(18) says: This pattern, however, is very far from establishing that licensing law has exercised or is likely to exercise a decisive influence on these trends ". I think that that is an important statement by a well-informed Committee.

One can say that licensing laws as such are unlikely to have a very marked effect, but what is most definitely likely to have a very marked effect are the suggestions set out in Circular 21/73, to which the noble Earl also referred. If I may quote from that Circular of 18th May 1973, I think it is most encouraging to see in paragraph 6 that: Given treatment two alcoholics out of three can be expected to respond, provided there are adequate community facilities to give support". Surely this was at the heart of the argument of the noble Earl.

If I may be permitted to say so, I liked particularly the very practical suggestion which he made in his summing up, that local centres should be encouraged. It follows the Report on liquor licensing regarding staffing, the after-treatment follow-up by Alcoholics Anonymous and other bodies, and the need to give help to alcoholics and their families in the early stages of alcoholism. I feel unable to offer technical advice, but may I say that it seems that the recommendations of the Departmental Committee on Liquor Licensing offer certain valuable suggestions. I therefore ask the Government to examine those recommendations in great detail.

6.20 p.m.

Lord DOUGLAS of BARLOCH

My Lords, it is true, as the noble Lord, Lord Hunt of Fawley, has said, that men learned to use fermented liquors many thousands of years ago. But a very great change took place three or four hundred years ago when the art of distilling was invented and very much more concentrated alcoholic drinks were produced. The human body has a very limited capacity to deal with alcohol. It is provided with certain substances which can metabolise it, but the supply of those things is limited and, if the consumption of alcohol exceeds the limits so imposed, it is transformed in the body into various complex substances some of which are alkaloids, which resemble somewhat the constitution of the active principle of heroin. This may explain why alcohol-ism is an addiction.

A point which I want to stress is the importance of educating the young, because if they do not understand what is involved in this they will easily get into trouble. I first came into contact with a case of alcoholism when I was quite a boy; the man in question was a student at Edinburgh University. He had an illness. When he was convalescent he was recommended to drink port wine; he did so and when his convalescence was ended he became an addict of alcohol. His career was ruined and he was shipped out to a farm in the wilds of Canada, where he was all right because he was 15 miles away from the nearest source of alcohol, but if he ever went into a town he immediately relapsed.

This points to an important factor and one which I have certainly observed ever since I discovered this case; that is, that people ought to be taught that alcohol should never be used in a way which is calculated to make one dependent upon it. It should not be used for the purpose of stimulating people when they are tired or for other reasons because then the dependence becomes immediate and, once there is a dependence on alcohol the problem becomes more and more acute.

I hope that recognising, as I believe everybody does now, what a serious problem this is in our society, the most active steps will be taken to educate the young in the schools to understand the dangers of this. It is not practicable in our society to prevent people from taking alcohol, but it is at any rate practicable to try to educate them about it and to make them understand that if they do take it they must take it in small amounts which are not likely to cause addiction, and to take it under circumstances which are not calculated to make them dependent upon it.

6.25 p.m.

Lord WELLS-PESTELL

My Lords, your Lordships never listen with greater care and attention than to noble Lords who take part in a debate and have some personal knowledge and experience to bring to our discussion. If the noble Earl, Lord Kimberley, does not think it is a piece of impertinence on my part, I should like to congratulate him on his courage and for introducing this matter which is recognised by everybody who has experience in the field of social service to be a very grave problem.

We have been fortunate in having the contribution of the noble Lord, Lord Hunt of Fawley, who brings a medical expertise to this problem, and my noble friend Lord Soper, who has spent more years working among alcoholics than I think he would care to admit. This goes for many of your Lordships, if not all of them, who have taken part in this debate. This is a subject which is of considerable interest to me, because I worked for some years in the field and I have been to America to look at what they are doing —or were doing at the time I was there —in this field.

I do not want to cover the ground that has been covered so well by the noble Earl who stated the problem, by the noble Lord, Lord Hunt of Fawley, who indicated what is being done and by my noble friend Lord Soper who gave us some indication of where the gaps are and what we ought to do to plug those gaps. But I want to say a few words about the situation as the Government see it. They recognise that there are substantial indications showing that there are a growing number of persons being admitted today to mental illness hospitals with alcoholism as the primary diagnosis, and we recognise that there is a considerable increase among young people who are already experiencing drink problems. The noble Lord, Lord Hunt of Fawley, drew attention to the definition of alcoholism given by the World Health Organisation and I do not want to go over that ground again, but one point I want to emphasise, and which he himself made, is that the World Health Organisation said, "There must be treatment". In the last analysis we cannot escape from that.

I am not in a position to estimate the number of man-hours lost in industry, commerce and business as a result of alcoholism and I shall not attempt to do so. But the noble Earl undoubtedly has information and we have no reason at all to feel that it is in any way exaggerated. Probably, as he says, it is only the tip of the iceberg. The Department has taken an interest in alcoholism since the early 1960s and has encouraged the development of specialised treatment facilities. I refer to specialist alcoholic units which are part of our psychiatric hospitals. I want to be perfectly frank and to recognise that progress has not been as rapid as we should like. There have been many difficulties, which I want to come to before I sit down, but, having said that, I want to emphasise that the Department is not unmindful of the nature of the problem and the serious social effects that it has.

However, I think everyone who has listened to the debate today will recognise that some considerable progress has been made. Four years ago when my noble friend introduced a debate on this subject there were 14 specialised alcoholic units in England. There are now twenty-two. Your Lordships may well say that that is not much of an improve-ment—eight in four years, but one has to see these units against a background of support. As has been said today, we can talk about community care, we can talk about having specialised units, but it is not just a question of having a competent member of the medical profession available to deal with all the physical symptoms. If that person is to return to the community and to take his place in the community, there has to be an enormous back-up service; there must be prolonged counselling by someone who is in a position to counsel.

There must be a good deal of supportive help within the home. There must be the right kind of work available, and a fair amount of continuous supervision. It is not just a question of drying out a person, and then feeling that the whole situation has been resolved. For that reason, it is not easy to establish a specialised alcoholic unit. However, in four years we have increased the number of these units from 14 to 22. There are three more special units in the pipeline. This means that with one exception, all regional health authorities have now at least one of these units which, as I mentioned earlier, are complemented by mental illness hospitals, which also pro-vide treatment facilities for the alcoholics.

My Lords, because I speak with some personal knowledge, having worked in this field for some years in the past, I should like to take this opportunity of paying a debt of gratitude to general practitioners at large, who have made a far greater contribution than perhaps many of us realise in the medical care and treatment of alcoholics who are not admitted to our hospitals. This work should not go unnoticed. I should like also to take this opportunity of paying a tribute to the Medical Council on Alcoholism, whose work I know only too well. I cannot begin to tell your Lord-ships of the value of their contribution to the community. We have heard about a one-day conference which will be held in the immediate future, but their work goes on 365 days a year. They are training doctors in this particular sphere; they are training nurses and health visitors. They are also training medical students. To my personal knowledge they have published quite a number of very read-able books on the problem of alcoholism and the alcoholic. I think I am right in saying that their activities have recently widened to include research.

In the last analysis, there is no point in doing something today unless you know what you must do tomorrow, and this is precisely what they are doing. I am sure they will not mind my saying, as I think I ought, that they are substantially grant-aided by the Department of Health and Social Security, and it is right that they should be. We must recognise that in a problem of this kind, the State is unable to help 100 per cent.

If we are to come to grips with this particular problem, and if we are to make any real impression, then we must harness plenty of good will. We must bring together those in the community, who are committed and concerned, people who can work along the lines that my noble friend and his friends have been working along for a good many years, and who have the right, if I may say so, to look to the State for financial support. Unless we harness the right sort of people in the community who can do this under voluntary aeges, we are not really going to make a great deal of progress.

My Lords, I should now like to say a word or two about detoxification centres. However, if I am going to do so, I ought to say that I stand before your Lordships in sackcloth and ashes, because I have to admit that very little progress has been made in this sphere. Such little progress has been made simply because it is a comparatively easy thing to establish a detoxification centre, but it is a very difficult thing to provide all the supportive help needed. Those of your Lordships who have been interested in problem families and in discharged offenders will know that everybody says, "Oh yes, there must be homes and there must be hostels for these people, but we do not want them in our street". Every-body says that there must be detoxification centres, but how many local authorities really want them? I do not think one can organise a detoxification centre without local planning approval. There are many other problems apart from the back-up problems. There are consider-able difficulties.

I must admit that after a considerable length of time and many difficulties, we have succeeded in planning only two centres, one in Manchester and one in Birmingham. In London, the Department of Health and Social Security is seeking the help of voluntary organisations to establish a community-based centre run in co-operation with hospitals, the police and local authorities. But having said that, I can assure your Lordships that we shall not be afraid to experiment— and "experiment" is the right word— with other types of centres. I want frankly to admit that we are far from happy at the slow progress. As I said a moment ago, it is not just a matter of providing facilities for drying out the alcoholic.

I spent some time in New York, and while there went to a detoxification centre, a drying-out centre, where the police and the social workers would go out in the early hours of the morning and collect alcoholics from under the arches and off the streets. Drying out would take five days, and these people were then returned to the community. Three nights later, they were in much the same condition as they were when brought into the centre. The idea of a detoxification centre sounds good, but it makes very little contribution to the problem unless one can provide what is a fairly extensive supportive system. One must look for medical and social work teams who can not only assist with the needs of the person, but who have the ability, the competence, the skills and the facilities for his further treatment, as well as continuous care and support in the community.

We should like to move much faster in the provision of treatment and other facilities for alcoholics, particularly in the provision of the special facilities needed by those homeless alcoholics to which the noble Lord, Lord Soper, referred—those who have become habitual drunken offenders. But again, there are many difficulties in developing this service. If I may say so, the difficulty is really not one of money. There are physical difficulties. Alcoholics are a diverse and difficult group in the community, individually or collectively not easy to identify, and not always willing to be helped or treated, as the noble Lord, Lord Leigh, knows only too well.

In the last four years, special financial provision of over £2 million has been made available to develop health services for alcoholics. This is reflected in the increased number of special units, to which I referred a moment or two ago. I do not want to say—and it would be wrong to mislead your Lordships—that this has nothing to do with financial stringency, but we would find the money; we would provide the money, if it were physically possible to have the co-operation of local authorities. But we would need to provide this support and back-up.

From the legislation that has been through your Lordships' House in the last year, your Lordships will know how much extra burden we have put on the local authority social services. We keep piling on them responsibility after responsibility. When the Children Bill, on which we have spent so many days, comes on the Statute Book, it will put far greater responsibility on the local authority. One of the problems with which we are faced is that they may well have reached saturation point in dealing with the social needs of the community. That is why I come back to the fact that we have to harness the good will in the community, the committed and the concerned, as I like to call them; not the great and the good, because I do not believe they really do very much good. It is the committed and the concerned we want, and they are available. If we can harness that good will, I think we can do far more than we are able to do at the present moment.

At this stage, while I am speaking about voluntary organisations and community services, I should like to pay tribute to what is being done at the moment. One is always on dangerous ground when one starts selecting organisa-tions—Alcoholics Anonymous, the National Council on Alcoholism, the Medical Council on Alcoholism. These are not the only people who are functioning. There are many voluntary organisations to which my noble friend Lord Soper referred, with which he him-self has been associated for a good many years, who are doing this work in a very quiet unassuming way. We have been able to provide a substantial sum of money in the last two years. In fact, we have provided something like £315,000 in less than two years—and I do not think that is a bad sum—to 10 voluntary organisations in order to provide hostel places for alcoholics.

Many of your Lordships will know that when a voluntary body is prepared to provide hostel accommodation, we are prepared to provide a capital grant up to £2,500 per place, and then to back that with another grant, which we call a deficit revenue grant, of up to £300 per annum per place. So if a voluntary organisation can itself raise only £100 per place, then we will provide the other £200. I was informed this afternoon that from 1st April next the deficit revenue grant will be raised to £350 per annum. At this stage, this is perhaps the only thing the Department can do to encourage the organisations which are working in this field to do more, to help them financially, and to encourage any other groups which may be able to do something in this field.

Something was said about the need for education. This might well be the key to a good many of the problems. We have, as we have heard today, a vast army of alcoholics dependent upon the community, but there is not much point in taking people off the front of the queue unless we are simultaneously doing some-thing to stop another vast army from joining the queue at the other end. We can do this only by a very skilful process of education. Here, again, far more is being done in this field than many people realise. The National Council on Alco-holism has something like 16 regional councils where they are providing counselling services to help people who have become the victims of alcoholism, and to refer them for treatment. But—and this is perhaps much more important—they have been able to take on and develop a rather extensive educational programme, not only among adults and young people, but among local firms and schools. This, one must hope, will pay off in the long run.

The other problem with which we are faced—and I think we ought to face this quite squarely—is that we cannot really let people loose on the community to do this kind of work unless they are equipped to do it. One can do a tremendous amount of harm if one tries to deal with a situation with which one is not competent to deal. One sees this in all forms of social work. The Department recognises that those involved with alcoholism require special training; this is a prerequisite for a satisfactory expansion of any of the services for alcoholics. The staffs of the specialised treatment units have a very important role in pro-viding the in-service training for people who are going to do this kind of work.

I know that Members of your Lord-ships' House who are doctors will not mind my saying that it must include members of the medical profession. If we are to make a sincere and sustained effort to do something to come to grips with this problem, the people whom we encourage to do it must be able to recognise and deal with certain situations in order to get the help that is needed. We were interested at the Department to learn that the Joint Board of Clinical Nursing Studies recently introduced a 36 to 39-week course for trained nurses on drug and alcoholic dependency. This again, is a move in the right direction.

Perhaps I may conclude by saying this. I think that a debate of this kind, in which so many people who have brought so much experience have taken part, can-not do anything but good. The noble Lord, Lord St. Just, asked me whether we had any information about the effect on babies born to mothers who are not necessarily alcoholics, but who perhaps take too much too regularly. The answer is, no, we have no information. I caused a message to be sent to the noble Lord, Lord Hunt, to see whether he knew of any, and he did not. I would not want to make a promise, but if anything comes our way or can put our fingers on any information, I will certainly let the noble Lord know. The noble Lord, Lord Sandys, raised the question of education. I think this is the key to the whole problem. We have to recognise that we are faced with two alternatives; education versus compulsion by legislation. We all know that compulsion by legislation will not deal with this problem. It has to be education, and we have to find the ways and the means.

The noble Lord, Lord Amulree, raised the question of research. This is some-thing which is being done. I think I am right in saying that the Medical Council on Alcoholism is doing some research in this field. One of the encouraging things —and perhaps I ought to conclude on this note because it is a very positive note, and I do not seem to have said very much that is positive—is that the Department, or I should say my right honourable friend the Secretary of State for Social Services, has established an Advisory Committee on Alcoholism. The Chair-man of that Advisory Committee is Professor Kessel who is Professor of Psychiatry and Dean of the Faculty of Medicine in the University of Manchester. I am informed that he is an authority on alcoholism and that, with his Advisory Committee on Alcoholism, which has an influential membership from the point of expertise and skill, rather than from names, he will in the near future be able to look at this whole problem and advise my right honourable friend the Secretary of State on the steps that need to be taken. With real sincerity I should like to thank everyone who has participated because I think that when we come to read Hansard the Department will find the report of the debate of considerable value.

Lord DOUGLAS of BARLOCH

My Lords, before my noble friend concludes may I ask him to clear up one point? He made two references to education, but he left me with the impression that so far as children of school age are concerned it depends entirely upon some voluntary association providing it. Is that right?

Lord WELLS-PESTELL

My Lords, I think that the noble Lord is perfectly right.

6.51 p.m.

The Earl of KIMBERLEY

My Lords, I am most grateful to all the noble Lords who have spoken in the debate this after-noon and also to those who have listened. I wish to wind up the discussion quickly because I think we have almost overrun our allotted two and a half hours. I am grateful to the noble Lord, Lord Hunt of Fawley, for exhibiting his great know-ledge of the family doctor. I can only say that if all the rest of the family doctors had his knowledge, probably this problem would be half solved. I fully appreciate the remarks on the spiritual side from the noble Lord, Lord Soper, but I thought he was in a much better position than I to speak about it! I agree with the noble Lord also that many of these advertisements on drink leave much to be desired. My noble friend Lord Leigh said some of the regional councils are short of money. I believe that that is sometimes the case. In view of the remarks of the noble Lord, Lord Wells-Pestell, it may be that these problems will begin to sort themselves out in the near future.

My noble friend Lord Amulree said that general practitioners should try to detect alcoholism earlier, and I agree. I also agreed when he said that they seem nervous about telling a patient that he might be an alcoholic. "Alcoholism" seems to be a dirty word. I think we must try to get rid of that idea. It is not a dirty word; it is no worse than TB, cancer or anything else. I am happy to know from the noble Lord, Lord St. Just, that pregnant women who are alcoholics do not pass the habit on to their children. The noble Lord, Lord Sandys, said that the public needs educating, particularly in first-aid. I agree. While the public may not necessarily be able to cure or help an alcoholic to recover, they may be able to prevent one from dying.

Lastly, I should like to thank the noble Lord, Lord Wells-Pestell, for everything he said. He was most constructive. It would take me too long to go through each point that he made. There is no doubt that the Department of Health and Social Security realises the vastness of this problem, and, as the noble Lord, Lord Wells-Pestell, said, a reading of Hansard tomorrow will probably assist everybody. My Lords, I beg leave to withdraw my Motion.

Motion for Papers, by leave, with-drawn.