Alcohol misuse: tackling the UK epidemic - London

school while experiencing poor levels of supervision in the home. 93
Comorbidities are vital to understanding smoking, drinking and drug use among adolescents. Concurrent
use of the second and third substance is the highest risk factor for involvement in any one of these three
activities. The Health Survey for England 1997 found that among 16 to 24 year olds, there was an
association between alcohol and cigarette smoking: smokers were considerably more likely than nonsmokers
to drink more than 21 units a week (males) or 14 units (females). 23
Moreover, many of the risk
factors associated with these activities are common to all three.
It has been estimated that at least two-thirds of young people with substance misuse disorders are likely to
have co-existing (usually pre-existing) psychosocial problems. 94
Positive correlations have been found
between substance misuse and suicide, depression, conduct disorder, school dropout and poor
achievement. Traumatic events such as family conflict, bereavement and sexual abuse seem to initiate or
increase drug use. 93
It is likely that there is reciprocity between mental health disorders and substance
misuse: the former acts as a potent risk factor for the latter, and substance use can contribute to the
existing disorder. .9
Interventions in adolescent smoking, drinking and drug use
Interventions in adolescent smoking
The white paper Smoking kills set targets to reduce the prevalence of regular smoking among adolescents
from a baseline of 13 per cent in 1996 to 11 per cent by 2005 and 13 per cent or less by 2010. 95
The
Government’s tactics include making clear the risks of smoking and enforcing the law on under age sales.
Scotland has also set targets to reduce adults’ and children’s smoking behaviour. It hopes to reduce the
prevalence of smoking for 12 to 15 year olds from 14 per cent in 1995 to 12 per cent in 2005 and 11 per
cent by 2010. It also aims to reduce the social class gradients in the prevalence of smoking. 96
Interventions in adolescent drinking
The government has made a commitment to implement a National Alcohol Harm Reduction Strategy
by 2004.
The Home Office has an interest in adolescent alcohol consumption because of the crime and disorderly
behaviour that can result from irresponsible use. Its current strategy includes the enforcement of licensing
regulations and consideration of education policy. The Department for Culture, Media and Sport, which is
responsible for licensing laws, will introduce new measures to back-up restrictions on underage drinking.
These are set out in the Time for reform proposals for the modernisation of our licensing laws white paper. 97
During the nineties, new ranges of alcohol drinks such as alcopops were introduced onto the market.
There has been significant debate on the appeal and marketing of these drinks to adolescents. 73
Since 1990
there has been a substantial increase in the popularity of spirits and alcopops among 11 to 15 year olds,
and especially among girls. 98
Currently there is a voluntary code of practice governing the marketing of
alcoholic drinks. Complaints can be made if it is considered that alcoholic drinks are marketed to appeal
in particular to under-18s. However, there are no legislative powers to undertake enforcement. 73
The UK
government considers that non-statutory controls are effective in subjective areas of advertising and
promotion content where they believe formal regulation is apt to be contentious. 99
In 2002 the Scottish Executive launched a plan for action on alcohol problems. Two key priorities of the
plan are to reduce binge and harmful drinking by children and adolescents. Methods include a national
communication strategy, prevention and education including school-based education and a framework
leading to the improvement of and support for treatment services. 99
British Medical Association Adolescent health 19