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Report launch: ‘Interventions for alcohol dependence in Europe: A missed opportunity to improve public health’ The event was held under the auspices of the Danish Presidency of the Council of the European Union – the Danish Ministry of Health Brussels, 10 May 2012, European Parliament, Room A3G-3 A3G

MEETING REPORT On 10 May MEP Glenis Willmott (S&D, UK), hosted an event in the European Parliament to launch the policy summary report ‘Interventions ‘Interventions for alcohol dependence in Europe: A missed opportunity to improve public health’. health’ The event was held under the he auspices of the Danish Presidency of the Council of the European Union (Danish Ministry of Health),, supported by the European Alcohol Policy Alliance (Eurocare) and sponsored by Lundbeck. The objective of the event was to present for the first time the results of extensive research on alcohol dependence ndence and to discuss the different elements needed for an integrated approach to tackle alcohol dependence that covers prevention to treatment. MEP Glenis Willmott moderated the event which included the following panel of speakers: o Astrid Krag, Danish Minister for Health o MEP Elena Oana Antonescu (EPP, RO) o Jürgen Rehm, Dresden University and author of the research presented o Alastair Campbell, Communicator and former spokesperson to Tony Blair o Diane Goslar, alcohol dependent patient working with the Royal College of Psychiatrists o Mariann Skar, Secretary General of the European Alcohol Policy Alliance (Eurocare) o Lars Møller, Programme Manager Alcohol and Illicit Drugs, WHO Europe o Paola Testori Coggi, Director-General, Director Directorate-General General for Health and Consumers, European Commission o MEP Antonyia Parvanova (ALDE, BU)

From left to right: Jürgen Rehm, Lars Møller, Diane Goslar, Alastair Campbell, Glenis Willmott, Mariann Skar, Paola Testori Coggi, Antonyia Parvanova

1 The views represented here do not necessarily reflect those of the organisers.


INTRODUCTION Alcohol dependence is a common medical and behavioural disorder and a recognised chronic brain disease1 characterised by structural and neurochemical changes in the brain and disturbances in behaviour2. Alcohol dependence is common in Europe, yet little has been done d to adequately address the issue. In addition, excessive consumption of alcohol is recognised as one of the key risk factors for ill-health ill in Europe3. The burden of alcohol and alcohol related harm is also recognised in the current EU Alcohol Strategy4 as affecting not only the individuals suffering from alcohol dependence but also their families and as having a considerable negative impact on society and the economy overall.

PANEL Member of the European Parliament Glenis Willmott (S&D, UK) opened the meeting highlighting a few figures on alcohol dependence: Europe has the highest alcohol consumption in the world; there are 12 million alcohol dependent people in Europe, putting a heavy burden on families and friends and leading to an estimated €155 billion in social costs. Ms Willmott called for EU and national alcohol policies to address the problem by having an integrated approach to alcohol dependence. This would include prevention (pricing, (pricing, labelling, marketing), treatment and care. Ms Willmott concluded by stressing the need for complete and accurate data on all issues related to alcohol consumption in order to better inform policy makers as they consider future action plans. MEP Glenis Willmott Astrid Krag, Danish Minister for Health and currently leading the Presidency of the Council of the EU in health matters, addressed the audience via a video link. She quoted facts and figures on the scale of alcohol dependence while highlighting the impact on the most vulnerable populations. She also provided an overview of the international policies and strategies in place in the EU and at the WHO level. Ms Krag concluded that increased knowledge-sharing knowledge and a more comprehensive and in-depth in knowledge of the issue would contribute constructively to the discussions on national initiatives and policies. 1

Alcohol dependence is well recognised as a chronic brain disease - most notably in Edwards, G., & Gross, M. M. (1976). Alcohol dependence: Provisional description of a clinical syndrome. British Medical Journal, 1, 1058–1061 1061 and Gilpin, N.W., Koob, G.F. (2008). Overview: neurobiology of alcohol dependence with a focus on motivational mechanisms. Alcohol Research & Health, 31, 185-95. 2 The European Medicine’s Agency (EMA) guidelines on the development of medicinal products for the treatment of alcohol dependence also underscores the genetic factors of alcohol dependence (available here).The ).The World Health Organisation (WHO) strategy ’A Global Strategy to reduce harmful use of alcohol’ recognises the neurological affects of alcohol (available (availa here). 3 As stated in the WHO factsheet on alcohol (available here). 4 The Commission Communication ’An An EU strategy to support Member States in reducing alcohol related harm’ is available here.

2 The views represented here do not necessarily reflect those of the organisers.


Member of the European Parliament Elena Oana Antonescu (EPP, RO) underlined that alcohol dependence is one of the most important modern health challenges that the European society will have to face in the 21st century and, as such, it requires a concerted solution from EU and national policy makers. She recalled that excessive drinking leads to diseases such as liver failure and brain damage which are costly for both the affected person and for the national healthcare systems. Ms Antonescu emphasised emp that in order to combat this EU wide disease, there is a need for stepping up the EU funded community programmes on alcohol (linked to promotion, training and awareness) together with improved coordination between healthcare professionals and national natio authorities as well as enforcement of the minimum drinking age.

MEP Elena Oana Antonescu

University, presented the key findings of his research Prof Jürgen Rehm, Dresden University which is available in the policy summary ‘Interventions for alcohol dependence in Europe: A missed opportunity to improve public health’ and focused on alcohol consumption and alcohol dependence in Europe. Amongst others, the research concludes that: • Alcohol dependence accounts for 71% of the net burden and 62% of the total alcoholalcohol attributable burden. • More diseases are caused by alcohol than by cigarettes. Prof Jürgen Rehm • Less than 9% of all people diagnosed with alcohol dependence receive treatment for the disease. Moreover, Prof Rehm pointed out that the most successful interventions have ve been proven to include pharmacological treatment. treatment In light of the above, Prof Rehm called for an integrated alcohol policy which would supplement provisions on prevention with improved patient access to treatment. Alastair Campbell, journalist and former Director of Communications to Tony Blair, Blair gave his personal account of what it is like to be alcohol dependent. Mr Campbell stressed the gradual nature of this disease and pointed out that currently, it is the “middle classes”” that are suffering from alcohol dependence, an issue that our society fails to recognise. This lack of recognition reco can be partly explained by the general acceptance of our drinking culture (e.g. daily overconsumption of wine at home). ). Mr Campbell stressed that in light of this, it is important that society as a whole faces

Alastair Campbell “It is the “middle classes” that are suffering from alcohol dependence” 3

The views represented here do not necessarily reflect those of the organisers.


up to the problem of alcohol dependence, improves the training of healthcare professionals, and ensures that health communication, marketing and education are conducted in a way that matches alcohol producers’ communication. Mr Campbell concluded by calling for the renewal of an EU Alcohol Strategy trategy that includes treatment.

Diane Goslar “A dealer on every corner”

Diane Goslar, an alcohol dependent patient working with the Royal College of Psychiatrists, gave a very personal account of o life as an alcohol dependant. Ms Goslar also presented the challenges for coping with alcohol dependence when alcohol is omnipresent in our society and it is “like like having a dealer on every corner”. Ms Goslar also accounted for the physical and social impact of her drinking and described her recovery journey. For Ms Goslar, one of the most devastating consequences of her dependence is the damage it has caused to her brain. Ms Goslar concluded that early interventions and treatment of alcohol dependence is very important to successfully addressing the disease and that earlier interventions will allow outreach to people at a stage of their dependence where reduction and drinking management can still be part of the solution.

Mariann Skar,, from the European Alcohol Policy Alliance (Eurocare), which represents 50 national organisations from Europe working on the prevention and reduction of alcohol related harm, reiterated the need to renew the EU Alcohol Strategy. According to Eurocare, from a prevention perspective, pective, a successful strategy should focus on: labelling, commercial communication, marketing, taxation, social inclusion, monitoring, data, and training of healthcare professionals (guidelines of prevention, diagnosis and treatment), as well as care for the unborn child and it should have a particular focus on young people. people Ms Skar concluded that more needs to be done in the area of commercial Mariann Skar, Eurocare communication to protect the young, such as establishing a marketing ban on alcohol and a ban on alcohol related sponsorship (e.g. music festivals and sports events) similar to the one already in place in France.

Dr Lars Møller

Dr Lars Møller,, Programme Manager Alcohol and Illicit Drugs WHO Europe, provided an overview of how alcohol has been addressed by the WHO through data collection and analysis reports on alcohol, the Global Strategy to Reduce the Harmful use of Alcohol (World Health Assembly resolution WHA63.13) and the European action plan to reduce the harmful use of alcohol 2012-2020. 2020. Dr Møller also provided an analysis of the effectiveness of different policy options to address alcohol dependence. For example, both treatment and a decrease in marketing pressure are effective ways to reduce the harmful effects alcohol can have on human health and the society. Figure 1 - What works in alcohol policy: evidence

The views represented here do not necessarily reflect those of the organisers.

4


Slide by Lars Møller, WHO Europe According to Dr Møller,, there are still four countries without a national action plan in place and two of these countries are currently in the process of developing such plans. plans Hopefully, the WHO Strategy and European Alcohol Action Plan will inspire countries to adopt national plans on alcohol or make the necessary revisions to enhance their their effectiveness in achieving their goals.

Paola Testori Coggi, Director--General of the Directorate-General General for Health and Consumers, European Commission, started her speech by acknowledging the importance of treatment and added that an integrated approach to alcohol dependence should also be inclusive of preventive measures (from preconception to adulthood and with a focus on the young). Ms Testori Coggi highlighted the importance of intervening interven before the brain is damaged and the he person in question becomes dependent on alcohol. The DirectorDirector Paola Testori Coggi General also emphasised the importance of early identification by healthcare professionals of harmful drinking behaviour and described some of the EU-funded funded projects dealing with this challenge, challen e.g. the Alcohol Measures for Public Health Research Alliance (AMPHORA) and Primary Health Care European Project on Alcohol (PHEPA). Ms Testori Coggi concluded, that although no decision on the renewal of the EU Alcohol Strategy will be taken until the th current review is completed (i.e., autumn 2012), the Commission welcomes the call from the Members of the European Parliament to renew the Strategy and encourages the European Parliament to voice its support.

5 The views represented here do not necessarily reflect those of the organisers.


Member of the European Parliament Antonyia Parvanova (ALDE, BG) stated that alcohol is more harmful to society than tobacco: “every year more people die due ue to alcohol than to cigarettes; a smoker will not cause a car accident but a drinker may. Smoking does not contribute to destroying a family but alcohol does and it is easier to quit smoking than to stop drinking”. She stressed that both tobacco and alcohol were powerful voices in decision-making making and appealed to the healthcare community to voice - loudly and continuously - the rationale for putting in place effective policies on alcohol, alcohol based on published evidence. Dr Parvanova added that support MEP Antonyia Parvanova from other policy areas besides public health is required and “Alcohol kills more people therefore asked the Commission, whether the DirectorateDirectorate General for Health had the support from other DGs within the than cigarettes do” European Commission (e.g. from the internal market, taxation, information society, etc.)) to renew the EU Alcohol Strategy. Strategy. Dr Parvanova concluded that stakeholders should create an environment where it becomes impossible to deny that alcohol is a problem in our society and that a Strategy to address it is key.

DEBATE AND CONCLUSIONS The following debate focused on the role the European Union and national Member States should have in the fight to combat alcohol related harm and the different policy options available. Some of the issues outlined in the debate are set out below. rom the German Road Safety Council urged Jacqueline Lacroix from the Commission to push for zero tolerance on drink driving and drink cycling. In response, Dr Parvanova added that a focus should be put on taxation policies and a ban on o selling alcohol in certain places, e.g. workplace. place. Johan Jensen from the Alcohol Policy Network mentioned that a total ban on alcohol advertisement would be the most effective and cheapest cheap policy to diminish alcohol consumption. As far as introducing a ban on alcohol advertisement, Ms Testori Coggi said the EU does not have the power to intervene and is therefore pushing for voluntary actions action to reduce advertising aimed at young people. In relation to this, Alastair Campbell made the point that the alcohol industry’s job is to sell alcohol and thus, voluntary actions are unlikely to work. Both Alastair Campbell and Diane Goslar underlined the importance of trained healthcare professionals, in particular GPs, for the early identification of people at risk, as well as for the effective communication to these risk groups about the different options available to them. 6 The views represented here do not necessarily reflect those of the organisers.


Both added that at a time where alcohol dependence is an increasing problem, it is regrettable that treatment centres are being closed. Katerina Ossenberg,, consultant to the European Liver Patients Association (ELPA) commented that liver enzyme tests could be used by GPs to identify alcohol dependent patients (as well as other diseases) and should therefore be reimbursed. The debate came to an end with a vivid discussion of whether alcohol should be regarded as a dangerous substance. The debate was concluded with a call from all panellists to renew the EU Alcohol Strategy.

PRESENTATIONS, PICTURES AND ADDITIONAL INFORMATION 1. The summary policy report ‘Interventions ‘Interventions for alcohol dependence in Europe: A missed opportunity to improve public health’ is available here: http://www.interventionsforalcoholdependenceineuropepolicysummary.eu/ http://www.interventionsforalcoholdependenceineuropepolicysummary.eu/ 2. PowerPoint Presentations from the panel and video address by the Danish Minister for Health, Ms Astrid Krag are available here: Report launch: ‘Interventions Interventions for alcohol dependence in Europe: A missed opportunity to improve public health’ health - presentations 3. Pictures of the event are available here: Report launch: ‘Interventions Interventions for alcohol dependence in Europe: A missed opportunity to improve public health’ health - pictures 4. EU Alcohol Strategy (currently being evaluated) is available here: http://eurhttp://eur lex.europa.eu/LexUriServ/site/en/com/2006/com2006_0625en01.pdf

7 The views represented here do not necessarily reflect those of the organisers.


ANNEX – LIST OF PARTICIPANTS

Accard Allvin Amberg Ancans Antonescu Appelby Black Blædel Lassen Brandao Bredsgaard-Lund Bro Campbell Capouet

Pauline Thomas Ariane Peteris Elena Oana Eric Diane Anders Maria Bo Nina Alastair Mathieu

Chomille Clarke Covaci

Dalida Frazer Elisabeta

Custódio Damgaard Jensen Das Defraigne Fridberg Fuchs Garnes Goslar Goulão Hagan Hasseriis Iversen Hentgen

José Johan Sarada Guy Susanne Doriane Nils Diane João Paul Jan Paul

Hockey Jesse Joao Podgorny

Andy Maris Maria

Kohlke Künstler Lalevska Langford

Gunda Franziska Vasilka Andrew

European Parliament, Assistant To Philippe Juvin MEP Permanent Representation of Sweden to the EU Swiss Mission to the EU Permanent Representation of Latvia to the EU Member of the European Parliament Alcohol Concern European FASD Alliance Lundbeck Lundbeck JKL Group Alcohol Policy Network Communicator, Former spokesperson to Tony Blair Belgian Federal public service: Health, Food Chain Safety and Environment - Belgium NBV Bryssel S&D Group – Citizens' Europe Unit (Head of Unit) European Parliament, Assistant to Elena Oana Antonescu MEP Lundbeck Alcohol Policy Network Standing Committee of European Doctors (CPME) Lundbeck Lundbeck European Public Health Alliance (EPHA) European Alcohol Policy Alliance (Eurocare) Working with the Royal College of Psychiatrists (UK) Chairman EMCDDA Management Board, IDT European Parliament, Assistant to Paul Skinner MEP Lundbeck Centre Hospitalier Neuro-Psychiatrique Psychiatrique Ettelbruck Luxembourg Lundbeck National Institute of Health Development of Estonia Assistant to Vital Moreira MEP (Chairman of INTA Committee) Lundbeck Assistant to Karin Maag MP Bundestag - Germany Active - Sobriety, Friendship and Peace British Liver Trust 8

The views represented here do not necessarily reflect those of the organisers.


Lacroix Manczuk

Jacqueline Marta

Møller Mulcock O’Sullivan Ossenberg Parvanova Pedersen Peuskens Pires Ribeiro Gomes Pops Pukeleviciene Rankauskas Rehm Renzelmann Sassi

Schöner Scott Skar Stihler Storm Tato Marinho Testori Coggi Theisen Vajer van Eimeren Veryga Voordeckers Walker Willmott Woodford Wymenga

German Road Safety Council The Maria Sklodowska-Curie Curie Memorial, Cancer Center and Institute of Oncology Lars WHO Regional Office for Europe Neil Lundbeck Aiden European Parliament, Assistant to Nessa Childers MEP Katharina Consultant to European Liver Patients Association (ELPA) Antonyia Member of the European Parliament Maria Permanent Representation of Denmark to the EU Hendrik UC St Jozef Kortenberg Cristina Advisor to the Secretary of State Assistant to the Minister Maria of Health – Portugal Kadri Lundbeck Estonia Vilma Center for Addictive Diseases Leopoldas Lundbeck Juergen Dresden University Johan David United European Gastroenterology (UEG) Franco Health Division, Directorate for Employment, Labour and Social Affairs, Organisation for Economic Co-operation Co and Development (OECD) Ulrike S&D ENVI Secretariat Sam Permanent Representation of the United Kingdom to the EU Mariann European Alcohol Policy Alliance (Eurocare) Catherine Member of the European Parliament Pernille Lundbeck Rui Directorate General of Health - Portugal Paola European Commission, DG Health and Consumers Caroline Organisation des Etablissements de Soins/Organisatie Gezondheidszorgvoorzieningen Peter Semmelweis University Mischa United European Gastroenterology (UEG) Aurelijus Lithuanian University of Health Sciences Michael Hill & Knowlton Margaret European Association for the study of the Liver (EASL) Glenis Member of the European Parliament Emma Association of European Cancer Leagues Bibiche Dutch Ministry of Health, Welfare and Sport – The Netherlands

-ENDS9 The views represented here do not necessarily reflect those of the organisers.


Meeting Report: Interventions for Alcohol Dependence in Europe