Alcohol misuse

Last updated: 2018-03-23 11:39:38
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1. Introduction

Introduction

 

 

Alcohol is the leading risk factor for preventable deaths in 15-49 year olds.

There are high levels of adults who now drink at levels that increase risk of harm with approx 1.6 million in England showing signs of alcohol dependency.

 

There are three main types of alcohol misuse:

  •  Hazardous drinking: Drinking over the recommended limits
  • Harmful drinking: Drinking over the recommended limits and experiencing alcohol-related health problems
  • Dependent drinking: Feeling unable to function without alcohol.

 

The short-term risks of alcohol misuse include:

  • Alcohol poisoning, which may include vomiting, seizures (fits) and unconsciousness
  • Injuries requiring hospital treatment, such as a head injury
  • Violent behaviour that might lead to being arrested by the police
  • Unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs)
  • Loss of possessions, such as a wallet, keys and/or phone, leading to feelings of anxiety. 

 

Long-term alcohol misuse is a major risk factor for a wide range of serious conditions, such as:

  • Heart disease or irregular heartbeat
  • High blood pressure
  • Stroke
  • Liver cirrhosis/disease
  • Liver cancer
  • Bowel cancer
  • Pancreatitis
  • Cancer of mouth, throat, oesophagus or larynx
  • Breast cancer in women
  • Reduced fertility
  • Harm to unborn child (Foetal Alcohol Spectrum Disorder –FASD)
  • Depression & anxiety

 

As well as health problems, long-term alcohol misuse can lead to social problems such as:

  • Unemployment
  • Divorce 
  • Domestic abuse
  • Homelessness.

 

Other JSNA topics this topic closely linked to:

Drug Use

Domestic Violence

Poverty

 

Key Issues

 

 Stronger communities 

  • Responsible National and local advertising is required to help reduce levels of drinking, especially by young people
  • Social marketing is not being fully utilised to reduce alcohol use in the population

Supporting children and young people

  • Low numbers of young people access treatment services
  • High number of children living with parents who are in treatment

Safer communities and sustainable environments

  • The needs of domestic violence victims and perpetrators may not be met and stronger links with treatment services are required
  • The effective use of drink banning orders and direction to leave notices
  • There is no effective system for utilising A&E data for community safety purposes
  • Alcohol-related violence is a problem in Hartlepool

At Risk Groups
 

Age

Children and adolescents are at increased risk due to:

  • Changes in physiological development;
  • Inexperience;
  • Experimentation and generally higher tolerance of risk;
  • Early exposure leading a greater chance of developing illness in later life;
  • Alcohol seriously impairing brain development in young people.

 

Older people are considered to be at increased risk due to:

  • Physiological changes (increased susceptibility);
  • The higher risk interaction with prescribed medication;
  • The stresses of ageing including the risk of isolation.

 

Gender

The following examples from Local Alcohol Profiles England (LAPE) shows data in relation to alcohol related incidences for 2016 for Hartlepool in comparison to England.

Alcohol Related Hospital Admissions - 2016

England

636

Hartlepool

952

Per 100,000 population

Male

818

Male

1266

Female

473

Female

664

 

Alcohol Related Deaths - 2016

England

46.6

Hartlepool

61.8

Per 100,000 population

Male

66.3

Male

92.8

Female

28.8

Female

33.3

 

Liver Mortality - 2016

England

12.0

Hartlepool

25.3

Per 100,000 population

Male

15.7

Male

36.9

Female

8.5

Female

14.3

 

Hospital Admissions for Alcohol Specific Conditions for Under 18’s - 2016

England

34.2

Hartlepool

38.5

Crude Rate per 100,000 population

 

Mental Health

The prevalence of alcohol dependence is almost twice as high among those with psychiatric disorders compared with the general population. Higher levels of stress are also linked to higher alcohol consumption.

Socioeconomic and environmental factors, and other determinants

High levels of deprivation are an influencing factor on alcohol consumption.

High levels of alcohol misuse are associated with clients who were unemployed and/or had difficulties with housing.

Many children and young people who live with substance misusing parents and carers are suffering ill effects. They are often neglected, suffer from witnessing domestic violence and are at an increased risk of misusing alcohol and illegal drugs themselves.

Risk exposure to alcohol-related harm is associated with:

  • Parental drinking;
  • Poor nutrition, health care, education and social networks (that is disadvantage, deprivation and inequality);
  • Certain professions, including those associated with the drinks industry (e.g., bar work), and those associated with higher stress levels (e.g. law enforcement).

 

Last updated: 09/05/18

2. The Challenge

What People Say

Findings from Balance North East’s ‘How We Drink, What We Think’ survey in 2017 showed that for the people of Hartlepool:

• 30% were concerned about how much they drink

• 80% were unaware how many units UK Chief Medical Officer recommends as a weekly limit

• 78% believed that the UK has an unhealthy relationship with alcohol

• 64% believed that children should be protected from exposure to alcohol advertising

• 12% were aware of drinking guidelines for children

• 49% Supported Minimum Unit Pricing and 28% were undecided on the issue

Data & Intelligence

The charts below are some examples of the data that is available from the Local Alcohol Profiles for England. For a full area profile on alcohol in Hartlepool please use this link.

Mortality

The chart below shows that the rate of alcohol-related mortality in Hartlepool in 2016 was significantly higher than the England average. However, this rate is showing a downward movement, closing the gap to the England average from 30.8 per 100,000 to 15.8 per 100,000.

The chart below shows that the rate of alcohol-specific mortality in Hartlepool is worse than the England average, and since 2012-14 has moved further away from the average year on year. The latest rate is more than twice the size of the national rate.

Hospital Admissions

The chart below shows that the rate of persons admitted to hospital for alcohol-related conditions in Hartlepool is higher than both the North East regional and England averages. Hartlepool has the 2nd highest rate in the North East region.

The charts below show the rate of alcohol-related hospital admissions (Broad) and the rate of alcohol-related hospital admissions (Narrow). Both of these charts show that Hartlepool is significantly worse than the England average. The Hartlepool rate has been worse than the national average for both measures for the entirety of the 8 yearly reporting periods, 2008/9 – 2015/16. The latest rate has shown a slight narrowing in the gap between Hartlepool and the national average in both charts.

When the admission episodes for alcohol-related conditions is broken down to those under 40, those aged 40-64 and those over 65, you can see that while all three are significantly worse than the England average, under 40 and over 65 are both are closing the gap between Hartlepool and England, while 40-64 are getting further away from the England average.

The chart below shows that the rate of alcohol-related hospital admissions for under 18-year olds in Hartlepool had been significantly worse than the England average up until 2013. However since 2014, Hartlepool has been similar to the England average, with the latest rate slightly below the national average. The rate for 2016 was the 3rd consecutive year the rate has fallen, and is now at an 8 year low.

Impact

The chart below shows that Hartlepool has been significantly worse than the England average for years of life lost due to alcohol related conditions for 3 consecutive years. From 2012 to 2015 the Hartlepool rate increased year on year, with the 2015 rate showing an increase of 60% on the 2012 rate, while at the same time the national average moved no more than 2%. However the latest rate shows a fall of 11% on the 2015 figure, beginning to close the gap to the national average.

The chart below shows that Hartlepool is similar to the England average for alcohol related road traffic accidents, though Hartlepool’s 2013-15 figures were the highest for 4 years, whilst the England rate was at a 4 year low.

The chart below shows that Hartlepool is both similar to the England average and the 2nd lowest in the North East region for claimants of benefit due to alcoholism. Hartlepool moved from being significantly worse than the England average in 2015, with a rate of 178.0 per 100,000, to a rate similar to the England average of 160.8 per 100,000 in 2016.

Alcohol Related Crime

The total number of crimes committed in Hartlepool between 1st January and 31st December 2017 was 10,432; of which 812 were recorded as being alcohol-related (7.78%).

An analysis of the main alcohol-related crime types shows that more than two thirds of alcohol-related crimes were violence offences: violence without injury 304 offences (37.43%) and violence with injury 270 offences (33.25%).

Criminal damage was the third highest crime type at 100 offences (12.32%). In comparison, 1,627 criminal damage offences were recorded in total which accounts for 15.60% of total crime.

Domestic violence offences accounted for just over half of alcohol-related crimes (53.94% or 438 offences), which is a much higher proportion than for all crime where domestic violence offences only accounted for 13.15% of total crime (1,372 offences).

When broken down by date and time, analysis shows that alcohol-related crime occurs primarily between 9.00pm and 1.00 am, which correlates with the times when licensed premises are open. Unsurprisingly, Friday, Saturday and Sunday were the days on which alcohol-related crime was most likely to occur.

The chart below shows the three wards with the highest numbers of alcohol-related crimes:

The locations reporting the highest numbers of alcohol-related crime correlate with the night time economy area and areas which experience high volumes of anti-social behaviour.

Alcohol Misuse Treatment

The rate of dependent drinkers in Hartlepool has remained static at 1.69% since 2013/14. This compares favourably against the nearest neighbours, which has a rate of 2.04%, but is slightly higher than the national rate of 1.39%. Within the dependent drinker population, the percentage of these who are not receiving any alcohol misuse treatment is 71% in Hartlepool in 2016/17. This has been increasing since 2013/14, and has increased by 10% in 3 years. Hartlepool’s rate compares favourably against both that of the nearest neighbours and the national average. Hartlepool’s 2016/17 rate of 71% is 9% lower than the nearest neighbours and 12% below the national average.

The chart below shows that the number of new episodes for Alcohol misuse treatment in Hartlepool has, apart from an increase in 2015/16, been declining from 284 new episodes in 2012/13 to 204 new episodes in 2016/17. This is a fall of 28.2% in 4 years. At the same time the number of treatment naive episodes, that is episodes for people who have never previously received alcohol misuse treatment, has had far less movement across the 4 year period, with the 2016/17 figure almost identical to the 2012/13 and 2013/14 figures.

The chart below shows that nationally successful completions have increased by 1% from 2012/13 to 2016/17, from 37.9% to 38.9%. During the same period Hartlepool’s successful completions have increased by 9.9%, nearly halving the gap between Hartlepool and the national average, from 19.2% in 2012/13 to 10.3% in 2016/17.

Evidence For Effective Intervention

Public Health Guidance: Alcohol: preventing harmful use in the community (2015) - https://www.nice.org.uk/guidance/qs83 - Centre for Public Health Excellence (CPHE) at NICE

Clinical Guideline: Alcohol use disorders: management of alcohol dependence (2011) - https://www.nice.org.uk/guidance/cg115 - National Collaborating Centre for Mental Health (NCC-MH)

Evidence Review: Best et al, ‘Research For Recovery: A Review of the Drugs Evidence Base’ (2010) - http://www.scotland.gov.uk/Publications/2010/08/18112230/0 

Children and Young People: Specialist substance misuse services for young people (2017) - https://www.gov.uk/government/publications/specialist-substance-misuse-services-for-young-people - Public Health England

Night-Time Economy: Alcohol Concern (Hadfield and Newton), ‘Factsheet: Alcohol, Crime and Disorder in the Night-time Economy’ (2010) - http://www.alcoholconcern.org.uk

Last updated: 09/05/18

3. Current Services

Name

Description

How to Access

Hartlepool Borough Council

Trading Standards

 

 

Underage Sales Enforcement (alcohol). Trading Standards Officers regularly use underage volunteers to test the legal compliance of shops selling alcohol.

Hartlepool Borough Council

Licensing Team

 

 

Licensing of premises selling alcohol. All premises that sell or supply alcohol require a licence from the local authority. Hartlepool Council’s Licensing Team deal with the administration and enforcement of the licensing system in Hartlepool.

Hartlepool Community Safety Team

 

 

 

Hartlepool Community Safety Team is made up from officers from Hartlepool Borough Council, Cleveland Police and Cleveland Fire Brigade based together in the Police Station on Avenue Road.

 

Hartlepool Community Safety Team is a single point of contact to:

  • Report anti-social behaviour
  • Request support for victims of crime and anti-social behaviour
  • Book a crime prevention visit
  • And more…

 

Safer Hartlepool Partnership

 

 

 

 

The Safer Hartlepool Partnership has a statutory duty to tackle crime and disorder and to help communities feel safer under the Crime and Disorder Act 1998. The Partnership offers a range of services including:

  • Commissioned domestic abuse services
  • Hate crime reporting and support for vulnerable victims
  • Dedicated anti-social behaviour unit
  • Target hardening and crime prevention
  • Victim Services
  • Community mediation service
  • Restorative justice interventions

 

 

Hartlepool Action Recovery Team

 

Hartlepool Recovery Action Team (HART) is Hartlepool’s specialist alcohol treatment services, which are provided through a partnership between Addaction and Hartlepool Borough Council.

 

The HART service comprises of 3 main strands:

  • Specialist Prescribing
  • A specialist prescribing service is in place for those wishing to complete either a community detox or a community abstinence programme. Both the community detox and the community abstinence programme are overseen by a team of nurse prescribers and a qualified doctor.
  • Psychosocial Interventions
  • The psychosocial interventions available work within a Neurological, Biological, Psychological & Sociological (NBPS) model. The NBPS team offers a wide range of evidence based, needs led group and personal interventions to work on an individual’s substance misuse and underlying addictions. The team also provides a 12 week intensive recovery programme, Community Reinforcement and Family Training (CRAFT)
  • Young People Service
  • Hartlepool’s Young People Substance Misuse team offer support around substance misuse treatment, prevention and early intervention. They provide harm minimisation and alcohol education in schools and other youth services.

SMART Recovery

 

Several SMART Recovery groups run in Hartlepool. SMART is a programme designed to help people manage recovery from any type of addiction.

Further information can be found at:

https://www.smartrecovery.org.uk/

 

Last updated: 03/05/18

4. Commissioning Priorities

Children and Young people

 Early identification and effective management of children and young people with alcohol problems;

 Seamless transition and effective management and safeguarding of young people during transition to adult services;

 Develop an evening and late night offer that is broader than youth-oriented and alcohol-based activity;

 Early identification of potential impact to children and young people by family member alcohol problems and provision of early help;

 

Adults

 Reduce alcohol admissions by joint working with primary and secondary care clinicians and the voluntary and community sector;

 Increase and ensure equitable access to treatment for dependent drinkers

 Promote responsible drinking

 

Wider determinants and control measures

 Explore together with neighbouring authorities the possibility of introducing minimum unit pricing for alcohol

 Reduce alcohol violence, crime, anti social behaviour and alcohol-related harm in the town centre

 Control of sales to underage individuals

 

Unmet Needs

Adult Treatmet Demand

  • There is under representation of BME communities in treamet
  • Dependency in higher socioeconomic groups is not reflected in treatmt
  • Demad for detoxification outweighs provison

 

Adult Treatment Demand

        There is an under-representation of BME communities in treatment

        Dependency in higher socioeconomic groups is not reflected in treatment

        Demand for detoxification heavily outweighs provision

 

Adult Service Provision and Delivery

        Intra-agency referrals are low, this can affect sustained improvement;

        There are data gaps in respect of treatment outcomes, specifically concerning impacts on wider health, reduced offending and re-attendances.

 

Wider Determinants and Control Measures

        Joint working with the private sector is required to change the culture and develop an alternative evening and late night experience;

        Co-ordinated action is needed to implement the new powers in Police Reform and Social Responsibility Act 2011.

 

Substance Misuse

        It is a priority to address alcohol use amongst problematic drug users, as evidence suggests many drug treatment clients are drinking at harmful levels.

 

Housing

        There continues to be a need for those requiring treatment for alcohol misuse and the need for accommodation in Hartlepool.

 

Children & Families of Alcohol Users

        The needs of young people living with drug and/or alcohol using parents in treatment are not being met.

 

 

Last updated: 26/03/18

5. References

Local strategies and plans

  • Hartlepool Alcohol Strategy

  • Safer Hartlepool Partnership, Strategic Assessment 2013.

  • Balance (North East Alcohol Office)

National strategies and plans

  • The Governments Alcohol Strategy, March 2012

  • The Department of Health’s national alcohol strategy ‘Safe. Sensible. Social’ outlined the next steps for reducing the harm associated with alcohol.

Last updated: 13/02/18

 

Key Contact

Name: Sharon Robson

Phone: 01429 523783

e-mail: sharon.robson@hartleool.gov.uk