Alcohol misuse

PLEASE NOTE: Content yet to be reviewed by Tees Valley Public Health Shared Service and maybe subject to change.

Alcohol misuse is consuming more than the recommended limits of alcohol.

Many people are able to keep their alcohol consumption within the recommended limits, so their risk of alcohol-related health problems is low. However, for some, the amount of alcohol they drink could put them at risk of damaging their health.

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.

Many people who have alcohol-related health problems are not alcoholics.

In 2009/10, around one million hospital admissions were due to an alcohol-related condition or injury.

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;
  • Stroke;
  • Liver disease;
  • Liver cancer and bowel cancer.

As well as health problems, long-term alcohol misuse can lead to social problems such as unemployment, divorce, domestic abuse and homelessness.

The Department of Health’s national alcohol strategy ‘Safe. Sensible. Social’ outlined the next steps for reducing the harm associated with alcohol. Within the strategy, it defines the following terminology for drinking categories:

  • Low risk drinking: Drinking alcohol within the current guidelines on alcohol consumption;
  • Increasing risk drinking: Drinking between 22 and 50 units per week for males and between 15 and 35 units per week for females;
  • Higher risk drinking: Drinking over 50 units per week for males and over 35 units per week for females and experiencing harm such as alcohol-related accidents, acute alcohol poisoning, hypertension or cirrhosis of the liver;
  • Dependent drinking: Continued drinking despite harm usually characterised by an inner drive to consume alcohol with the drinker experiencing withdrawal symptoms when they cease drinking;
  • Binge drinking: Drinking over eight units a day for men and over six units a day for women.
Last updated: 2015-10-12 12:05:45
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1. What are the key issues?

Middlesbrough has higher levels of alcohol related admissions to hospital than the national average.

There has been an increase in alcohol related mortality for females in Middlesbrough, and is currently higher than the national average.

Middlesbrough is higher than the national average for the prevalence estimates for binge drinkers.

There is widespread availability of cheap alcohol in off license premises across the town.

Last updated: 12/10/15

2. What commissioning priorities are recommended?


Children and young people

  • Ensure early identification and effective management of children and young people with alcohol problems;
  • Ensure seamless transition and effective management and safeguarding of young people during transition to adult services. 



  • Reduce alcohol admissions by joint working with primary and secondary care clinicians and the voluntary and community sector;
  • Develop strong links with the Big Diversion Project, implementing recommendations where possible;
  • Increase and ensure equitable access to treatment for dependent drinkers;
  • Ensure the local model of delivering services includes:
    • Asset-based community approaches;
    • A family approach;
    • A targeted approach for location and individuals.
  • Tackle a broad base of health issues of clients;
  • Utilise social marketing approaches to raise awareness and raise the profile of prevention.


Social marketing and public education

  • Continue to support co-ordinated regional approaches to lobby and advocate reducing alcohol-related harm through national, regional and local policies;
  • Build upon the experience gained from the current social marketing and by commissioning further work if appropriate.


Wider determinants and control measures

  • Ensure a co-ordinated approach to tackle alcohol-related harm by agencies and partners;
  • Explore together with neighbouring authorities the possibility of introducing minimum unit pricing for alcohol.


Improve partnership work between sectors to:

  • Develop an evening and late night offer that is broader than youth-oriented and alcohol-based activity;
  • Promote responsible drinking;
  • Reduce alcohol violence and alcohol-related harm in the town centre;
  • See a reduction in standing venues.


Continue to develop current hospital provision and pathways to reduce the number of alcohol related admissions to hospital.


Improve pathways for early identification of problem drinkers via a robust model of brief intervention delivery.


Continue working closely with licensing departments to help inform licensing reviews from a Public Health perspective.

Last updated: 12/10/15

3. Who is at risk and why?


There are more hospital admissions related to alcohol consumption in the older age groups than in the younger age groups (2010/11).

On average, teenagers drink twice as much now as they did in 1990.

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.


In 2007, 33% of men and 16% of women were classified as hazardous (increasing risk) drinkers. This includes 6% of men and 2% of women estimated to be harmful (higher risk) drinkers, the most serious form of hazardous drinking, which means that damage to health is likely.

26% of men drink more than 21 units in an average week. For women, 18% drink more than 14 units in an average week.

The average weekly alcohol consumption is 16.4 units for men and 8.0 units for women.

In 2009/10, 63% of alcohol-related admissions were for men.

Physiological differences mean that women may be at greater risk than men. Pregnant women are also generally identified as a population at risk.

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 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: 08/11/12

4. What is the level of need in the population?



Conditions that are wholly related to alcohol (e.g. alcoholic liver disease or alcohol overdose).


Alcohol-specific conditions plus conditions that are caused by alcohol in some, but not all, cases (e.g. stomach cancer and unintentional injury).

Prevalence of population at risk

The proportion and numbers of the local population estimated to be at risk are shown in the table.  Comparisons are made with the prevalence for the North east and England.

Source: Local Alcohol Profiles for England (

Levels of local risk relative to England

The Local Alcohol Profiles for England (LAPE) illustrate the extent to which alcohol related harm differs across the country. The table below shows the 22 indicators with the Middlesbrough, North East and England rates, alongside the rank against other local authroties in England and the percentage change over time.

For every indicator Middlesbrough performs worse when compared to the England average, and the North East for the majority. Middlesbrough is among the top worst local authroties for indicators related to alcohol hospital adnissions. This group of indicators have seen a negative trend in recent years compared to alcohol related mortality and crime.

Source: Local Alcohol Profiles for England

*Indicators 1 & 2 – statistical significance not calculated

*Rank against 326 local authorities in England and percentage change over 6 years (2006/07 – 08/09 to 2011/12 – 13/14)

Alcohol Treatment

Middlesbrough has a high number of adults in specialist alcohol treatment services, as shown in the graph below. There are 5.2 per 1,000 population, the 5th highest in the country. The graph shows local authorities that are in the most deprived decile and further highlights the above average rate of alcohol harm. However in part the high rate can be seen as a high quality of local service provision.

Source: NDTMS

Small Area Analysis

The table below shows the ward level hospital admissions for alcohol attributable conditions ratio (ordered by highest ward) alongside the binge drinking prevalence and IMD rank. Hospital admissions closely mirror deprivation with the most deprived wards having the highest number of admissions. However some more affluent wards have higher percentages of binge drinkers.

Last updated: 12/10/15

5. What services are currently provided?

Tier 1

Alcohol awareness training

GP shared care for alcohol/non-opiates/opiates

Volunteer training

Drug/recovery training for Tier 1 staff

Development and support of recovery community

Tier 2

Advice and information

Hospital Interventions and Liaison Team

Initial assessment

Brief interventions for all substances

Assertive Outreach

Drop in service

Advocacy support

Telephone/new media support


Tier 3

Care co-ordination of treatment

Criminal Justice Interventions

Comprehensive assessment

Counselling support

Evidence based Psychosocial therapies

Specialist prescribing

Assertive Outreach

Community detox

1:1 support

Group support

Tier 4

Co-ordination of inpatient alcohol/opiate detox pathways

Rehab/detox preparation

Six supported flats for at risk clients

Last updated: 12/10/15

6. What is the projected level of need?

No projections at present.

Last updated: 12/10/15

7. What needs might be unmet?

There are gaps in the information collected by treatment services on the number of young people living with drug and/or alcohol using parents;

There are low numbers of referrals from the hospital being picked up by community alcohol teams;

About 9 in 10 dependent drinkers are not in treatment;

About 97% of dependent drinkers would benefit from a brief intervention do not receive one;

There could be an under-representation of BME communities in treatment;

There is insufficient provision for inpatient detoxification at James Cook University Hospital;

Minimum unit pricing needs co-ordination;

Last updated: 12/10/15

8. What evidence is there for effective intervention?

NICE is developing guidance relating to alcohol use disorders over the next two years. This will focus on the prevention and early identification of alcohol use disorders through to the clinical management of acute alcohol withdrawal and alcohol-related liver disease and pancreatitis. The guidance will also focus on the management of alcohol dependence and psychological interventions.

Adult treatment

Best et al, ‘Research For Recovery: A Review of the Drugs Evidence Base’ (2010) []

DH/NTA ‘Models of Care for Alcohol Misusers’ (2006) []

NICE, ‘Pathways for alcohol-use disorders’ (2011) []

Raistrick et al, ‘Review of the effectiveness of treatment for alcohol problems’ (NTA, 2006)


Children and young people

DfE, ‘Drugs: Guidance for Schools February 2004 – Curriculum Standards for KS1, KS2, KS3 and KS4 (Ref DfES/0092/2004)’, and ‘Drug Education: an entitlement for all 2008’

NTA, ‘Commissioning Young People’s Specialist Substance Misuse Treatment services’ (2008) []

NTA, ‘Young people’s specialist substance misuse treatment: Exploring the Evidence’ (2009) [ ]

NICE, ‘Community-Based Interventions to Reduce Substance Misuse Among Vulnerable and Disadvantaged Children and Young People’ (2007) []

Social marketing and public education

Within the public sector, see The Alcohol Learning Centre []

Safer communities and sustainable environments

NICE, ‘Alcohol-use disorders: preventing the development of hazardous and

harmful drinking’ (2010) []

Night-time economy

Alcohol Concern (Hadfield and Newton), ‘Factsheet: Alcohol, Crime and Disorder in the NightTime Economy’ (2010), []

Last updated: 08/11/12

9. What do people say?

Key findings from the 2014 Client Satisfaction Survey (Carried out with a sample of at least 15% of the local treatment population)

89% of clients surveyed were very/fairly satisfied with treatment services overall

91% of clients were very/fairly satisfied with the range of services available

44% said that services have improved since recommissioning in October 2013

92% said the way staff treat them is excellent or good

In the last five years, 46% feel that drug use locally has got worse

In the last five years, 58% feel that alcohol use has got worse



Last updated: 12/10/15

10. What additional needs assessment is required?

Little is known about the positive impact that local treatment services have on the wider health system, which could be addressed by cross-referencing treatment and other health data.

There appears to be generally high rates of arrest within the treatment population, and further investigation is required into the types of crime committed and detected.

There needs to be further work done to look at people in treatment who have problematic alcohol use, alongside drug misuse issues.

There are many references to families at point of  assessment, but there is no evidence of the impact of treatment on families, or ongoing data collection on living situation by treatment services.

Further work is required to understand why clients drop out of treatment and have repeated unsuccessful treatment journeys.

Qualitative research may be needed to investigate treatment need for women; and if what is currently being delivered is appropriate.

Last updated: 12/10/15

Key contact:

Name: Rachel Burns

Job title: Health Improvement Specialist


Phone: 01642 728762


Local strategies and plans,

Middlesbrough Alcohol Strategy 2011-14

National strategies and plans with dates

National alcohol strategy 2009


[i] NWPHO,

[ii] The Balance study followed Brand and Price, ‘The economic and social costs of crime’ (HORS 217, 2000) and Duborg et al, ‘The economic and social costs of crime against individuals and households 2003/04’ (HOOR 30/05, 2005)

[iii] ‘Balance Benchmarking’ (November 2011)

[iv] See [], accessed 29 Dec 2011


1. Children and Young Persons Needs analysis 2011-14

2. Middlesbrough Survey Responses