Alcohol misuse

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: 2015-08-21 11:42:12
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1. What are the key issues?

Redcar and Cleveland has a higher proportion of people admitted to hospital for Alcohol-specific conditions than the national average (JSNA support pack 2015/16).

Redcar and Cleveland has a higher proportion of people admitted to hospital for alcohol-related conditions than the national average (JSNA support pack 2015/16).

The proportion of people exiting treatment in a successful manner in Redcar and Cleveland is lower than the national average (47% R&C, 59% National) (NDTMS 2013/14).

3% of people experience a waiting time to start treatment of six of more weeks, which is higher than the national average.

GP referrals into treatment account for only 9% of all new treatment starts, lower than the national average of 17% (NDTMS 2014/15).

One third of all males and females in treatment for Alcohol misuse in Redcar and Cleveland are aged 40-49 years old.

Redcar and Cleveland have a higher proportion of people in treatment for Alcohol misuse (32%) receiving care from mental health services  than the national average (21%)(NDTMS 2013/14).

In Redcar and Cleveland a higher proportion of people in treatment are unemployed/economically inactive (67%) when compared to the national average (40%).

NICE recommend a stay in residential rehabilitation may be appropriate for the most serious of cases. In Redcar and Cleveland only a small number of people receive residential rehabilitation (1% in 2014/15).

NICE public health guidance 24 recommends that commissioners should ensure at least one in seven dependent drinkers can get treatment locally. Preliminary analysis for Redcar and Cleveland equates to between one in ten and one in eighteen dependent drinkers has access to community based treatment in 2010/11.

Last updated: 21/08/15

2. What commissioning priorities are recommended?

2012/01

Reduce the number of alcohol-related hospital admissions.

2012/02

Improve community awareness of the health risks associated with alcohol consumption.

2012/03

Ensure adequate capacity for residents wishing to access community alcohol treatment.

2012/04

Collate qualitative and quantitate data to allow the partnership develop a better understanding of community needs.

2012/05

Young people’s substance misuse

  • Increase alcohol awareness/education to reduce substance misuse;
  • Strengthen early intervention at Tier 1 and Tier 2 by workforce development with key stakeholders;
  • Secure longer-term funded services to support young people with substance misuse problems;
  • Determine inter-organisational issues (potential for integration/joint commissioning);
  • Access critical areas of quality or service effectiveness (for example primary care access);
  • Review current service provision in relation to the Targeted Youth Support Service;

Consider developing an ‘in house service’ as part of the Targeted Youth Support Service.

2015/01

Reduce the number of alcohol related hospital admissions, by tackling the root cause(s) of admission.

2015/02

Development of a comprehensive, practical and realistic alcohol early intervention strategy in order to prevent those people at risk of developing harmful alcohol consumption before it becomes problematic.

2015/03

Development of a comprehensive harm reduction and education strategy with all key partners.

2015/04

Increased use of Brief advice and screening for alcohol consumption, across local authority and partner agencies.

2015/05

Improve community awareness of the health risks associated with alcohol consumption by increased community based events and advertisement

2015/06

Development of alternative treatment options to enhance the existing provision. In order to offer as many opportunities as practical for people to successfully free themselves from problematic alcohol consumption

2015/07

Develop intelligence model across the entire Alcohol treatment pathway(s) enabling a focused approach to growth areas and areas with increasing need.

2015/08

Development of increased activity around routes to employment with key stockholders

Last updated: 21/08/15

3. Who is at risk and why?

Age

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.

Gender

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?

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 Redcar & Cleveland please use this link.

Mortality

The chart below shows that the rate of alcohol-specific mortality in Redcar & Cleveland is similar to the England average.

The chart below shows that the rate of alcohol-related mortality in Redcar & Cleveland is similar to the England average.

Hospital admissions

The chart below shows that the rate of alcohol-specific hospital admissions in Redcar & Cleveland is significantly worse than the England average.

The chart below shows that the rate of alcohol-related hospital admissions (Broad) in Redcar & Cleveland is significantly worse than the England average and is increasing each year.

The chart below shows that the rate of alcohol-related hospital admissions (Narrow) in Redcar & Cleveland is significantly worse than the England average.

The chart below shows that the rate of alcohol-related hospital admissions for under 18-year-olds in Redcar & Cleveland is significantly worse than the England average, although this rate is decreasing each year.

Impact

The chart below shows that the rate claimants of benefits due to alcoholism in Redcar & Cleveland is similar to the England average.

Numbers in Treatment and Successful Completions

The number of alcohol users receiving treatment has decreased from 445 to 393 between April 2013 and May 2015. There has been a consistent downward trend among those accessing treatment; however it is worth noting that, over the same period, the number of alcohol users who also use non-opiates has increased.  

The number and percentage of successful completions within the borough has fluctuated over the last two years with a clear dip in successful completions during summer 2014. Since August 2014 the percentage of successful completions has increased, exceeding national performance in Dec 2014. As at May 2015 the percentage of successful completions is marginally lower than the national comparator.



[i] Adult Successful Completions and Re-presentations Partnership Report.

 

Last updated: 21/08/15

5. What services are currently provided?

Support services available to individuals aged 18 or over

Lifeline:

Lifeline provides information, advice and support to overcome drug or alcohol issues. It is provided to adults (aged 18 and over) living in Redcar and Cleveland.

Lifeline provides an integrated drug and alcohol treatment system through prevention, recovery co-ordination and through aftercare services. They promote safer injecting practices; provide needle exchange facilities, blood borne virus screening and immunisation, information and advice around drug or alcohol misuse and support to overcome problematic drug or alcohol use which can include the provision of clinical support. They operate from a number of premises across Redcar and Cleveland so that support can be delivered locally within communities affected by substance misuse.

Support services available to under 18-year-olds.

CREST

CREST provides information, advice and support to young people from Redcar and Cleveland who use drugs or alcohol.

CREST also supports young people whose lives are affected by their parents, carers or siblings drug or alcohol use. The service is for under 19-year-olds only. CREST is a confidential service which can offer advice, support and guidance. They also aim to support young people who have drug or alcohol problems with housing, employment, education and training as well as offering support to parents and carers.

Last updated: 21/08/15

6. What is the projected level of need?

It is too difficult at this stage to identify local projected levels of need.

Last updated: 21/08/15

7. What needs might be unmet?

Local residents of Redcar and Cleveland need to receive adequate information about levels of drinking and associated risks. To ensure the local community receives these messages, all partnership staff need to undertake the e-learning Information and Brief Advice training

The present Treatment Outcome Profile (TOPS) reporting system although providing significant insight into client treatment progress, should be considered as one tool in many to fully support a person into sustained recovery. A comprehensive and rounded approach is therefore the preferential starting point to ensure people receive the best possible outcome to treatment.  Understanding all aspects of a person’s life and focusing on positive change to support lasting recovery.  Future consideration should be given to the introduction of tool(s) such as ‘the outcome star’ to enhance the present treatment offer.

Local intelligence provision is insufficient to provide a comprehensive assessment and detailed analysis of the present treatment pathway(s). In conjunction with Key stockholders a local and detailed needs assessment should be developed which reliably reflects operational reality.

Last updated: 21/08/15

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

Public health guidance: Alcohol use disorders in adults and young people: prevention and early identification (published June 2010) - Centre for Public Health Excellence (CPHE) at NICE

Clinical guideline: Alcohol use disorders in adults and young people: clinical management (published June 2010) - National Collaborating Centre for Chronic Conditions (NCC-CC)

Clinical guideline: Alcohol use disorders: management of alcohol dependence (publication expected February 2011) - National Collaborating Centre for Mental Health (NCC-MH)

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

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 [http://www.alcohollearningcentre.org.uk/]

Safer communities and sustainable environments

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

harmful drinking’ (2010) [http://www.nice.org.uk/nicemedia/live/13001/48984/48984.pdf]

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: 21/08/15

9. What do people say?

Local consultation requires development to ensure meaning full and informed feedback.

Nationally consultation is of limited use, as this does not necessarily reflect local sentiment.

Last updated: 21/08/15

10. What additional needs assessment is required?

Anaysis of the effect of alcohol unit price.

Research into pre-loading in Redcar & Cleveland

Research into the transition from pre-18 to post-18 (legal) drinking. Do younger people establish problematic drinking habits in early life prior to legal age? are these habits continued into legal drinking age? and what impact does this have on the number of people entering treatment for alcohol misuse?

Last updated: 21/08/15

Key Contact

Name: Mark Fox

Job title: Health Improvement Commissioner

e-mail: mark.fox@redcar-cleveland.gov.uk

Phone number: 01642 771632