Alcohol misuse


 

Last updated: 2019-01-09 12:46:11
[+] Expand all

1. Summary

Last updated: 09/01/19

2. Introduction

Alcohol-related harm is largely determined by the volume of alcohol consumed and the frequency of drinking occasions. As such, the risk of harm is directly related to levels and patterns of consumption. However there can be a considerable lag between alcohol consumption and alcohol-related harms, particularly for chronic conditions where the lag can be many years. In January 2016 the CMO issued revised guidance on alcohol consumption, which advises that in order to keep to a low level of risk of alcohol-related harm, adults should drink no more than 14 units of alcohol a week. In England, a quarter of the population are drinking at above low risk levels so may benefit from some level of intervention. However, harm can be short-term and instantaneous, due to intoxication or long-term, from continued exposure to the toxic effect of alcohol or from developing dependence. This requires a multi-component response and pathways will differ from area to area (PHE, 2018).

For the majority of people, alcohol can be consumed responsibly and within recommended limits. However, around 10,400,000 people are drinking at levels which increase the risk of harm to their health (Public Health England, 2016). 38% of people in Stockton-on-Tees who participated in the Balance Perception survey self-reported drinking at levels of increasing risk and at levels harmful to health (Balance Perception Survey 2015).

Alcohol contributes to over one million hospital admissions per year in England and 22,000 deaths per year in the North East.

According to Public Health England alcohol is now the leading risk factor for ill-health, mortality and disability in the 15-49 age groups (Public Health England, 2016). It is the biggest cause of liver disease and after smoking is the second biggest cause of cancer. Many people who suffer from alcohol related health harms are not dependent drinkers.

The trend nationally is seeing more people aged 16 – 24 years abstaining from alcohol; however those who did drink consumed more alcohol on their heaviest drinking day than any other age group (ONS). The proportion of 11 to 15 year olds drinking is also declining, however those who drink regularly (4%), were more likely to drink to intentionally get drunk with 69% of young people reporting to have done so (Alcohol England).  More under 18s accessing alcohol services have other vulnerabilities associated with alcohol consumption (Ref https://publichealthmatters.blog.gov.uk/2017/12/13/5-things-to-know-about-young-people-in-drug-and-alcohol-treatment/).

Women who drink alcohol during pregnancy risk damaging the health of their unborn child, resulting in irreversible mental and physical problems known as foetal alcohol spectrum disorder.  Guidance from the Chief Medical Officer states that there are no safe levels of alcohol consumption during pregnancy.

Higher socioeconomic groups report consuming alcohol at much higher levels than those in lower socioeconomic groups. Those in lower socioeconomic groups however are much more likely to be affected by alcohol harms and die earlier than their counterparts who routinely consume more (Public Health England, 2016), this is known as the Alcohol Harm Paradox.

In 2015/16 the cost of alcohol harm in Stockton-on-Tees was estimated to total £79.6m, with associated costs to the NHS and Health (£15m), Social Services (£9m) and Crime and Disorder (£26.7m). Wider costs to the local economy including absenteeism, and alcohol related deaths were estimated at £28.9m (Balance Cost Profile 2015/16).

Other JSNA topics this topic closely linked to:

Domestic violence victims

Crime

Mental and behavioural disorders

Education

Illicit drug use

Sexual violence victims

Poverty

Injuries

 

Last updated: 09/01/19

3. Data and Intelligence

Patterns of consumption

The Health Survey for England (2014) reports a smaller proportion of adults who abstain from drinking alcohol in Stockton-on-Tees is lower than the national average (12.4% as opposed to 15.5%).  Adults consuming more than 14 units a week is 36.7% (nationally 25.7%) are drinking at above low risk levels so may benefit from some level of intervention. Harm can be short-term and instantaneous, due to intoxication or long-term from continued exposure to the toxic effect of alcohol.

Hospital admissions

Alcohol admissions in Stockton-on-Tees have been increasing over the last 5 years. The levels of admissions are significantly higher than the national value and higher than Stockton’s statistical neighbours.  In Stockton-on-Tees, there are significantly higher hospital admissions for alcohol related conditions compared to England, there are also significantly higher levels of alcohol specific conditions in Stockton-on-Tees.

Under 18 hospital admissions have generally been declining since 2006, however there has been a small increase the last two years. The Stockton value is worse than the national average and worse than its statistical neighbours.

Treatment and unmet need

Prevalence estimates of dependent drinkers in Stockton-on-Tees set against those accessing treatment services suggests that only 25% access treatment services (PHE, 2018).

Mortality

Alcohol specific mortality in Stockton-on-Tees is significantly higher than the national average but similar to most of Stockton’s statistical neighbours.

There are significantly higher levels of alcohol related hospital admissions in Stockton-on-Tees, however there is a downward trend. The Stockton value is statistically similar to its statistical neighbours.

There is a significantly higher level of alcohol related hospital admissions than the England value with a year on year upward trend in the 40-64 age group.  Stockton-on-Tees is also worse than the majority of its statistical neighbours.

The largest proportion of admissions to hospital was for those who had not previously been admitted to hospital for alcohol related condition.  The rate is significantly higher than the England rate (PHE Commissioning Support Pack),

PHE estimated there to be 14.2 per 1000 population who are dependent drinkers, it is estimated that there is approximately 72% whose needs are unmet. (PHE Commissioning Support Pack)

Evidence links availability and affordability of alcohol to the increasing high-risk consumption of alcohol.  In Stockton-on-Tees there are large groups in the population drinking above the weekly recommended limit in a single day.

Crime

50% of people in the North East have been negatively affected by another person’s drinking; this can be assault, abuse, or other crime related offenses. Evidence suggests women and children are disproportionately affected by other people’s drinking. Alcohol plays a part in 25 to 33% of known cases of child abuse. Parental alcohol misuse is also identified as an adverse child experience (Public Health England, 2016). A recent survey by Balance highlighted that 65% of people in the North East avoid town centres due to other people’s drinking.

50% of all violent crime is alcohol related (Balance) the amount of alcohol and crime related disorder is associated with outlet density (Public Health England, 2016). Perpetration of domestic abuse and child abuse are also associated with alcohol consumption.

 

Last updated: 09/01/19

4. Which population groups are at risk and why?

Last updated: 09/01/19

5. Consultation and engagement

Last updated: 09/01/19

6. Strategic issues

Last updated: 09/01/19

7. Evidence base

Issue number

1 = highest priority

 

1

Source

NICE PH24

Title incl. web link

Alcohol - use disorders: Prevention (availability)

LINK

Summary

This guideline covers alcohol availability; evidence suggests strong management of alcohol outlet density and hours of alcohol sales through local licensing arrangements. Evidence suggests this as an effective way to reduce alcohol related harm, including alcohol related violence.

Source

PHE 2016

Title incl. web link

Alcohol and the Effectiveness and the Cost-Effectiveness of Alcohol Control Policies

LINK

Summary

This report covers multi-component approaches to reducing alcohol related harms, including working with communities, raising awareness of legislation and training serving staff in relation to the legislation on serving those who are intoxicated

 

Source

PHE 2016

 

Title

The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies - An evidence review

LINK

 

Summary

This evidence review documents the wide range of alcohol related harms experienced by family members including domestic and intimate partner violence and child abuse. 

The review also establishes a strong relationship between drinking and aggression, violence and public disorder and drink driving.  Incidences are higher where there is a greater concentration of pubs and clubs. 

2

Source

NICE PH24

Title incl. web link

Alcohol - use disorders: Prevention (Screening & Brief Advice)

LINK

Summary

This guideline covers brief advice and screening to be undertaken by health professionals including  Primary Care, A&E, Social Services, Pharmacies and Local Commissioned Services

3

Source

 NICE PH7

Title incl. web link

Alcohol: school-based interventions

LINK

Summary

This guidance covers school-based education and advice interventions including, ensuring alcohol education is part of PHSE, to challenge social-norms, encourage young people not to drink and delay the age of onset and ‘Introduce a 'whole school' approach to alcohol.  It should involve staff, parents and pupils and cover everything from policy development and the school environment to the professional development of (and support for) staff. Where appropriate, offer parents or carers information about where they can get help to develop their parenting skills. (This includes problem-solving and communication skills, and advice on setting boundaries for their children and teaching them how to resist peer pressure.)

Source

NICE PH24

Title incl. web link

Alcohol - Use Disorders: Prevention

LINK

Summary

This guideline promotes supporting young people aged 10-15 years old who are at risk of drinking. Targeting those with a safeguarding responsibility and those who routinely come into contact with at risk young people. Obtaining a history of a young person’s drinking, family and educational context, using a CAF approach.

 

Last updated: 09/01/19

8. What is being done and why?

Change Grow Live (CGL) Alcohol Service (Adults)

Provide alcohol support services for adults within the Borough of Stockton. They offer support within General Practice and within North Tees Hospital through the Drug and Alcohol Referral Team, CGL also provide “Have a Word”, Alcohol Brief Advice training.

Change Grow Live (CGL) Alcohol Service (Young People)

Provide a comprehensive young people’s alcohol service to the age of 19 with links to local youth services.

Risk Taking Behaviour Toolkit

The toolkit provides support to schools with lesson plans and roadshow events held in schools

GP Local Enhanced Service

Public Health commission General Practice to undertake alcohol brief advice and audits.

Enforcement (Licensing/Trading Standards)

It provides an important regulatory function, carrying out a range of duties aimed at protecting the public. Licensing is responsible for the production of the statement of licensing policy and administration of licensing applications and ensuring licensees meet their regulated standards. The Licensing team also work with local businesses both on and off-sales, in the Borough of Stockton-on-Tees.

Trading Standards have a regulatory function in relation to protecting consumers. Trading standards can undertake under 18 test purchases based on intelligence to protect children from harm.

Cleveland Police

Cleveland Police have a dedicated role linked to licensing, supporting the local licensing team with intelligence and enforcement aiming to reduce local crime, disorder and domestic abuse. 

Stockton Town Pastors

Stockton Town Pastors is a charitable imitative involving local churches who provide support for people during the night time within Stockton. The model follows the ‘Street Angels’ approach and has been running since 2009. They offer a safe haven for those who are vulnerable or in need during the hours of 10pm and 3am on a Friday and Saturday, the unit is based at The Shambles in Stockton Town Centre.

Last updated: 09/01/19

9. What needs are unmet?

Last updated: 09/01/19

10. What needs to be done and why?

Last updated: 09/01/19

11. What additional needs assessment is required?

A greater understanding of alcohol-related harm based on local data and intelligence to support the development and review of a SLP and targeting of social norms campaigns and population-based interventions.

Anecdotal evidence suggest an under-recording of alcohol as a factor in anti-social behaviour, violence and disorder, particularly in the night time economy.  Improved recording of alcohol as a factor by Cleveland Police when attending to incident calls, particularly in town centre areas at weekends may improve this. 

Work needs to be undertaken to identify and understand the scale and need for prevention work to avoid at-risk harmful drinkers becoming dependant.

Last updated: 09/01/19

12. References

See section 7.

Last updated: 09/01/19

13. Key contact

Name: Mandy MacKinnon

Job title: Early Intervention Manager

Organisation: Stockton-on-Tees Borough Council

Phone number: 01642 528478

Last updated: 09/01/19

Email: mandy.mackinnon@stockton.gov.uk