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: 2016-01-27 11:55:39
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1. What are the key issues?

Alcohol-related hospital admissions are significantly worse than the England average.

Alcohol-specific hospital admissions are significantly worse than the England average

It has been identified that a large proportion of drug users are consuming excessive amounts of alcohol along with both illicit and prescribed medication.

The most common alcohol-related crime was violence against the person.

Binge drinking levels in the North East are significantly worse than the England average.

Last updated: 21/08/15

2. What commissioning priorities are recommended?

2012/01

Reduce alcohol-related harm to young people, families and communities, through the delivery of sustained and consistent messages about alcohol consumption, in order to influence attitudinal change and create a cultural shift.

2012/02

Reduce the number of alcohol-related hospital attendances and admissions.

2012/03

Deliver treatment services which are evidenced-based, cost-effective and are responsive to and accessible for all individuals who require treatment.

2012/04

Target offenders of alcohol-related crime, with a focus upon violent crime, anti-social behaviour and domestic violence.

2012/05

Enable frontline staff to identify early problematic alcohol use, provide brief interventions and make appropriate referrals.

2012/06

Reduce the availability of alcohol with a particular emphasis on sales to young people.

Stockton-On-Tees re-commissioned its adult and young people’s alcohol treatment services following in depth consultation. Those services began delivery in January 2014. The priorities for the new service are to move long-term clients from a regime of maintaining opiate replacement treatment to recovery focused treatment.

2015/01

Commission the delivery of brief interventions training for alcohol and other substance misuse.

2015/02

Review and consider the re-commissioning of the alcohol nurse specialist function.

2015/03

Commission further social norms work to monitor local drug and alcohol trends in schools and colleges.

Last updated: 21/08/15

3. Who is at risk and why?

Recent research by the Government’s Health and Social Care Information Centre show that the amount of alcohol consumed across England is on the decline. Alcohol consumption outside of the home has declined significantly. However consumption in the home appears to be increasing and consumption above the recommended daily amount is a significant risk factor.

  • Among adults who had drunk alcohol in the last week, 55 per cent of men and 53 per cent of women drank more than the recommended daily amounts, including 31 per cent of men and 24 per cent of women who drank more than twice the recommended amounts in 2012.
  • In real terms, between 2009 and 2012 household spending on alcoholic drinks in the UK increased by 1.3 per cent, whilst that bought for consumption outside the home fell by 9.8 per cent.
  • In 2012, 43 per cent of school pupils (aged 11-15) said that they had drunk alcohol at least once. This continues the downward trend since 2003, when 61 per cent of pupils had drunk alcohol.

 

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 although recent research shows that the number of 11 to 15 year olds that have drank alcohol fell from 61%in 2003 to 43% in 2012. The number that drink on a weekly basis has fallen significantly from 26% in 2003 to 10% in 2012.

Young people (those aged 16 to 24) are more likely to have drunk very heavily (more than 12 units for men and 9 units for women) at least once during the week (27%), with similar proportions for men (26%) and women (28%). Only 3% of those aged 65 and over were very heavy drinkers.

Children and adolescents that do drink 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

Men are more likely to drink regularly and also more likely to drink at hazardous and harmful levels. 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. Higher Risk Drinkers are typically men and those aged under 55.

This gender variation is reflected in the levels of alcohol related and alcohol specific mortality figures. Mortality for females in Stockton-On-Tees is below the National average and well below the figures for the region. Male deaths are also below national and regional levels. However they remain relatively much higher than female specific mortality figures at 11.55 per 100,000 for males compared to 4.4 for females

In 20012/13, 66% of alcohol-related admissions were for men. This is an increase from 63% in 2010.

When women do drink at harmful or hazardous levels, physiological differences mean that women may be at greater risk than men. Pregnant women are also generally identified as a population at risk.

There is little gender difference in the children that report having tried alcohol.

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 are unemployed and/or have 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: 19/08/15

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 Stockton-On-Tees please use this link.

Mortality

The chart below shows that the rates of alcohol-specific mortality in Stockton-On-Tees from 2008-10 to 2011-13 were significantly similar to the England average. However, this rate increased in 2012-14 and is now significantly worse than the England average.

The chart below shows that the rates of alcohol-related mortality in Stockton-On-Tees from 2008 to 2012 were similar to the England average. However, this rate increased in 2013 and again in 2014 and is now significantly worse than the England average.

Hospital admissions

The chart below shows that the rate of alcohol-specific hospital admissions in Stockton-On-Tees is significantly worse than the England average. Although since 2013/14, the gap between Stockton-On-Tees and England has reduced.

The chart below shows that the rate of alcohol-related hospital admissions (Broad) in Stockton-On-Tees is significantly worse than the England average.

The chart below shows that the rate of alcohol-related hospital admissions (Narrow) in Stockton-On-Tees was statistically similar to the England average in 2013/14. However, this rate increased in 2014/15 and is now statistically worse than the England average.

The chart below shows that the rate of alcohol-related hospital admissions for under 18-year-olds in Stockton-On-Tees had been statistically worse than the England average in 2011/12-2013/14. However, this rate has decreased, and as of 2012/13-2014/15, the rate is significantly similar to the England average.

Impact

The chart below shows that the rate claimants of benefits due to alcoholism in Stockton-On-Tees is significantly higher than the England average.

Last updated: 16/08/16

5. What services are currently provided?

Lifeline (Stockton alcohol service)

Lifeline provides advice, information and support to alcohol users, their relatives and friends.  The service provides tier-2 and tier-3 treatment for alcohol users and has a team based within the University Hospital of North Tees.

The team was put in place to deal with drug and alcohol users who are admitted to hospital. They offer bedside brief interventions and outward referrals into the appropriate community drug or alcohol treatment service.

Lifeline young people’s drug and alcohol service

A comprehensive service for young people with drug and or alcohol issues who are under 19 years old.

The Birchtree Practice

A specialist GP prescribing service for patients living in Stockton-On-Tees.

Local Enhanced Service (GPs)

All GPs in Stockton that have agreed to offer a service for alcohol support.

BRIDGES (Family & carer support services)

BRIDGES is available to everyone who has been directly affected by someone else's substance misuse. This includes parents, partners, grandparents, brothers and sisters (over 18 years old).

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: 08/11/12

7. What needs might be unmet?

Local comparisons continue to suggest that levels of recurrent alcohol funding in Stockton-on-Tees are insufficient for the size of the population estimated to require treatment.

A review of the performance and suitability of the Local Enhanced Service (LES) is required.

The delivery of brief interventions training for alcohol and other substance misuse is required.

There is a need to consider the re-commissioning of the alcohol nurse specialist function.

There is a need for further social norms work to monitor local drug and alcohol trends in schools and colleges.

The number of GPs referring people to treatment services varies greatly as does the information available regarding population alcohol consumption and patients being prescribed chlordiazepoxide.

Crime

Although 188 clients accessing the arrest referral service were deemed as being suitable for and requiring a referral into community alcohol treatment, only 23 were shown to have been in tier 3 treatment with a treatment provider in Stockton-on-Tees in 2010/11.

Mental health

Alcohol-related admissions for Stockton-on-Tees have increased 149% since 2002/03 for people with mental and behavioural disorders.

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 link between those requiring treatment for alcohol misuse and the need for settled and/or suitable accommodation. There is a need for accommodation support for alcohol clients in Stockton-on-Tees.

Children & families of alcohol users

More robust data is required in respect to the number of children affected by parental alcohol misuse.

The number of GPs referring people to treatment services varies greatly as does the information available regarding population alcohol consumption and patients being prescribed chlordiazepoxide. The Local Enhanced Service (LES) has had a significant positive impact on the number of referrals. We will be reviewing this following the collection of one year of data to ensure that there are no gaps in assessment and referral.

Despite alcohol misuse being identified in all age groups, there continues to be a number of groups who are under-represented within the treatment system, including young adults, females and the BME community. In particular, young Women aged between 18 and 24 appear to be drinking more alcohol which is going against the overall trend.

Crime

The Arrest referral service was de-commissioned in April 2014. The new service provided by Cleveland police does not currently provide any brief interventions or referral for alcohol related offending.

Housing

There continues to be a link between those requiring treatment for alcohol misuse and the need for settled and/or suitable accommodation. There is a need for accommodation support for alcohol clients in Stockton-on-Tees.

Children & families of alcohol users

More robust data is required in respect to the number of children affected by parental alcohol misuse.

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?

Concern was raised in relation to the practice of alcohol-treatment workers only outreaching clients for their initial appointments but then having to attend the service for all future appointments. It was felt that workers should do more outreach at home and it was also suggested that more follow-up work should be done by alcohol treatment services when a client fails to attend an appointment;

Due to the nature of alcohol clients, it was suggested that key workers should continue to challenge service users to ensure they are truthful and honest. In addition it was suggested that increased involvement of carers and/or family members within the treatment of alcohol clients would encourage a more honest relationship and therefore better support the recovery of the client. An idea was suggested for workers from both Lifeline and Bridges to attend the client’s home together to try to encourage the client to engage with treatment. Also, where alcohol treatment clients consent to carer involvement in their care planning, it was felt that treatment services could be more inclusive of carers within this process;

Further partnership working was discussed, including the idea of shadowing staff between services to allow both to better understand each other’s practices.

Last updated: 21/08/15

10. What additional needs assessment is required?

No further needs assessments are required at present.

Last updated: 21/08/15

Key Contact

Topic lead

Name: Mark McGivern

Job Title: Specialty Registrar in Public Health

e-mail: mark.mcgivern@stockton.gov.uk

phone: 01642 528706

Topic author

Name: David Morton

Job title:

e-mail: david.morton@stockton.gov.uk

phone:

References

Local strategies and plans

 

 

 

National strategies and plans

 

 

Other references