Misuse of Alcohol
In Somerset the work to tackle the harm associated with substance misuse is co-ordinated through Somerset Drug and Alcohol Partnership (SDAP).
Why Tackle Alcohol?
Most people who consume alcohol do so at lower risk levels, within the guidelines of safer alcohol use. It becomes an issue for individuals, their families and the wider community when people drink alcohol at levels above the guidelines causing significant health, social and criminal justice problems.
This broadly relates to 20% of the Somerset adult population (aged 16 years and over) who are drinking at a level which damages their health and wellbeing (Alcohol Concern)
The current guidance on safer drinking limits recommends that:
- Men should not regularly* drink more than 3 - 4 units a day
- Women should not regularly* drink more than 2 - 3 units a day
*regularly means drinking at this level every day or most days of the week.
The guidance also promotes having some alcohol free days in a week.
Somerset has adopted an approach which seeks to reinforce sensible drinking messages to the wider population; whilst providing evidence based support and interventions for those drinking at increasing or higher risk levels and those who are possible dependent drinkers. For the best example which summarises the high impact changes that areas can make, please see Signs for Improvement – Commissioning interventions to reduce alcohol related harm (Department of Health 2009).
Alcohol misuse covers different alcohol drinking categories. The figure below shows the estimated numbers of people, aged 16 years and over, in Somerset by drinking risk level:
(source: Local Alcohol Profiles England 2014 and ANARP 2005 model)
Dependent drinking is identified in some increasing risk drinkers but is more prevalent in higher risk drinkers.
Binge drinking spans the increasing and higher risk drinking groups. Binge drinking is defined as drinking at least twice the daily recommended amount of alcohol in a single drinking session (that is, eight or more units for men and six for women). For Somerset this is estimated at 85,400 people aged 16+.
Alcohol in Somerset - Key Facts
- In 2012/13 there were an estimated 109,000 alcohol related admissions and attendances in Somerset, of which 70,000 were A & E attendances; 11,000 were inpatient admissions; and 28,000 were outpatient admissions
- Deaths for under 75s due to liver disease are increasing faster in Somerset than nationally.
- Although alcohol specific hospital admissions rates for under 18s in Somerset are higher than the national average, rates are falling and were below the regional average in 2013/14. Due to relatively small numbers, data in this profile is aggregated over a 3 year period and the rate is given per 100,000 population. There were 177 admissions in Somerset in the latest 3 year period. The figures are based on the number of admissions and not individual people; it is possible that rates could be skewed by multiple admissions by a few individuals.
- The 2014 Somerset Children and Young People Survey indicated that:
- the proportion of young people who drink alcohol in a week rises exponentially with age from 6% of Year 6 pupils (aged 9-11) to 43% of Year 12s (aged 18-19).
- as with adults, drinking alcohol is not restricted to the most vulnerable groups but those 14 – 15 year olds who do drink alcohol are more likely than other young people to have smoked, had sex or taken drugs.
- the most common location for drinking alcohol in the past week was at home (27%), followed by at a friend’s home (17%) and in a pub or bar (16%).
- almost half of 44% of 14-15 year old drinkers said their parents don’t always know that they are drinking alcohol; however national and local evidence shows the clear relationship between parental use of alcohol and the impact and influence on young people’s use of alcohol.
- Between April and September 2014 the total number of children whose parents were in contact with Somerset Drugs and Alcohol Service (SDAS) was 2,118. The number of children with parents in structured treatment with SDAS was 1,426.
- Approximately 400 under 24s are admitted to hospital in Somerset each year with an alcohol related condition.
Identifying those at risk
- 3 years' complete data from the Health Checks programme running in Somerset (Apr 2012- Mar 2015), shows that out of 38,114 records, 34,929 had an Audit C score recorded (91.6%)
- Of these, 23% had a score of 5 or more, which would be an indicator of drinking alcohol at risk levels. The Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organisation (WHO) and is considered the gold standard for screening for alcohol use.
- The profile of those drinking potentially at a risk level (score of 5 or more using AUDIT C) indicated that:
- there were more men than women (31% males compared to 17% females);
- they were more likely to be aged between 40 and 50 years old ( 27% aged 40-44 and 28% aged 45-49) than any other age group;
- a greater proportion were smokers (33%) than non-smokers (21%).
- the proportion with Audit C score over 5 was very similar across the deprivation quintiles.
- Alcohol treatment provision has been specifically commissioned since April 2008 in Somerset; and in the period to March 2015 has been provided under two different contract arrangements. The contract changed on 1st February 2014.
- The number of people entering and completing alcohol treatment has been rising over this seven year period (see Table 1).
Table 1 Adults, new and open clients and successful completions of alcohol only structured treatment in Somerset (2010/11 – 2014/15)
|New Alcohol clients
|Open alcohol clients
|% successful completions Somerset
|% successful completions England
** not available until end of financial year Source: NDTMS 2010-2013 and Halo 2014-15
- Alcohol is however a major feature in the profile of many SDAS clients; in 2014/15, 901 adults in contact with SDAS list alcohol as either their first, second or third substance used.
In addition to estimating numbers of dependent drinkers (12,800 for Somerset), theDepartment of Health's 2004 Alcohol Needs Assessment Research Project (ANARP) suggested the proportion of them expected to access treatment - referred to as the Prevalence Utilisation Ratio (PSUR) – to be 6.9%. In 2009, the figure increased to 15%. Table 2 sets out the challenge this presents to Somerset to create the capacity for people to access treatment for the alcohol misuse.
Table 2: Predicted numbers for alcohol treatment based on two national Prevalence Service Utilisation Ratios (PSUR)
||Predicted % of dependent drinkers to enter treatment per year
||Estimated number of dependent drinkers in Somerset
||Predicted number to enter treatment
|Predicted number not in treatment
||% of number expected in treatment per year
Key Issues Nationally
- Alcohol is linked to over 60 different health conditions including cardiovascular disease, cancers of the digestive organs, breast cancer, depression and suicide, fertility problems.
- Liver disease is the only major disease category in which premature mortality is increasing in England while decreasing in Europe (PHE Liver Disease Profiles)
- In pregnancy, alcohol can cause a range of harms to the foetus, including miscarriage, low birth weight, cognitive deficiencies, and foetal alcohol spectrum disorders
- Up to 1.3 million children in the UK are adversely affected by family drinking; around a quarter of child protection cases involve alcohol (Chief Medical Officer Report (2008) Collateral Damage from Alcohol).
- Although drink-drive casualties have fallen significantly in recent years, almost 1 in 6 deaths on the road involve drivers who have been drinking over the legal alcohol limit (Institute of Alcohol Studies, 2013)
- More than 2 in 5 (44%) of violent crimes are committed by people who have been drinking alcohol (Crime Survey of England & Wales 2009)
- Alcohol is a factor in over a third (37%) of domestic violence incidents (Home Office (2009) The Offending, Crime and Justice Survey)
- Over one third of all UK A&E attendances and ambulance costs are alcohol related, rising to 70% of A&E attendances at peak times on the weekends (between midnight and 5am) (Public Health England 2014)
- Lost productivity due to alcohol is estimated to cost the UK economy over £7billion each year (Public Health England 2014)
- Alcohol is more than half (54%) more affordable than it was in 1980 (Statistics on Alcohol, HSCIC 2015)
- Of all alcohol sold, very cheap alcohol products play the biggest part in affecting alcohol related harm (Institute of Alcohol Studies 2013)
- People in the most deprived areas of the country are disproportionately more likely to experience the impacts of alcohol-related crime, more likely to suffer the impacts of alcohol-related health conditions, and more likely to die from a condition caused by alcohol consumption (Institute of Alcohol Studies)
Current service provision
Service responses are framed with the Alcohol Pathway for Somerset. It is based on using the Alcohol Use Disorders Identification Test (AUDIT, see Identifying those at risk, above). AUDIT identifies the drinking risk for an individual and the pathway shows the actions to address that level of use.
To support people to maintain sensible drinking, Somerset uses the national Dry January campaign as a means for people to think about their drinking at the start of the New Year.
Somerset has also developed sensible drinking brands that are used across the county: Look out for your mates (LOFYM) targeted at 16 – 24 year olds; and One tooo many? targeted at adults over 30 years old.
Screening, simple advice and brief interventions is both nationally and internationally evidenced[i]. The evidence suggests that for every eight people who receive simple advice one will reduce their drinking to within lower risk levels. The ambition is to make every contact count[ii] and Somerset has been training a wide range of staff and volunteers to be able to deliver simple advice and short interventions as part of the everyday contact they have with people through the roll out of Alcohol Brief Interventions training.
Since 2008-09 over 900 people working in Somerset have completed the training and can make positive responses with anyone they encounter. This work targets the 77,000 increasing risk drinkers and the 25,800 higher risk drinkers in Somerset.
There are settings such as Further Education colleges, police custody suites, hospitals, NHS Health Checks and work with specific groups (offenders and vulnerable young people) where this work has been extended to ensure that alcohol misuse is addressed. This work makes the links with drug use as often alcohol is one of a range of substances used by people who might also experience other vulnerabilities or behaviours whose consequences mean they are arrested or attend A&E.
The work with increasing and higher risk drinkers ensures that early interventions take place, minimising harms and preventing escalation to dependency. It also means that they can identify early those who are already alcohol dependent and support them to access treatment with specialist services.
[i] Moyer, A., Finney, J., Swearingen, C. and Vergun, P. (2002) Brief Interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment seeking and non-treatment seeking populations, Addiction, 97, 279-292.
[ii] Department of Health (2012) The NHS’s role in the public’s health. A report from the NHS Future Forum
The alcohol treatment service was re-commissioned in 2013/14 and the new Somerset Drug and Alcohol Service (SDAS) for young people and adults started in February 2014. Alcohol treatment is a major strand of the new service seeking increased referrals in and successful completions for alcohol dependence. SDAS can respond to all ages bridging the gap for those who need treatment for their alcohol (and/or drug use) without changing service.
- The recommendations in national guidance on the capacity to enable 6.9% to 15% of its possible alcohol dependent population to access treatment presents a significant challenge as local authority and other public sector partner funding reduces.
- To balance using the levers available at a local/regional political level to lobby for minimum unit pricing on alcohol; whilst also enabling the growth of local alcohol industry to support economic prosperity.
- Evidencing the impact of early identification of alcohol use and deliver effective interventions to reduce harm. This is an important stream of work that in the long term may start to reduce the demand for treatment. This however is a long term strategy and Somerset needs to support the concept that the earlier intervention will contribute to improvements across the public services though measuring impact may take some time.
- To maintain and develop effective communication of sensible drinking messages, targeted to specific groups.
For more information:-
Author: Public Health Somerset