11 Alcohol. Key Points. Table 1 Risk ratings related to units of alcohol

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Rafe Tucker
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1 Key Points Drinking alcohol above the recommended guidelines directly impacts on health; people are at increased risk of liver disease, cancer, stroke and heart disease. In addition, alcohol is involved in a wide range of other social and health issues; risky behaviours such as sexually transmitted infections; domestic violence; suicide and deliberate self-harm; child abuse and child neglect; mental health problems; unwanted pregnancies and homelessness. The general perception of alcohol problems are that they are associated with alcohol dependency and binge drinking. The biggest challenge for the NHS continues to be effective communication about the serious health impacts of regularly drinking above the recommended guidelines, a level of drinking which is usually socially acceptable. The reported rate of alcohol-related hospital admissions has risen from 1,375 to 1,837 per 100,000 population. This is similar to national trends and continues to represent a significant challenge to public health. continues to be detrimental to the health of people in Milton Keynes. More than 25% of our population aged 16 and over drink above the recommended guidelines. It is estimated that 37,000 people drink at a level of increased risk, 9,000 at a level of high risk and 40,000 binge drink (see table 1 for definitions). There are significant health and social harms caused by drinking alcohol excessively. The effects of alcohol are different for each person, and for men and women. The level, the frequency and the length of time an individual has been drinking alcohol all make a difference to their level of risk for individual diseases such as liver disease, cancer, stroke, mental illhealth, heart disease and sexually transmitted diseases. Table 1 Risk ratings related to units of alcohol Risk Men Women Lower Risk (within recommended limits) Increasing Risk Higher Risk Binge drinking No more than 3 to 4 units per day on a regular basis Four or more units per day on a regular basis More than 50 units per week Eight units or more in one episode No more than 2 to 3 units per day on a regular basis Three or more units per day on a regular basis More than 35 units per week Six units or more in one episode Generally understood to be drinking to get drunk 78

2 There are significant health and social harms caused by drinking alcohol excessively Milton Keynes has one of the highest rates of alcohol-related hospital admissions in the South East region (figure 1) at 1,837 for every 100,000 people. Figure 1 West Midlands South West Rate of hospital admissions for alcohol-related conditions, South East region, West Oxfordshire Vale of White Horse Test Valley Cherwell Oxford West Berkshire South Oxfordshire Bassingstoke & Deane Winchester East Midlands Aylesbury Vale East Hampshire Eastleigh Southampton New Forest Fareham Havant Portsmouth Gosport Milton Keynes Wycombe Chiltern East of England Slough Windsor & Maidenhead Reading Bracknell Spetthorne Forest Wokingham Runnymede Surrey Elmbridge Heath Woking Hart Rushmoor Guildford Chichester South Bucks Waverley Arun Mole Valley Horsham London Epson & Ewell Reigate & Banstead Crawley Mid Sussex Lewes Adur Brighton Worthing & Hove Hospital admissions rate for alcohol-related conditions per 100,000 persons, ,623.0 to 1,993.4 (worst quintile) 1,371.5 to 1, ,253.1 to 1, ,135.3 to 1, to 1,135.2 (best quintile) England rate: 1,742.8 South East England rate: 1,335.1 Worst rate in South East: Portsmouth (1,993.4) Best rate in South East: Isle of Wight (849.5) Medway Dartford Gravesham Tonbridge & Sevenoaks Malling Maidstone Tandridge Wealden Eastbourne Tunbridge Wells Rother Hastings Swale Ashford Caterbury Shepway Thanet Dover 11 Isle of Wight Source: NWPHO. Local Profiles for England. ( 79

3 Additionally, figure 2 shows that there is a significant increasing trend in alcohol-related hospital admissions in Milton Keynes which is in line with national projections for England. Figure 3 Compared to England average: Significantly better Significantly worse Profile of -related harm in Milton Keynes Not significant Not calculated England Worst Regional Average 25th Percentile England Average 75th Percentile England Best -related harm increases people s risk of ill-health, it also impacts on a wide range of social issues such as domestic violence, family breakdown, child neglect, mental health problems, unwanted pregnancies and homelessness. Months of life lost - males Months of life lost - females -specific mortality - male -specific mortality - female Mortality from chronic liver disease - males Mortality from chronic liver disease - females -attributable mortality - males The North West Public Health Observatory produces profiles of each Primary Care Trust (PCT) and provides comparisons Figure Related Admissions with projected trend 2002/3-2010/11 -attributable mortality - females -specific hospital admission - under 18s -specific hospital admission - males -specific hospital admission - females -attributable hospital admission - males -attributable hospital admission - females DASR per 100, Hospitals admissions for alcohol-related harm (NI 39) -related recorded crimes -related violent crimes -related sexual offences Claimants of incapacity benefits - working age Mortality from land transport accidents Increasing risk drinking (synthetic estimate) Higher risk drinking (synthetic estimate) Year England Actual Milton Keynes Actual England Projected Linear (England) Binge drinking (synthetic estimate) Employees in bars - % of all employees Treatment-Prevalence per 1,000 population Source: N.B. A local problem with data submission is the cause of the low Milton Keynes value in 2006/7 80

4 between the PCT, the region and England using the latest available information and some estimates (described as synthetic estimates in the profile). Our region includes Buckinghamshire, Berkshire East, Berkshire West, Hampshire, Isle of Wight, Oxfordshire, Portsmouth and Southampton. Figure 3 shows Milton Keynes measure for each indicator identified. Multi-agency response Multiple agencies, including Milton Keynes Council, NHS Milton Keynes, HMP Woodhill, Thames Valley Probation, Thames Valley Police, the Community Safety Partnership (Safer MK), the Fire and Rescue Service, the National Treatment Agency and the Government Office for the South East are part of the Drug and Strategic Group (DASG) and involved in reducing alcohol harm. As part of the work of this group throughout 2010, a new Drug and strategy was developed. The reported rate of alcohol-related hospital admissions has risen from 1,375 to 1,837 per 100,000 population Many people think that the alcohol problems we experience in our country and borough relate to binge drinking and alcohol dependency. A major challenge is to successfully communicate the health impacts of drinking above the recommended guidelines, which are often socially acceptable. The following actions are currently in progress and recommendations from the 2008 drug and alcohol needs assessment continues to be implemented: Research is currently being undertaken with local residents to establish what mechanisms we can use to deliver the messages about socially acceptable drinking behaviours and their potential to impact on health and social wellbeing. In addition to offering general medical services, GP practices can also provide enhanced services. We are commissioning services called Identification and Brief Advice (IBA) for the identification of all patients registering with the GP surgery who are drinking above the recommended guidelines. They can either be offered support through the GP practice to reduce their alcohol consumption or referred to specialist alcohol services. During 2010, a multi-agency group and treatment service users were involved in the process of selecting new drug and alcohol service providers. The next challenge for the alcohol 81

5 services is to ensure that IBA interventions in primary care and other settings are developed further to work in synergy with these services. We have piloted an IBA programme within Brook Sexual Health Services. A total of 1,318 clients were screened to assess their level of alcohol intake. Of these, 987 were identified as low risk drinkers, 265 as increasing risk drinkers, 29 as higher risk drinkers and 23 as potentially dependent drinkers requiring referral into the alcohol services. Of the 265 clients identified as at increasing risk, 60 (23%) reduced their drinking levels to low risk. Of the 29 higher risk drinkers, 10 (34%) have reduced their drinking levels to low risk drinking. This has been a very successful pilot and we will be developing these IBA services through Brook into the future. How will we know we are making progress? The measures of success will be determined in the following way: the number of patients receiving brief advice through GP practices; Brook Sexual Health Services; the number of patients whose drinking levels have dropped to below the recommended guidelines following extended brief advice; a reduced trend or decrease in alcohol related hospital admissions (National Indicator); and finally the reduction in violent crime in Milton Keynes. It is estimated that 37,000 people drink at a level of increased risk, 9,000 at a level of high risk and 40,000 binge drink The increase in alcohol-related hospital admissions described above is reflected nationally and clearly shows the result of many years of harmful alcohol consumption. This is a complex public health problem and we will continue to work towards reversing this trend. 82

6 The biggest challenge for the NHS continues to be effective communication about the serious health impacts of regularly drinking above the recommended limits Recommendations Monitor the new drug and alcohol service to ensure that alcohol continues to be a priority within these joint services. Use the findings of the social marketing research to inform our communications about the health impacts of drinking above recommended guidelines. Continue to develop innovative approaches to IBA (identification and brief advice) services. References 1. Substance misuse (drug and alcohol) and services in Milton Keynes: Needs Assessment, Final report. August Drug and Strategy Drugs_and Strategy.pdf 83

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