Information & statistics related to alcohol & drug misuse and community pharmacybased brief advice & intervention
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1 Information & statistics related to alcohol & drug misuse and community pharmacybased brief advice & intervention 1
2 INTRODUCTION Alcohol and Drug Misuse and their related harms cost our society hundreds of millions of pounds every year. However this financial burden can never fully describe the full impact that substance misuse has on many vulnerable individuals including children and young people, families and communities in Northern Ireland 1 A recent piece of work published by the Department of Health in 2010 estimated that the cost of alcohol misuse could be as much as 900 million each year. According to the Continuous Household Survey, alcohol consumption has remained relatively constant since 2000/2001, although in recent years there has been a slight decrease in the proportion of people drinking above sensible levels. See below graph below 1 Levels of alcohol consumption in Northern Ireland are banded into weekly guidelines for sensible drinking. On a weekly basis, males drinking 21 units or less are considered to be within sensible limits, those drinking between 22 and 50 units are considered to be above sensible but below dangerous and those drinking 51 units and above are drinking at dangerous levels. The sensible limit for women is 14 units per week, the above sensible and below dangerous is between 15 and 35 units and dangerous are 36 units and above. The graph results show a significant decrease in the percentage of respondents drinking above sensible and below dangerous levels from 23% in 2005 to 19% in However, similar proportions of respondents were drinking at dangerous levels in both 2005 and 2008 (6% and 5%) respectively. 1 New Strategic Direction for Alcohol and Drugs Phase : A Framework for Reducing Alcohol and Drug Related Harm in Northern Ireland, December
3 Substance misuse, including alcohol and prescription drug misuse is a significant public health and social issue in Northern Ireland. It is estimated that alcohol is a significant factor in 40% of all hospital admissions rising to 70% of Accident and Emergency weekend attendances 2 Drug Misuse Drug misuse compared to alcohol can vary in respect of scale, pattern and intensity. Drug misuse in Northern Ireland over the last 20 years has reflected the changing nature of illicit drug use. In fact, Northern Ireland s pattern of drug misuse has probably mirrored that in Great Britain and the Republic of Ireland in terms of recreational use, but has not seen the same intensity of problem drug misuse especially in respect of heroin and crack cocaine. Figures provided by the DRUG PREVALENCE SURVEY show that cannabis remains the main illegal drug of choice and the most commonly reported on by treatment services. In the early 1990s, ecstasy, LSD and speed became illicit drugs that posed concern especially among young people. At the same time there was increasing public concern over the use of heroin in certain parts of Northern Ireland. Since then the rise in drug misuse among young people seems to have slowed and there has not been an explosion in opiate use as was seen in Dublin and parts of Great Britain at the end of 1990s. However, cannabis use is still of some concern and it would also appear that there has been an increase in the use of cocaine as exemplified by increased seizures, treatment referral figures and anecdotal evidence. The most recent prevalence figures (2006/07) over a range of drugs are set out in the table 1 below. 1 Another aspect of drug use in Northern Ireland is the misuse of over-the-counter (OTC) medicines and prescribed drugs, often but not solely by older people. In addition volatile substance misuse remains a perennial issue, especially among young people. The Drug Prevalence Survey (2006/07) showed that about one-fifth of adults (aged years) in Northern Ireland had used sedatives and tranquilisers (20%) and anti-depressants (21%) at some point in their lifetime. The Government document New Strategic Direction for Alcohol and Drugs Phase , has identified emerging issues of concern. Information sources and Prevalence Surveys have continued to demonstrate the high levels of prescription and OTC drug use in Northern Ireland. There appear to be issues around the illicit use of prescription and OTC drugs and more recently the buying of prescription drugs on the Internet. 2 Making it Better through Pharmacy in the Community a draft 5 year strategy for pharmacy in the community in Northern Ireland 3
4 Table 1 Lifetime Prevalence figures 2006/7 Health Risks of Alcohol Consumption The New Strategic Direction for Alcohol and Drugs Phase 2 proposes a population approach to address alcohol misuse. It is seeking to reduce overall consumption by having a much greater focus on reducing health and community harms including anti-social behaviour and serious violent crime arising from alcohol misuse. Excessive alcohol intake has many adverse effects. It can cause concentration, attention, understanding and memory problems and excessive drinking often results in inappropriate behaviour, paranoia, irritability, and aggression. The BMA reported that alcohol contributed to over 60 medical conditions (BMA, Board of Science, 2008) ranging from alcohol dependence syndromes to chronic conditions such as cardiovascular disease, epilepsy and cancer. 1 New Strategic Direction for Alcohol and Drugs Phase : A Framework for Reducing Alcohol and Drug Related Harm in Northern Ireland, December
5 Identifying Harmful and Hazardous Drinking Historically the focus of research and management of alcohol related problems has been on those that experience severe alcohol dependence. In recent years there has been growing evidence leading to the identification of hazardous and harmful drinking within the population. Problem drinking is often defined in terms of alcoholism and related consequences such as domestic and public violence. However there are comparatively large numbers of individuals who consume hazardous amounts of alcohol and yet continue to function at work and in their homes. Recent policy documents have emphasised a proactive multi-disciplinary harm reduction approach using a variety of healthcare professionals and community support teams to address this very important public health issue. Harm reduction strategies include education and identification of at-risk drinkers and communication with clients about the impact and consequences of their alcohol consumption (WHO, 2010; SIGN 2003). 5
6 Brief Interventions for Alcohol Users Brief interventions are intended to provide early treatment following the detection of alcoholrelated problems. Guidance from NICE (following an evidence review) concluded that interventions delivered in primary care are beneficial and effective in reducing alcoholrelated outcomes. (Jackson et al 2010). Often this advice is supplemented by self-help materials such as leaflets or supportive websites. Customers may often present in the pharmacy with symptoms associated with alcohol misuse such as sleeping irregularities, indigestion, gastric problems, and requests for hangover cures or generally feeling run down. NICE guidance recommends that brief advice should be based on FRAMES principles: Feedback: provide feedback on the patient's risk for alcohol problems Responsibility: highlight that the individual is responsible for change Advice: advise reduction or give explicit direction to change Menu: provide a variety of options for change Empathy: emphasise a warm, reflective and understanding approach Self-efficacy: encourage optimism about changing behaviour Brief interventions Brief interventions for alcohol misuse are of four main types: alcohol education simple advice simple advice plus brief counselling and continued monitoring referral to specialist services for diagnostic evaluation and treatment. Brief interventions by pharmacists have achieved statistically significant reductions in alcohol consumption of about six units per week in primary care populations, showing greater benefits for men than women. Developed by the World Health Organisation (WHO) in 1982 it uses ten questions that assess frequency of drinking, dependency indicators and the presence of problems related to alcohol use to ascertain whether alcohol use disorders may exist and the intervention needed to treat. It has both high sensitivity (92%) and specificity (94%) and can be used in a wide range of settings. A shortened version of the screen known as AUDIT-C can also be used. This has the convenience of being easy to employ, including the possibility of self-administration, but it is not as sensitive as the full AUDIT tool having a sensitivity of 82.6% and a specificity of 81.3% in detecting hazardous or harmful drinking at a cutoff point of 5 or greater (Dawson et al, 2005). 6
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