Prevention and treatment of alcohol misuse

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1 Prevention and treatment of alcohol misuse Liz Burns Public Health Development Advisor Alison Rodriguez Head of Service Community Alcohol Team and Brian Hore Unit

2 Estimates of prevalence of different types of drinking in Manchester for 2013: 84,116 adults drinking at increasing/higher risk levels 54,858 binge drinking drinking more than double recommended limits in at least one single session (subset of increasing/higher risk drinking group) 13,166 adults drinking at dependent levels Manchester Alcohol Strategy

3 Different levels of alcohol use and misuse Risk level Men Women Lower risk to health No more than 3-4 units per day on a regular basis No more than 2-3 units per day on a regular basis Increasing risk to health 4 or more units per day on a regular basis 3 or more units per day on a regular basis Higher risk to health 8 or more units per day on a regular basis, or 6 or more units per day on a regular basis, or Probable dependence 50+ units per week 35+ units per week

4 One drink is rarely one unit 25ml shot of spirits 40% 1 unit Home measure at least double shot 50ml 40% 2 units Pint of Carling 4% 2 units Pint of Stella / Bulmers 5% 3 units Large 250ml glass of wine 14% 3.5 units 500ml can of Skol Super 9% 4.5 units 1 litre of White Cider / Lambrini / Chardolini 7.5% 7.5 units Bottle of wine 14% 10.5 units Bottle of spirits (vodka, whisky) 40% 28 units If you have a website, you can embed the online drinks checker tool by contacting the Change4Life Partnership Team C4LPartnerships@dh.gsi.gov.uk

5 In pregnancy or when trying to conceive No risk of harm to the baby No alcohol Low to moderate risk of Fetal Alcohol Spectrum Disorder (FASD) Higher risk of FASD No more than 1-2 units (not drinks ), once or twice a week * No alcohol is recommended in first three months to reduce risk of miscarriage More than 4 units a week * Includes getting drunk, binge drinking and dependent drinking

6 Most people in the North West unaware of serious illness YouGov, December % did not realise it increases the risk of breast cancer 63% did not realise it increases the chance of pancreatitis 61% did not realise it increases the risk of bowel cancer 55% did not realise it increases the risk of mouth, throat and neck cancer 34% did not realise it reduces fertility 26% did not realise it increases the risk of high blood pressure

7 No Health Without Mental Health Prevalence rates of co-morbidity in alcohol service population (COSMIC study, 2003) No co-morbidity 15% Psychiatric disorder present in 85% of alcohol service users, of which: 53% were considered to have low potential for referral (disorder present, but no additional vulnerability criteria) 32% considered high potential for referral (presence of either psychosis or severe depression plus at least one of the following vulnerability criteria: previous psychiatric admission, recorded history of suicide attempt, self-harm or serious self-neglect) (Weaver et al, 2003)

8 Impact on parenting and families Approximately 3.3 million children in the UK estimated to be living with at least one parent drinking at risk levels million children living with an increasing/higher risk drinker - 705,000 children estimated to be living with a parent who is alcohol dependent 9 out of 10 people think that heavy drinking by a parent has a negative affect on children and families Alcohol Concern, 2012; Manning et al, 2009

9 Alcohol-use disorders: preventing the development of hazardous and harmful drinking Nice Public Health Guidance (June 2010) NHS professionals should routinely carry out alcohol screening as an integral part of practice, completing a validated alcohol questionnaire with the adult being screened Use AUDIT (Alcohol Use Disorder Identification Test) to decide whether to offer them a brief intervention or whether to make a referral If time is limited, use an abbreviated version such as AUDIT-C

10 AUDIT-C (3 questions) Validated, abbreviated identification tool First three questions of the full AUDIT which focus on consumption AUDIT-C score of 0-4, lower risk drinking can normally be assumed (*except in pregnancy) AUDIT-C score of 5-12, increasing or higher risk drinking can normally be assumed

11 AUDIT (full 10 questions) Gold Standard identification tool Indicates whether risk level is at: - Increasing risk (AUDIT score 8-15) - Higher risk or (AUDIT score 16-19) - Probable dependent level (AUDIT score 20-40)

12 Interpreting AUDIT scores Risk level Full AUDIT Score Indicated outcome Lower risk 0-7 No further action (unless contraindicated) Increasing risk 8-15 Brief advice Higher risk Brief advice (+ Extended brief intervention) Probable dependence (sub-set of higher risk drinkers) Support referral to specialist alcohol service ie. Community Alcohol Team primary care based clinics

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14 Community Alcohol Team Structured community-based treatment service where people receive a comprehensive assessment to identify agreed care plan to reduce or stop drinking in safe manner Where alcohol dependence is moderate or severe, assessments for alcohol detox to support planned withdrawal in most appropriate setting Alcohol treatment can involve 1:1 motivational interviewing, CBT, abstinence peer support groups, family support, relapse prevention medications

15 Alcohol Linkworker for each GP practice One-to-one appointments with Alcohol Linkworkers Exploring motivation to help set a goal and stay on track Agreeing a plan of action to reduce drinking or stop Assessment for assisted and planned withdrawal as a part of recovery and relapse prevention planning Advice for relatives or carers

16 Our contact details Telephone: (new direct line) Secure Fax: Address: Manchester Community Alcohol Team Longsight District Office Stockport Road Manchester M12 4LL Opening times: Monday to Friday, 9.00am 4.30pm

17 Alcohol Identification and Brief Advice Toolkit Public Health Development support staff with an evidence-based Alcohol IBA toolkit as recommended by NICE: - a short guide on how to deliver brief advice - a validated alcohol risk screening questionnaire - a visual aid to compare the person s drinking levels with the average - practical advice on how to reduce alcohol consumption - a self-help leaflet - a poster for display in waiting areas To order alcohol resources or refresher training contact: Liz Burns elizabeth.burns@mhsc.nhs.uk