TIME TO CALL TIME. Cumbria Alcohol Strategy

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1 TIME TO CALL TIME Cumbria Alcohol Strategy

2 ACKNOWLEDGEMENTS This strategy has been produced by Cumbria Drug and Alcohol Action Team, on behalf of Cumbria Strategic Partnership, with the active involvement of a wide range of partners. Cumbria Strategic Partnership The Cumbria Strategic Partnership (CSP) is the countywide partnership which brings together partners representing the public, private and third sector. It is responsible, on behalf of the County Council, for developing a Sustainable Community Strategy and the Local Area Agreement. Cumbria Drug and Alcohol Action Team Cumbria Drug and Alcohol Action Team is the strategic partnership responsible for the local delivery of the national drug and alcohol harm reduction strategies. Our mission statement is We work through partnership to reduce the harm caused by drug and alcohol use. By doing so, we aim to produce safer and healthier communities. Partner Organisations Cumbria Drug and Alcohol Action Team would like to thank the following organisations and partnerships for their support in developing this strategy. Allerdale Borough Council Barrow Borough Council Booth s plc Business Link Northwest Cumbria British Beer and Pub Association Carlisle City Council Carlisle Local Strategic Partnership Connexions Cumbria Copeland Borough Council Co-op plc Cumbria Alcohol and Drug Advisory Service Cumbria Children s Trust Board Cumbria Constabulary Cumbria Police Authority Cumbria Chamber of Commerce Cumbria County Council Cumbria Criminal Justice Board Cumbria Healthy Schools Cumbria Domestic Violence - Cumbria Fire and Rescue Service Strategic Management Board Cumbria Partnership NHS Foundation Trust Cumbria Police Authority Cumbria Primary Care Trust Cumbria Strategic Partnership Cumbria Users Project Eden District Council Eden Local Strategic Partnership Furness Local Strategic Partnership HMP Haverigg Impact Housing Marston s (Jennings) plc Natural England National Probation Service, Cumbria Risk Taking Behaviour Board South Lakeland Local Strategic Partnership South Lakeland District Council Supporting People West Cumbria Local Strategic - Youth Offending Service Partnership Page 1 of 20

3 CONTENTS A INTRODUCTION Page 1 FOREWORD 3 2 WHAT IS THE PURPOSE OF THE STRATEGY? 4 3 WHAT IS THE PROBLEM? 5 B STRATEGIC FRAMEWORK 4 WHAT SHOULD WE FOCUS ON? 7 5 WHAT DO WE NEED TO DO? 9 6 WHO IS RESPONSIBLE FOR DELIVERY? 10 7 HOW WILL WE MEASURE PROGRESS? 11 C OBJECTIVES 8 REDUCE THE HARM TO HEALTH 12 9 SAFEGUARD CHILDREN AND YOUNG PEOPLE REDUCE ALCOHOL RELATED CRIME AND IMPROVE 14 COMMUNITY SAFETY 11 REDUCE ECONOMIC AND SOCIAL HARMS 15 D NEXT STEPS 12 WHAT HAPPENS NEXT? 16 APPENDICES 1 SAFER DRINKING RECOMMENDATIONS AND DEFINITIONS 2 MAP OF ALCOHOL RELATED HARMS TO HEALTH 3 EVIDENCE BASE AND GOOD PRACTICE GUIDANCE 4 REFERENCES Page 2 of 20

4 1 FOREWORD Jill Stannard, Chair of Cumbria Drug and Alcohol Action Team It is time to call time. Our relationship with alcohol has to change, so that we achieve a less harmful drinking culture. This strategy sets out why and how we plan to change that relationship. Why do we need to change? Well, it is true that the moderate consumption of alcoholic drinks does little if any harm, for most people, most of the time. It can be a pleasant accompaniment to meals, social gatherings and celebrations. It can help us unwind, relax and enjoy each other's company. However, alcohol is a powerful drug. It can and does cause a great deal of harm if it is misused. Over the last few years there has been a growing recognition of the problems caused by excessive drinking. These have included health problems, crime and disorder problems, problems at work, at home and in the streets. There are very few people in Cumbria who have not been affected by these problems, either through their own misuse of alcohol, or through exposure to other people s misuse. This strategy, produced by Cumbria Drug and Alcohol Action Team, clearly sets out the scale and seriousness of the harms related to excessive drinking. We have collected the evidence of the harms caused by alcohol misuse. We have consulted a wide range of people and agencies about the harms caused by alcohol, and what we could do to tackle them. And we have drawn up a strategic framework for action, based on that consultation. It is important that we acknowledge all the work that has been done until now, and continues to be done, to tackle alcohol related harms in Cumbria, by hard working and committed staff in the statutory, voluntary and private sectors. But there is still a lot of work to do, and for the first time we have a framework to move forward in a more focused, co-ordinated and consistent way. Our relationship with alcohol has to change. Changing the culture will not be easy, and it will take time. But it has changed in the past, and it can be changed again. It is time to call time. Jill Stannard Chair Cumbria Drug and Alcohol Action Team Page 3 of 20

5 2. WHAT IS THE PURPOSE OF THE STRATEGY? 2.1 What are the Aims and Objectives? Our overall aim is to promote safe, sensible and social drinking in Cumbria. Our objectives are: To reduce the harm to health caused by alcohol To reduce alcohol related crime and anti-social behaviour To safeguard children and young people To reduce the economic and social harms, whilst keeping the economic and social benefits 2.2 Why Do We Need a Strategy? A wide range of partners in Cumbria in the statutory, voluntary and private sectors have done a great deal of valuable work to address alcohol misuse. But until now, Cumbria has never had a co-ordinated strategy to tackle these problems. The key reasons for having a strategy are: The scale and seriousness of alcohol related harms reported by all relevant agencies The need for us to achieve better co-ordination between agencies, more consistency across the county, and better ways of introducing and spreading good practice The publication of Safe, Sensible, Social, the Government s alcohol strategy The refreshed Local Area Agreement for Cumbria, which forms the delivery plan for the Community Strategy and specifically includes alcohol as a cross cutting theme Above all, our everyday experience of the problems linked to alcohol misuse tells us that it really is time to call time. 2.3 What is the Function of the Strategy? The strategy provides an overarching framework, which sets out the challenges facing Cumbria and the way forward in those challenges at a headline level. The strategy is not intended as a detailed action plan. Cumbria Drug and Alcohol Action Team will work with partners to produce a detailed implementation plan which will be refreshed annually. That implementation plan will more fully describe actions, milestones and responsibilities for delivery, and will be agreed within the partnership structures Cumbria has committed to. This will include making explicit the responsibilities of partner agencies and stakeholders. Page 4 of 20

6 3. WHAT IS THE PROBLEM? The problem is that too many people are drinking too much alcohol, too often. This excessive drinking is harming the people who are drinking too much, harming the people near to them (especially children) who are affected by their drinking, and indirectly harming all of us. The following section outlines the problems in more detail. The facts and figures are either drawn from local data or are reliable estimates of the problem in Cumbria. 3.1 Consumption The first problem is the amount of alcohol being consumed by individuals, and the way they consume it. The Health Related Behaviour Survey undertaken by Exeter University with over 2,000 school children in Cumbria, and the 2007 Cumbria Trading Standards Alcohol Survey, show that: 27% of young females and 15% of young males are exceeding the recommended number of units per week for an adult 1 A significantly higher proportion of 15 to 16 year olds drink alcohol compared to the regional and national averages 2 Frequency of consumption of alcohol by 15 and 16 year olds is higher than the regional and national averages 3 Binge drinking by 15 and 16 year olds is higher than the averages 4 Obtaining alcohol by 15 and 16 year olds from their parents is higher than the averages 5 31% of 15 to 16 year olds claim to purchase alcohol, a higher proportion than the averages. 6 Applying national figures to Cumbria we see that: 80,000, or 20%, of adults aged drink more than the recommended limits (hazardous drinking) 7 17,000, or 4.5%, of adults aged drink more than the recommended limits and are experiencing or causing problems (harmful drinking) 8 16,000, or 4%, of adults aged are experiencing signs of dependence on alcohol (dependent drinking) 9 Problem drinking is a problem throughout Cumbria, amongst people of all ages, in all areas, and from all walks of life. It is particularly a problem, however, in deprived areas generally, and in certain groups of the population. If we look now at some alcohol related harms caused by this problem drinking, we begin to see the full scale and seriousness of the problem. National figures have been used where we currently have gaps in local data. Where we know data for Cumbria, we specify in Cumbria. Page 5 of 20

7 3.2 Harms to Children and Young People in Cumbria There are approximately 9,000 children of problem drinkers in Cumbria 10 In Cumbria 35% of case conferences on children involve substance misuse 11 Under 19 year olds commit 26% of alcohol related crime in Cumbria 12 Alcohol specific hospital admissions in Cumbria for under 18s are above the regional and national average 13 9% of Year 10 boys in Cumbria report drinking in licensed premises in the last week, compared to only 4% nationally; Health Harms to Adults in Cumbria On average men in Cumbria lose 10 months of life, and women 4.5 months, directly attributable to alcohol 15 13% of all premature deaths in Cumbria between 2002/03 and 2006/07 were attributable to alcohol 16 Each death attributable to an alcohol specific condition in Cumbria between 2002/03 and 2006/07 lost on average 21 years of life 17 In Cumbria there has been a 49% rise in hospital admissions for alcohol specific conditions from 1,761 in 2002/03 to 2,619 in 2006/07 8 In 2006/07 an average of 37 hospital beds were permanently occupied by people recovering from alcohol specific conditions Crime and Disorder Harms in Cumbria In Cumbria over 30% of violent crime is recorded as alcohol related 20 In Cumbria over 50% of domestic violence victims and offenders are problem drinkers 21 In Cumbria 25% of people report that drunkenness and rowdiness in public places is a significant problem Economic and Social Harms in England Nationally 17 million working days are lost annually to alcohol misuse 23 Nationally over 38,000 people claim Incapacity Benefit because of alcohol problems 24 The overall annual cost of productivity lost as a result of alcohol misuse is estimated to be 6.4bn per annum 25 Nationally 50% of homeless people are dependent on alcohol. 26 Page 6 of 20

8 4. WHAT SHOULD WE FOCUS ON? 4.1 Introduction There are several ways in which Cumbria, or parts of Cumbria, are experiencing high rates of alcohol related harm. This section sets out some of the issues we need to focus on as a matter of priority. 4.2 Where Should We Prioritise Our Work? Appendix 2 shows a map of the rates of alcohol related hospital admissions. Alcohol Related Harm is most visible in Barrow, West Cumbria and Carlisle but we know that there are also challenges with hazardous drinking in Eden and South Lakeland. There are clear links between social and economic deprivation and alcohol related harm. Addressing alcohol related harm is a key challenge in the context of reducing health and other inequalities. The indices of deprivation from 2004 are split into five groups (quintiles, or 20%). Quintile one is the most deprived, and quintile five the most affluent. The chart below shows the relationship between deprivation and a measure of alcohol related harm to health. The highest rates are in quintile one and two, showing a clear correlation between deprivation and alcohol related harm. People with alcohol specific condition rates per 1,000 by deprivation quintile Who Should we be Most Concerned About? Children and Young People Based on long term research with primary and secondary school children in Cumbria we know that compared to the national average: More children in Cumbria report drinking in the previous week Those children drink more units and drink more frequently Those children are more able to buy alcohol The majority of children who drink access alcohol from their parents Page 7 of 20

9 We know that alcohol misuse significantly undermines children achieving the Every Child Matters outcomes Harmful and Hazardous Drinkers, Age The majority of harmful and hazardous drinkers are aged This age group accounts for the highest number of alcohol related crimes, both as offenders and victims, with clear links with the night-time economies in most of our town centres Dependent Drinkers, 40 and older The majority of dependent drinkers are aged 40 and older, with the most acute impact on health in relation to damage to the liver, heart and cognitive functioning occurring in people of over 40. Data from 2006/07 shows that 66% of alcohol related hospital admissions were to people over 40, and during 2002/ /07 people over 40 accounted for 91% of alcohol specific deaths, with 45% of deaths occurring during the ages In 2006/07 people over 60 accounted for 25% of alcohol related hospital admissions. The number of admissions for people aged over 60 has doubled since 2002/ Men Compared to women, men drink more alcohol, experience more harm to their own health, and are more likely to be both a victim of alcohol related crime and to commit alcohol related offences: On average in Cumbria men are estimated to lose 10 months of life attributable to alcohol use, whereas women lose 4.5 months 29 During men accounted for 65% of hospital admissions for alcohol specific conditions 30 83% of alcohol related crime is committed by men 31 However, we need to recognise that there has been a relative increase in drinking by women. The type of drinking behaviour, and number of units consumed, is increasingly less differentiated by gender amongst children and younger adults Vulnerable Groups There are some groups at greater risk of alcohol related harm, including: People with poor mental health and emotional wellbeing Victims and perpetrators of domestic violence Offenders and ex-prisoners Children of dependent drinkers Page 8 of 20

10 5 WHAT DO WE NEED TO DO? 5.1 Introduction In this section we provide a summary of the framework for action. In sections 8 11 we set out some of the key things we need to do to achieve each of the objectives of the strategy. 5.2 Change attitudes, values and behaviour through: Identifying opportunities for culture change and supporting the big drink debate Increasing knowledge of how much is too much, and of alcohol related harms Supporting actions to manage and re-shape our night time economies 5.3 Regulate and enforce the retailing of alcohol through: Continuously reviewing our activities around licensing, regulation, enforcement and planning of our night time economies; Promoting responsible retailing with pubs, clubs, shops and supermarkets. 5.3 Reduce the excessive consumption of alcohol through: Reducing problem drinking Reducing the number of children who drink alcohol, and the amounts of alcohol drunk 5.4 Minimise the harms associated with alcohol through: Continuing the drive to tackle alcohol-related crime, disorder and antisocial behaviour Continuing to tackle alcohol-related economic and social harms Continuing to improve the availability and effectiveness of treatment and behaviour modification services 5.5 Influence national policies and legislation Reducing access and availability by supporting national and local action on pricing, promotion and enforcement. 5.6 The wider root of the problem We need to promote wider wellbeing, and address the causal factors which lead so many of us to use chemicals of one sort or another to manage our interaction with our social environment We need to equip people with better coping skills and also tackle stress producing conditions in the first place Page 9 of 20

11 6 WHO IS RESPONSIBLE FOR DELIVERING THE STRATEGY? 6.1 Introduction Delivering Time to Call Time is a partnership commitment, with shared accountability. Partner organisations are responsible for ensuring delivery within their areas of responsibility, and for working collaboratively with partners to achieve shared goals. This section sets out the responsibilities of agencies and partnerships. 6.2 Cumbria Strategic Partnership Cumbria Strategic Partnership (CSP) is responsible for providing overarching senior leadership, endorsement and monitoring of the implementation of the strategy, and its impact. It will do this by receiving monitoring reports from Cumbria Drug and Alcohol Action Team, and performance reports against the Local Area Agreement. 6.3 Thematic Partnerships The Thematic Partnerships of Cumbria Strategic Partnership, will be responsible for: Working with the DAAT and partner agencies in developing detailed, evidence based actions to be included in the implementation plan Monitoring and performance management of those actions 6.4 District Local Strategic Partnerships The District Local Strategic Partnerships will be responsible for: Ensuring that the implementation plan and its delivery is responsive to the particular needs of the area For ensuring that its sub-groups address alcohol related harms, for example the Crime and Disorder Reduction Partnerships and the Children s Local Planning Groups For developing an area based implementation plan if appropriate 6.5 Partner Organisations Partner organisations will actually deliver the key actions. They will do so in accordance with the framework set out in this strategy, with the more detailed commitments recorded in the implementation plan, and through their existing statutory responsibilities. 6.6 Cumbria Drug and Alcohol Action Team Cumbria Drug and Alcohol Action Team (DAAT) will be responsible for providing the active coordination, monitoring and review of the implementation of the strategy. This will include: Enabling partnerships and partner organisations in the above work Servicing an Advisory Group comprised of stakeholders from the public, private and voluntary sectors Reporting on progress to the Cumbria Strategic Partnership Page 10 of 20

12 7 HOW WILL WE MEASURE PROGRESS? 7.1 Introduction This section sets out how we will measure progress at a headline level, so that we can judge what difference we make in delivering the strategy. 7.2 Public Service Agreement Indicators and the Local Area Agreement In 2007, the Government published Public Service Agreements for which set out the key performance indicators against which local areas will be judged. Cumbria has selected 35 of those indicators to be included in the Local Area Agreement , which forms the delivery plan for the Cumbria Community Strategy. Those measures include: Direct Alcohol Measures Included in the Cumbria Local Area Agreement NI 39 Alcohol related hospital admission rates NI 41 Perception of drunk and rowdy behaviour in a public place Alcohol Related Measures Included in the Cumbria Local Area Agreement NI 30 Re-offending rate of prolific and priority offenders NI 47 People killed or seriously injured in road traffic accidents NI 32 Repeat incidents of domestic violence NI 112Under 18 conception rate NI 111First time entrants to the Youth Justice System aged NI 70 Hospital admissions caused by unintentional and deliberate injuries to children and young people NI 65 Children becoming the subject of a Child Protection Plan for a second or subsequent time Further Alcohol Related Public Service Agreement Indicators NI 115 Reduce the number of children frequently drinking alcohol or using illegal drugs 7.3 Local Performance Indicators A range of locally determined performance indicators will also be developed and included in the strategy implementation plan, to ensure that we are able to measure the things that stakeholders consider to be important. Page 11 of 20

13 8 REDUCE THE HARM TO HEALTH 8.1 What are the priorities for immediate action? The priorities to be addressed in the detailed implementation plan are: To promote wider wellbeing and address causal factors for alcohol misuse A longer term approach to raising awareness of sensible drinking levels to address harmful and hazardous drinking A clear focus on those experiencing the most harm to health Interventions which will reduce the years lost to life attributable to alcohol 8.2 What needs to be achieved? We need to achieve the following: a measurable reduction in alcohol related hospital admissions, and put in place actions that will reduce alcohol related mortality a measurable increase in the number of people receiving alcohol related brief intervention, behaviour modification, and structured treatment services a measurable increase in knowledge of sensible drinking 8.3 How will we do it? Public information campaigns and social marketing Deliver evidence based approaches to influencing public and community attitudes to alcohol and the harm that it can cause. This will include using social marketing approaches to influence behaviour amongst the general population and higher risk groups More help for people who want to drink less Develop assessment and brief intervention capacity in a wide range of NHS and non NHS services including: Commission evidence-based behaviour modification support and treatment services, recognising that investment in such services is relatively low nationally and will need to become a priority Reduce unplanned alcohol detoxification episodes in acute hospitals by increasing capacity for earlier intervention community settings 8.4 Who Will Do It? The Health and Wellbeing Board will provide the partnership accountability for delivering against this objective of the strategy. Working with a wide range of partners Cumbria Primary Care Trust will play a key leadership role. Page 12 of 20

14 9 REDUCE ALCOHOL RELATED CRIME AND ANTI-SOCIAL BEHAVIOUR 9.1 What are the priorities for immediate action? The priorities to be addressed in the detailed implementation plan are: Addressing underage sales of alcohol, and the number of adults illegally providing alcohol to children Addressing public drunkenness and violent crime, including domestic violence Addressing the perception and impact of alcohol related anti-social behaviour 9.2 What needs to be achieved? We need to achieve: A measurable reduction in the number of children and young people illegally procuring alcohol A measurable reduction in alcohol related violent crime and domestic violence A measurable reduction in the perception of alcohol related anti-social behaviour 9.3 How will we do it? We will need to agree further evidence based actions. These are likely to include: Further development of effective test purchasing and training of retailers and their staff by Police and Trading Standards Further develop voluntary agreements with licensed premises such as Pubwatch and Best Bar None Enhance the local management of transport including taxis, lighting and CCTV Develop approaches to managing offenders with alcohol problems such as arrest referral schemes, conditional cautioning and options for courts to order alcohol treatment 9.4 Who Will Do It? The Safer and Stronger Communities Thematic Partnership will provide the partnership accountability for delivering against this objective of the strategy. Working with a wide range of partners Cumbria Constabulary will play a key leadership role in this work. Page 13 of 20

15 10 SAFEGUARD CHILDREN AND YOUNG PEOPLE 10.1 What are the priorities for immediate action? The priorities to be addressed in the detailed implementation plan are: We need to reduce the number of young people drinking in ways which are damaging to their health and relationships We need to reduce young peoples access to alcohol, including from parents We need to reduce the harm caused to children by parental alcohol use What needs to be achieved? We need to achieve: A measurable reduction in the number of children and young people who drink, and the volume and frequency of drinking Contribute to a measurable reduction in alcohol related outcomes, including teenage conceptions and first time entrants to the youth justice system A measurable reduction in the harm experienced by children associated with parental alcohol use 10.3 How will we do it? We will need to agree further evidence based actions. These are likely to include: Develop positive activities for young people Improve education, advice and information programmes for young people and for parents Ensure the delivery of effective screening and treatment services Develop capacity within family support services to work with families experiencing alcohol related harm, and ensure effective safeguarding practice 10.4 Who Will Do It? The Children s Trust Board will provide the partnership accountability for delivery against this objective of the strategy. The actions to reduce children and young people s drinking, and its negative impact, will be discharged through the Risk Taking Behaviour Board. The actions to reduce the harms caused by parental drinking will be discharged through the Local Safeguarding Children Board. Working with a wide range of partners, County Council Children s Services will play a key leadership role in this work. Page 14 of 20

16 11 REDUCE ECONOMIC AND SOCIAL HARMS 11.1 What are the priorities for immediate action? The priorities to be addressed in the detailed implementation plan are: We need to reduce the negative impact alcohol use has on the local economy in relation to sickness, absenteeism, reduced efficiency and accidents We also need to reduce alcohol related homelessness and enable people to obtain and sustain suitable accommodation 11.2 What needs to be achieved? We need to achieve: A measurable increase in the number of employers with effective alcohol policies A measurable increase in the number of alcohol misusers obtaining and sustaining appropriate accommodation 11.3 How will we do it? We will need to agree further evidence based actions. These are likely to include: Develop workplace alcohol policy toolkits, training programmes and pathways for employers to access appropriate support services for their employees Develop more supported accommodation for harmful and dependent drinkers, and more support to enable people to sustain their own accommodation 11.4 Who Will Do It? Cumbria Drug and Alcohol Action Team will co-ordinate work with organisations who represent or support business, particularly Cumbria Chamber of Commerce and Business Link Northwest, as well as public and voluntary sector employers. Cumbria Drug and Alcohol Action Team will work with Supporting People and other partners to achieve the objectives in relation to accommodation. Page 15 of 20

17 12 WHAT HAPPENS NEXT? This section briefly sets out the key stages in the alcohol strategy implementation and review. The Strategy Implementation Plan will set out detailed milestones for delivery. April 2008: April August 2008: September 2008 onwards: March 2009: March 2010: October 2010: Formal launch of the strategy Development of detailed implementation plan Delivery of implementation plan Review of strategy and implementation plan delivery. Refreshment of the implementation plan for 2009/10 Review of strategy and implementation plan delivery. Refreshment of the implementation plan for 2009/10 Review strategy and develop a successor strategy or alternative arrangements. Page 16 of 20

18 APPENDIX 1 DRINKING RECOMMENDATIONS AND DEFINITIONS Alcohol Units The definition of one unit of alcohol is 8mg (or 10ml) of pure alcohol. The number of units in an alcoholic drink depends on the type of drink, how strong it is and the size of the measure. As a general guideline one unit of alcohol can be considered to be half a pint of normal strength (3.5% ABV) beer/lager or cider, a small glass (125ml) of table wine (around 9% ABV) or a standard (25ml) measure of spirits (around 40% ABV). See the back cover of this strategy for a simple guide to units. Daily and Weekly Recommended Limits Current recommendations are that men should consume no more than 21 units per week, and no more than 3-4 units in a single session. Women should consume no more than 14 units per week and no more than 2 to 3 units in a single session. It is also recommended that everyone should have at least 2 alcohol free days a week. Binge drinking Binge drinking is difficult to define. The best and most widely used measure for binge drinking is drinking over twice the recommended daily guidelines. That is drinking over 8 units for men and 6 units for women. Hazardous drinking Hazardous drinkers are drinking at levels over the sensible drinking limits, either in terms of regular excessive consumption or less frequent sessions of heavy drinking. However, they have so far avoided significant alcohol-related problems. Despite this, hazardous drinkers, if identified, may benefit from brief advice about their alcohol use. Harmful drinking Harmful drinkers are usually drinking at levels above those recommended for sensible drinking, typically at higher levels than most hazardous drinkers. Unlike hazardous drinkers, harmful drinkers show clear evidence of some alcohol-related harm. Dependent drinkers and drinkers with complex problems Dependence is essentially characterised by behaviours previously described as psychological dependence, with an increased drive to use alcohol and difficulty controlling its use, despite negative consequences. More severe dependence is usually associated with physical withdrawal upon cessation, but this is not essential to the diagnosis of less severe cases. Page 17 of 20

19 APPENDIX 2 MAP OF ALCOHOL RELATED HOSPITAL ADMISSION RATES People admitted to hospital with an alcohol specific condition - average annual rate per 1,000 people /03 to 2006/07. Page 18 of 20

20 APPENDIX 3 EVIDENCE BASE AND GOOD PRACTICE GUIDANCE There is a wide range of literature available describing the evidence base for effective interventions in reducing alcohol related harm. Below are listed some of the key documents used in constructing this strategy. General Safe, Sensible, Social. Alcohol Strategy Implementation Toolkit Alcohol Treatment and Behaviour Modification Department Of Health, National Treatment Agency for Substance Misuse Models of Care for Alcohol Misusers. National Treatment Agency for Substance Misuse (2006) Review of the effectiveness of treatment for alcohol problems. Children and Young People Velleman R. et al. (2005) The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people. Drug and Alcohol Review, 24: National Institute for Health and Clinical Excellence, 2007, Interventions to reduce substance misuse among vulnerable young people. Health Advisory Service(2001)The Substance of Young Needs: Review 2001 Turning Point/Addaction 2005, Developing the Evidence Base for Children with Substance Misuse Problems Department for Children and Families 2005, Every Child Matters, Change for Children, Young People and Drugs Crime and Community Safety Home Office, 2007, A Practical Guide for Dealing with Alcohol Related Problems: What You Need to Know National Probation Service (2006) Working with Alcohol Misusing Offenders a strategy for delivery. NOMS. HM Prison Service (2004) Addressing Alcohol Misuse A Prison Service Alcohol Strategy for Prisoners. London: HMPS. Page 19 of 20

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