Needs Assessment For Adult Alcohol Treatment Services. in Warwickshire

Transcription

1 Needs Assessment For Adult Alcohol Treatment Services in Warwickshire Prepared by Warwickshire Drug & Alcohol Action Team Autumn 2010 Warwickshire Joint Strategic Needs Assessment 1

2 CONTENTS Page 1. Introduction 1.1 Recommendations 2. About Warwickshire 2.1 Population 2.2 Deprivation 3. Current Picture 3.1 Adult Drinking Population 3.2 Health 3.3 Crime, Anti-Social Behaviour and Fire 3.4 Licensing 3.5 Employment and Benefits 4. Current Provision 4.1 Funding 4.2 Community Alcohol Services 4.3 Inpatient Treatment 4.4 Alcohol Arrest Referral Service 4.5 Housing Provision 5. Provider and Service User Input 5.1 Overall Service Provision 5.2 Outreach Provision 5.3 Ongoing Aftercare, Support and Provision 5.4 Joined Up Working across Services 6. Conclusion and Recommendations 6.1 Education and Prevention 6.2 Criminal Justice System 6.3 Work with Health Professionals 6.4 Licensing 6.5 Funding and Specialist Treatment Provision 6.6 Future Provision

3 1. Introduction This needs assessment looks at the alcohol related issues concerning the adult population in Warwickshire. It covers: The current picture across a range of alcohol related issues including health, crime, fire, licensing, employment and housing An assessment of the current alcohol treatment service provision Input from providers and service user representatives on perceived gaps in the current treatment system Conclusions and recommendations for future action. The purpose of this assessment is to assist partners in the planning and commissioning of appropriate and effective services. The findings will also inform the development of a refreshed Alcohol Harm Reduction Strategy for Warwickshire and its associated Implementation Plan. Warwickshire DAAT would like to thank the partners, providers and service users who contributed to the production of this needs assessment. 1.1 Recommendations Where recommendations relate specifically to the collation of data, they are included at the relevant point in the document. All other recommendations are set out in the final section of the document. For ease of reference, all the recommendations made within the assessment are set out, in the order they appear in the document, in the box below. 3

4 Recommendations: NHS Warwickshire and DAAT to work with providers to improve the capture of screening and IBA information. Work with West Midlands Ambulance Service to establish what additional data can be provided to enable: a) specific information relating to alcohol to be extracted and b) the cross referencing of cases seen by the ambulance service with those known to treatment providers. NHS Warwickshire to explore the possibility of establishing recording systems which enable alcohol related A&E presentations to be reliably identified. Warwickshire Police to explore the possibility of establishing recording systems which enable alcohol and drug related offences to be separated. Job Centre Plus to explore the possibility of setting up systems to enable the numbers of customers provided with brief intervention and advice and referred into treatment to be recorded. All partners to consider what further work can be undertaken to highlight the dangers associated with increased drinking to the wider population, and specific target groups within this population. Warwickshire Police to investigate opportunities to deliver conditional cautioning across the county. Community Safety partners to implement projects to tackle alcohol related crime and anti-social behaviour in the priority areas of Nuneaton and Bedworth and Warwick. Swanswell and Warwickshire Probation Trust to investigate why the completion rate for ATRs is significantly lower in Rugby and implement measures to improve this. NHS Warwickshire to work with GPs to: a) assess the training needs of GPs around assessing alcohol use and providing brief advice and intervention b) increase the number of newly registered patients screened through the DES c) increase the number of patients who test positive on the audit tools who then go on to receive brief advice and intervention. A&E departments to signpost individuals who present with alcohol related conditions to treatment services and, where relevant, wider support provision. DAAT to explore the feasibility of expanding Shared Care to include treatment for alcohol problems. Licensing and responsible authorities to explore opportunities for greater sharing of information, best practice and services across agencies and the county. All partners to consider whether greater opportunities to enter residential treatment, or suitable alternatives, should be made available to alcohol service users in Warwickshire. DAAT Commissioners to take feedback from providers and service user representatives into account when developing the specification for the service modernisation process. DAAT and treatment providers to increase promotion of alcohol education campaigns and alcohol treatment services, with a focus on the north of the county and Rugby. H:\DAAT\Drug All partners Action Team to consider Work\Annual what DAT additional Plans\ \Needs research Assessments\Alcohol\Final into unmet needs and version\alcohol barriers to treatment would prove useful, and commission this as appropriate for inclusion in future needs assessments. 4

5 2. About Warwickshire Comprising of five districts North Warwickshire, Nuneaton and Bedworth, Rugby, Stratford and Warwick Warwickshire is generally perceived to be a pleasant place to live and work, with good quality of life for most. However, like many places, the county is diverse, with many social and economic contrasts. In some areas there are pockets of high deprivation resulting in high levels of ill health and mortality. In others there are high levels of affluence and economic prosperity. These disparities are most obvious between the north and the south of the county with the north having more pockets of deprivation than the south. Leicester Birmingham Coleshill North Warwickshire Borough Atherstone Nuneaton Nuneaton & Bedworth Borough Bedworth Coventry Rugby Borough Rugby Kenilworth Redditch Studley Henley-in-Arden Warwick District Leamington Spa Warwick Southam Alcester Stratford-upon-Avon Wellesbourne Stratford-on-Avon District Evesham Shipston-on-Stour Banbury Motorways Based on Ordnance Survey Mapping with the permission of the Controller of the Stationery Office Crown Copyright. Unauthorised reproduction infringes Crown Copyright and may lead to prosecution or civil proceedings. Warwickshire County Council Licence No ,

6 2.1 Population Warwickshire is home to 535,100 people according to the 2009 mid-year estimates from the Office for National Statistics (ONS). Area Population Sq. miles Mid-2009 Estimates Persons per sq. mile North Warwickshire , Nuneaton and Bedworth ,000 4,067 Rugby , Stratford , Warwick ,000 1,275 Warwickshire , (Source: Warwickshire Observatory; National Statistics mid-year population estimates 2009) North Warwickshire has the smallest population of the Warwickshire districts and Warwick has the largest. Nuneaton and Bedworth has the highest density of population, with 4,067 people per square mile; compared to only 315 per square mile in Stratford-on- Avon. Non- White British groups make up approximately 10.4% of Warwickshire s total population. Asian Indian and Other White ethnic groups are the largest non- White British groups in the county. At District level, Warwick District is estimated to have the highest proportion of non- White British residents, at 15.4%, and North Warwickshire has the lowest proportion, at 6.3%. 2.2 Deprivation The latest Indices of Deprivation (2007) show that Warwickshire is ranked 123rd out of the 149 County Councils and Unitary Authorities in England, according to the rank of average score measure of deprivation, where a rank of 1 indicates the most deprived authority. Whilst, at a County level, it appears that Warwickshire is not particularly deprived, there is considerable variation across the Districts and Boroughs, and at a more localised level various distinct pockets of severe deprivation exist within the County. Nuneaton & Bedworth has the highest levels of deprivation in the County, indicated by the highest average Super Output Area (SOA) score. The Borough ranks as the 112th most deprived Local Authority District (out of the 354 Local Authorities in England). In comparison, Stratford-on-Avon District is the least deprived in Warwickshire with a national rank of 307th. There are six SOAs in Warwickshire ranked within the top 10% most deprived SOAs nationally on the overall Index of Multiple Deprivation These are all located within Nuneaton & Bedworth Borough. 6

7 The following table indicates the top 3 most deprived Super Output Areas in each district: Super Output Area District District Warwickshire Rank Rank Atherstone Central Centre North Warwickshire 1 11 Mancetter South & Ridge Lane North Warwickshire 2 18 Atherstone North St Georges & North Warwickshire 3 40 Carolyn Bar Pool North & Crescents Nuneaton & Bedworth 1 1 Camp Hill Village Centre Nuneaton & Bedworth 2 2 Abbey Town Centre Nuneaton & Bedworth 3 3 Brownsover South Lake District Rugby 1 13 North Town Centre Rugby 2 19 Overslade North Rugby 3 27 Alcester North & Conway Stratford 1 57 Stratford Mount Pleasant East Stratford 2 77 Maybird Stratford 3 83 Lillington East Warwick 1 15 Brunswick South East Warwick 2 30 Packmores West & The Cape Warwick 3 35 (Source: Warwickshire Observatory; Index of Multiple Deprivation 2007) 7

8 3. Current Picture 3.1 Adult Drinking Population According to the National Statistics mid-year population estimates for 2009, there are 423,900 adults aged 18 and over in Warwickshire. The Rush Model enables partners to estimate, based on size of population, the number of adults drinking at above low risk, harmful and dependent levels. The table below provides an estimate of the number of adult drinkers in each of these categories in Warwickshire. % of total Number in Warwickshire Adult population ,900 Adults drinking above low risk levels ,062 Adults drinking at harmful levels ,467 Adults dependent on alcohol ,260 (Source: Alcohol Learning Centre - Rush Model) Binge drinking can be defined as the consumption of at least twice the daily recommended amount of alcohol in a single drinking session (that is, 8 or more units for men and 6 or more units for women). Using this definition, data from the latest Local Alcohol Profiles (for ) shows that over a fifth of adults aged 16+ in Warwickshire reported engaging in binge drinking, with levels highest in Rugby and lowest in Nuneaton and Bedworth. There has been a significant increase in levels of reported binge drinking from the previous Local Alcohol Profiles, which used data from The biggest increases have been seen in Rugby, where reported levels increased from 17.9% to 24.7% and North Warwickshire, where levels increased from 18% to 24.5%. This is shown in the table below. 8

9 Percentage of population who report engaging in binge drinking Percentage N Warks Nun and Bed Rugby Stratford Warwick 2003/ /08 Area (Source: North West Public Health Observatory Local Alcohol Profiles) Figures for Warwickshire are higher than the national average of 20.1%. It is worth noting that the latest figures show six areas with reported levels of binge drinking over 30%. These are all in the North East of England. Five areas report levels of binge drinking under 10%, and these are all in the South East. Figures for Warwickshire are significantly higher than the West Midlands average of 18.8% and are the joint highest in the region. Reported levels of binge drinking in Warwickshire compared to other West Midlands PCTS are shown in the table below. Primary Care Trust % of Population Reporting Engaging in Binge Drinking Walsall Teaching 14.9 Wolverhampton City 15.2 Telford and Wrekin 15.9 Sandwell 16.1 South Birmingham 16.3 Heart of Birmingham Teaching 16.3 Birmingham East and North 16.3 Solihull 17.6 Herefordshire 17.7 Dudley 18.5 Shropshire County 18.7 Worcestershire 19.7 South Staffordshire 20.8 North Staffordshire 21.2 Coventry Teaching 22.3 Stoke on Trent 22.4 Warwickshire 22.4 (Source: North West Public Health Observatory Local Alcohol Profiles) 9

10 In 2005, a Regional Lifestyle Survey was undertaken by the West Midlands Regional Observatory. Although now slightly outdated, this survey still provides a useful insight into the drinking habits of Warwickshire residents. This survey shows: More than three quarters (75.3%) of Warwickshire respondents stated that they currently consumed alcohol, exceeding the comparative regional figure of 70.5% Males were more likely to drink than females, 84% and 68% respectively The likelihood of drinking alcohol reduced with age, with the youngest age group (18-24) most likely to consume alcohol (83%) and the oldest age group (75 plus) least likely to consume alcohol (56%). The survey asked respondents who stated that they did drink alcohol to assess the number of days in the week preceding the survey they had consumed alcohol. Almost six in ten respondents had consumed alcohol on one, two or three days during the week preceding the survey. However, one in nine respondents stated that they had consumed alcohol every day during the previous week. Information broken down by age, location and gender is shown in the table below. Number of days alcohol consumed in week prior to survey or more West Midlands 6% 20% 22% 17% 10% 8% 4% 12% 24% Warwickshire 6% 19% 21% 19% 11% 8% 5% 11% 24% Males 5% 15% 19% 20% 12% 10% 5% 13% 28% Females 8% 22% 22% 17% 11% 7% 4% 9% 20% Warwickshire % 20% 26% 20% 12% 6% 2% 3% 11% % 21% 21% 22% 13% 9% 3% 4% 16% % 22% 20% 19% 11% 9% 4% 10% 23% % 15% 20% 18% 12% 9% 7% 13% 28% % 15% 19% 18% 11% 10% 6% 17% 33% % 17% 19% 18% 9% 8% 5% 19% 33% 75 plus 5% 17% 17% 11% 10% 7% 8% 25% 40% North Warks. 7% 20% 21% 17% 13% 8% 4% 9% 22% Nuneaton & Bed. 8% 24% 21% 18% 10% 7% 3% 10% 20% Rugby 7% 20% 20% 21% 14% 7% 3% 9% 18% Stratford-on-Avon 5% 15% 19% 18% 10% 12% 7% 14% 33% Warwick 6% 16% 21% 20% 12% 9% 6% 11% 26% (Source: Warwickshire Observatory; West Midlands Regional Lifestyle Survey 2005) 10

11 The survey also asked respondents who stated that they did drink alcohol to assess how much they had consumed during the week prior to the survey. Responses to this question showed that approximately half of Warwickshire s adult drinking population consumed between 1 and 10 units of alcohol during an average week. Around 7% consumed more than 30 units. Again, this information broken down by age, location and gender is shown in the table below. Number of units consumed in week prior to survey plus 21 plus West Midlands 13% 25% 23% 21% 9% 6% 3% 17% Warwickshire 13% 26% 23% 22% 9% 5% 2% 16% Males 10% 16% 20% 27% 13% 9% 4% 26% Females 15% 35% 26% 18% 4% 1% 0% 6% Warwickshire % 16% 18% 26% 9% 6% 4% 20% % 23% 23% 26% 8% 6% 3% 17% % 26% 25% 21% 9% 6% 2% 17% % 27% 22% 23% 8% 6% 2% 17% % 27% 24% 25% 7% 4% 1% 13% % 37% 22% 19% 5% 4% 0% 10% 75 plus 20% 28% 30% 16% 4% 3% 1% 8% North Warks. 16% 27% 21% 21% 8% 4% 3% 15% Nuneaton & Bed. 14% 24% 21% 23% 10% 6% 3% 18% Rugby 12% 27% 24% 23% 8% 5% 2% 14% Stratford-on-Avon 12% 26% 24% 21% 8% 5% 3% 16% Warwick 11% 25% 25% 23% 9% 5% 1% 16% (Source: Warwickshire Observatory; West Midlands Regional Lifestyle Survey 2005) 11

12 3.2 Health Identification and Brief Advice (IBA) Primary Care The Directed Enhanced Service for Alcohol (DES) was introduced in Warwickshire in April This DES provides funding to enable GPs to screen newly registered patients aged 16 and over using either the Alcohol Use Disorders Identification Test (AUDIT-C) or the Fast Alcohol Screening Test (FAST). It also aims to enable GPs to deliver a simple brief intervention to help reduce alcohol related risk in adults drinking at hazardous and harmful levels. By September 2010, all 76 GP practices in Warwickshire were signed up to the DES. However, as shown below, detailed information on the service is only currently available up to March In 2008/09 there were 24,261 new registrations with GP practices in Warwickshire. Of these, 6,616 (27.3%) were screened using either the AUDIT-C or FAST tools. Intervention Number Receiving Intervention Patients completing FAST or AUDIT-C 6,616 Patients testing positive via FAST or AUDIT-C 644 Patients receiving brief intervention 182 Patients scoring 20+ on AUDIT referred 24 for specialist advice (Source: DES Monitoring Spreadsheet provided by NHS Warwickshire) Information provided through the DES for Alcohol shows that 9.7% of those assessed were drinking at harmful, hazardous or increasing risk levels. If these results are representative of the population of Warwickshire, it can be estimated that over 40,000 adults are drinking at a level that may cause them health problems, either now or in the future. Of the patients testing positive on the audit tools, only 28.3% then went onto to receive a brief intervention. Further work may be required with GPs to ensure patients who are drinking at levels above low risk receive appropriate advice and interventions. Whilst, from the data available, it is not possible to accurately state how many of the 24 individuals referred for specialist advice then commenced treatment with community alcohol services, section four of this document shows that 152 referrals into alcohol treatment were received from GPs in 2009/10. This suggests that links between GPs and treatment services are in place and that increasing the number of new patients screened and advised as appropriate through the DES would enable greater numbers of those drinking at harmful levels to access treatment. 12

13 Secondary Care Secondary care practitioners (medical specialists to whom patients are generally referred by a primary care provider such as their GP) will also see patients with alcohol issues. However, there is currently no data available on screening carried out, and alcohol issues identified, by secondary care practitioners to enable us to understand the size of the problem. Although alcohol screening is in the NHS Warwickshire maternity specification, with midwives referring onto specialist services where required, it is not a Key Performance Indicator and therefore no data is currently collected. Recommendation: NHS Warwickshire and DAAT to work with providers to improve the capture of screening and IBA information Alcohol Related Hospital Admissions The headline indicator used to assess performance in reducing alcohol related harm is National Indicator (NI) 39, which measures the rate of alcohol related hospital admissions. Provisional figures for show that the rate of alcohol-related hospital admissions per 100,000 population has increased in every District and Borough and across Warwickshire as a whole over the past 12 months. NI 39 - District Comparison by Quarter 2009/ Warwick Stratford Rugby Nun & Bed Nth Warks Q1 2009/10 Q2 2009/10 Q3 2009/10 Q4 2009/10 (Source: North West Public Health Observatory) The table below shows data for compared to the previous year. This data presents a similar picture as the quarterly information, with particularly notable increases in Rugby and North Warwickshire. The West Midlands region as a whole has seen an increase of 7% over this period. 13

14 NI 39 Percentage Change Information % Change North Warks 1,327 1,541 16% Nuneaton and Bedworth 1,682 1,804 7% Rugby 1,454 1,700 17% Stratford 1,275 1,368 7% Warwick 1,364 1,446 6% Warwickshire 1,425 1,561 10% West Midlands 1,663 1,780 7% England 1,582 1,743 10% (Source: North West Public Health Observatory) The rate of alcohol related hospital admissions has increased steadily over the previous few years, rising from 822 per 100,000 Warwickshire residents in 2003/04 to 1,561 per 100,000 in 2009/10 (provisional data). This mirrors both the regional and national picture, as shown in the chart below. NI39 - Change over time 2,000 Rate per 100,000 population 1,500 1, Warwickshire West Midlands England 2003/ / / / / / /10 Year (Source: North West Public Health Observatory) Ambulance Call-Outs Whilst some information relating to ambulance call-outs to alcohol related incidents is available, this is of limited use in its current format. In quarter 1 of 2010/11, West Midlands Ambulance Service attended 499 overdose/poisoning/ingestion incidents in Warwickshire. However, it is not possible from the data provided to extract the number of 14

15 incidents related to alcohol (all substances including, for example, accidental overdose of household cleaning products are included within the statistics). There is also no data on individual cases available to enable practitioners to establish whether individuals seen by the ambulance service are already known to treatment providers. Recommendation: Work with West Midlands Ambulance Service to establish what additional data can be provided to enable: a) specific information relating to alcohol to be extracted and b) the cross referencing of cases seen by the ambulance service with those known to treatment providers Accident and Emergency Presentations Data is collected in each hospital Accident and Emergency (A&E) Department on the presenting complaint of patients. Within the overall category of poisoning is a sub category for other, including alcohol. This category covers all poisonings not related to prescriptive, proprietary or controlled drugs. As with the ambulance statistics, the way the data is captured means that it is not possible to gain a completely accurate understanding of the number of people presenting at A&E Departments with alcohol related complaints. Recommendation: NHS Warwickshire to explore the possibility of establishing recording systems which enable alcohol related A&E presentations to be reliably identified. The chart below shows the number of presentations at each A&E department for poisonings other, including alcohol in A&E Presentations, by Hospital and Outcome George Eliot S Warks UHCW Hospital Admitted Discharged (Source: NHS Warwickshire) 1 UHCW is University Hospitals Coventry and Warwickshire, covering hospitals in Coventry and Rugby. The data available does not make it possible to split the hospitals. 15

16 This chart shows that the number of presentations at George Eliot Hospital was much higher than that at University Hospitals Coventry and Warwickshire or South Warwickshire Hospitals Trust. A recording system that enabled alcohol related A&E presentations to be reliably identified across all hospitals would also enable us to assess if this apparent difference reflects the actual picture or is a product of how the data is recorded around the county. Appropriate interventions designed to reduce alcohol related A&E admissions could then be put in place in priority areas. Data for all poisonings is available, broken down by day and time of presentation. This presents a mixed picture, with the peak days for admission being Friday, Saturday and Sunday at South Warwickshire, Sunday, Thursday and Saturday at George Eliot but Monday, Tuesday and Wednesday at UHCW. Peak admission times are generally early evening through into early morning, which would be consistent with individuals presenting with alcohol related conditions following an evening out. However, as this data is for all poisonings, it does not enable firm conclusions about alcohol related presentations to be drawn Alcohol Related Mortality The ultimate harm that can be caused by the misuse of alcohol is death. Although it is difficult to accurately assess the numbers of deaths caused by, or related to, alcohol misuse, Coroners records do provide an idea of the numbers involved. In 2009/10, 1906 deaths were reported to the coroner in Warwickshire. Of these, 35 (1.8%) were recorded as alcohol related deaths. Data on alcohol related deaths can also be collated from the Office for National Statistics (ONS) Public Health Mortality File (PHMF). Data for 2007, 2008 and 2009 shows that the total number of alcohol related deaths amongst females is small, and declined from 17 in 2007 to 11 in The available data does show that deaths amongst the and age groups declined over the three year period, whilst deaths amongst the slightly younger age group increased. No similar obvious patterns emerge for male alcohol related deaths, where numbers are slightly higher (a total of 130 over the three year period, peaking at 54 in 2009). As with females, the majority of the deaths occurred amongst year olds. It can be inferred that these deaths occurred due to problems caused by alcohol use over many years but further investigation into the specific causes of death would be required to enable any firm conclusions to be drawn. The Local Alcohol Profiles contain information on alcohol attributable mortality for males and females by District and Borough. The latest data (for 2008) shows that rates were highest for males in Warwick District and females in Stratford District. 16

17 Alcohol Attributable Mortality - Rate per 100,000 (2008) Rate per 100, North Warks Nun & Bed Rugby Stratford Warwick Males Females District / Borough (Source: North West Public Health Observatory Local Alcohol Profiles) The rate of alcohol attributable mortality has remain fairly constant in Warwickshire over the previous few years, rising for males from 35.4 per 100,000 in 2004 to 38.2 per 100,000 in 2008 and for females from 15.3 per 100,000 in 2004 to 16.6 per 100,000 in

18 3.3 Crime, Anti-Social Behaviour and Fire Violent Crime Where offences reported to Warwickshire Police are judged to be related to alcohol and/or drugs, they are marked with an alcohol/drugs flag. It is not possible to separate alcohol and drug related offences. However, it can be inferred that the majority of violent crime with an alcohol/drugs flag will be associated with drinking and the night time economy. Recommendation: Warwickshire Police to explore the possibility of establishing recording systems which enable alcohol and drug related offences to be separated. In 2009/10 there was a total of 5,290 violence against the person offences in Warwickshire. Of these, 2,106 (39.8%), were marked with an alcohol/drugs flag. The table below shows how this breaks down to a District / Borough level. Violence against the person offences 2009/ N Warks Nun & Bed Rugby Stratford Warwick Total violence against the person offences Alcohol / Drug related (Source: Warwickshire Police) Both the number of violence against the person offences and the percentage that were marked with an alcohol/drugs flag reduced in 2009/10 compared to 2008/09. In 2008/09 there were 5,962 violence against the person offences, of which 2,613 (43.8%) were marked with an alcohol/drugs flag Fixed Penalty Notices Fixed Penalty Notices (FPNs) are utilised by the Police to deal with lower level offences on the spot. Again, Warwickshire Police record the number of incidents which result in the issuing of a FPN and are deemed to be alcohol/drugs related, but do not separate 18

19 the two. In 2009/10, 213 FPNs were issued and marked with the alcohol/drugs flag. The chart below shows the distribution of these FPNs over the course of the year, with a peak in June and July and a smaller spike in November and December. Fixed Penalty Notices with an alcohol/drugs flag 2009/ FPNs with an alcohol/drugs flag Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar (Source: Warwickshire Police) Warwickshire Police also record the crimes for which the FPNs are issued, as can be seen in the table below. Offence type Number issued in 2009/10 Serious Sexual Offences 1 Common Assault 1 Public Fear, Alarm or Distress 119 Harassment 0 Drug Offence 49 Theft 0 Shoplifting 20 Criminal Damage 21 Other offences against the State or public order 2 Other 0 All Crime 213 (Source: Warwickshire Police) All Crime The Local Alcohol Profiles produced nationally do provide some information on crime that is specifically alcohol related. This is calculated by applying attributable fractions for alcohol for each crime category, based on survey data of arrestees who tested positive for alcohol. 19

20 Using this methodology, there were 3,008 crimes attributable to alcohol in 2009/10. This represents a reduction from 2008/09, when 3,382 crimes were attributable to alcohol. The chart below provides a breakdown of the 2009/10 offences by District / Borough. Crimes attributable to alcohol 2009/ N Warks Nun & Bed Rugby Stratford Warwick (Source: North West Public Health Observatory Local Alcohol Profiles) Anti-Social Behaviour The overall number of Anti-Social Behaviour (ASB) incidents reported to Warwickshire Police decreased by 14.1% in 2009/10 (25,749 incidents), when compared to 2008/09 (29,966 incidents). This reduction followed a significant decrease during 2008/09, when figures for that year are compared to those for 2007/08. Street drinking sits as a sub-category within the overall recording code of ASB and can be used to give an idea of the levels of ASB that are directly linked to alcohol. It should be noted that many of the incidents recorded as rowdy/nuisance behaviour, which make up the majority of ASB calls to Warwickshire Police, may be alcohol related but this cannot always be determined based on the information available at the time of the report. In line with the overall figures for ASB, recorded incidents of street drinking fell by 11.4% in 2009/10 (when compared to 2008/09). The table below shows the reductions seen at a District / Borough level. Street Drinking Incidents District / Borough Breakdown 2008/ /10 Percentage Reduction N Warks % Nun & Bed % Rugby % Stratford % Warwick % Warwickshire % (Source: Warwickshire Police) 20