Focus on... Alcohol October 2012

Transcription

1 A project by: Focus on... Alcohol October 2012 Alcohol plays an important role in many aspects of society. The majority of people who drink, do so in a way that is unlikely to cause harm. However, a significant minority are drinking above recommended safe levels. Drinking above recommended safe levels increases the risk of harm to health, and is a factor in a number of long-term conditions including high blood pressure, heart disease, stroke, some cancers, and liver disease. Drinking too much alcohol is a factor in many early deaths. There are also a number of social harms associated with alcohol misuse, including alcohol-related crime and antisocial behaviour, domestic violence, and child abuse and neglect. Drinking too much can also have adverse effects on relationships, work, studies, social life and neighbourhoods. Key facts and figures 55 alcohol-related deaths in Islington each year ,426 ambulance callouts for alcohol-related incidents in Islington each year. 2011/12 Key issues for Islington 4,256 hospital admissions wholly or partly due to alcohol, each year. 2011/12 1,926 alcohol-related crimes recorded in Islington each year. 2011/12 Islington had the third highest rate of alcohol-specific deaths among men in London in Islington has the highest rate of alcohol-related hospital admissions in London. This cost nearly 7.5 million in 2008/09, which amounts to 39 for every person who lives in the borough. Islington had the seventh highest rate of alcohol-related violent crime in London in 2011/12. Key programmes and services Screening and brief interventions for alcohol misuse are provided by GP practices when people register, and as part of NHS health checks. They are provided at A&E, urgent care centres, and medical assessment units in hospitals. Screening and brief interventions are also provided in criminal justice settings including custody suites, probation and prison. There is a Community Alcohol Service in Islington, and a Primary Care Alcohol and Drugs Service works across GP practices. Specialist alcohol treatment services are also available in the borough. Key measures for reducing inequalities Addressing inequalities in alcohol misuse outcomes is a key priority for Islington, and includes: Providing people with increasing or higher-risk alcohol use with screening and brief interventions. Raising awareness of alcohol-related harm, particularly in deprived communities, and in communities or groups where alcohol use may be hidden.

2 Key population groups Gender Men are more likely to drink alcohol than women. Furthermore, men who drink alcohol generally consume more than women who drink alcohol. However, over the last two decades, the frequency and amount of alcohol consumed by women has increased at a faster rate than the amount consumed by men. Age Average alcohol consumption is lower among older people compared to other adults. The contribution of alcohol to age-related problems such as falls or memory loss may be overlooked or ignored by professionals. Middle-aged groups (45 years and over) drink more regularly than younger adult age groups, and younger adults are more likely to binge drink compared to all other age groups. Ethnicity Alcohol consumption is lower among many ethnic communities compared to the general population. This is often due to cultural or religious customs. These customs can be different for men and women, and may lead to hidden drinking. Socio-economic group The amount and frequency of alcohol consumption tends to rise in line with household income. But high-risk and dependent drinking is more common in lower socio-economic groups. Alcohol-attributable hospital admissions are significantly higher in lower socio-economic groups in Islington. People living in the most deprived areas are about 30% more likely to have an alcohol-related admission than those living in more affluent areas. Other groups are often at increased risk of harm from others alcohol misuse, including partners, carers, and children. What influences alcohol consumption? Affordability of alcohol index 160% 150% 140% 130% 120% 110% 100% 90% 80% Affordability index of alcohol, Year Alcohol consumption also tends to increase with the number of licensed premises in a given area (density). It also tends to increase with longer hours of sale, including 24 hours a day, seven-day-a-week licenses. As well as greater availability, research shows that new licensed premises increase competition, reducing alcohol prices which tends to lead to increased consumption. Islington has the third highest density of licensed premises in London, with particular concentrations in some areas such as Angel/Upper Street and south Clerkenwell more affordable less affordable The availability and price of alcohol has a great influence on levels of consumption. One of the key factors contributing to an increase in alcohol consumption is the rise in disposable income relative to the price of alcohol. The graph to the left shows that, compared to 1980, alcohol is now 45% more affordable. Although alcohol prices increased by 24% more than retail prices generally, per-capita adult income increased by 79% over the same period.

3 The Islington Picture In 2011, data showed that in Islington 73% of adults (aged 18 and over) who are registered with a GP, have had their alcohol consumption risk recorded. In the previous 15 months, a greater proportion reported abstaining and/or drinking at lower risk levels than estimates based on the national General Lifestyle Survey would suggest. This may be because patients under-report the amount that they are drinking. Alcohol consumption of patients aged 18 and over in Islington, recorded in the last 15 months, % 37% 56% 6% Abstainers Low-risk Increasing risk Higher risk Percentage of the drinking population age 16+ that binge drink, by London borough, 2008 Percentage of people Source: LAPE, Breakdown of alcohol consumption by age group, London, 2012 Percentage 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% City of London Hammersmith and Kensington and Chelsea Westminster Wandsworth Islington Camden Richmond upon Thames Lambeth Kingston upon Thames Southwark Sutton Greenwich Barking and Dagenham Haringey Bromley Merton Lewisham Hackney Havering Bexley Enfield Hounslow Waltham Forest Barnet Hillingdon Croydon Ealing Tower Hamlets Redbridge Brent Harrow Newham Who drinks alcohol? London borough Age range Never drinks alcohol Drinks once a month or more Drinks every 1-2 weeks Drinks every 2-5 days Drinks daily Source: General Lifestyle Survey 2010, Office for National Statistics (ONS) London average England average Binge drinking is defined as men drinking eight or more units in a single session or women drinking six or more units in a single session. Around one in five Islington adults binge drinks. The graph to the left shows that Islington has the 6th highest proportion of binge drinkers in London, higher than the average proportion in London, but similar to the average in England. The graph to the left shows that daily drinking increases with age. Drinking every two to five days is more common among middle-aged people (45-54 and year olds). 3.4% of year olds drink daily (about 200 people). This is lower than any other age group % of year olds abstain from drinking, a higher proportion than any other age group. 2010

4 Contribution of alcohol to the development of alcohol-related conditions Alcohol contributes to more than 60 health conditions. In some conditions, alcohol plays a small part and there may be several other factors that contribute. In other conditions, such as liver disease, alcohol plays a much more important role in the development of disease. The table below shows how harmful alcohol use (drinking over the recommended levels on a weekly basis, and experiencing harm as a result) contributes to the risk of developing the following conditions: Condition Men (increased risk) Women (increased risk) High Blood Pressure 4 times Double Stroke Double 4 times Coronary Heart Disease 1.7 times 1.3 times Pancreatitis 3 times Double Liver Disease 13 times 13 times Identification and brief advice for alcohol use disorders Identification (screening) and brief advice (IBA) is an evidence-based intervention that reduces alcohol consumption, alcohol-related death and ill health, alcohol-related injuries, alcohol-related social harm and the use of health services for alcohol-related issues. Identification and brief advice is offered at most GP practices when new patients register, or as part of the NHS health check programme for 35 to 74 year olds. In Islington, NHS health checks are also provided in some community pharmacies and community settings. Hospitals are offered incentives to deliver IBA in accident and emergency departments, urgent care centres and medical assessment units. IBA is also delivered in criminal justice settings in Islington, including police custody suites and probation. Hospital admissions 35% of people who had an NHS health check reported drinking patterns that required further Aug 2011 April 2012 investigation. Directly standardised rate of alcohol-related and specific hospital admissions, Islington, 2011/12 Directly standardised rate per 100,000 population 4,000 3,500 3,000 2,500 2,000 1,500 1, Men Women Persons Men Women Persons Alcohol-related Alcohol-specific Source: SUS 2011/12 Islington has the highest rate of alcohol-related hospital admissions in London. The graph shows that men are more likely to be admitted for both alcohol related and alcohol specific conditions than women. In 20011/12, there were 2,707 admissions for alcohol-related conditions among men and 1,549 among women. This is equivalent to 9% of all admissions. For alcohol-specific admissions, numbers were much higher among men (932) compared to women (379).

5 What do local people think about the issue? Londoners top concerns about alcohol-related harm are crime (72%) and antisocial behaviour (58%). Ahead of concerns over long-term health impacts such as liver disease (48%) and short term health issues such as hangovers (33%). Islington Council s Place Survey 2009/10 shows that 42% of residents thought people being rowdy or drunk in public places was a problem (compared to 38% in 2003/4). This is significantly more than in London as a whole (36%) or England (29%). What works? Advice on sensible drinking limits plays an important role in alcohol education. People want clear, concise and consistent messages explaining the health risks of alcohol consumption. Increases in alcohol tax/price are associated with reductions in alcohol consumption, alcohol-related ill health and a range of alcohol-related criminal activity and offences. Responsible management of the drinking environment can help reduce crime and disorder in licensed premises. There is a lot of evidence supporting IBA in primary care. One in eight people drinking at increasing or higher risk who receive advice will reduce their drinking to within lower-risk levels. Patients presenting for alcohol-related reasons at A&E who received IBA made 50% fewer visits to A&E during the following twelve months, compared to similar patients who did not receive brief advice. There is growing evidence for the effectiveness of IBA in criminal justice settings. Systematic recording of where an assault victim s last drink was purchased or consumed, enables better targeting of enforcement and policing to prevent or reduce alcohol-related violence and crime. Future need Alcohol-related harm is a problem that spans multiple settings, environments and agencies. A joined-up, strategic approach, which includes statutory, community and voluntary organisations, is essential to reduce the significant harms associated with alcohol.

6 Targets and outcomes The Public Health Outcome Framework specifically focuses on alcohol-related admissions to hospital and mortality from liver disease (to which alcohol is a major contributor). It also highlights the contribution of alcohol misuse to the emotional wellbeing of looked after children, hospital admissions for self harm, successful treatment of drug users, and new entrants to prison. Reducing alcohol consumption will also assist with improving outcomes across a number of NHS Clinical Outcomes Framework indicators. Target Deliver 18 alcohol brief advice training sessions to a minimum of 15 people per session in 2012/ people new to treatment in alcohol treatment services during 2012/13 National and local strategies Document or strategy target is taken from Alcohol Brief Advice Training service level agreement Substance misuse commissioning plans Deadline for target March 2013 March 2013 Alcohol has been a priority area for action over the last decade, and a multi-agency cross-cutting approach has been taken to reflect the wide-ranging impacts of alcohol. A national alcohol harm reduction strategy was published in 2004 and updated in The current Government published its alcohol strategy in National strategies The Government s Alcohol Strategy (2012) The Government s alcohol strategy identified the following priority areas: Ending the availability of cheap alcohol and irresponsible promotions, and introducing a minimum unit price for alcohol. Ensuring that local areas have the power to tackle alcohol-related problems locally. Working with the industry to support changes to individual drinking behaviour. Supporting individuals to make informed choices around alcohol use. The Police Reform and Social Responsibility Act (2011) This Act set out a new approach to tackling alcoholrelated crime and disorder. It brings a number of new measures including a levy on late-night licences to cover the cost of increased policing of those venues, flexibility to restrict alcohol sales in the early hours, and increased penalties for persistent under-age sales. Local strategies Islington Alcohol Harm Reduction Strategy This strategy set objectives to raise awareness of the impact of alcohol, reduce alcohol-related crime and disorder, improve case-finding, increase the effectiveness of the local treatment system, and actively engage with licensees. Islington Licensing Policy This policy sets out how the Council as a Licensing Authority promotes the licensing objectives in the Licensing Act It describes the wider context for licensing, standards of management expected, and specific licensing policies. This includes licensing hours, cumulative impact and saturation, and licence reviews. It also states licensing policy in relation to specific areas including Angel/Upper Street, south Clerkenwell, and Kings Cross. Annual Public Health Report (2012) One too many? The impact of alcohol in Islington analyses key data on levels and patterns of consumption of alcohol and its impact on society, health, and crime. It looks at control and availability, and links with crime. It presents a case for change and sets out recommendations for increasing awareness, strengthening enforcement, improving Identification and Brief Advice, and improving treatment services. It sets the context of increased collaborative working and the sharing of data and intelligence.

7 What is being done locally to address the issue? Social harms, licensing and enforcement Islington Council regulates alcohol licenses in line with its licensing policy, which is being revised (2012) Responsible Authorities (including the police, health bodies, fire service and trading standards) and interested parties (residents and businesses) can make representations concerning new applications and variations to existing licenses. Responsible Authorities are able to call for a review of a premises license where there has been a breach of the licensing objectives. A police borough task force works with licensed premises and safer neighbourhood teams to tackle alcohol-related crime and disorder. Multi-agency Geographical Panels in Islington (MAGPIs) bring together police, the parks service, registered social landlords, outreach teams and local residents to tackle alcohol related anti-social behaviour and crime, including that arising from street drinking. Identification and Brief Advice (IBA) Alcohol screening as part of the NHS health check programme showed that between August 2011 and April 2012, 863 people of 3,359 (26%) who were screened had drinking patterns that required further investigation. Among 13,529 patients who registered at GP practices in 2010/11, 1,140 (8%) had drinking patterns that required further investigation. In 2011, alcohol misuse was identified in 1,027 probation cases, 37% of the total number of cases. Treatment services in Islington There are a number of treatment services in Islington, in addition to the work of voluntary agencies providing support to people to reduce or stop their drinking. These are split across four tiers, depending on need. Tier 1 services include IBA delivered in a range of settings, as outlined previously. Tier 2 services offer assessment, brief interventions, safer drinking models and harm reduction. They also offer support around an alcohol misuser s other needs. Services include ICAS (Islington Community Alcohol Service), PCADS (the Primary Care Drug and Alcohol Service) and ISIS (an integrated alcohol and substance misuse service). Tier 3 services are structured treatment centres offering the support of a key worker, care planning and goal setting, psycho-social interventions, community detoxification, and relapse prevention. Services include the ISATS specialist service in addition ICAS, PCADS and ISIS Tier 4 services offer detoxification and rehabilitation at residential centres. Referrals are via the single point of access phone number or . Numbers in alcohol treatment services in Islington decreased from 832 in 2009/10 to 589 in 2011/12. Men accounted for 60% of people in treatment in 2011/12. Exits linked to the ending of non-recurrent funding, from alcohol treatment may be described as successful (or planned) completions, or unplanned exits, where people have dropped out of treatment. In addition, referrals or transfers to other providers can include people who have not successfully completed treatment. In Islington, the proportion of successful/planned exits as a proportion of all exits increased from 30% (124 people) in 2009/10 to 54% (353 people) in 2011/12.

8 Further information Further information on this topic can be found at the following locations: Change4Life has a section for members of the public who may be interested in how they can cut down on alcohol or search for change4life alcohol Drinkaware ( has general information on alcohol, its effects and harms, and sensible drinking The Government s National Alcohol Strategy 2012 is available online at publications/alcohol-drugs/alcohol/alcohol-strategy Islington s Licensing Policy is available online at Leisure-and-culture/Business-planning/Policies/ /( )-Licensing-Policy pdf Islington s Annual Public Health Report, One too many? The impact of alcohol in Islington The Islington Alcohol Harm Reduction Strategy For alcohol statistics for English local authorities, primary care health organisations, regions, and England see the Local Alcohol Profiles for England pages at International statistics and reports are available from the World Health Organisation at About the Evidence Hub The Evidence Hub is a partnership between the local NHS and the Islington Council that brings together information held across different organisations into one accessible place. It provides access to evidence, intelligence and data on the current and anticipated needs of the Islington population and is designed to be used by a broad range of audiences including practitioners, researchers, commissioners, policy makers, Councillors, students and the general public. This profile has been produced by Ian Sandford, Public Health Strategist and signed off by Jonathan O Sullivan, Assistant Director of Public Health. For more information contact ian.sandford@nclondon.nhs.uk or call Islington Public Health