Reducing the costs from alcohol–related harm

Risk Men Women

Lower Risk

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

4 or more units per day on a regular basis

3 or more units per day on a regular basis

Higher Risk

8 or more units per day on a regular basis or 50+ units per week

6 or more units per day on a regular basis or 35+ units per week

15% 60% 6.9m16.5%

2.2m5.2%

6.9m16.5%

1.6m3.8%

26.3m62.5%

Source: General Household Survey 2009 & mid-2009 population estimates (ONS) & Adult Psychiatric Morbidity Survey 2007

6.6m15.8%

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7% of all hospital admissions ◦ In 2009/10 there were around 1.1 million alcohol

related hospital admissions◦ an increase of 12% compared with 2008/9.

Up to 35% of all A&E attendance and ambulance costs may be alcohol-related◦ Up to 70% of A&E attendances at peak times

on the weekends (between midnight and 5am) may be alcohol-related

Alcohol misuse is calculated to cost the health service £2.7bn per annum

Between 15,000 and 22,000 premature deaths annually in England and Wales each year

Nearly 5,000 (3.5%) cancer deaths per annum are attributable to alcohol ◦ Cancers of the oral cavity and pharynx, larynx,

oesophagus and liver ◦ Suggestive but inconclusive data for role in rectal and

breast cancer A severe risk of cardiovascular disease

◦ 1,200 associated deaths per year due to haemorrhagic stroke

◦ 10% of deaths due to hypertension Liver Cirrhosis is now the 5th most common cause of

death and continues to rise ◦ The top 4 conditions – HD, CVD, Chronic Lung Disease and

Cancer deaths are all falling. ◦ Alcohol accounts for 58% of all Liver Disease ◦ 4,500 deaths, a 90% increase over the past decade

986,000 violent incidents in England and Wales in 2009/10, where the victim believed the offender to be under the influence of alcohol (50% of all violent crimes) (Flatley et al., 2010)

Nearly half of all offences of criminal damage are alcohol-related alcohol is implicated in domestic violence, sexual assaults, burglary, theft

robbery and murder (Prime Minister‘s Strategy Unit, 2003) In 2008 estimated 13,020 reported road casualties (6% of all road

casualties) occurred when someone was driving whilst over legal limit. The provisional number of people estimated to have been killed in drink-

drive accidents was 430 in 2008 (17% of all road fatalities) (Department of Transport, 2009)

Approximately two thirds of male prisoners and over a third of female prisoners are hazardous or harmful drinkers and up to 70% of probation clients are hazardous or harmful drinkers (Singleton, et al., 1998)

Identify those at risk

Deliver Brief Advice to those drinking at increasing and higher risk

Refer Dependent Drinkers to Specialist Services

Opportunistic alcohol case Identification and the delivery of Brief Advice (IBA)

is the same as

Screening and Brief Interventions for alcohol misuse (SBI)

Alcohol risk levels can be quickly ascertained using a simple screening tool

Developed by WHO Validated screening tool High specificity (94%) High sensitivity (92%) Adapted version for the UK Various shortened adaptations for pre-

screening More accurate and economical than most

bio-chemical tests

Feedback - provides feedback on the client’s risk for alcohol problems

Responsibility - the individual is responsible for change

Advice - advises reduction or gives explicit direction to change

Menu - provides a variety of options for change Empathy - emphasises a warm, reflective and

understanding approach Self-efficacy - encourages optimism about

changing behaviour

The recommended brief intervention is 5 minutes of advice developed by the WHO

In the UK, the University of Newcastle had refined this into a programme called How Much Is Too Much?

Content◦ Understanding units◦ Understanding risk levels◦ Knowing where they sit on the risk scale◦ Benefits of cutting down◦ Tips for cutting down

Benefits of cutting downBenefits of cutting down

Physical Reduced risk of injury Reduced risk of high blood

pressure Reduced risk of cancer Reduced risks of liver

disease Reduced risks of brain

damage Sleep better More energy Lose weight No hangovers Improved memory Better physical shape

Psychological/Social/Financial

Improved mood Improved relationships Reduced risks of drink

driving Save money

Have an alcohol-free day once or twice a week Plan activities and tasks at those times you usually

drink When bored or stressed have a workout instead of

drinking Explore other interests such as cinema, exercise, etc. Avoid going to the pub after work Have your first drink after starting to eat Quench your thirst with non-alcohol drinks before

alcohol Avoid drinking in rounds or in large groups Switch to low alcohol beer/lager Avoid or limit the time spent with “heavy” drinking

friends

There are times when you will be at risk even after one or two units. For example, with strenuous exercise, operating heavy machinery, driving or if you are on certain medication.

If you are pregnant or trying to conceive, it is recommended that you avoid drinking alcohol. But if you do drink, it should be no more than 1-2 units once or twice a week and avoid getting drunk.

Your screening score suggests you are drinking at a rate that increases your risk of harm and you might be at risk of problems in the future.

What do you think?

This is one unit...

Half pint of regular

beer, lager or cider

1 very small glass of

wine

1 single measure of

spirits

1 small glass of sherry

1 single measure of

aperitifs

How many units did you drink

today?

A pint of regular

beer, lager or cider

A pint of “strong”/

”premium” beer, lager

or cider

Alcopop or a 275ml bottle

of regular lager

440ml can of “regular” lager or

cider

440ml can of “super

strength” lager

250ml glass of wine (12%)

Bottle of wine

...and each of these is more than one unit

Risk Men Women Common Effects

Lower Risk No more than 3-4 units per day on a regular basis

No more than 2-3 units per day on a regular basis

Increased relaxationSociabilityReduced risk of heart disease (for men over 40 and post menopausal women)

Increasing Risk

More than 3-4 units per day on a regular basis

More than 2-3 units per day on a regular basis

Progressively increasing risk of: Low energy•Memory loss•Relationship problemsDepressionInsomnia•Impotence•Injury•Alcohol dependence•High blood pressure•Liver disease•Cancer

Higher Risk More than 8 units per day on a regular basis or more than 50 units per week

More than 6 units per day on a regular basis or more than 35 units per week

(9%)

“regular”

3

(12%)

For more detailed information on calculating units see - www.units.nhs.uk/

Making your plan•When bored or stressed have a workout instead of drinking•Avoid going to the pub after work•Plan activities and tasks at those times you would usually drink•When you do drink, set yourself a limit and stick to it•Have your first drink after starting to eat•Quench your thirst with non-alcohol drinks before and in-between alcoholic drinks•Avoid drinking in rounds or in large groups•Switch to low alcohol beer/lager•Avoid or limit the time spent with “heavy” drinking friends

The benefits of cutting downPsychological/Social/Financial•Improved mood•Improved relationships•Reduced risks of drink driving•Save moneyPhysical•Sleep better•More energy•Lose weight•No hangovers•Reduced risk of injury•Improved memory•Better physical shape•Reduced risk of high blood pressure•Reduced risk of cancer•Reduced risks of liver disease•Reduced risks of brain damage

What targets should you aim for?MenShould not regularly drink more than 3–4 units of alcohol a day. WomenShould not regularly drink more than 2–3 units a day

‘Regularly’ means drinking every day or most days of the week.You should also take a break for 48 hours after a heavy session to let your body recover.

This brief advice is based on the “How Much Is Too Much?” Simple Structured Advice Intervention Tool, developed by Newcastle University and the Drink Less materials originally developed at the University of Sydney as part of a W.H.O. collaborative study.

What’s everyone else like?

% of Adult Population

What is your personal target?

Population by Risk Category

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Abstaining Lower risk Increasingrisk

Higher risk

Male

Female

There is a very large body of research evidence 56 controlled trials (Moyer et al., 2002) all have

shown the value of IBA A recent Cochrane Collaboration review (Kaner et

al., 2007) shows substantial evidence for IBA effectiveness

For every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels (Moyer et al., 2002)

This compares favourably with smoking where only one in twenty will act on the advice given (Silagy & Stead, 2003)

Staffing and staff attitudes◦ Don’t have time◦ Not my job◦ Uncomfortable commenting on patient’s personal

life◦ To close to home◦ Don’t feel trained to intervene◦ Don’t believe it will do any good

Focus on dependence

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Not my job◦ ‘Every contact counts’◦ reduces problems caused by alcohol

Training◦ Less is more◦ E-learning

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The SIPS study recently published findings of three randomised control trials on IBA using various screening tools, levels of intervention and in three different settings.◦Primary Care◦A&E◦Probation

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In probation Training crucial Alcohol Health Worker support crucial Senior management buy in crucial

But IBA can be equally effective in a non-health setting if adequately supported and delivered by well trained practitioners

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IBA e-Learning module & Alcohol Learning Centre http://www.alcohollearningcentre.org.uk/

NICE guidancehttp://guidance.nice.org.uk/PH24http://guidance.nice.org.uk/CG115

Primary Care Frameworkhttp://www.pcc.nhs.uk/alcohol

SIPS Research Programmehttp://www.sips.iop.kcl.ac.uk/index.php

Materials, Units Calculator and Drink Check http://www.nhs.uk/LiveWell/Alcohol/Pages/

Alcoholhome.aspx

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