Interesting things about alcohol and other drugsAugust 2016ANDREW BROWN@ANDREWBROWN365

Monitoring of alcohol consumption in primary care among adults with bipolar disorder

Apr 2000 - March 2002

Apr 2002 - March 2004

Apr 2004 - March 2006

Apr 2007 - March 2009

Apr 2009 - March 20011

Apr 2011 - March 2013

0100200300400500600700800900

88.6168.3

244.7307.5

388

837.4People with bipolar disorder People without servere mental illness

Rate

of a

lcoh

ol r

ecor

ding

per

10

00 p

erso

n-ye

ars 

The current high alcohol recording rates in people with bipolar disorder is very encouraging, especially given evidence that assessment of alcohol use alone (without subsequent intervention) can lead to reductions in hazardous drinking (Kypri et al., 2007, McCambridge and Day, 2008, McCambridge and Kypri, 2011). Nevertheless screening is just a first step in the management of AUDs in people with bipolar disorder. To fully address the high prevalence of AUDs in this population, appropriate effective interventions need to be delivered, where indicated by the screening. Further research is needed to determine the extent to which alcohol interventions are implemented in people with bipolar disorder.

SMI QOF in effect

Alcohol screening added in SMI QOF

Source: Monitoring of alcohol consumption in primary care among adults with bipolar disorder: A cross-sectional and retrospective cohort study, Hardoon, Sarah L. et al. Journal of Affective Disorders , Volume 198 , 83 - 87

Proportion of injecting drug users who are under 25 in Unlinked Anonymous Monitoring Survey

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150%

2%

4%

6%

8%

10%

12%

14%

16% 15%14%

15%

13% 13%

11%

9% 9%

6% 6%

4%

Source: People who inject drugs: HIV and viral hepatitis monitoring

Hepatitis C prevalence in people who inject drugs by age; England, Wales and Northern Ireland

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150%

10%

20%

30%

40%

50%

60%

70%Under 25 25 to 34 35 and over The prevalence of antibodies to the hepatitis

C virus (anti-HCV) among the survey participants across England, Wales and Northern Ireland was 50% (95% CI, 49%-52%) in 2015. This is significantly higher than the anti-HCV prevalence of 45% (95% CI, 44%-47%) seen in 2005, but similar to the prevalence in 2013 and 2014. However, the level seen during the last decade, though a little higher than at the end of the 1990s, is much lower than those found in the early 1990s when prevalence was over 60%. By country, anti-HCV prevalence in 2015 was as follows: Northern Ireland, 27% (95% CI, 21%-35%); Wales, 53% (95% CI, 47%-59%); and England, 52% (95% CI, 50%-54%).

Source: People who inject drugs: HIV and viral hepatitis monitoring

In 2009 a phased change in the sample type from oral fluid to dried blood spot (DBS) started. The sensitivity of the anti-HCV tests on these two sample types are different.

Levels of needle and syringe sharing and injection into the groin among the participants in the Unlinked Anonymous Monitoring Survey of PWID who had injected during the preceding four weeks

Londo

n

East o

f Eng

land

South

East

South

West

West Midla

nds

North W

est

Yorks

hire &

Humbe

r

East M

idland

s

North E

astWale

s

Northe

rn Ire

land

0%

10%

20%

30%

40%

50%

60%

15% 16%21% 22%

4%

15% 15%19% 16% 13%

17%24%

36% 37%42%

32%

46% 48%

29%

39% 40%46%

Direct Sharing Injecting into groin

Source: People who inject drugs: HIV and viral hepatitis monitoring

Together, these findings indicate that unsafe injecting continues to be a problem and that there is a need to maintain and strengthen public health interventions that aim to reduce injection related risk behaviours. The impact of public health interventions which aim to prevent HIV and hepatitis C infection through injecting drug use by reducing these risks, such as needle and syringe programmes and opiate substitution therapy, have been shown to be dependent on their coverage. The provision of interventions that aim to reduce infections among PWID should be regularly reviewed to ensure that the coverage of these is appropriate to local need.

Characteristics of people who inject drugs in 2015 in England, Wales and Northern Ireland

Ever b

een in

priso

n

Ever b

een h

omele

ss

Ever tr

aded

sex f

or mon

ey, go

ods o

r drug

s

Curren

tly in t

reatm

ent fo

r drug

use

Ever u

sed a

need

le exch

ange

0%20%40%60%80%

100%

67% 74%

13%

70%90%

Source: People who inject drugs: HIV and viral hepatitis monitoring

Number of attendances at A&E in England recorded as having social problems (including chronic alcoholism and homelessness)

2013-14 2014-1538,500

39,000

39,500

40,000

40,500

41,000

39,507

40,867Please note:

During the period covered (2013-14 and 2014-15) not all NHS trusts have provided data submissions to A&E HES and data quality can be poor for some fields. 

Source: Accident and Emergency Attendances in England - 2014-15

% change in the number of offences recorded, by offence type, in England and Wales between year ending March 2015 and year ending March 2016

Violence

again

st the

perso

n

Theft

offen

ces

Posse

ssion

of wea

pons

offen

ces

-20.0%-10.0%

0.0%10.0%20.0%30.0%40.0%

27.5%20.6%

1.3% 0.3%7.2%

-13.1%

16.4%

28.3%21.0%

Source: Crime outcomes in England and Wales 2015 to 2016

Trafficki

ng of

drug

s

Posses

sion o

f drug

s0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

25,402

122,155

Number of drug of -fences recorded

Number and proportion of permanent and fixed term exclusions for drug or alcohol from secondary schools in England

2008 - 2009

2009 - 2010

2010 - 2011

2011 - 2012

2012 - 2013

2013 - 14

2014 - 15

200

250

300

350

400

450

500

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

360 370 290 330 360 410 480

6.30%7.30%

6.50%7.50%

9.20%10.30%10.00%

Permanent exclusionsTotal drug and alcohol related exclusionsPercentage of exclusions that were drug and alcohol related

2008 - 2009

2009 - 2010

2010 - 2011

2011 - 2012

2012 - 2013

2013 - 14

2014 - 15

6,000

6,500

7,000

7,500

8,000

8,500

9,000

0.00%

0.50%

1.00%1.50%

2.00%

2.50%

3.00%3.50%

4.00%

8,220 8,470 7,570 7,360 6,590 7,280 7,900

2.70%3.00% 2.80% 2.90% 3.10%

3.50% 3.30%

Fixed term exclusionsTotal drug and alcohol related exclusionsPercentage of exclusions that were drug and alcohol related

Source: Permanent and fixed-period exclusions in England: 2014 to 2015

Number of prescription items for the treatment of alcohol dependence dispensed in the community in England

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

20,00040,00060,00080,000

100,000120,000140,000160,000180,000200,000

Prescribed in primary care Prescribed in NHS hospitals

Source: Statistics on Alcohol, England 2016 (HSCIC)

Prescription items for the treatment of alcohol dependence per 100,000 population by Commissioning Region

North of England Midlands and East of England

London South of England0

100

200

300

400

500

600549

289

194280

Pres

crip

tions

per

10

0,00

0

Source: Statistics on Alcohol, England 2016 (HSCIC)

Babies Born In England diagnosed with neonatal abstinence syndrome.

2012 2013 2014 20150

100200300400500600700800900

1000934 897 849

789

Neonatal abstinence syndrome (NAS) is a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother’s womb.

[It] may occur when a pregnant woman takes drugs such as heroin, codeine, oxycodone (Oxycontin), methadone or buprenorphine.

These and other substances pass through the placenta that connects the baby to its mother in the womb. The baby becomes dependent on the drug along with the mother.

Source: Medline Plus

Source: BBC Analysis/Freedom Of Information Requests

Change in local government budgeting for substance misuse services

2015-16 2016-17 £-

£100,000,000 £200,000,000 £300,000,000 £400,000,000 £500,000,000 £600,000,000 £700,000,000 £800,000,000 £900,000,000

£1,000,000,000

£558,864,000 £408,451,000

£208,059,000

£183,296,000

£62,466,000 £56,534,000

£141,434,000

£104,983,000

£72,178,000 £38,835,000

Stop smoking services and interven-tions

Specialist drug and alcohol misuse services for children and young people

Preventing and reducing harm from alcohol misuse in adults

Preventing and reducing harm from drug misuse in adults

Treatment for alcohol misuse in adults

Treatment for drug misuse in adults

Source: Local authority revenue expenditure and financing (DCLG)

Offenders aged between 14 and 20 found guilty at all courts of drug offences, England and Wales

2011 2012 2013 2014 20150

2,0004,0006,0008,000

10,00012,00014,00016,000

13,719

11,74810,584

9,2078,395

Source: Ministry of Justice written question – answered on 5th July 2016

Proportion of cannabis used with tobacco by country

AustriaBelgium

FranceGermanyHungary

Republic of IrelandDenmarkPortugal

SpainNetherlandsSwitzerland

United KingdomBrazil

United StatesCanadaMexico

AustraliaNew Zealand

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%89%91%

88%87%89%

81%87%

90%86%88%

91%77%

7%4%

16%7%

52%21% “Our results are consistent with…

other previous research suggesting tobacco smoking is more problematic for those who also use cannabis, and we were also able to adjust for the frequency of cannabis and tobacco use. Our results suggest that tobacco routes of administration are associated with a reduced motivation to use less tobacco and more negative effects of cannabis, which may account for the poor tobacco-related cessation reported previously.”

Source: Hindocha C, Freeman TP, Ferris JA, Lynskey MT and Winstock AR (2016) No Smoke without Tobacco: A Global Overview of Cannabis and Tobacco Routes of Administration and Their Association with Intention to Quit. Front. Psychiatry 7:104. doi: 10.3389/fpsyt.2016.00104

Average treatment costs for those engaged by the liaison and diversion trial

Substance misuse Alcohol misuse Mental health £-

£200 £400 £600 £800

£1,000 £1,200 £1,400 £1,600 £1,800

£1,606 £1,505

£1,236

Source: Evaluation of the Offender Liaison and Diversion Trial Schemes

Level of need identified and numbers accepting and declining contact in offender liaison & diversion trial

Gang involvementSocial and communication difficulty

Learning disabilityFinancial

Abuse victimPhysical disability

AccomodationSuicide / self-harmSubstance misuse

AlcoholMental health

02,0

004,0

006,0

008,0

0010

,000

12,00

0

Accepted Declined Among those with a mental health need identified the most prevalent mental health category was depressive illness (34%), with schizophrenia or other delusional disorder being the second most prevalent (22%). There was the option of identifying and recording more than one mental health need. The majority of cases (77%) were identified as having only one mental health need, 20 per cent were identified as having two different needs, while three per cent were identified with three.

Source: Evaluation of the Offender Liaison and Diversion Trial Schemes

Prisoners saying that they had a problem with drugs or alcohol on arrival in prison

Alcohol Drugs0%5%

10%15%20%25%30%35%40%45%

30%

41%

16%

25%

Women Men

Source: HM Chief Inspector of Prisons for England and Wales Annual Report 2015–16

It is easy/very easy to get drugs/alcohol in this prison

Alcohol Drugs0%5%

10%15%20%25%30%35%40%

Women Men

Source: HM Chief Inspector of Prisons for England and Wales Annual Report 2015–16

Local prisons

Category B training prisons

Category C training prisons

Young adult prisons

Open prisons

0% 20% 40% 60%

36%

31%

42%

31%

34%

Drugs