Interesting things about alcohol and other drugsMarch 2017ANDREW BROWN@ANDREWBROWN365

Numbers of adults receiving treatment for drug and alcohol use disorders in prisons and other secure settings in England in 2015-16

Opiate Non-opiate only Non-opiate and alcohol

Alcohol only0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

29,146

10,25912,298

8,551

Source: Adults and young people in secure settings in England: data for 2015-16 (PHE, 2017)

In all, 60,254 adults were in contact with drug and alcohol treatment services within secure settings during 2015-16, and most (56,803) of these were within a prison setting, with 3,124 within YOIs and 327 within IRCs [Immigration Removal Centres]. Just under half (48%) of those in contact with treatment in adult settings presented with problematic use of opiates, a further 37% presented with problems with other drugs (non-opiates) and 14% presented with alcohol as their only problem substance.

Proportion of the population supporting or opposing more treatment for dependent drinkers in England and Scotland

Strongly Oppose

Oppose Neither Support Strongly support

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

4%5%

14%

43%

33%

Focus group findings:

“Participants were more divided on increased funding for treatment services for dependent drinkers. Some felt it was a good idea, ‘I think if someone has got a problem then help’ (E4), but there was also a perception that services were often a waste of public resources and money, with those receiving treatment frequently relapsing. Underlying some of these comments was a feeling that it was the individual who was to blame for their problem; ‘I know people say that it’s an illness, but they get themselves into that state in the first place’ (S3), as well as concern over where the additional funding would come from. This lack of consensus contrasts with the more favourable support within the survey and indicates that though some may believe treatment in principle is beneficial, others may be unconvinced of its overall effectiveness and less sympathetic towards dependent drinkers.”

Li, Jessica, et al. "Public attitudes towards alcohol control policies in Scotland and England: Results from a mixed-methods study." Social Science & Medicine (2017).

It is estimated that the following proportion of a GP’s practice (with 2,000 patients) will have…

Common mental health problems

Psychosis Below diagnositic threshold for

psychosis

Alcohol dependency Drug dependency Personality disorder0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%17.6%

0.4%

6.0% 6.0%

3.0%

8.8%

Source: Mental health in the West Midlands Combined Authority (Centre for Mental Health and University of Birmingham 2017)

Annual public spending for those with three severe and multiple disadvantage profiles, per person 2016-17 prices

Physical health Criminal justice Mental health Prison Rough sleeping Hostels Benefits Substance use treatment

£-

£1,000

£2,000

£3,000

£4,000

£5,000

£6,000

£7,000

£1,916

£6,047

£1,957

£1,235

£5,075

£3,108

£325

£3,108

Source: Faulty by design. The state of public-service commissioning (Reform, 2017)

Proportion of rough sleepers with an assessed need for alcohol, drugs, and/or mental health support in London

Alcohol Drugs Mental health No alcohol, drugs or mental health support needs

0%

10%

20%

30%

40%

50%

60%

42%

33%

46%

28%

48%

39%

48%

19%

Q1 2014/15 Q2 2014/15 Q3 2014/15 Q4 2014/15 Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2015/16 Q1 2016/17 Q2 2016/17 Q3 2016/17

Source: Combined Homelessness and Information Network (CHAIN) quarterly reports (GLA)

Rough Sleeping Statistics Autumn 2016, England

2010 2011 2012 2013 2014 2015 2016 -

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

England London Rest of England Rough sleeping counts and estimates are single night snapshots of the number of people sleeping rough in local authority areas. Local authorities decide whether to carry out a count or an estimate. They are encouraged to gain intelligence for street counts and estimates from local agencies such as outreach workers, the police, the voluntary sector and faith groups who have contact with rough sleepers on the street

Source: Rough sleeping in England: autumn 2016 (DCLG, 2017)

Positive drug tests carried out by Liverpool police on arrest, by drug type (2014-15 vs 2015-16

2014-15 2015-160

500

1000

1500

2000

2500Cocaine only

Opiates only

Both cocaine & opiates

The number of attempted drug tests conducted in Liverpool’s custody suites halved between 2014-15 and 2015-16, while the number of individuals testing positive decreased by around two-fifths (41%). The rationale for targeted testing was to reduce the number of negative tests in order to reduce police time. Although the positive drug test rate has increased, it is only by a small proportion (6%). There are substantially lower numbers of offenders being imposed with an RA and therefore lower numbers of drug using offenders coming into treatment. This is where there is considerable concern by treatment services, commissioners and the Police themselves. This concern is greater still for opiate drug users in Liverpool who are not coming into the treatment system.

Source: Criminal Justice Project: Impact of targeted drug testing on drug using offenders coming into treatment in Liverpool (PHI, 2017)

Number of arrest occasions for high end offenders who were arrested and tested five or more times in 2014- 15, and arrested and tested again in 2015-16

One Two Three Four Five Six Seven Eight -

2

4

6

8

10

12

14

16 15

11

3

9

5

3

1 2

High end offenders (those who presented five or more times) in the May 2014 to April 2015 cohort were matched to successful drug tests across all of Merseyside between May 2015 and April 2016. Of the 59 offenders arrested and tested five times or more in the May 2014 to April 2015 cohort, 49 were tested in Merseyside between May 2015 and April 2016 (83%).

Just under seven in ten (69%) of these offenders presented more than once (n=34), with 11 offenders arrested five times or more. Figures suggest the majority of high end offenders arrested and tested under the Test on Arrest scheme during 2014-15 are being tested through targeted testing, and their number of arrest occasions are reducing.

Source: Criminal Justice Project: Impact of targeted drug testing on drug using offenders coming into treatment in Liverpool (PHI, 2017)

Proportion of violent crime that is perceived by victims to be alcohol-related, combined data from 2013/2014, 2014/15 and 2015/16 CSEW

Morning Afternoon During early evening

(6pm - 10pm)

During late evening (10pm

-midnight)

During night (midnight -

6am)

0%

10%

20%

30%

40%

50%

60%

Time of day

Source: Appendix Tables - focus on violent crime and sexual offences (ONS 2017)

Around the home

Around work Street Pub or club Other location0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Location

Number of homicides in licensed premises

2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-160

10

20

30

40

50

60

52

35 35

27

21

31

1923

27

Source: Appendix Tables - focus on violent crime and sexual offences (ONS 2017)

Age-standardised rates of alcohol-related deaths for males, by region

0.0

5.0

10.0

15.0

20.0

25.0

30.01995 2005 2015 With the exception of London, alcohol-

related death rates have increased in regions of England since the mid-1990s and have tended to be higher in the north of England relative to the south of England. Since the mid-2000s, the alcohol-related death rate has declined in London, which now has one of the lowest alcohol-related death rates, whereas the rate has remained comparatively high in the north of England.

Source: Alcohol-related deaths in the UK: registered in 2015 (ONS, 2017)

Prevalence of self-reported non-prescription medicine (NPM) misuse in a UK population

Yes - past month Yes - more than a month ago

No - never0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

4.6%

13.9%

77.1%n = 393 The lifetime prevalence of any type of

self-reported NPM misuse was 19.3% (n = 76): 11.9% (n = 47) for using a higher dose than recommended, 10.6% (n = 42) for using more often than recommended and 10.6% (n = 42) for using for a longer time than recommended.

Analgesics, with and without codeine, were the most frequently misused products.

Niamh A. Fingleton, Margaret C. Watson, Eilidh M. Duncan, Catriona Matheson; Non-prescription medicine misuse, abuse and dependence: a cross-sectional survey of the UK general population. J Public Health (Oxf) 2017; 38 (4): 722-730. doi: 10.1093/pubmed/fdv204

Does taking drugs (or NPS) predict misuse of non-prescription medicine

Used drugs or 'legal highs' Never used drugs / 'legal highs'0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Ever misused or abused NCM Never misused or abused NCM

Niamh A. Fingleton, Margaret C. Watson, Eilidh M. Duncan, Catriona Matheson; Non-prescription medicine misuse, abuse and dependence: a cross-sectional survey of the UK general population. J Public Health (Oxf) 2017; 38 (4): 722-730. doi: 10.1093/pubmed/fdv204

Years of life lost due to alcohol-related conditions – rate per 100,000

2008 2009 2010 2011 2012 2013 2014 20150

100

200

300

400

500

600

700

800

900

1000

Persons Male Female In 2015 there were an estimated 294,000 years of life lost in England up to the age of 75 ( a rate of 552.3 years lost per 100,000 population). The rate of years of life lost fell by 1.3% in the latest year and has fallen most years since the beginning of the time series (2008). Again the rate for men (797.1 years lost per 100,000 population) is more than double the rate for women (311.3 years lost per 100,000 population).

Source: Local Alcohol Profile for England

Rate of alcohol-related mortality by gender and deprivation decile, England, 2015

1 - most 2 3 4 5 6 7 8 9 10 - least0

10

20

30

40

50

60

70

80

90

Female Male PersonsThe alcohol-related mortality rate for the most deprived 10% of the population was 56.2 per 100,000 population, which is significantly higher than that of the least deprived 10% of the population (35.2 per 100,000 population).

Source: Local Alcohol Profile for England

Numbers of adults in secure settings (prisons, Youth Offending Institutions, and Immigration Removal Centres) in England being treated for use of NPS by type

Predominantly cannabinoid

Other

Predominantly stimulant

Predominantly hallucinogenic

Predominantly sedative/opioid

Predominantly dissociative

0 500 1,000 1,500 2,000 2,500

Six percent of all adults in treatment cited New Psychoactive Substances (NPS) as one of their problem substances, or their only problem substance. This figure represents the number of adults presenting for treatment with problem NPS use and not necessarily a reflection of overall NPS prevalence in adult secure settings.

Source: Adults and young people in secure settings in England: data for 2015-16 (PHE, 2017)

Substance use of all young people in treatment in secure settings, in England in 2015-16

Cannabis

Alcohol

Nicotine

Cocaine

Amphetamines

NPS

Ecstasy

Other

Opiates

Solvents

Crack

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

There were 1,541 young people in specialist substance misuse treatment in a secure setting in 2015-16. The majority (69%) of young people in treatment in secure settings reside in YOIs, with a further 16% residing in Secure Children’s Homes (SCHs), 12% in Secure Training Centres (STCs) and 3% in Welfare Only Homes (WOHs).

Cannabis was the most commonly cited problem substance amongst young people in treatment in secure settings (91% of all in treatment). Around half cited problematic alcohol use (51%). Other substances reported by young people included nicotine (19%), cocaine (19%), amphetamines (9%), ecstasy (8%) and NPS (8%). Two percent of young people cited problematic opiate use.

n = 1,541

Source: Adults and young people in secure settings in England: data for 2015-16 (PHE, 2017)

Vulnerabilities of young people in treatment for substance use in secure settings in England in 2015-16

Poly substance use

High risk alcohol user

Pregnant / parent

Injecting - currently or previously

Opiate and/or crack use

0% 10% 20% 30% 40% 50% 60% 70% 80%

n = 1,172 Young people in custody report a disproportionately higher level of substance misuse than in the young population in general3 and substance misuse is a factor that may exacerbate the additional vulnerabilities experienced by children and young people within the secure estate.

The majority reported poly substance use (72%). Lower proportions reported high-risk alcohol use (4%), pregnant / parent (3%), current or previous injecting (2%), and opiate and/or crack use (2%). Two or more vulnerabilities were identified in 9% of young people starting treatment.

Source: Adults and young people in secure settings in England: data for 2015-16 (PHE, 2017)

The 20 local authorities with the highest rate of rough sleeping per 1,000 households in England

City of L

ondon

Westminste

r

Brighton and Hove

Isles o

f Scill

yLu

ton

Bedford

Cambrid

ge

Canterb

uryExe

ter

King's Ly

nn and West

Norfolk

Hastings

Mansfi

eld

Southend-on-Se

a

Oxford

Harlow

Redbridge

Norwich

Thanet

Maidstone

Steve

nage

0

2

4

6

8

10

12

Source: Rough sleeping in England: autumn 2016 (DCLG, 2017)

Population mean consumption (units per week) as measured by General Lifestyle Survey of Great Britain

1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 0

1

2

3

4

5

6

7

8 Beer Wine Fortified wine Spirit

Robin C. Purshouse, Alan Brennan, Daniel Moyo, James Nicholls, Paul Norman; Typology and Dynamics of Heavier Drinking Styles in Great Britain: 1978–2010. Alcohol and Alcoholism 2017 1-10. doi: 10.1093/alcalc/agw105

Prevalence of heavier drinking as measured by General Lifestyle Survey of Great Britain

1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 0%

5%

10%

15%

20%

25%

30%

13% 13% 13% 13% 14% 14% 14% 15% 16% 16% 17% 18% 18% 16%

20%18% 18%

5% 5% 4% 4%4% 4% 4% 4%

4%4% 4%

5% 5%4%

7%

6%5%

Increasing risk (%) Higher risk (%) ‘Increasing risk’ (>21–50 units per week for males; >14–35 units per week for females) and ‘higher risk’ (>50 units per week for males; >35 units per week for females) levels are defined according to the weekly equivalent UK Government guidelines on safe drinking levels 1987–2016.

Robin C. Purshouse, Alan Brennan, Daniel Moyo, James Nicholls, Paul Norman; Typology and Dynamics of Heavier Drinking Styles in Great Britain: 1978–2010. Alcohol and Alcoholism 2017 1-10. doi: 10.1093/alcalc/agw105

Proportion of patients treated in general hospitals with serious mental illness identified as having coexisting drug and alcohol misuse problems

Schizophrenia Otherpsychosis

Bipolaraffectivedisorder

Personalitydisorder

0%

5%

10%

15%

20%

25%

30%

35%

15%12%

8%

26%

17%

11% 11%

30%

Drug misuse Alcohol misuse

n = 204 n = 57 n = 142 n = 43

Source: Mental Health in General Hospitals: Treat as One (NCEPOD, 2017)

Estimated tax gap (£ million) caused by the illicit sale of beer in the UK

2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15£0

£200,000,000

£400,000,000

£600,000,000

£800,000,000

£1,000,000,000

£1,200,000,000

£1,400,000,000

£1,600,000,000Upper estimate

Implied central estimate

Lower estimate

“The beer illicit market share was estimated at 15% in 2014-15. This resulted in estimated losses of £650 million in duty and a further £300 million in Value Added Tax (VAT) giving a total loss of £950 million.

“The illicit market share in beer has increased from 9% in 2007-08 to 15% in 2014-15.

“HMRC uses two different methods to estimate the beer tax gap. These methods provide an upper estimate and lower estimate. The true tax gap could be anywhere between these two estimates. The implied central estimate is intended to be an indicator of long-term trends.”

Source: Measuring tax gaps 2016 edition (HMRC, 2016)

Estimated tax gap (£ million) caused by the illicit sale of spirits in the UK

2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15£0

£200,000,000

£400,000,000

£600,000,000

£800,000,000

£1,000,000,000

£1,200,000,000

£1,400,000,000

Upper estimate Implied central estimate

Lower estimate

The estimated illicit market share for spirits was 12% in 2014-15, with a total tax gap of £650 million. This is broken down into a loss of £240 million in VAT and £410 million in duty.

The estimates of the spirits tax gap are quite volatile. The confidence intervals for the spirits tax gap are wide and year-on-year changes should be interpreted in the context of this statistical uncertainty.

Source: Measuring tax gaps 2016 edition (HMRC, 2016)

Estimated tax gap (£ million) caused by the illicit sale of wine in the UK

2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15£0

£200,000,000

£400,000,000

£600,000,000

£800,000,000

£1,000,000,000

£1,200,000,000Upper estimate Central estimate Lower estimate It has not been possible to estimate the

illicit market share for wine, due to a change in one of the underlying commercial data sources previously used to estimate the wine tax gap. An illustrative estimate of 3% is provided for 2013-14 and 2014-15 by taking the average illicit market share of 2011-12 and 2012-13. This would indicate a total wine tax gap of around £200 million in 2013-14 and 2014-15. HMRC is exploring alternative data sources in order to develop a new method to estimate the wine tax gap in the future.

Source: Measuring tax gaps 2016 edition (HMRC, 2016)