Alcohol

If you only read four things:

1. In Suffolk, 15% of adults drink to excess

2. 22,000 people in Suffolk are alcohol dependent

3.  182,000 working days in Suffolk are lost due to alcohol

4.  In 2016-17 there were 4,310 Suffolk alcohol-related hospital admissions

1.Key points

  • Excessive alcohol consumption is one of the top five risk factors contributing to early death and reduced quality of life in the UK1.
  • Reduction of harmful drinking is one of Public Health England’s seven priority areas2.

The numbers:

  • In the UK, alcohol is the second biggest risk factor for premature death (behind tobacco)1.
  • In Suffolk, 15% of adults drink in excess of advised limits (approximately 1 in 7 people) and 3.8% of over 18s (22,000 people) are alcohol dependent3.
  • In 2016/17, there were 4,310 hospital admissions for alcohol related conditions in Suffolk5.  Admissions to hospital where the primary diagnosis is an alcohol-related condition or a secondary diagnosis is an alcohol-related external cause. The corresponding rate of alcohol related hospital admissions for Suffolk was statistically significantly lower than England (568 per 100,000 v 636 per 100,000)5.
  • Both the number and rate of alcohol-specific deaths in Suffolk have decreased since 2011.
  • Among adults aged under 75, the potential years of life lost due to alcohol-related causes were comparable between Suffolk and England (Figure 1). The districts of Mid Suffolk, Suffolk Coastal and Ipswich showed the lowest number of years of life lost5.

Figure 1: Years of Life Lost due to alcohol-related causes, 2016 (adjusted per 100,000 <75 population)

Table showing districts in Suffolk have years of life lost due to alcohol-related causes that are similar to England as a whole

Source: 5

2.What are the key inequalities in Suffolk?

The potential years of life lost in adults aged under 75 due to alcohol-related causes were not significantly different between Suffolk and England5.

Alcohol-specific mortality in Suffolk is statistically significantly lower than the national average. However, a statistically significant gender gap exists for both alcohol-specific and alcohol-related mortality, with more than twice the rate of male deaths compared to female deaths.  On a positive note, there is a downward trend in alcohol-specific deaths overall5.

The rural nature of Suffolk can pose challenges when accessing services in a reliable and timely manner, and although Suffolk is perceived as a reasonably affluent area, significant pockets of rural deprivation exist.  These elements may all contribute to inequality. Deprivation and poverty (including ‘hidden pockets’ in rural areas) are the root cause of poor outcomes for many children, adults and families. 

3.Costs

Research by Public Health England in 2016 indicates that the overall economic burden due to alcohol is between £27bn and £52bn in 2016.  - adding up to 1.3% to 2.7% of GDP11

An estimated 182,000 working days are lost annually in Suffolk through absences caused by drinking and over 3,000 people in Suffolk go to work with a hangover every day12.

The financial costs of alcohol harm impact on both the county of Suffolk and the individual involved. But it doesn’t stop there because alcohol harm can also have non-monetary costs, such as health and/or societal implications. Alcohol can have an influence on  more than 60 diseases/conditions13.

However, the economic benefits of the alcohol industry cannot be dismissed. In 2011/12, the 699 pubs and 25 breweries in Suffolk employed nearly 10,000 people, making a significant input to the local economy14. Within Suffolk the alcohol business sector is important as both an employer and a contributor to tourism.

The 2015 Suffolk Annual Public Health Report3, outlines the costs and benefits of investing in intervention strategies. If alcohol screening and brief interventions were given to suitable patients during a GP appointment, each £1 of investment would return £199 over a 5 year period (although the health care benefits would accrue over a much longer time period). If 30% of A&E attendees with alcohol related issues were to receive alcohol screening and a brief intervention, each £1 of investment would return £356 over a 5 year period, although again the health care benefits would accrue over a longer period.

4.What are we doing?

Current services provided across Suffolk fall into several categories including harm reduction services, recovery support and aftercare, family interventions, specialist nursing, open access services and outreach/community initiatives. These services support the priorities outlined in the Government’s Alcohol Strategy.15

Acute Hospital services include a Suffolk-wide alcohol treatment service and specialist consultants and nurses. In the primary care setting, NHS Health Checks (a free check-up of overall health offered to 40-74-year olds) include an alcohol-risk assessment tool called the AUDIT-C questionnaire.

Making Every Contact Count (MECC) training encourages everyone who works with people to make the most of any opportunity to offer a brief lifestyle intervention with their patient, client, customer or even a colleague or relative. MECC training is delivered nationally and is supported by Public Health England.

The Integrated Drug and Alcohol Service, which supports adults and young people affected by drug and alcohol misuse, has been operating in Suffolk since April 2015. The service is led and supported by Suffolk Recovery Network (Turning Point as lead provider, working in conjunction with Iceni and Suffolk Family Carers). Recent examples of services include drop in sessions under the “Navigating the Road to Recovery” banner.

The “Reducing the Strength” campaign was launched in 2012 to tackle problem street drinking. The campaign encourages retailers not to stock very strong lagers, beers and ciders and has been successful in cutting anti-social behaviour associated with street drinking. By December 2013, 94 off-licence premises in Ipswich had signed up to the Reducing the Strength scheme and been declared “super strength free”.3 In year one of the initiative, police recorded a drop from 341 to 261 events (a 23.5% decrease) related to street drinking reported by the public16. As the voluntary sign up of retailers in Ipswich further increased into the summer of 2014 (to 71%), likewise the reduction in street crime committed by street drinkers continued (by 43% over a one year period)17.

The Alcohol Recovery Project for street drinkers has enabled identification and support for street drinkers in Ipswich, assisting them to access mainstream services to help address their substance misuse issues.  

The Purple Flag scheme is an accreditation scheme that recognises excellence in the management of town and city centres at night. On a similar note, Best Bar None (BBN) is a national scheme aimed at promoting responsible management and operation of alcohol licensed premises. In Ipswich, this initiative is backed by a Crime & Disorder Reduction Grant from the Home Office.

One of the key building blocks for recovery is the provision of suitable and stable housing.   Supporting Treatment, Accommodation and Recovery in Suffolk (STARS) provides advice and support to those who are accessing treatment and who may be at risk of losing their tenancy.  Alongside this, STARS also provide intensive support where required to vulnerable individuals who

have repeatedly been unable to maintain a home.  The support offered enables individuals to acquire the skills necessary to be able to live independently.

The Drug & Alcohol Training Service allows professionals from across the county who either work with or have contact with people who have issues with alcohol and/or drugs to better understand the nature of addiction and to recognise the behaviours and issues facing people whose alcohol use is problematic.  

In some circumstances, it is necessary for people to receive a detox from alcohol in a medical environment.  Clients who are assessed by Turning Point as requiring this provision can access in-patient services and residential rehabilitation where a therapeutic need exists.

The Suffolk alcohol strategy 2014-2022 has been endorsed by the Suffolk Health and Wellbeing Board (HWB).  Suffolk are working in partnership with the Local Government Association prevention at scale initiative to deliver the strategy.

5. What else could we do? 

Despite inroads made, opportunities remain to further develop the alcohol intervention strategies across both primary and secondary care sectors.  Whilst recognising there are multiple target groups, interventions can be combined at individual, community and population-levels.

Similarly, continual promotion of assessment and advice in GP, A&E and workplace settings will help reiterate and spread the message across a wider audience. There may also be intervention opportunities during significant events or transition points in people’s lives. It is therefore important that the journey through treatment is joined up, appropriate and person-centred to ensure a smooth pathway.

The alcohol use in those aged 50+ needs assessment highlighted the need to strengthen harm reduction services for older people; social isolation and reduced accessibility of services in rural areas were both cited as possible issues contributing to alcohol misuse18. Older residents may also be reluctant to visit the Integrated Drug and Alcohol Service due to the perceived stigma associated with the use of illegal drugs.  Collaboration with well-placed third sector organisations like Age UK Suffolk and the Rural Coffee Caravan could also support harm prevention.

In spring 2018 the substance misuse in young people needs assessment was completed. To view the full document go to: https://www.healthysuffolk.org.uk/jsna/jsna-ill

6.Recommendations

Access to quality treatment intervention and recovery services will be pivotal in achieving a better relationship with alcohol for communities and individuals in Suffolk. Service users, referrers and providers all need to be able to navigate the treatment system simply, easily and quickly when needed. Continued coordination of treatment is essential and involves joint working between the drug and alcohol treatment service, primary care, acute care, mental health and other organisations.

Specific recommendations:

  • Decrease excessive alcohol consumption by continued multiagency support to deliver the Suffolk Alcohol Strategy.
  • Continued multiagency working needs to occur to promote safer alcohol consumption, taking a strategic approach to tackling alcohol.
  • Develop new ways of allowing access to treatment at a community and population-level, recognising that there are multiple target groups, to maximise impact.  
  • Utilise digital technology where appropriate to widen the reach for those living in rural areas.  
  • Build upon maximising the use of medical staff by upskilling nurses and considering new ways of offering medical appointments.
  • Roll out new methods of assessing and collecting client information in order to streamline the process.

7.Useful links

8.References

1.        Murray CJL et al. UK health performance: findings of the Global Burden of Disease Study (2010). Lancet. 2013;381(9871):997-1020.

2.        Public Health England. From Evidence Into Action: Opportunities to Protect and Improve the Nation’s Health Public Health England; 2014.

3.        Suffolk County Council. Suffolk Annual Public Health Report 2015. 2015. 

5.        Public Health England. Fingertips Local Alcohol Profiles for England (LAPE) - July 2017. 2017. http://fingertips.phe.org.uk/profile/local-alcohol-profiles. Published 2017.

6.        Public Health England. Public Health England Fingertips Co-occurring substance misuse and mental health issues (June 2018). https://fingertips.phe.org.uk/drugsandmentalhealth#gid/1938132791/ati/102. Published 2018.

7.        NHS Choices. Alcohol misuse - NHS Choices. 2015. http://www.nhs.uk/conditions/Alcohol-misuse/Pages/Introduction.aspx. Accessed July 21, 2017.

8.        Black C. An Independent Review into the Impact on Employment Outcomes of Drug or Alcohol Addiction, and Obesity.; 2016.

9.        Public Health Action Support Team. Hidden Harm Needs Assessment. Ipswich; 2016.

10.      Blackburn with Darwen Council. Adverse childhood experiences (ACES). https://www.blackburn.gov.uk/health/childhood-trauma. Published 2018. Accessed June 18, 2018.

11.      Public Health England. The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies An Evidence Review; 2016. https://www.gov.uk/government/publications/the-public-health-burden-of-alcohol-evidence-review.

12.      NICE. Alcohol-Use Disorders: Preventing the Development of Hazardous and Harmful Drinking; 2012.

13.      Corrao G, Bagnardi V, Zambon A LVC. A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med. 2004;38(5):613-619.

14.      IWSR. International Wine and Spirit Research. 2013.

15.      HM Government. The Government’s Alcohol Strategy March 2012; 2012.

16.      Gornall J. New way to call time on high strength, cheap alcohol. BMJ. 2014;348.

17.      Everitt L. Ipswich: Reducing the Strength campaign hailed for cutting crime committed by street drinkers.

18.      Suffolk County Council. Healthcare Needs Assessment Alcohol Treatment Services in Suffolk December 2013; 2013.

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