New data on the level of alcohol misuse in England was recently released as part of the Adult Psychiatric Morbidity Survey (APMS) 2014. The headline figures show that whilst hazardous drinking has declined since 2000, levels of harmful and dependent drinking have remained stable.
See the full chapter list for the Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014 and the specific alcohol chapter here [pdf] and alcohol tables [xls].
The APMS aims to capture the state of the nation’s mental health in England every seven years through the national survey of adult 'psychiatric morbidity’. The survey's use of specific alcohol assessment tools including the AUDIT and SADQ gives the most accurate indication of the prevalence of alcohol problems in the population. This compares favourably with data used in the annual national statistics reports based on snapshots of consumption which do not account for other indicators of alcohol problems or harms.
Broadly though the recent APMS data shows a similar picture to 2013 Health Survey England figures in terms of differences amongst groups and overall trends. APMS identifies that hazardous drinking - sometimes described as 'increasing risk' - has fallen in men over the last 15 years but remained stable in women. In 2000, the year of the first AMPS alcohol data, 36.8% of men were hazardous drinkers, falling to 32.4% for the 2007 survey and 27.9% for 2014.
However levels of harmful and dependent drinking have remained stable as falls amongst younger age groups have been countered by rises in older adults. Harmful drinking (scoring 16+ on the AUDIT) fell amongst 16 to 24 year olds from 6.2% in 2007 to 4.2% in 2014. Among 55 to 64 year olds though the percentage doubled from 1.4% to 2.8% in 2014. Indeed significant increases in alcohol-related hospital admissions in this age range has been often been described as the problem of the 'baby boomer' generation.
The report identifies that APMS may under-represent dependent adults, in part owing to the higher levels of dependence in groups not picked up household surveys such as the homeless or those in institutions. Furthermore those with more severe alcohol problems are thought to be 'less available, able or willing' to respond to such surveys.
The scale of Dual Diagnosis revealed?
A stark figure within the new APMS data is the proportion of adults with probable alcohol dependence (AUDIT score 20+) receiving 'treatment or services for a mental or emotional problem'. In men, whilst 7.2% of hazardous and 9.2% of harmful drinkers were receiving mental health treatment, this rose to 26.9% of those with probable dependence.
However a staggering 47.3% of probably dependent and 38% of harmful drinking women reported receiving mental health treatment, with 14.2% of low risk and 16.6% of female hazardous drinkers. APMS states the majority of mental health treatments received were medication only, with only a minority also or only receiving psychological support.
Despite such high levels of mental health treatment amongst dependent drinkers, only 6.3% reported receiving substance misuse counseling. The APMS alcohol chapter concludes that alcohol dependence remains 'both under-diagnosed and under-treated in England'.
Could APMS 2014 mark 'trough booze'?
With policy debates so often framed around trends in alcohol consumption and harms, anticipating the future direction of alcohol misuse prevalence is a charged topic. Whilst it has been theorised that consumption falls since 2004 were inevitable following 'peak booze', the most recent data suggests the overall downward trend has now come to end. Despite this, alcohol-related hospital admissions have yet to follow suit.
Regardless of the direction of travel in national figures, public health roles will not want to see further reductions in resources to support early intervention and treatment services offered to those drinking across the alcohol misuse spectrum. Public health cuts are happening though, adding to the challenge of seeking to establish services that can address the long running issue of co-morbid alcohol and mental health problems.