Alcohol Policy UK

'Statistics on Alcohol: England 2013' admissions still rising along with increasing drug treatment prescribing

The latest annual statistics on alcohol for England 2013 have been released, confirming a continuing rise in alcohol-related and primary alcohol attributable hospital conditions. Alcohol-related admissions rose 4% on the previous year with primary diagnosis conditions up 1%. Prescribed drugs for treating alcohol dependence were up 6%. Download the full report here (pdf).

This comes despite falls since 2004 in the proportion of adults reporting drinking alcohol. Continuing admissions - many being long term conditions - are linked to decades of rising consumption prior to 2004. A useful interactive Guardian data blog includes a table which allows admission types to be selected. Related acute admissions such as violence or accidents and injuries show falling or more stable trends, whereas long-term conditions such as cardiac, hypertensive or cardiac admissions show clear upwards trends.

Key findings from the report:

• In 2011/12, there were an estimated 1,220,300 admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (broad measure). This is an increase of 4% on the 2010/11 figure (1,168,300) and more than twice as many as in 2002/03 (510,700).
• In 2011/12, there were 200,900 admissions where the primary diagnosis was attributable to the consumption of alcohol. This is a 1% increase since 2010/11 when there were 198,900 admissions of this type and a 41% increase since 2002/03 when there were around 142,000 such admissions.
• In 2012, there were 178,247 prescription items prescribed for the treatment of alcohol dependence in primary care settings or NHS hospitals and dispensed in the community. This is an increase of 6% on the 2011 figure (167,764) and an increase of 73% on the 2003 figure (102,741). The Net Ingredient Cost (NIC) of these prescriptions was £2.93 million in 2012.

The report also identifies that on-trade alcohol sales in particular have fallen by 46% over 10 years, whereas off-trade sales have risen by 32% overall since 1992. Alcohol is also 62% more afordable than in 1980.

The report also provides a comprehensive overview of alcohol related health and consumption data including regional breakdowns. It also covers knowledge and attitudes to alcohol amongst the adult population.

Media reports so far have focused on headlines such as the 50% rise over the last decade in overall alcohol-related admissions - Guardian - and a 75% increase in drug treatment prescriptions over the last 9 years - see BBC and Information Daily reports.

Latest guidance offering to commissioners of drug and alcohol services

A new guidance document for commissioning drug and alcohol services has been released by the Joint Commissioning Panel for Mental Health (JCPMH).  

Guidance for commissioners of drug and alcohol services [pdf] presents an overview of key considerations for those with local remits for developing treatment services. It highlights ten key messages ranging from the invest to save case, utilisting NICE guidance, commissioning for outcomes, building partnerships and workforce development.

A wide range of guidance and resources now exists to support drug and alcohol commissioning. NICE has a comprehensive set of alcohol guidance and quality standards, including alcohol pathways and further tools. NICE also recently released Public Health Guidance for local authorities.

Previous to the NICE resources, alcohol commissioning guidance was released by the Department of Health in 2009, titled 'Signs for Improvement'. It identified a number of 'High Impact Changes', including IBA, alcohol liaison roles and improving treatment effectiveness and capacity. Models of Care for Alcohol Misusers was released by the then National Treatment Agency in 2006.

The NTA also published a range of other commissioning resources including 'commissioning for recovery', a JSNA support pack and annual alcohol treatment statistics reports.

This year DrugScope released a briefing on 'Public Health Reforms: What they mean for drug and alcohol services'. A recent RCGP briefing explores Primary Care Drug and Alcohol Commissioning.

NTA survey seeks to establish national picture of alcohol services in hospital settings

Commissioners in England are being asked to partake in a survey of alcohol services in hospital settings in England by the National Treatment Agency (NTA). The NTA are to be part of Public Health England (PHE) as of 1st April.

Investment in a variety of models of hospital based alcohol services has increased in recent years, particularly since 2009 Department of Health alcohol guidance identified 'Appoint an Alcohol Health Worker' as a 'High Impact Change'. However the extent, nature and sustainability of these services is unknown.

The survey will provide the first ever national picture of the number and nature of the alcohol services in England’s hospitals and PHE will go on to develop guidance and materials to support the continued development and delivery of such services. Iain Armstrong of the NTA has indicated around half of the key Local Authority areas have completed the survey to date, with the survey remaining open to commissioners until 5th April 2013.

An NHS Evidence QIPP case study is available on Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care. In 2010 Alcohol Concern published Alcohol Health Workers - description and review of the AHW posts

Further alcohol hospital resources are available here on the Alcohol Learning Centre, including on hospital based Alcohol Health Work. See here for NICE alcohol commissioning guidance.

Alcohol & Gambling: Alcohol Concern report explores links and recommendations

Alcohol Concern Cymru and the Royal College of Psychiatrists (RCPysch) Wales have published a joint report on the links between alcohol misuse and gambling, exploring key policy implications and recommendations.

Download 'A losing bet? Alcohol and gambling: investigating parallels and shared solutions' [pdf]

The press release includes warnings from professionals who identify links in addictive behaviours and the limited recognition of problem gambling and associated research. The report includes a "snapshot" survey of 66 people from which one in six respondents who had sought help for alcohol misuse said they had also experienced problems with gambling. BBC report here.

Mark Leyshon from Alcohol Concern Cymru said:
 
“Both alcohol misuse and excessive gambling can be regarded as significant public health problems, with adverse consequences to individuals and the wider society... It is likely, however, that mechanisms proposed in the alcohol field, such as restricting the availability of alcohol, tightening marketing rules, and providing tougher measures to protect the young, may be equally effective in curtailing problematic gambling.

Professor Jim Orford from Gambling Watch UK backed the report’s findings:
 
“The field of gambling studies has a great deal to learn from its alcohol counterpart, which is much better and longer established. Gambling Watch UK welcomes this report and fully endorses its recommendations. Problem gambling is now as prevalent as the problematic use of illicit drugs, but gets minimal attention by comparison. We need to start taking it far more seriously.”

The report’s key recommendations include:

• Further research into: the effects of curtailing gambling opportunities, the identification of problematic gambling, and new treatments that can be used to tackle this issue
• Access to treatment for both alcohol and gambling problems to be available and well-funded, and screening for gambling problems should be routine in substance misuse services
• Greater protection to children and young people against potentially addictive products such as alcohol and gambling
• A national database to capture the scope of problems associated with gambling, and this should feed into national strategies for managing addictions.

GamCare provides support, information and advice to anyone suffering through a gambling problem. Gambleaware also offers signposting and support and information on Gamblers Anonymous is here. See here for alcohol support or call Drinkline 0800 917 82 82.

DrugScope briefing 'Public Health Reforms: What they mean for drug and alcohol services' & RCGP briefing on Primary Care treatment

Drugscope, the national organisation representing the drug treatment sector, has published a briefing exploring the public health reforms and their expected impacts on drug and alcohol services.

Download The Public Health Reforms: What they mean for drug and alcohol services [pdf]

The briefing explains the key changes including:

In April 2013, the National Treatment Agency for Substance Misuse will be abolished and its key functions transferred into Public Health England. Most of the current budget for drug and alcohol services will be transferred to Directors of Public Health employed by Local Authorities, who will also be statutory members of the new Health and Wellbeing Boards.

Directors of Public Health (DPH) will be responsible for delivering public health outcomes in their local area, will control the bulk of drug and alcohol funding and will oversee a department or directorate that will be responsible for delivering the outcomes from the local Health and Wellbeing Strategy. Health and Wellbeing Boards (HWBs) will set out local strategies through the development of Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs). A new executive agency, Public Health England (PHE), will take the national lead on public health issues from April 2013.'

The briefing also gives a detailed exploration of key issues such as 'What will happen to Drug (and Alcohol) Action Teams (DATs)?' and 'what will be the role of Public Health England (PHE) in providing the sort of national co-ordination that the NTA has provided?'.

On the subject of 'How much will be invested in drug and alcohol services in the new system' the briefing details:

On 10 January 2013, the Government announced the ring fenced public health grants for upper tier and unitary local authorities for 2013-14 and 2014-15. A total of £2.66 billion in 2013 -14 and £2.79 billion in 2014-15 will be available to local authorities to spend on public health services for their local populations. This money absorbs an estimated £800 million to a £billion plus of current drug and alcohol funding. This means that approximately a third of the local authority grant for public health will be comprised of money that has to date been invested in drug and alcohol interventions, including what was contained in the 2012-2013 pooled treatment budget and the former health support component of DIP (total around £460 million).

RCGP & SMMGP briefing on primary care treatment commissioning

A briefing on Primary Care Drug and Alcohol Treatment: Commissioning and Provision Against a Backdrop of Localism has been produced by The Royal College of General Practitioners (RCGP) and Substance Misuse Management in General Practice (SMMGP). The briefing considers the future impact of the changing commissioning environment on primary care drug and alcohol treatment.

The Cabinet Office and the LGA are launching an academy to help senior public servants improve commissioning, reports the Guardian.

Latest Findings alcohol bulletins: NICE treatment update; NTA alcohol figures review; electronic alcohol screening/advice findings

Recent alcohol bulletins from the drug and alcohol bank:

UK clinical guidance on treating dependent drinkers

Assessment by the National Institute for Health and Clinical Excellence (NICE) of what evaluation research means for alcohol dependence treatment in Britain, distinguished by comprehensive reviews of the literature. Updated analysis cites evidence update released in January 2013 which was not considered to require changes to the original 2011 guidance.

Unmet need undermines contribution of alcohol treatment in England

More problem drinkers started specialist treatment in 2011/12 but more successfully completed it, slightly reducing the overall numbers; scope for many more to benefit from treatment is indicated by the low levels of referrals from primary medical services.

Leadership commitment needed to implement electronic alcohol advice prompts

Computerised reminders to consider an alcohol brief intervention have led to high rates of advice-giving in primary care, yet at a service for US ex-military personnel the same system was rarely used and made no difference to patients’ drinking. Lack of leadership commitment and incentives seemed the explanation.

Electronic prompts mean more primary care patients get advised about drinking

When a patient has screened positive for risky drinking, up pops a computerised prompt to remind the clinician to consider counselling. In one service for US ex-military personnel, this resulted in nearly three quarters of patients being counselled and a hint of consequentially reduced drinking; at another, findings were negative. Why the difference?

See the Alcohol Learning Centre, Alcohol Research UK, NHS Evidence alcohol page or NICE alcohol guidance and resources for further resources and information.

NICE harmful drinking and alcohol dependence (CG115): 2013 Evidence Update

The National Institute of Clinical Excellence (NICE) have released an evidence update to its 2011 guidance alcohol dependence and harmful alcohol use (CG 115).

Download the Alcohol use disorders: harmful drinking and alcohol dependence Evidence Update - January 2013 (pdf)

The update includes the latest evidence relating to the use of drugs in supporting alcohol treatment and other findings including: 

Principles of care: 

• Evidence suggests that involving the family in treatment is beneficial to responding to the individual needs of family members.

Interventions for alcohol misuse:

• Motivation enhancement therapy during detoxification may help to initiate and maintain people in aftercare inpatient treatment programmes compared with treatment as usual plus a peer delivered twelve-step facilitation intervention.
• Telephone monitoring and counselling may produce better alcohol use outcomes for relapse prevention than telephone counselling and ‘treatment as usual’.
• Using symptom-triggered benzodiazepines in an outpatient setting appears no more effective in reducing alcohol withdrawal symptoms than a fixed dosage regimen, and concerns remain about the safety of high dosage and potential for benzodiazepine misuse in largely unsupervised settings.
• The cost of treatment for alcohol dependent people after withdrawal may be offset by a reduction in social costs.

NICE alcohol commissioning guidance is available to support attainment of the alcohol quality standard which builds on:

• NICE CG115 - alcohol dependence and harmful alcohol use
• NICE PH24 - alcohol-use disorders - preventing harmful drinking
• NICE CG 100 - alcohol-use disorders: physical complications
• Supporting resources including alcohol pathways and further tools.

See the Alcohol Learning Centre, Alcohol Research UK, NHS Evidence alcohol page or the Findings Bank for further resources and information.

NTA release national alcohol treatment statistics 2011-2012

The National Treatment Agency for Substance Misuse (NTA) have published national alcohol statistics for 2011 - 31 March 2012: 

• Alcohol treatment in England 2011-12 (NTA commentary report)
• Alcohol treatment 2011-12 Statistical release
• NTA press release

The figures are taken from the National Drug Treatment Monitoring System (NDTMS) and show:

• 108,906 people received alcohol treatment in 2011-12, down 2% from the year before. This includes 74,353 new entrants to treatment during the year, a rise of 1% compared to 2010-11.
• 38,174 people successfully completed their treatment, 6% more than the previous year.
• Most people (38%) referred themselves into treatment, 19% were referred by their GP
• 70% of all those in alcohol treatment were concentrated in the 30 to 54 age range and the average age of a person in treatment was 42. Men accounted for nearly two thirds of the treatment population during the year. By far the biggest ethnic group was white British (88%).

The NTA has been working to support local areas to develop effective alcohol treatment to meet local needs. In April 2013 the NTA will become part of Public Health England (PHE) which will have responsibility for national action on preventing and tackling alcohol misuse. PHE will focus on work to progress the wider development of two key elements of the Alcohol Strategy: Identification and Brief Advice (IBA) and hospital based provision.

See here for a recent report on changes to alcohol treatment recording and alcohol PbR update.

See here for NICE alcohol guidance on treatment and commissioning.

Changes to alcohol treatment recording; Alcohol PbR update

Planned alcohol Outcomes for NDTMS dataset April 2013

The National Treatment Agency for Substance Misuse (NTA) have announced  alcohol treatment data outcomes will be included as part of the core NDTMS dataset for drug and alcohol treatment services. See here for the NTA's summary report [pdf].

As part of a consultation earlier this year, alcohol consumption was agreed as the key indicator of successful treatment outcomes. Therefore from April 2013, services will be required to be monitor alcohol consumption through NDTMS at start (assessment) and finish (discharge) of treatment via the two following measures:

• How many days in the last 28 have you had an alcoholic drink?
• On an average drinking day in the last 28, how many units of alcohol were consumed?

In addition, a secondary outcome measure will assess physical and psychological health as part of the core dataset as currently included in the drug Treatment Outcome Profile (TOP) form. Poor physical and mental health is strongly associated with alcohol misuse so, tool, from April 2013 NDTMS will also assess at start and finish:

• Client’s rating of physical health status (extent of physical symptoms and bothered by illness) – scored 0-20 (poor to good)
• Client’s rating of psychological health status (anxiety, depression and problem emotions and feelings) – scored 0-20 (poor to good)

The most recent alcohol treatment statistics are available in the Statistics from the National Alcohol Treatment Monitoring System (NATMS) 1st April 2010 - 31st March 2011. See here for NICE alcohol guidance on treatment and commissioning.

The NTA will cease to exist as of April 2013 as its functions will come under Public Health England.

Alcohol Payment by Results (PbR) update

A progress statement on the alcohol PbR pilots identifies the current status of the project:

'Packages of care', based on NICE guidance have been developed to support each cluster and treatment outcome measures are being explored. Four pilot areas have been testing out these products and how they can report costs for treatment based on the currencies / clusters.

When they are fit for purpose, we will make them available for future use by local authorities and alcohol treatment providers'

See here for a Alcohol PbR overview presentation.

Findings alcohol bulletins: preventing underage sales; fewer under-18s needing treatment; health promotion gains limited; alcohol testing lorry drivers?

Recent bulletins from the drug and alcohol bank:

Road-tested good ideas to prevent underage alcohol sales 

No controlled studies, but lots of ideas which seem to have worked from case study areas across the UK featuring innovation and cooperation in promoting compliance with laws banning sale of alcohol to under-18s and in reducing related public nuisance.

Fewer under-18s need specialist treatment in England 

National Treatment Agency for Substance Misuse documents increasingly successful specialist treatment of children with alcohol and drug problems in England. Patient numbers have fallen in line with falls among young adult patients and the general population, a sign of fewer drug problems generally, though cannabis bucked the downward trend.

Few sustained gains from health promotion session with college students

US university students at first cut back their drinking and cannabis use in response to a brief face-to-face contrast of their desired image versus their health-related behaviour, but the gains were no longer apparent a year later. Yet still at that time they had at least experienced more positive trends in how well they felt than students who had just read a fitness brochure.

Too little evidence to recommend drug/alcohol testing lorry drivers 

Exhaustive search finds just two rigorous studies of workplace testing for alcohol and/or drug use of people employed as drivers. For drugs there was some evidence of a long-term effect averting injuries and deaths, but in respect of both drugs and alcohol the evidence was too thin to support any particular policy.