1. People with alcohol related harm: who else suffers…? Fiona O’May Queen Margaret University Edinburgh fomay@qmu.ac.uk

2. Research Team Prof. Jonathan Chick Dr. Jan Gill Fiona O’May Robert Rush Prof Barbara McPake Heather Black Cheryl Rees Jane Doogan Christine Galloway Lucie Michalova Conflict of Interest: Professor Jonathan Chick reports personal fees from H Lundbeck A/S and Drinkaware outside the reported study, and is currently Medical Director at Castle Craig Hospital, West Linton, Scotland. The remaining authors declare no competing interests.

3. Acknowledgements; Grant CZH/4/645 Grant R2011/01 Participants and staff at NHS settings in Edinburgh and Glasgow, Scotland, and in-kind support from the Scottish Recovery Network (Mental Health).

4. UK & Scotland Context UK Responsible Drinking Guidelines 2/3 units alcohol/day + 2 drink free days/week (F) (14-21 units/week) 3/4 units alcohol/day + 2 drink free days/week (M) (21-28 units/week) 1 unit = 8g/10ml ethanol Unit examples Wine - 75cl bottle 12% = 9 units Lager - 330ml bottle 5-6% = 2 units Vodka - 70cl bottle 37.5% = 28 units White cider - 3l bottle 7.5% = 22.5 units. Our participants (n=639): Median consumption for index week 136.5 units (F) and 225 units (M)

5. UK & Scotland Context (cont) Licensing hours: 10:00hrs – 22:00hrs, off sales; 24 hours potential on- sales. 72% of pure alcohol sold through off-sales (Robinson et al. 2015) - 95% within our sample. Sales figures: Scotland (2014) - 10.7 litres pure alcohol per adult, England & Wales – 9 litres per adult = 18% difference (Robinson et al. 2015) Availability Affordability Deaths: 1,152 alcohol-related deaths in Scotland last year (5% increase on 2013) (National Records of Scotland, 2015 ) (1 in 6 of our participants died). Treatment/Services: Only 25% of Scottish adults with possible alcohol dependence accessed alcohol services in 2012 (Beeston et al. 2014) NHS services and treatment free at point of delivery.

6. Participant inclusion criteria Measures Detailed record of drinks consumed in ‘last’ or ‘typical’ week, type, volume, price paid, location of purchase. Self-reported health conditions. ARPQ – 11 item questionnaire, physical and mental health(6), domestic (3), police (1), work-related problems (1). Attending an alcohol problems service out-patient appointment Or being admitted to hospital, and having a diagnosis of an alcohol-related condition (whether or not another diagnosis has also been made)

7. Findings: Summary of responses to Alcohol Related Problems Questionnaire (n=615) (Patience et al. 1997). ARPQIn the last 6 months, have you..?Harm% yes 1* Been in hospital/attended casualty Self/others89.3 2Retched/vomitedSelf81.1 3Suffered from diarrhoeaSelf80.7 4*Been in accident due/partly due to alcohol which came, or should have come to medical attention Self/others57.2 5Been depressed due to drinkingSelf83.1 6Tried to harm yourselfSelf33.5 7*If working, have you been sick or absent due to drinking, warned/dismissed due to drinking. If not working, unable to fulfil a commitment due to drinking Others/family71.5 8*Had arguments at home arising from drinkingFamily60.3 9*Been so angry due to drink that hit someone in home or a member of public Family, friends, others 25.4 10*Been drinking which led to arguments to partner leaving or you threatening to leave Family, friends56.4 11*Been in trouble with the police due to drinkingSociety, family42.0

8. Findings (2) – Qualitative Interviews (n=20) Acknowledgement of harm to others and damaging consequences Harmful ways to fund consumption Immediacy of need Proactive steps to prevent harm to others Challenge for policy More research required

9. References: Beeston C, Geddes R, Craig N, Gordon R, Graham L, McAuley et al. (2014). Monitoring and Evaluating Scotland’s Alcohol Strategy: Fourth Annual Report. Edinburgh: NHS Health Scotland. Black H, Michalova L, Gill J, Rees C, Chick J, O’May F, Rush R, McPake B (2014). White cider consumption and heavy drinkers: a low–cost option but an unknown price. Alcohol and Alcoholism, 49(6), 675-680. Johnston MC, Ludbrook A, Jaffray MA (2012). Inequalities in the distribution of the costs of alcohol misuse in Scotland: a cost of illness study. Alcohol and Alcoholism, 47(6), 725- 731. National Records of Scotland (2015). Website: http://nationalrecordsofscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/vital-events/deaths/alcohol-related-deaths/main-points (accessed 8.9.15) Patience D, Buxton M, Chick J, Howlett H, McKenna M, Ritson B (1997). The SECCAT Survey: II. The Alcohol Related Problems Questionnaire as a proxy for resource costs and quality of life in alcoholism treatment. Study of Socio-Economic Consequences and Costs of Alcoholism and Treatment. Alcohol and Alcoholism, 32(1), 79-84. Robinson M, Beeston C, McCartney G, Craig N (2015). Monitoring and Evaluating Scotland’s Alcohol Strategy: Annual update of alcohol sales and price band analyses. Edinburgh: NHS Health Scotland. http://nationalrecordsofscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/vital-events/deaths/alcohol-related-deaths/main-points