1. Evidence into Action (and Action into Evidence) Dr Lesley Graham ISD

2. UK consumption 1900-2006

3. Alcohol Problems in Scotland Enough alcohol is sold in Scotland for every adult over 18 to exceed male weekly limits [Health Scotland 2010] Enough alcohol is sold in Scotland for every adult over 18 to exceed male weekly limits [Health Scotland 2010] Excess consumption is across all age and socio- economic groups [Scottish Health survey 2009] Excess consumption is across all age and socio- economic groups [Scottish Health survey 2009] 1 in 20 deaths attributable to alcohol [Grant, Springbett and Graham 2009] 1 in 20 deaths attributable to alcohol [Grant, Springbett and Graham 2009] Those from the most deprived areas in Scotland are 5 times more likely to die an alcohol related death [Alcohol Statistics Scotland 2009] Those from the most deprived areas in Scotland are 5 times more likely to die an alcohol related death [Alcohol Statistics Scotland 2009]

4. Chronic Liver Disease mortality rates per 100,000 population 1950-2006 updated from Leon and McCambridge, Lancet 367 (2006)

5. Alcohol and Crime Half (50%) of prisoners in Scotland reported being drunk at the time of their offence, rising to three quarters (77%) of young offenders [Scottish Prison Survey 2009] Half (50%) of prisoners in Scotland reported being drunk at the time of their offence, rising to three quarters (77%) of young offenders [Scottish Prison Survey 2009] Rise in proportion of young offenders who consider alcohol has contributed to their offending (48% in 1979; 58% in 1996 to 80% in 2007) [McKinlay et al 2009] Rise in proportion of young offenders who consider alcohol has contributed to their offending (48% in 1979; 58% in 1996 to 80% in 2007) [McKinlay et al 2009] 1 in 6 deaths on British roads are caused by drink driving [Road Casualties in Great Britain 2007] 1 in 6 deaths on British roads are caused by drink driving [Road Casualties in Great Britain 2007] Alcohol related crime is estimated to cost Scotland over £700 million per year [Societal Cost for Alcohol Misuse in Scotland in 2007 University of York 2010] Alcohol related crime is estimated to cost Scotland over £700 million per year [Societal Cost for Alcohol Misuse in Scotland in 2007 University of York 2010]

6. Alcohol and Violent Crime Where known, alcohol is a factor in more than two thirds (69%) of those accused of homicide [Homicide in Scotland 2008/9] Where known, alcohol is a factor in more than two thirds (69%) of those accused of homicide [Homicide in Scotland 2008/9] 70% of assaults in A&E may be alcohol related [QIS 2006] 70% of assaults in A&E may be alcohol related [QIS 2006] In 62% of violent crime, victims said the offenders were under the influence of alcohol [Scottish Crime and Justice Survey 2010] In 62% of violent crime, victims said the offenders were under the influence of alcohol [Scottish Crime and Justice Survey 2010]

7. Effectiveness of Interventions MeasureEffective? Pricing+++ Availability Age Limit Age Limit Reducing Outlet Density Reducing Outlet Density+++++ Safer Drinking environments Server Liability Server Liability Enforcement Enforcement+++++ Advertising+/++ Treatment Brief Interventions (primary care) Brief Interventions (primary care) Brief Interventions (A&E) Brief Interventions (A&E)+++++ Information and education School education School education Product Labelling Product Labelling Public service messaging Public service messaging ? / + No (on own)

8. Increased knowledge and changed attitudes to alcohol + drinking Reduced acceptability of hazardous drinking and drunkenness Reduced availability of alcohol Individuals in need receive timely, sensitive & appropriate support A culture in which low alcohol consumption is valued and accepted as the norm Less absenteeism + presenteeism the workplace. Less alcohol related incapacity Reduced alcohol related injuries, physical and psychological morbidity + mortality Fewer brain-damaged children Increased educational attainment Safer & happier families and communities Reduced health, social care, justice costs Healthier individuals and populations Intermediate outcomesLong term outcomes Children in need receive timely and appropriate support Safer drinking + wider environments Increased workplace productivity Less alcohol related violence/abuse, offences and ASB Less absenteeism + presenteeism in educational establishments Fewer children affected by parental drinking Reduction in Individual and population consumption Changed patterns of consumption Reduced affordability of alcohol National outcomes Reduce significant inequalities Model 2: Model 3: Model 4: Model 5: Model 6: Model 7:

9. Key Events in alcohol in Scotland 2003: ISD alcohol team set up 2005 Alcohol Statistics Scotland published 2007: Scottish Health Action for Alcohol Problems established and publish Price, Policy and Public Health 2007: Health Scotland develop alcohol logic models 2007: SNP government 2009: Alcohol Framework 2010: Alcohol Bill 2011: alcohol and offender conference and publication of reports 2011: MESAS baseline report

10. What are the key elements for success?

11. Contact Dr Lesley Graham Public Health Lead for Substance Misuse ISD, NHS National Services Scotland Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB lesley.graham@nhs.net