1. Alcohol Misuse How big is the Problem? Michelle Loughlin Consultant in Public Health Rochdale Metropolitan Borough Council

2. Alcohol in Our Society Key Influences: Price: Cheaper alcohol – Supermarkets – Home drinking Availability: Licensing Act 2003 – Flexible opening hours Promotion: Social normalisation of alcohol misuse Touches everyone’s lives Part of celebrations, social occasions etc. 2/3 people drink sensibly, or not at all

4. Drinking Risk Levels in GM % of Sample MalesFemales All Lower risk drinkers 6176 68 Increasing risk drinkers 2819 23.5 Higher risk drinks 125 8.5 Greater Manchester Alcohol Survey estimated alcohol consumption in 16+ in 2010 n=1,971 Suggests Most People in GM do Drink Sensibly 4% Dependent 15% Don’t drink

5. Crime and Disorder Domestic violence Sexual assault Public fear Antisocial behaviour Risk taking behaviour Crime Public Disorder Accidents Road accidents Other accidents Drownings Burns Health hospital admissions Liver disease Blood pressure Stroke Cancers Foetal Alcohol Syndrome Mental illness Alcohol Dependence STIs Unplanned pregnancy Inequalities Social & Economic £ Lower workplace productivity Unemployment Impacts on family & social networks Truancy & school exclusion Homelessness Economic costs Litter Town Centre – no go areas Children and Young People Offending, pregnancy, truancy, exclusion, mental illness, poor educational attainment, reduced life chances etc. Impacts of Alcohol

6. Alcohol Impacts – Some Numbers 1.2 million Alcohol related hospital admissions per yr and rising –75% for chronic conditions e.g. CVD, liver disease, cancer –16% are for mental and behaviour disorders from alcohol use 10,000 drink driving accidents each year 8, 750 alcohol related deaths and rising –Liver disease a rising cause of premature death in under 65s Alcohol involved in 44% of violent incidents, 37% domestic violence Workplace absenteeism costs the economy up to £6.4 billion annually Total annual cost of alcohol harms has been estimated at £55 billion

7. Young People in GM (14 to 17 years) 31% drinking at least weekly in GM 20% binge drinking at least weekly 22% drinking outside 21% mainly drank in venues such as pubs 22% bought alcohol themselves Trading Standards’ North West Schools Survey of Young People (2011)

8. GM: Number of claimants of Incapacity Benefit/Severe Disability Allowance whose main medical reason is alcoholism (Aug 2011)

9. Alcohol and Inequalities Alcohol is strongly linked to health inequalities People from deprived groups suffer greater harm than the more affluent –e.g. There are 4 times more alcohol related deaths among men in routine and manual jobs compared with those in professional jobs

10. Alcohol and Mental Ill Health –Alcohol is associated with a range of mental health problems e.g. depression, anxiety, suicide, risk-taking behaviours, personality disorders and schizophrenia –Alcohol is a depressant –The prevalence of alcohol dependence among people with psychiatric disorders is almost twice as high in the general population –Dual Diagnosis – group of people with complex needs –Alcohol often used as a coping strategy

11. Rochdale Alcohol Assertive Outreach Pilot: Patient Stories, Common themes HOUSING & FINANCE Transience, relocation, poor or unsuitable housing, sofa surfing, fear of home loss due to drinking, homelessness, eviction, loss of income, increased debt, home repossession, unemployment (although several previously had regular work), poor budgeting skills HEALTH PROBLEMS & WITHDRAWAL Epilepsy, pain, ADHD, self harm, OCD, trapped nerves, anxiety attacks, avoiding the seizure threshold, onset of seizures, panic, fear, anxiety RELATIONSHIPS, CHILDHOOD PROBLEMS & ALCOHOL ASSOCIATES Marriage breakdown, new/multiple partners and children, large families (up to 9 siblings), volatile and chaotic family life, parental, peer and partner drug and alcohol use, problems in childhood including child sexual abuse, bullying, disability, learning disability, drinking onset in childhood LOSS Home, bereavement, children, relationships, jobs Multiple barriers to change – none wanted to stop drinking but were open to reducing risk & harm. Many driven by desire not to lose home.

12. Reducing Harm: Local Action (from PHE Stocktake Tool) Understand Needs, clear strategy and investment Licensing – Underage/illegal sales, Cumulative Impact Policies Reduce Risk – Identification of Risk and Brief Advice IBA – Make Every Contact Count (tools on alcohollearningcentre.org.uk) Clear Alcohol Pathways in Place e.g. Acute & MH Trusts to community, programme to support frequent attenders Specialist Alcohol Treatment – joint commissioning between NHS / LA Targeting and support for high risk groups e.g. Prison, MH Patients Focus on Recovery – peer support, family work, employment, housing etc.

13. Reducing Harm: National Action (from Health First) MUP of 50p Health warnings on labels Restricted sale times Review of licensing legislation to control availability Restrictions on advertising and promotion All health and social care professionals to be trained in IBA to reduce risk (tools on alcohollearningcentre.org.uk) Referrals of people with alcohol problems to specialist alcohol services for comprehensive assessment and treatment

14. Key Messages Most people drink sensibly Alcohol affects health, mortality, crime economy, and inequalities Availability, Price, Promotion have impact Issues are complex and need multi agency responses locally and nationally

15. Thankyou Michelle Loughlin Email: michelle.loughlin@rochdale.gov.uk