Alcohol - healthy lifestyles

Alcohol is a significant issue in Slough negatively impacting levels of ill-health, hospital admissions, mortality rates and crime levels. It is also a significant factor in family breakdown and children being taken into care.

What do we know?

Alcohol misuse is a significant concern to the local community. The Safer Slough Partnership Strategic Assessment highlights that 30% of residents surveyed view alcohol related nuisance as a significant problem.

Alcohol misuse is a significant health issue for the local population of Slough. Alcohol related mortality and hospital admissions rates exceed the national average with wide variations in rates between men and women. The cultural and diverse make-up of Slough’s population provides particular challenges in relation to alcohol.

Although some aspects of Slough’s health are good, health in Slough is negatively affected by alcohol. Although many people express positive feelings about their local area, the town suffers significant levels of social and economic deprivation and there are high levels of crime and anti-social behaviour, a proportion of which is driven by alcohol.

Facts, Figures and Trends

Prevalence of alcohol dependence

There is currently a lack of reliable data on the prevalence of alcohol dependence by unitary authority. Nationally, the prevalence is estimated to be 5.9% (8.7% of men, 3.3% of women). For men, the highest levels of dependence were identified in those between the ages of 25 and 34, for women in those between the ages of 16 and 24. (Source: Adult Psychiatric Morbidity in England, Results of a household survey)

Data is available on levels of ‘increasing risk’ drinking. That is, drinking regularly in excess of recommended levels and in a way that is likely to have adverse impacts on health or mental well-being. Model based estimates from Alcohol Concern in 2014 show that the prevalence of increased risk drinking in Slough is approximately 19%, similar to the national average of 20%. (Source: https://www.alcoholconcern.org.uk/training/alcohol-harm-map/)

Treatment Services

In 2014/15, there were 96 alcohol only referrals with 41 reporting alcohol as a secondary substance (to non-opiate). There were 145 in treatment (alcohol only). Of these clients 91% were in effective treatment, which is higher than the national figure of 86.8%.

Of those in treatment, 66% of clients consumed alcohol every day of the 28 days prior to treatment start, which is similar to the national figure of 56%. 58% of the clients drink 10-30 units a day, 16% drinking 30-40 units per day and 18% drink 40+ units per day, and this latter figure is slightly higher than the national figure of 14%.

In 2014/15 93% of clients were over 30 years old, with 47% being over 50, this is in line with local feedback that the alcohol using community is older. Those attending the service in Slough with alcohol as their main problem are mainly white British (57%) males (68%) who have mainly been referred by their GP or the early intervention substance misuse service (42.7%) or who have self-referred (38.5%).
(Source: www.ndtms.net Quarterly activity reports Q4 14_15)

Of those in treatment60% are dual diagnosis clients highlighting the need for close working with community mental health teams. In addition, 28% of adults accessing treatment during 2014/15 were living with children. This is similar to the national figure of 25.8%.
(Source: www.ndtms.net DOMES reports Q4 14_15)

Hospital Admissions

In 2013/14 there were 570 men and 192 women per 100,000 population who were admitted to hospital with an alcohol-specific diagnosis. Overall this rate is similar to the national average. Over this same period, however, the total number of admissions that were related to alcohol were higher in Slough than nationally with a rate for men at 2,052 per 100,000 (vs. 1,715 nationally) and women at 1,013 per 100,000 (vs. 859 nationally).

Figure 1. Alcohol related admissions (broad definition) in Slough

Figure 1: Alcohol-harm related hospital admissions in Slough (2007/08 to 2011/12)

Source: Public Health England (2012)

In 2013/14 it was identified that Slough had higher rates of alcohol specific death rates per 100,000 when compared against the regional averages (17.1 male and 3.9 female alcohol compared 10.6 for men and 7.5 for women). Alcohol related deaths are lower in Slough than nationally, with 60.4 vs. 65.4 for men and 27.5 vs. 28.4 for women. This suggests that although with have a higher rate of alcohol related admissions, we have appropriate measures in place as our mortality rate is low in comparison to national figures.

In an estimate of the number of months of life lost as a result of alcohol, men in Slough lose 11.4 months and women lose 4.8 months. These are slightly lower than national figures of 12 months and 5.6 months respectively.

(Source: http://www.lape.org.uk/ Local Alcohol Profiles for England 13_14)

Crime and Antisocial Behaviour

Excessive or binge drinking is associated with numerous different types of crime and ASB. However, the relationship between crime and alcohol is complex and can contribute to different types of crime, such as criminal damage, sexual offences, acquisitive crime and assault. There has been a considerable amount or research done on the nature of the link between alcohol and crime and it is generally acknowledged to be complex. Alcohol is not always a causal factor in crime.

Alcohol related crime in Slough is relatively high with nearly 700 crimes in 2013/14. This makes up part of the total for Thames Valley Police, which is just over 5,000 for 2013/14.

(Source: Data provided by SSP 13/14 (June 2015))

National & Local Strategies (Current best practices)

National

Clear outcomes have also been set out in the Government’s Alcohol Strategy 2012, the strategy argues in favour of actions to combat the effects of “excess” and has set outcomes to:

  • change in behaviour in the way people view acceptable levels of drinking;
  • reduce alcohol-fuelled violent crime;
  • reduce adults drinking above the NHS Guidelines;
  • reduce binge drinking;
  • reduce alcohol-related deaths; and
  • implement actions or a sustained reduction in 11-15 year olds drinking alcohol and the amounts consumed.

Local

The key aims of the Slough DAAT are to provide an effective drug/alcohol treatment system in order to:

  • Minimise the social and health related harms caused by drug misuse
  • Increase positive outcomes within effective treatment and to ensure the needs of all drug users are met, regardless of ethnicity, gender, age, drug type and status
  • To help more clients to become drug free and ensure relapse prevention.

There are several services for drug treatment provided in Slough that have capacity to support clients with alcohol misuse issues.

A wide range of psycho-social interventions provided by CRI including:

  • Motivational interviewing
  • Cognitive behavioural therapy 
  • Couples therapy
  • Coping skills training 
  • Family interventions
  • Aftercare support

Increased capacity for community alcohol detoxification also provided by CRI:

  • An assessment to identify priority needs
  • A specialist nurse to provide a community detoxification or referral for an inpatient detoxification as appropriate
  • One to one brief interventions (including a reduction program)
  • Referral for structured psychosocial work if required

(These services follow the assessment process as set out in the Models of Care for alcohol misusers 2006.)

What is this telling us?

  • We have a relatively high number of problematic drinkers in Slough, with the majority drinking high levels every day.
  • We have a high number of clients in treatment with 91% in effective treatment (for over 3 months).
  • We have a high proportion of alcohol clients who live with children and links within the services with social services are good.
  • Our clients are mainly white British men over 50 years old.
  • We need to work on engaging more females and people from BME communities, although, some stigma can surround substance misuse, so this will be a constant barrier to treatment.
  •  We have a high level of dual diagnosis clients, so work with mental health teams will need to continue.

What are the key inequalities?

The report ‘Alcohol, health inqequalities and the harm paradox’ by the Institude of Alcohol Studies highlights that while those from lower socioeconomic groups experience greater health problems due to alcohol despite on average drinking less than those in higher income groups.

What are the unmet needs/service gaps?

 

  • Alcohol specific services: It was identified that across East Berkshire, there were many repeat attenders presenting at A&E and taking up beds in the Acute Wards at Wexham Park Hospital. This continues and we continue to support the local hospital to signpost clients appropriately.
  • Alcohol rehabilitation:We currently have full staff provision through CRI for community alcohol detoxification. We also have excellent provision through our partners (Broadway Lodge, Western Counselling and Pheonix Futures) offering Tier 4 residential treatment.
  • Alcohol open access services: Clients with an alcohol problem can access services on an ‘open-access’ basis. Clients can drop in or be referred by other agencies and will be assessed through the LASAR and be transferred to the care of CRI. This also needs to cater for any young people who may attend.
  • Outreach: A community survey carried out during Alcohol Awareness Week in 2009 highlighted that on average, 60% of people couldn’t correctly state the safe daily limits for alcohol consumption, 50% of people underestimated the number of units in an average glass of wine and 42% over estimated the number of units in a measure of gin/vodka/whisky. This links in with the need for improved information availability for those that need it/the population as a whole. The services and the DAAT also provide support to the tier 1 workforce (and other agencies) to promote safer drinking and advertise referral pathways.
  • Co-ordination, Monitoring and Evaluation: Public Health England should consider re-starting the Alcohol Harm Reduction Group to co-ordinate, monitoring and evaluate alcohol-related work in Slough. The Safer Slough Partnership’s aim in relation to alcohol is to minimise the health harms, violence and antisocial behavior associated with alcohol in Slough, while ensuring that people are able to enjoy alcohol safely and responsibly. The action plan for this group is available from the Drugs and Community Safety team at Slough Borough Council. The Action plan covers the following areas of work:

Recommendations for consideration by other key organisations:

  • More support needs to be provided for alcohol specific health problems as they are a big strain on hospital services (in respect of admissions on wards and attendance at A&E).
  • Alcohol related crime is a big issue in Slough and targeted work needs to continue to decrease this.
  • Cross-organisational work on prevention of alcohol-related related harm is required. This will work to not only to improve health but reduce burden on health services and reduce crime.
  • A partnership approach to reintegration of service users into life without alcohol is needed