Alcohol

Young people are particularly vulnerable to alcohol and the harm it causes, because they are still developing both physically and emotionally. Delaying the age at which a young person takes their first alcoholic drink and limiting the amount they drink are likely to be beneficial to their health and wellbeing. However, the evidence tells us that chronic diseases and conditions associated with excess alcohol consumption in adults and deaths from liver disease are now occurring at younger ages (Newbury-Birch et al, 2009). Impact of alcohol consumption on young people report.

The UK Chief Medical Officer for England guidance is clear that young people under the age of 15 should not drink alcohol at all. This is because young people who start drinking alcohol at an early age drink more frequently and more than those who start drinking later. These young people are in turn more likely to go on to develop problems with alcohol in adolescence and into adulthood. (Department of Health, 2009).An update of Alcohol Guidelines in 2016 made no changes to these existing recommendations.

What do we know?

The Smoking, drinking and drug use among young people in England Survey 2014 tells us a lot about the patterns of alcohol use among adolescents in England:

In 2014, just over a third (38%) of 11 to 15 year olds had tried alcohol at least once, the lowest proportion since the survey began. As may be expected, this varied according to age from under 10% of 11-year-olds to almost 70% of 15-year-olds having tried alcohol at least once.

More boys had tried alcohol at age 11, whereas by age 15 more girls had tried alcohol. As well as trying alcohol earlier, a higher proportion of boys deliberately tied to get drunk than did girls of the same age. Among 14 and 15 year olds, almost two thirds (65%) had drunk three or more units of alcohol on each drinking day.

Most young people obtain alcohol from friends or family. Almost 50% of 11 to 15 year olds had been given alcohol by friends, parents or relatives, whereas around 20% had taken or stolen alcohol from home or a friend’s home.

In terms of types of alcohol chosen, though very prevalent ten years ago, the use of alcopops has reduced from 65% in 2004 to 40% in 2014, meanwhile the same proportion of young people report drinking beer, lager and cider which continues to be the most common drink of choice.

Evidence suggests that factors that increase the risk of early use and misuse of alcohol by young people include:

  • early exposure to drinking alcohol;
  • family history of alcohol problems;
  • physical and/or sexual abuse in childhood;
  • family conflict or inconsistent parenting;

(Source: Reducing Young People’s Drinking)

Similarly, evidence tells us that the potential consequences of alcohol use in young people include:

  • increasing risky behaviour
  • having unprotected sex
  • drink driving
  • antisocial behaviour and crime
  • danger to brain development for young people if alcohol use is sustained
  • mental health problems, particularly depression

(Source:Imact of Alcohol Consumption on Young People - A Review)

A recent Ofsted report "Not Yet Good Enough" (2013) found that whereas most pupils understood the health risks of tobacco and illegal drugs, they tended to be less aware of the physical and social damage associated with alcohol misuse, including personal safety issues

Facts, Figures, Trends

A local survey of young people in Slough (a small sample of year 8 and 10 pupils) noted that 7% drank alcohol on a monthly basis or more. The source of just under 40% of the alcohol was mainly from the home with parents’ permission but a similar proportion was obtained for them by another person. These results reflect anecdotal reports of widespread concern among residents about alcohol sales in off licences and local shops. (See section on alcohol in adults)

Alcohol-specific hospital stays in those aged under 18 were 18.3 per 100,000 (2011/12-2013/14) in Slough which is lower than the national rate of 40.1 per 100,000 in England but has not changed significantly since 2008 (Figure 1).

Figure 1. Alcohol-specific hospital stays in those aged 18 in Slough

Figure 1

Information on alcohol-related ambulance pick-ups has been shared for 2013 by South Central Ambulance Service. This shows that 79 people under the age of 20 were dealt with by South Central Ambulance Service in Slough, of which 16 were aged 14 or younger.

In 2013, 89 young people were involved in an alcohol related crime in Slough. Of these, 53 (59.5%) are recorded as suspects or alleged offenders with the remaining 36 (40.5%) being aggrieved parties. Work is currently being undertaken to investigate the geographical patterns of alcohol-related crime and domestic abuse in relation to school catchment areas to support local education and prevention initiatives.

National & Local Strategies (Current best practices)

National

The latest guidance for local councillors (Alcohol Concern, 2016) sets out guidelines for Health and Wellbeing boards to set up a local alcohol strategy group to; consider the impact on the community of alcohol misuse as well as on demands on local council and hospital services and plan to reduce this demand by working in partnership with many agencies.

Some of the public health outcomes relevant to alcohol and young people are:

  • self-harm
  • successful completion of drug treatment
  • alcohol admissions to hospital

Others include reducing the increase in sexually transmitted infections and reducing rates of teenage pregnancy.

The Government’s Alcohol Strategy
The Government’s Alcohol Strategy was produced in 2012. It sets out plans for encouraging a change in drinking behaviour and reducing the harm that excessive drinking cause to the individuals’ health and wellbeing and to society. The Strategy calls for the delivery of evidence-based education and prevention programmes aimed at reducing drinking by young people. It specifically highlights the negative impact of the availability of cheap alcohol and “pre-loading” (the practice of drinking indoors before going out to drink more) on alcohol consumption in young people.

The Department of Health policy (2013) on reducing harmful drinking as it relates to children and young people, has an ambition to reduce the number of people aged 11 to 15 years who drink alcohol and to reduce the amount they drink. The policy also includes specific plans to:

  • further control the advertising and promotion of alcohol to young people and
  • develop a model to support young people who go to A&E with an alcohol-related problem, so that they get proper follow up and care (which may include informing their GP or their parents, where appropriate)

The policy also seeks to address the wider context around alcohol, such as minimum unit pricing, the role of the alcohol industry in reducing the amount of alcohol consumed, helping individuals to change their drinking behaviour and improving treatment services for alcohol dependency.

The UK Chief Medical Officer Guidance (2009) makes 6 key recommendations:

  • children should have an alcohol-free childhood - if children drink alcohol, it shouldn't be before they are 15 years old
  • if young people aged 15 to 17 years old drink alcohol, it should always be with the guidance of a parent or carer or in a supervised environmen
  • parents and young people should be aware that drinking, even at age 15 or older, can be hazardous to health and not drinking is the healthiest option
  • if children aged 15 to 17 drink alcohol they should do so infrequently and on no more than one day a week - they should never drink more than the adult daily limits recommended by the NHS
  • the importance of parental influence on children's alcohol use should be communicated to parents, carers and professionals
  • support services should be made available for children and young people who have alcohol-related problems and their parents

National Institute for Health and Clinical Excellence (NICE) Guideline PH24 Alcohol-use disorders: Prevention (2010) includes recommendations to professionals for supporting vulnerable children and young people who drink, including understanding some of the complex reasons why they drink and to encourage them to include their parents or guardians in any professional intervention, whilst being aware of confidentiality and consent issues in accordance with Fraser Guidelines.

The Guidelines give advice on supporting children and young people aged 10 – 15 years who are thought to be at risk from their use of alcohol. Along with screening young people aged 16 and 17 years and offering them extended brief interventions if they have been identified as drinking hazardously or harmfully.

Other NICE Guidelines of note include CG115 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (2011) and  CG100 Alcohol-use disorders: diagnosis and management of physical complications

Local

  • Community Alcohol Partnership (CAP)
    The CAP scheme is a national initiative aimed at reducing underage alcohol misuse. Fostering cooperation between alcohol retailers and local stakeholders to address problems faced in Slough, the scheme provides advice, guidance and support to develop coordinated responses to underage alcohol misuse in Slough. Currently the CAP scheme in Slough covers the Langley area and will be extended if successful. So far the scheme has seen a reduction of 44% in the number of underage test sales and a public consultation is underway aimed at enabling evaluation of the scheme.
  • Slough’s Drug and Alcohol Action Team (DAAT)
    The DAAT commission services providing support to all young people living in Slough who are experiencing issues relating to drug or alcohol use. This service also runs a peer education program for young people interested in learning about substance misuse and using this knowledge to help other young people.
  • Young Peoples Service
    Young Peoples Service in Slough provides Substance Misuse services to Young People and their families affected by Substance Misuse. Working in an integrated way, they deliver appropriate interventions to those young people who need it most. It specifically targets areas of Slough which have high numbers of Young People not currently engaged in alcohol treatment (and other) services. Based in central Slough it also has satellite bases in Britwell, Manor Park, Chalvey and Langley.
    The aims of the service are to:
    • decrease the consumption of substances used by individual young people taken onto the caseload
    • increase the numbers engaging in effective services
    • Increase the number of days attended at School, College or Employment by individual young people taken onto the caseload
    • decrease offending by individual Young People not subject to YOT supervision
    • improve the health and wellbeing of individual young people taken on to the caseload

What is this telling us?

Though there is relatively little intelligence on local alcohol use and its effects in young people in Slough, we know that there are a significant number of children in Slough who are vulnerable to alcohol and alcohol misuse problems.

It is also clear that alcohol-related crime is an important issue particularly in terms of young people and that reducing alcohol use in this group will also have a beneficial effect on child and adolescent mental health (see section on CAMHS).

What are the key inequalities?

Evidence suggests that looked after children, those with special educational needs, and those in contact with youth offending services are more vulnerable to alcohol problems. Children and young people with mental health problems are also at risk of alcohol misuse.

(Source: Alcohol Concern)

What are the unmet needs/service gaps?

The prevention of alcohol related harm among young people is a key priority. There is currently insufficient support for young people who have problems in relation to alcohol. Targeted and dedicated work with schools and youth services is therefore required. These should be combined with work to examine the causes of binge drinking among young people in Slough including the availability of cheap, high strength alcoholic drinks.

It is also identified through the Foster and Brown research (2012) that there is a lack of mental health / counselling support for young people in Slough. The Integrated Youth Support Service (IYSS) used to supply this but is currently looking to fund this provision again. With young people reporting to the service with risk issues (e.g. self-harm etc.) it is important that this lack of provision is tackled.

Recommendations for consideration by other key organisations:

  • Targeted early intervention and youth work: Although there is a specific young persons service within the adult substance misuse services in Slough, this can only provide certain levels of intervention once the service user is engaged. It is recommended that dedicated support, preventative initiatives and education be provided in schools (and other youth services) before a young person has to attend the substance misuse services. This will also work towards reducing demands on emergency/health services (in respect of criminal activity, anti social behaviour and hospital admissions as a result of substance misuse or where substance misuse is a contributing factor).
  • Mental health: Slough need to strengthen the pathways to mental health resources for young people to manage those with mild to moderate mental health conditions. The substance misuse services in Slough provide some interventions to support with this.
  • Family support: The young peoples substance misuse service currently provides a ‘What about me?’ group to provide support to those young people who (may not using substances but) are affected by substance misuse by members of their family. This support could be provided within other services.
  • Recovery capital: It is important to build a young persons capital; including physical and mental health, family involvement, criminal/anti social behaviour, employment and education. This is provided within the substance misuse services as a core part of the treatment journey. Young people must be encouraged (and able) to move through any system in a positive way with good prospects of continued success within their community.

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