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Tackling Alcohol Harm Together

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Title: Tackling Alcohol Harm Together


1

2
Welcome
Tackling Alcohol Harm Together
3
Welcome
Maura Noone Head of Service Commissioning, Health
and Wellbeing, Wirral Adult Social Services
Chair of the Joint Investment Group for Alcohol.
4
Identification and Treatment
Kathy Doran Chief Executive of Wirral PCT Chair
of Wirral Drug and Alcohol Action Team
5
Young Peoples Alcohol Misuse
Stephen Maddox Chief Executive, Wirral Council
6
Alcohol Crime, Disorder and communities
Jon Ward Chief Superintendent, Merseyside Police
7
CONTEXT
8
Performance Comparison 2007/2008
9
Wirral Position within Family of 15 Most Similar
BCUs 2007 - 2008
10
(No Transcript)
11
Estimated Total Cost of Crime by Crime Type
2003/04
12
Cost of Violence - Breakdown
13
Estimated Total Cost of Violence 23007/08
If all recorded offences had reached the CJS
system
14
Estimated Total Cost of Violence 23007/08
Based on sanction detections (most having reached
the CJS system in part or full)
15
Problem Analysis Triangle
Problem
16
Penny Cook Reader in Public Health Epidemiology
Centre for Public Health, Liverpool John Moores
University
17
Overview
  • Alcohol harm
  • North-South divide
  • Harm in Wirral
  • Interventions to reduce harm
  • Challenge misconceptions
  • Conclusions

18
Alcohol harm in the UK
  • 60 types of harm
  • physical, social, economic, family

19
Alcohol Harm in the UK
  • 8758 deaths/year
  • Over 700 month
  • 24 deaths/day
  • one death every hour
  • 10 increase each year
  • Females will catch up
  • Age of death younger
  • True burden higher
  • Death at top of pyramid massive alcohol-related
    burden on society
  • Costs 20 billion/year

20
North South Divide (LA level)
Months Life Lost
Violent Crime
Females
Males
21
North South Divide (LA level)
Hospital Admission
Females
Males
22
North South Divide
Alcohol-specific mortality per 100,000, 2005
Hospital admission for alcohol-specific
conditions per 100,000, 2005/06
23
Wirral data LAPE tool
England average
North West average
Sig. worse than England average
Sig. better than England average
Trends
24
Why we did it
  • Hazardous Drinking
  • Weekly gt21 ? Units 14 ?
  • 1 in 5 adults (8 million)
  • Harmful Drinking
  • Weekly gt50 units ? 35 ?
  • 1 in 20 adults (2 million)
  • Estimated Consumption
  • Conservative calculations
  • Glass of wine 1 unit
  • Tend to underestimate
  • Holidays, Parties, Friday night
  • Telling the doctor
  • HM Revenue and Customs estimates double GHS
  • Dependent Drinkers
  • 1.1 million in England
  • 1 in 18 in treatment

25
Social Profiling People and Places
  • Mature Oaks
  • Country Orchards
  • Blossoming Families
  • Rooted Households
  • Qualified Metropolitans
  • Senior Neighbourhoods
  • New Starters
  • Multicultural Centres
  • Urban Producers
  • Weathered Communities
  • Disadvantaged Households
  • Urban Challenge

Increasing Deprivation
26
What types of communities are affected
27
Advertising
  • Appeals to young people
  • Music
  • Characters
  • Stories
  • Humour
  • Young people
  • Drink more
  • Drink earlier
  • Complete ban
  • 16.4 drop in alcohol-related
  • life-years lost (American data)

Source Chen et al 2005, Snyder et al 2006,
Hollingworth et al 2006
28
EU Regulations
29
Increased amount of alcohol (strength and volume)
  • One small glass wine
  • (125ml) 8 1 Unit

Standard pint beer 42 Units Strong pint beer
6.53.5 Units
  • One large glass wine
  • (250ml) 14 3.5 Units

30
Drinking Driving
  • Blood Alcohol Content limit (BAC) 0.08mg
  • Almost one in six road fatalities involve drivers
    over the limit
  • Lower levels elsewhere
  • Zero (or 0.02 mg) limit for young and
    inexperienced drivers
  • US and Australia implementation of 0.02 BAC for
    new/young drivers gave average reduction in
    serious road traffic injuries of 17

Zwerling and Jones, 1999
31
Mean weekly alcohol consumption of children in
England, 1992-2006
Source Fuller et al 2006
32
Interventions to reduce alcohol harm in children
  • Protective effect of family
  • those who bought their own more likely
  • to drink in public
  • more likely to binge
  • more likely to be a frequent drinker
  • Family-based brief advice
  • Raise minimum drinking age
  • Increase price

Phillips-Howard et al 2008, Hughes et al 2008
33
Drinking and Getting Fat
  • Bottle of wine 500 Kcal
  • Average Night out in Liverpool
  • Men 2,190 Kcal
  • Women 1,260 Kcal
  • Add a Kebab Chips, 1000Kcal
  • Weight gain (1 year) gt2 stone
  • Critical issue for young people
  • Non alcoholic drinks labelled
  • half of females and one in three males age
  • 12-15 would like to lose weight

SHEU, 2007
34
Why tell me what to drink?
  • Youth Violence
  • ½ AE assault patients aged 18-24 have been
    drinking
  • Sexual Violence
  • One in three rape victims have been drinking
  • Intimate Partner Violence
  • 1/3 of intimate partner violence committed
    under influence
  • of alcohol
  • Child Maltreatment
  • 44 of Childline calls for family members
    alcohol
  • problems also report physical abuse
  • Elder Abuse
  • Carers alcohol use key factor in elder abuse

World Health Organization Centre for Public
Health, 2006
35
Cultural Change
  • Safe.
  • Sensible.
  • Social.

36
Licensing Act 2003
  • Licensing Act 2003 aimed to
  • Reduce alcohol-related crime and disorder
  • Prevent public nuisance
  • Promote public safety
  • Protect children from harm
  • How?
  • Enhanced partnership working, increased
    flexibility
  • and increased powers
  • Internal venue design and town planning can also
    be used to combat nightlife problems.

37
Safer by Design
  • Inside
  • Adequate seating and Table space (cf.
  • vertical drinking)
  • Bar staff sight lines central, raised floor
  • Realistic attractive alternatives to alcohol
  • Trained Servers do not serve drunks
  • Trained Door Staff
  • Overall
  • Shared vision for nightlife

38
Possible Planning Involvement
39
Cheap Off-Licence Alcohol
  • Improved Night time bars and clubs
  • Off-licenses and Supermarkets
  • Promotions encouraging wholesale purchase of
  • large quantities
  • Alcohol is very cheap
  • Price and availability relates to consumption
  • Off-licensed sales as of total
  • 24.0 in 1980 34.8 in 2004

Bar 2.50 3.00 Supermarket 0.60
40
Night-Life, PreLoading
41
Nightlife Problems in last 12 months
Source Bellis et al 2007
42
Admission rates for alcohol related liver
disease in England
Females
Males
  • Most countries in southern Europe have shown a
    decline

(Leon McCambridge 2006)
43
Characteristics of people with ALD
Smith S et al (2006) Alcohol and Alcoholism, 41,
(3), 274-277
44
Risk of cirrhosis of the liver by alcohol intake
Women 3 units / day
Men 4 units / day
Source Corrao et al 2004
45
Alcohol Consumption and risk of disease
Source review of 150 studies, gt100,000 subjects
- Corrao et al 2004
46
Daily Consumption and Lifetime Risk of dying from
an Alcohol Related Disease
mgs of pure alcohol per night
Ignores risks associated with accidents, violence
and injury
Australian National Health and Medical Research
Council
47
Conclusions
  • Harm from alcohol is multiple, and the North West
    suffers disproportionately
  • Interventions that work include (international
    evidence)
  • Increasing price, amendments to drink driving
    legislation,
  • training for bar staff, brief advice,
    restrictions on availability
  • Need to address peoples perceptions (including
    health professionals)

48
Big Drink Debate
49
Thank You
Penny A Cook Reader in Public Health
Epidemiology p.a.cook_at_ljmu.ac.uk Centre for
Public Health Liverpool John Moores
University www.cph.org.uk
50
Identification and Treatment
Andy Mills Head of Partner Public Engagement,
Public Health, Wirral Primary Care Trust.
51
Problem? What Problem?
52
We need a plan
53
PCT Commissioned Alcohol Treatment Programme
54
Wirral Primary Care Trust Alcohol Service
Re-design Programme Evaluation 06/08 Charles
Gibbons Jim McVeigh
55
Alcohol Service Redesign Programme Evaluation
06/08.
  • Ensure agencies providing services for women and
    older people are fully aware of the problems of
    alcohol abuse and the impact this can have on
    individuals and families.
  • The provision of services to minority ethnic
    communities should be culturally sensitive
  • Ensure all data input is complete, up to date and
    entered correctly. All staff should collect and
    record data in the same way
  • Review the number of clients excluded from the
    offer of help and support from WAS by the current
    discharge referral pathways (Attendance and/or
    Admissions)

56
Alcohol Service Redesign Programme Evaluation
06/08.
5. WAS needs to address dna rates. 6. All
potential criminal justice clients should be
screened and appropriately referred 7. Increase
capacity to support the delivery of the programme.
57
Alcohol Service Redesign Programme Evaluation
06/08.
  • Reviewed processes with in APH so that all
    patients where alcohol may be an issue can be
    screened (using agreed tool)
  • All patients shown to be at risk will be given
    appointments
  • All patients that dna their appointments will be
    followed up
  • Extending numbers of screenings within primary
    care x 10
  • Developing social marketing campaign
  • Developing more ways into treatment
  • Web site, call centre

58
Alcohol Service Redesign Programme Evaluation
06/08.
  • Working with JMU to review data collection and
    reporting
  • Developing an urgent care response
  • Extend use of community detox
  • Increase capacity in daycare/aftercare

59
Alcohol and Drug related medical admission care
pathways at Wirral Hospital Trust
60
Nirvana Improving the client journey
Community Integration
Engagement (11444 p.a by 2010)
Completion
Treatment Delivery Inc Maintenance (2374 p.a)
Community Integration
61
Young People
Julia Hassall Head of Branch of Children and
Young Peoples Department, Wirral Council
62
Welcome
  • It is estimated that over 90 of the British
    population drink alcohol and the consumption of
    alcohol amongst young people has risen steadily
    in the last decade.
  • By the age of 13 years, most young people have
    experimented with the drug of popular choice
    alcohol.
  • Alcohol is the most widely used over the counter
    drug in the UK, it is associated with having fun
    and being sociable but for some people it may
    cost them their health, their family, their jobs,
    their homes and even their lives.

63
How Much Children Young People Drink
  • Most young people drink.
  • Young people are drinking more.
  • Young people are drinking more regularly.
  • Greater numbers are binge drinking and regularly
    getting drunk.
  • Drinking starts when children are in primary
    school.
  • Regular use of alcohol is starting younger.

64
Why do young people drink?
  • Chief Executive of Wirral PCT Chair of Wirral
    Drug and 12-13 year olds start tentatively
    experimenting with alcohol, usually within the
    family environment.
  • 14-15 year olds prefer to drink outside the
    family environment and are more secretive, hiding
    their behavior from their parents.
  • 16-17 year olds have moved on from
    experimentation and see themselves as more
    responsible drinkers, with an awareness of their
    own limits.
  • Drinking is also linked to image and
    self-definition.

65
Risks
  • Young people may be particularly at risk from the
    effects of alcohol for the following reasons  
  • Their bodies are still developing and the alcohol
    may disrupt this process
  • Their bodies are smaller and they are therefore
    more likely to be affected by smaller amounts of
    alcohol
  • Their bodies are not used to alcohol

66
Parents Drinking
  • Childrens attitudes and behaviors are initially
    shaped by families.
  • A sensible drinking example set by parents seems
    to be particularly important.
  • Living with a parent or parents with an alcohol
    problem can have a significant impact on a young
    person.
  • Significantly, the children of problem drinkers
    have more problems than children of non-problem
    drinkers
  • There is also evidence from some studies that
    children of problem drinkers have difficulties
    making the transition to adulthood.

67
Risk Factors
  • Poor parental supervision and discipline
  • Truancy from school
  • Disadvantaged neighbourhood
  • Early involvement in problem behaviour

68
Protective Factors
  • Strong bonds with family friends and teachers.
  • Healthy standards set by parents, teachers and
    community leaders.
  • Opportunities for involvement in families,
    schools and the community.
  • Social and learning skills to enable
    participation.
  • Recognition and praise for positive behaviour.

69
The Way Forward
  • Effective delivery of alcohol education in
    schools about the risks of drinking and getting
    drunk.
  • Increased awareness of parental drinking behavior
    as model for young people.
  • The development and evaluation of local education
    and diversionary activities.
  • Without criminalizing young people unnecessarily,
    licensing laws and regulations should ensure that
    age restrictions are effectively enforced.

70
Wirrals Alcohol Harm Reduction Strategy 2007
2010
Strategic Priority 1
71
Young Peoples Alcohol Misuse, priorities, aims
and actions
  • To ensure that young people, families, carers and
    professionals are provided with clear accessible
    information and education, to allow them to make
    informed choices about alcohol
  • To increase the number of professionals trained
    to address alcohol misuse amongst young people
  • To tackle, address and reduce alcohol related
    youth anti social behaviour

72
Young Peoples Alcohol Misuse, priorities, aims
and actions
4. To reduce the rate of alcohol related under 18
years teenage conceptions and Sexually
Transmitted Infections (STIs) 5. To reduce
admission and re-admission rates amongst young
people presenting at Wirral Hospital Trust as a
consequence of alcohol misuse  6. To improve
access into alcohol interventions and specialist
alcohol programmes for young people
73
Young Peoples Alcohol Misuse, priorities, aims
and actions
7. To secure compliance with relevant legislation
within the licensed trade and promote the
licensing objectives with a focus on young people
and alcohol misuse. 8. To address alcohol misuse
amongst young people within Criminal Justice
settings  9. To engage more young people in
diversionary activities as an alternative to
misusing alcohol 10. Develop and implement a
multi partnership performance management
framework to measure and monitor alcohol misuse
amongst young people
74
Action Plan Topics
  • Education, Information and Prevention
  • Training
  • Anti social behaviour
  • Sexual Health and Teenage Pregnancy
  • AE Pathways
  • Treatment and Delivery Services
  • Underage sales
  • Criminal Justice
  • Diversionary Activities
  • Performance Management

75
Delivery Organisations
  • Childrens and Young Peoples Department
  • Youth Service Response, Wirral Outreach team
  • Connexions Youth Offending Service
  • Wirral Joint Community Safety Team
  • Churches Action on Substance Misuse (CASM)
  • Wirral Primary Care Trust Wirral Hospital Trust

76
Delivery Organisations
  • Merseyside Police Trading Standards
  • Public Health Wirral CAMHS
  • Wirral DAAT Govt Office North West
  • Voluntary and Community Sector

77
Crime Disorder Communities
Phillip Davies Phillip Davies, Acting
Superintendent, Merseyside Police
78
Key Partners
  • Wirral DAAT
  • Merseyside Police
  • Wirral Primary Care Trust (NHS)
  • Wirral Borough Council
  • Wirral Joint Community Safety Team
  • Arch Initiatives
  • Probation
  • Wirral Alcohol Service
  • The Chamber of Commerce
  • The Crown Prosecution Service
  • Wirral Magistrates Court

79
Our Priorities
  • Ensure that all partners work together to tackle
    alcohol related crime
  • To reduce crime for which alcohol is a common
    cause particularly Domestic Violence, anti-social
    behaviour, Hate crime and crime involving weapons
    and theft
  • To ensure pubs, clubs and off-licences comply
    with the law
  • To support communities and vulnerable groups
    effected by alcohol
  • To develop a way of measuring the success of our
    activity

80
Alcohol fuels crime and disorder undermines
safer, stronger communities
  • Alcohol misuse makes it more likely that a person
    will commit an offence
  • Alcohol misuse makes it more likely that a person
    will become a victim of crime
  • Alcohol related crime disorder makes people
    feel less safe
  • Alcohol misuse undermines family stability
  • Alcohol misuse damages the economy and can lead
    to absenteeism, unemployment increases in
    benefit claims.

81
The Wirral Alcohol Intervention Programme (Wirral
AIP)
82
Why we did it
  • Clear links between alcohol and crime
  • 78 of all assaults are linked to alcohol misuse
    (Home Office 2006)
  • 63 of all incidents of domestic violence on
    Wirral have involved misuse of alcohol by the
    victim or offender (local audit)
  • Over 2000 alcohol related arrests (adults) made
    on the Wirral every year (Wirral BCU Audit 2007)
  • Alcohol related crime/disorder a key community
    concern (Wirral BCU KIN surveys)
  • Similar schemes elsewhere in the country have
    reported up to 50 reductions in offending rates.
    Independent studies have also shown that those
    engaged have learnt to drink more safely and
    sensibly.
  • The Wirral Drug Intervention Scheme (using
    similar processes to the AIP) has been highly
    successful locally.

83
What we did
  • Used the Criminal Justice System to compel
    offenders to attend intervention/treatment
    sessions
  • Funded employment of CJS alcohol specific workers
    to work at Wirral Custody Suite and within key
    treatment providers
  • Created the opportunity for intervention at key
    points along the criminal justice pathway.

84
(No Transcript)
85
Outcomes
40 Conditional Cautions for alcohol (highest
performance in Merseyside) 86 Custody Suite
based alcohol interventions as part of bail
conditions other police processes (highest
performance in Merseyside) 76 Alcohol Treatment
Referrals made by Probation to Wirral Alcohol
Service (exceeded performance target for 2007-08)
86
Thank you
Any Questions?
87
Drama Production
The Wright Stuff - Theatre Production Team
88
Facilitated Workshops
  • Young Peoples Alcohol Misuse
  • Crime, Disorder Communities
  • Identification and Treatment

89
Plenary Sessions
90
Thank you
Any Questions?
91
Drama Production
The Wright Stuff - Theatre Production Team
92
Facilitated Workshops
  • Young Peoples Alcohol Misuse
  • Crime, Disorder Communities
  • Identification and Treatment

93
Plenary Sessions
94
Thank you
Thank you for participating in this conference
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