Turning The Corner With Alcohol

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• Turning The Corner With Alcohol ?
• The Scottish Experience with
• Prevention
• Treatment
• Policy

Peter Rice, Consultant Psychiatrist, NHS Tayside
Vice Chair, Alcohol Focus Scotland
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The Scots A Peaceable People
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We Travel Round The World Making Friends
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We Have A Noble Tradition in Medicine
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Alcohol Related Deaths in Scotland 1980 - 2003
ISD 2005
ISD 2005
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Liver Cirrhosis Death Rates 1950 2006 An
International Comparison
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SCOTTISH ALCOHOL HARM or INTOXICATION
ADMISSIONS THE AGE and GENDER PROFILE
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UK Alcohol Consumption
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INTERNATIONAL TRENDS IN ALCOHOL
CONSUMPTION 1990
2002 Consumption in pure litres of alcohol per
head total population
Ireland 7.6 10.8
UK 7.7 9.6
Netherlands 8.1 8.0 Belgium 9.9 7.9 Au
stria 10.4 9.2
New Zealand 8.8 6.9 Australia 8.5 7.3
World Drink Trends 2004
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Male Cancer Deaths in Scotland 2007 - 1997
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• SUICIDE IN SCOTLAND
• THE CONFIDENTIAL ENQUIRY
• Suicides identified from General Registrar Office
  of Scotland
• NHS Boards identify those in contact
• with services in previous 12 months
• Detailed questionnaire to Consultant
• Psychiatrist. (97-100 return rate)
• Data analysed by Confidential Enquiry
• team at University of Manchester
• First published analysis of Scotland only data in
  June 2008

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Suicides in Scotland 1998-2005 Rates of
Substance Misuse Alcohol Dependence 17 Drug
Dependence 9 Alcohol Misuse
58 Drug Misuse 39
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• It is likely that alcohol and drugs lie behind
  Scotlands higher rates of suicide and
• homicide.
• Our findings support the view
• that alcohol and drugs are the most pressing
  mental health problems in Scotland

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Alcohol and Violence
in 60 of violent incidents (2000-04) victims
believed perpetrators under influence of
alcohol
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Alcohol and Offending
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Child Protection and Parental Substance Misuse

• Of all 109 children on CP Register in a Scottish
  Council in 2007.
• 65 with identified parental substance misuse.
• 1/3 Drugs only. Mainly paternal use.
• 1/3 Alcohol only. Mainly maternal or both parents
  use.
• 1/3 Drugs and Alcohol
• Commonly associated with Domestic Violence.
• Children registered due to Physical Neglect
  (60)
• 
  Emotional Abuse (35)

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Fragmenting Scotlands Cohesion total cost
2.25bn

• Healthier
• 11 of AE
• 1 death every 6 hours

• Safer Stronger
• 45 of prisoners
• 65 of homicides

• Wealthier Fairer
• 820m productivity loss

• Smarter
• gt65,000 children
• 1 in 3 divorces
• 40 of 15yr olds 15 of 13yr olds

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MeasurePricingAvailability - Age limit-
Outlet DensitySafer Drinking- Sever training-
Safer glassesTreatment- Brief
InterventionsRegulating Ads
PromotionsInformation- Schools- Product
Labelling
ALCOHOL No Ordinary Commodity

• Effect
• High
• High
• Mid
• Mid
• Low

WORLD HEALTH ORGANISATION 2003
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Relationship between price and alcohol
consumption in UK 1960-2002
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THE ARITHMETIC 36 cans Tennents Lager for
15 36x440mlx4 634 ml alcohol 63 UK units
for 15 10mls alcohol for 24 pence 1 Standard
NZ drink for 0.74
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Ban sale of cheap alcohol, Tesco urges
Brown Britain's biggest supermarket will call on
Gordon Brown today to introduce new laws to ban
the sale of cut-price alcohol amid growing
concern over the level of drink-fuelled crime and
disorder. Tesco said there was now a need for
legislation to "ensure responsible pricing on
alcohol", but urged the Government to take the
lead. Competition laws prevent it from discussing
an industry-wide alcohol price increase with its
rivals, but the supermarket said it would support
a mandatory rise.
February 21st 2008
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• Population Approach High Risk
  Approach
• - Overall reduction of consumption - Promotes
  responsible alcohol use
• Target is whole population -
  Targets segments of the population
• National action - Local solutions
• - Regulation and legislation - Information on
  products and harm
• Wider public interest - Personal
  choice and responsibility
• Wide range of outcomes - Specific targets
• (Binge drinking, Drink Driving)
• Early interventions - Treatment for
  dependence
• Leadership - Partnership

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The Licensing Objectives - Prevention of Crime
and Disorder - Securing Public Safety -
Preventing Public Nuisance - Protecting and
Improving Public Health - Protecting Children
from Harm.
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What do we expect?

• Reduced consumption and harm
• More responsible retailing
• Licensing policies to suit area
• Public engagement in process
• Fairness

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HEALTH IMPROVEMENT TARGETS 2008

• - Coronary Heart Disease
• Childrens Dental Care
• Childhood Obesity
• Suicide Prevention
• Smoking Cessation
• Breastfeeding and.
• Achieve agreed number of screenings using the
  setting-appropriate screening tool and
  appropriate alcohol brief intervention, in line
  with SIGN 74 guidelines by 2010/11

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• A TARGETED SCREENING APPROACH
• - 19 of adult population, c 800,000 seen in
  Primary Care with target presentations
• pop seen per year
• Mental health problems (depression) 4.9
• Anxiety related problems 5.1
• Fatigue/malaise/ dizziness 4.6
• All injuries 7.2
• GI presentations (including gastritis, ulcer,
  pancreatitis) 0.5
• Alcohol and/or substance misuse 1.5
• - 25 of those screened by FAST are positive
• - 75 receive Brief Intervention
• - Potential number in AE, general hospital and
  Ante Natal settings, c 135,000 will compensate
  for number missed in Primary Care.

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WHERES THE MONEY ??

• Investment of 125m over 3 years.
• First call on the additional funding should be to
  enable NHS Boards to meet these targets, and for
  brief interventions to become part of the
  standard services offered by NHS Scotland.
• We anticipate that considerable work will be
  required in 2008/09 to establish delivery
  arrangements and build capacity across the
  priority settings of
• Primary Care,
• AE
• Ante natal
• Acute Care
• Deprived populations

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Alcohol Problems A Continuum
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Alcohol Interventions A Continuum
Screen BI
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1 UK Drink is 10 mls of alcohol 250ml
beer 80ml wine
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A Stepped Care ApproachSBI in a Care Pathway
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SCOTTISH GOVERNMENT PUBLIC HEALTH ALLOCATIONS
08/09
Increased screening for alcohol misuse will have
a knock-on effect on the volume of downstream
services required. As a consequence the overall
package delivers a considerable uplift in funding
for early intervention and treatment (including
support for newly identified dependent drinkers),
and for prevention activities. Where
appropriate, services should comply with guidance
contained in the Health Technology Assessment
Report 3 on Prevention and Relapse in Alcohol
Dependence.
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Cost Effectiveness
Recent studies suggest that alcohol treatment has
both short and long-term economic benefits. The
Review of the effectiveness of treatment for
alcohol problems suggests that provision of
alcohol treatment to 10 per cent of the dependent
drinking population within the UK would reduce
public sector resource costs by between 109
million and 156 million each year. Analysis
from the United Kingdom Alcohol Treatment Trial
suggests that for every 1 spent on alcohol
treatment, the public sector saves 5.
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Scottish Strategy 2008
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• SCOTTISH GOVERNMENT PROPOSALS 2009
• A Minimum Price for Alcohol
• (Example of 40p per unit / 1.20 per NZ
  standard drink)
• No discounts for multiple purchase. (3 for 2, 20
  for 12)
• Age limit of 21 in off sales.
• Social responsibility fee from industry for city
  centre management.
• More support and treatment.

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