Alcohol misuse (health and wellbeing needs in South Tyneside)

• The Chief Medical Officer (CMO) published new alcohol guidelines that state drinking any level of alcohol regularly carries a health risk for everyone. Men and women should limit their intake to no more than 14 units a week to keep the risk of illness like cancer and liver disease low.
• Most people have heard of units of alcohol and the sensible drinking message. However, evidence shows that people do not always understand what constitutes a unit; it is difficult to keep track of units (principally because the more a person drinks the less reliable their recollection is). Therefore many people could be drinking more than they think and results in less accurate assessments of the levels of drinking in a population.

• 14 units equal:
  • 6 pints of 4% beer
  • 6 (175ml) glasses of 13% wine
  • 14 glasses of (25ml or one shot) of 40% spirits
• Both men and women are advised to have at least two alcohol free days a week and spread drinking evenly over three or more days.
• Evidence shows that there were almost 24,000 alcohol-related deaths in England, an increase of 1.3% since 2015. Deaths from alcohol-specific conditions increased by 2.1% to 16,196 in 2014 to 2016 compared to the previous 3 year period. The rate of alcohol-specific deaths increased by 1% in the latest 3 year time period to 10.4 per 100,000 in the population (LAPE)
• 10.8 million adults in England are drinking at levels that pose some risk to their health (GOV.UK: Health matters: Harmful drinking and alcohol dependence)
• An analysis of 67 risk factors and risk factor clusters for death and disability found that alcohol is the third leading risk factor for death and disability after smoking and obesity.
• Alcohol dependence can be a long-term condition, which may involve relapses even after good quality treatment. Dependent individuals also experience many health problems and are frequent users of health services.

• The short-term risks of alcohol misuse include:
  • Alcohol poisoning, which may include vomiting, seizures (fits) and unconsciousness;
  • Injuries requiring hospital treatment, such as a head injury;
  • Violent behaviour that might lead to being arrested by the police;
  • Unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs);
• Long-term alcohol misuse is a major risk factor for a wide range of serious conditions, such as:
  • high blood pressure
  • stroke
  • pancreatitis
  • liver disease
  • liver cancer
  • mouth cancer
  • head and neck cancer
  • breast cancer
  • bowel cancer  
  • depression
  • dementia 
  • sexual problems
  • infertility 

• As well as having a significant impact on your health, alcohol misuse can also have long-term social implications. For example, it can lead to:
  • family break-up and divorce
  • domestic abuse
  • unemployment
  • homelessness
  • financial problems

Age

• Among those aged 15 to 49 in England, alcohol is the now the leading risk factor for Ill-health, early mortality and disability and the fifth leading risk factor for ill-health across all age groups (Public Health England, 2016 Burden of alcohol).
• The ONS's new alcohol-specific deaths indicator accounts for around 80% of the deaths included in their alcohol-related deaths dataset. At the UK level in 2016 alcohol-related deaths totalled 9,214 compared to 7,327 alcohol-specific deaths.
• There are more hospital admissions related to alcohol consumption in the older age groups than in the younger age groups (2010 / 11).
• In England, the average age at death of those dying from an alcohol-specific cause is 54.3 years. The average death from all causes is 77.6 years.
• On average, teenagers drink twice as much now as they did in 1990.

• Children and adolescents are at increased risk due to:
  • Alcohol seriously impairing brain development in young people
  • Changes in physiological development;
  • Inexperience;
  • Experimentation and generally higher tolerance of risk;
  • Early exposure leading a greater chance of developing illness in later life;
• Children affected by parental alcohol misuse are more likely to have physical, psychological and behavioural problems. Alcohol plays a part in 25 to 33% of known cases of child abuse. Health Matters, 2016

• Older people are considered to be at increased risk due to:
  • Physiological changes (increased susceptibility);
  • The higher risk interaction with prescribed medication;
  • The stresses of ageing including the risk of isolation.

 Gender

• In England, alcohol dependence is more common in men (6%) than in women (2%). This gender difference is found to be the case all over the world and is one of only a few key gender differences in social behaviour.
• Levels of alcohol consumption vary with age and gender. Among men, the prevalence of drinking more than 14 units a week increases with age and is most common among men aged 65 to 74 years. Thirty-nine per cent of men this age drink at this level (Health Survey for England 2014)
• Among women, the proportion that drink more than 14 units a week declines between the ages of 25 and 44 years, and is the highest among women aged 55 to 64 years with 21 % of women this age drinking at this level. 
• For men and women, binge drinking, defined as exceeding eight units in one day for men and six units in one day for women, is highest in the youngest age groups, peaking in the 25 to 34 years group and then reduces with age. Nineteen per cent of men and 11 % of women were exceeding these daily values on at least one occasion in the previous week in 2014 (Health Survey for England 2014).
• The average weekly alcohol consumption is 16.4 units for men and 8.0 units for women.26% of men drink more than 21 units in an average week. For women, 18% drink more than 14 units in an average week.
• Men account for the majority of alcohol-related admissions (65%), which reflects a higher level of harmful drinking (higher risk) among men compared to women overall (stats on alcohol 2017, NHS digital).  Alcohol has been identified as a causal factor in more than 60 medical conditions, including circulatory and digestive diseases, liver disease, a number of cancers and depression.
• In 2013 - 2015 the incidence rate of alcohol-related cancer in men was 50.90 per 100,000 higher than the national rate of 39.29. Physiological differences mean that women may be at greater risk than men. Pregnant women are also generally identified as a population at risk. The Department of Health recommends that pregnant women, or women trying for a baby, should avoid alcohol altogether. The National Institute for Health and Clinical Excellence (NICE) advises that the risks of miscarriage in the first three months of pregnancy mean that it is particularly important for women not to drink alcohol at all during that period, If women do choose to drink, to minimise risk to the baby, the government's advice is to not have more than one to two units of alcohol once or twice a week, and not to get drunk. Miscarriage, stillbirth, premature birth, small birth weight, and Foetal Alcohol Spectrum Disorder (FASD) are all associated with a mother's binge drinking which means consuming more than six units on one occasion whilst pregnant.
• In relation to health, for every 100 admissions for alcohol attributable admissions in England South Tyneside can expect 149. This is the fifth highest alcohol related admissions rate in the country, and the third highest for females.
• The adverse effects of alcohol are common to both sexes. However, evidence suggests that many of these effects pose a greater risk to women's physical health at lower consumption levels than men.[1] The Royal Medical Colleges reported that studies conducted into alcohol-related harm in women were consistent in suggesting that the consumption level at which relative risk of mortality starts to rise is around 16 grammes of alcohol per day, or approximately 2 units. A woman will attain consistently higher blood ethanol concentrations than men following a standard oral dose of ethanol, regardless of body weight. This occurs primarily because their body water, and hence the compartment in which the ethanol distributes, is significantly smaller than in men.
• Later life poses unique issues surrounding alcohol for women. Older women have less lean muscle mass and continue to lose this with age, which makes them more susceptible to effects of alcohol. Similarly, the liver enzymes which process alcohol and medication lose effectiveness with age, and the central nervous system becomes more sensitive; this poses a greater problem for older women who drink, as older women tend to take more medication.
• In 2016, the UK Chief Medical Officers (CMO) published updated Low Risk Drinking Guidelines, based on an analysis from an expert group of the available evidence on alcohol's health effects. The CMO note that evidence produced since the previous drinking guidelines suggests that drinking alcohol increases women's breast cancer risk, that this risk starts from any level of alcohol consumption, and that this risk rises with alcohol consumption.

Mental health

• An estimated 44% of community mental health patients have reported problem drug use or harmful alcohol use in the previous year.
• There is a strong association between alcohol misuse and suicide. The National confidential inquiry into suicide and homicide by people with mental illness found that there was a history of alcohol misuse in 45% of suicides among the patient population during period 2002 to 2011 (Health Matters, 2016)

Socioeconomic and environmental factors and other determinants

• Alcohol kills people early and is a cause of health inequalities. Compared with those living in most affluent areas, people in the most deprived fifth of the country are 3 - 5 times more likely to die of an alcohol-specific cause.
• People of lower socioeconomic status show greater susceptibility to the harmful effects of alcohol (52) and are more likely to die or suffer from a disease relating to their alcohol use (53). In the English population, rates of alcohol-specific and related mortality increase as levels of deprivation increase (54) and alcohol-related liver disease is strongly related to the socioeconomic gradient (55) (Figure 11)
• Lower socioeconomic groups often report lower levels of average consumption, as shown by the decreasing lines in Figure 11. Yet experience greater or similar levels of alcohol-related harm. This is particularly true for mortality from chronic liver disease. This gives rise to what has been termed the 'alcohol harm paradox' whereby disadvantaged populations who drink the same or lower levels of alcohol, experience greater alcohol-related harm than more affluent populations. GOV.UK: Alcohol: Public health burden evidence review

• The following statistics are from a self-reported survey (ONS 2017 Adult drinking habits in Great Britain; 2005 to 2016):
  • As a proportion of the whole population, those in employment are most likely to drink at least once in the week (62%) leading up to interview. Economically inactive people (a group represented by students and the retired) are most likely to drink on at least five days in that week (12%), but are also most likely to abstain from drinking (30%). Unemployed drinkers are most likely to binge drink (39%) on the heaviest drinking day in the week. Institute of Alcohol Studies: Alcohol knowledge centre
  • Those in employment in the managerial and professional classes drink most frequently (12%). Although routine and manual workers are most likely to abstain from drinking (20%), they are also most likely to binge drink on the heaviest drinking day in the last week, highlighting a greater disparity in drinking behaviours compared with other workers.
  • There is a positive correlation between income and the frequency of alcohol consumption.
  • Low-income earners are also least likely to drink on at least five days in the week (7%); those on the highest incomes are most likely to do so (13%). Although the range is small (six percentage points), the proportion of drinkers who binge drank was lowest among low-income earners.
  • High levels of alcohol misuse are associated with clients who were unemployed and/or had difficulties with housing.

Impact of alcohol misuse on children and families

• Alcohol misuse impacts not just on the drinker but also those around them. Children affected by parental alcohol misuse are more likely to have physical, psychological and behavioural problems.
• Parental alcohol misuse is strongly correlated with family conflict and with domestic violence and abuse. This poses a risk to children of immediate significant harm and of longer-term negative consequences.
• In a study of 4 London boroughs, almost two-thirds of all children subject to care proceedings had parents who misused substances including alcohol.
• In a study of young offending cases where the young person was also misusing alcohol, 78% had a history of parental alcohol abuse or domestic abuse within the family.
• Alcohol misuse also affects carers and adult family members. The Care Act 2014 recognises this and recommends an assessment of their own needs.
• The impact of harmful drinking and alcohol dependence is much greater for those in the lowest income bracket and those experiencing the highest levels of deprivation.

Veterans

• It is difficult to know the number of veterans in the borough as the Ministry of Defence does not provide any formalised data on discharges. However, the Foresight Report tells us that there is 2 - 3 times the rate of binge drinking compared with civilians at risk and there is a correlation of alcohol and violent offences with 75% of violent offences amongst soldiers are alcohol-related.