Alcohol screening and brief interventions in primary care Dr Richard Watson

NHS Health Scotland © NHS Health Scotland

NHS Health Scotland © NHS Health Scotland Burden of disease and disability 3rd greatest risk factor for disease and disability. 4% of worldwide deaths attributed to alcohol Screening and ABI considered 1 /7 effective ways to tackle the problem Scotland’s CMO has added alcohol liver disease to the list of Scotland’s ‘big killers’ alongside heart disease, stroke and cancer, emphasising the scale and seriousness of the problem we are now facing.

NHS Health Scotland © NHS Health Scotland Global drinking and European drinking, –6 litres 6–9 litres 9–12 litres 0–3 litres 12–15 litres 15–25 litres Per capita alcohol consumed in litres of pure alcohol, 2005 Averages 2004–2006 for Comparative Risk Assessment WHO Global Information System on Alcohol and Health (GISAH)

NHS Health Scotland © NHS Health Scotland Patterns of consumption 2005 Least risky = regular drinking, often with meals and without infrequent heavy drinking bouts Most risky = infrequent but heavy drinking outside of meals

NHS Health Scotland © NHS Health Scotland Alcohol Related Deaths 15 of the 20 local areas in the UK with highest male alcohol-related death rate are in Scotland: –Glasgow City –Inverclyde –West Dunbartonshire –Renfrewshire –Dundee City [ONS]

NHS Health Scotland © NHS Health Scotland Compared to Europe

NHS Health Scotland © NHS Health Scotland Alcohol Misuse impacts on Costs Scottish economy 3.56 billion per year – half of this due to absenteeism from work, dying young or illness caused by consumption. Physical health: the brain and nervous system; affect the immune system; harm bones, skin and muscles; cause fertility problems and impair foetal development, accidents, linked to cancers, & liver cirrhosis. Alcohol is a causal factor in 60 types of diseases and injuries and a component cause in 200 others. Mental Health: heavy drinkers are also more prone to anxiety, depression and suicide than moderate or non-drinkers. Affects non drinkers: drink driving, violence, child neglect and abuse, fires, accidents, relationships

NHS Health Scotland © NHS Health Scotland UK Alcohol Consumption Litres of pure alcohol consumption per capita RTD are alcohol pops

NHS Health Scotland © NHS Health Scotland Scale of the problem Drinking too much across all socio-economic and age groups around 50% of men and 30% of women drinking above weekly limits = 1.6m people in Scotland Industry data shows sales in 2007 enough for every man & women over 16 to exceed male guidelines every week of year no longer a marginal problem. Population-wide approach required.

NHS Health Scotland © NHS Health Scotland Causal factor 60 types of Disease & Injury & component in 200

NHS Health Scotland © NHS Health Scotland Alcohol Misuse impact HEALTH EDUCATION JUSTICE EDUCATION CRIME Child neglect HOUSING /FIRES EMPLOYMENT HEALTH

NHS Health Scotland © NHS Health Scotland Exceed alcohol limits by age group

NHS Health Scotland © NHS Health Scotland

NHS Health Scotland © NHS Health Scotland Alcohol related deaths by deprivation

NHS Health Scotland © NHS Health Scotland Scotland’s Alcohol Policy Achievement Brief Interventions Delivered in Primary Care, A&E and Antenatal Care (LES) £90 million new investment in Alcohol Treatment Licensing Act New Minimum Pricing Bill -(SWA challenge)

NHS Health Scotland © NHS Health Scotland Alcohol brief interventions

NHS Health Scotland © NHS Health Scotland Guidelines Weekly limits: –21 units for men –14 units for women Daily benchmarks: –3-4 units for men –2-3 units for women –with two alcohol free days per week –Pregnant women should avoid alcohol

NHS Health Scotland © NHS Health Scotland Why do brief interventions? Very good evidence that brief interventions are effective. Brief interventions in primary care can reduce total alcohol consumption and episodes of binge drinking in risky drinkers for periods lasting up to a year. The reduction in alcohol consumption is of the order of 15-35%. SIGN Guideline 74, 2003

NHS Health Scotland © NHS Health Scotland Why do brief interventions? Very brief or minimal (5-10 minute) interventions are as effective as longer ones. “The benefits of brief interventions in normal clinical settings are similar to those in research studies with greater resources.” Cochrane Review of Brief Interventions in Primary Care;

NHS Health Scotland © NHS Health Scotland References Final business and regulatory impact assessment for minimum price per unit of alcohol: – h/Services/Alcohol/minimum- pricing/Impact-Assessmenthttp:// h/Services/Alcohol/minimum- pricing/Impact-Assessment