Is Alcohol a Problem? -Setting the Scene Eunice Reed Lead Psychologist, Substance Misuse Directorate, NHS Lothian

“ There is little doubt that alcohol consumption is continuing to increase across Scotland and that the health and social harms associated with this trend are positioning alcohol alongside obesity as the top public health concerns facing Scotland.” Dr Harry Burns, Scotland’s Chief Medical Officer, 2006

Alcohol Related Harm Scotland is 8th in the world for alcohol consumption per head of population People in Scotland drink 25% more alcohol per head of population than individuals in England and Wales There were 2372 alcohol related deaths in Scotland in 2005 – enough to fill 33 double decker buses Source: Alcohol Information Scotland

“Although life expectancy across Scotland as a whole is improving, the significant adverse impact on health of alcohol is now obvious. Mortality from cirrhosis of the liver amongst males in Scotland has overtaken that in other European countries including France which has had the highest rate for much of the 20th century.” Dr Harry Burns, Scotland’s Chief Medical Officer, 2006

Time trends in age-standardised mortality rates for liver cirrhosis per 100 000 by age-group, sex, and country between 1950 and 2002 (Lancet, 2006)

Scotland has a level of alcohol-related mortality much higher than that of the other UK countries, for both men and women. All the countries experienced a large increase during the 1990s and early 2000s, flattening off into the mid 2000s. Scotland has had the highest position throughout the period and the absolute differences between Scotland and the other countries have grown for both men and women. The relative difference has grown for men but not for women. This was a special analysis by the Office of National Statistics in 2007, using a consistent definition of alcohol-related mortality for the four countries.

A population approach Reduced alcohol consumption Culture change Delivery of alcohol brief interventions Improved treatment

What are the Implications of Delivering for Mental Health in Relation to Alcohol Use and Misuse? Commitment 4: We will increase the availability of evidence-based psychological therapies for all age groups in a range of settings and through a range of providers. Target 1: Reduce the annual rate of increase of defined daily dose per capita of anti-depressants to zero by 2009/10. Target 3: We will reduce the number of readmissions (within one year) for those that have had a hospital admission of over 7 days by 10% by the end of Commitment 13: We will translate the principles of Mind the Gap and A Fuller Life into practical measures and advice on what action needs to be taken to move the joint agenda forward and support joined-up local delivery by the end of 2007. . Commitment 7: Key frontline mental health services, primary care and accident and emergency staff will be educated and trained in using suicide assessment tools/ suicide prevention training programmes. 50% of target staff will be trained by 2010. Target 2: Reduce Suicides in Scotland by 20% by 2013. Commitment 8: Ensure that people are managed and cared for more effectively in the community and avoid inappropriate admissions by ensuring that the crisis standards are achieved by 2009.

Why should this concern all Psychological Therapists? 65% suicides are linked with excessive drinking 24%clients with a severe mental health problem also use substances problematically Anxiety can be a cause and effect of heavy drinking Withdrawal symptoms can be similar to symptoms of depression, anxiety and agitation

Changing Scotland’s Relationship with Alcohol – A framework for Action New strategy for Scotland published March 2009 (http://www.scotland.gov.uk/Publications/2009/03/04144703/0) Recovery Agenda

Workshop Aims To consider training needs of staff in mental health and substance misuse services in relation to psychological therapies To consider the issues raised by comorbidity both for Substance Misuse Services and also for Mental Health Services This includes primary care therapists