1. YOUNG PEOPLE, SEX AND ALCOHOL, CAN HEALTH ADVISERS HELP WITH THE HANGOVER? RICHARD BETOURNAY

2. DIONYSUS GREEK GOD OF WINE AND ECSTACY RITUAL GATHERINGS KNOWN AS ORGIES

3. Sex and Alcohol..... is there a link? Little Evidence British Youth Council Survey, 68% believe link between drinking and unprotected or regretted sex 50% report sex later regretted, half of these think drinking before hand a factor. British Youth Council 2009 No interlinking between UK Sexual Health Strategy and UK Alcohol Harm Reduction Strategy

4. Government Strategy In 2007 launched “Safe sensible and sociable” next steps in national strategy targeting: Under 18 year olds 18-24 binge drinkers Higher risk drinkers

5. Youth Drinking in the UK

6. Children’s Attitudes 43% Think older people drink alcohol to look cool 30% think wine drinkers have 5 or more glasses per night 30% think binge drinking is normal. 3 in 5 think people drink to forget problems Life Education UK Survey of attitudes of 9-11 year olds 2008

7. Why do young people drink? The same reasons as every one else does-to have fun, to relax, to socialise and feel more outgoing

8. Quotes from Rochdale Study “ if someone says why did you do such a thing then you can say because i was pissed, and yes you have got a reason (female). “You don’t know if they really want it when your drunk”(male) “helps you feel good about yourself” (female).

9. Rochdale Study Alcohol seen as playing both positive and negative roles in relation to sex. To have a laugh emerges as most common reason for drinking. Negotiating consent is seen as very difficult by effects of alcohol. A third of respondents cite confidence as a benefit of drinking alcohol before having sex Redgrave and Limmer 2006

10. Economics for young people

11. Trends of Alcohol Consumption in Young People

12. Summary of Southampton Study 520 GU attendees questioned 86% 0f GU attendees exceed government limits, 54%in GHS Clinic attendees binged alcohol, average of 13 units on usual night and 26 on a heavy night 32% thought alcohol played part in clinic visit 77% had been drinking before sex with a new partner In women reporting pregnancy - 55% said unwanted pregnancy and 28% of those reported drinking before UPSI Standerwick et al 2006.

13. Where are we at now? and... Who said what? ‘Alcohol is a problem for society, quite simply England has an alcohol problem’. ‘Deeply ingrained drinking culture costs NHS £2.7 Billion a year’. ‘We don’t want the responsible drinkers to have to pay more or suffer as a result of the excesses of a minority’. ‘Increased alcohol duty would be unpopular as many were struggling with their finances as result of the recession’.

14. Where do sexual health services fit in?

15. Opportunities to influence risk behaviour STI clinics are well placed to identify substance use and offer onward referral if necessary. Patten et al 2008 Young people must be able to access advice on how to make choices to avoid unprotected, unsafe or regrettable sexual experiences, this advice must include information on how to avoid drinking leading to unprotected, unsafe or regrettable sex. British youth council report 2009.

16. Making the most of “The teachable Moment.” A time when a person is most receptive to learning something or particularly responsive to being made aware. Can not be created, may be combined with different emotions. Has a “half life” delay between identification and intervention must be kept to a minimum. Williams et al 2004.

17. Screening for hazardous and harmful drinking SASQ Single Alcohol Screening Question. When was the last time you had more than x units in one day Never/ More than 12 months ago, 3- 12 months ago, within past 3 months Within past 3 months = positive response. Sensitivity and specificity =86% for detecting hazardous drinking in past 3 months or alcohol disorder in last year.

18. What is brief alcohol intervention? “The giving of information, advice and encouragement to the patient to consider the positives and negatives of their drinking behaviour, plus support and help to the patient if they decide they want to cut down on their drinking “Brief interventions are usually “opportunistic”- that is they are administered to patients who have not attended a consultation to discuss their drinking. Make use of “Teachable moments” Alcohol Harm reduction strategy for England

19. Features of Brief interventions A family of interventions ranging from a few minutes simple but structured advice to 20 minutes counselling.

20. Style of brief advice Similar to motivational interviewing Stages of change, help think about initiating and maintaining new patterns of healthy behaviour Empathic and non judgemental Work with ambivalence, patient may not have been expecting discussion about alcohol issues.

21. Rationale for screening and brief interventions Early intervention and secondary prevention of medical and social harm. Public health improvements. Reduce costs to health service. Evidence of effectiveness 56 trials of effectiveness, mainly in primary care. Number Needed to treat (NNT) rate of 8-12

22. Training and Information www.alcohollearningcentre.org.uk Alcohol Identification and Brief advice Online E learning DOH approved package Supported by RCN, RCP, RCGP.

23. Conclusions Health advisers have transferable skills to provide effective brief interventions. Intervention possible at “teachable moments” Need multi faceted approach, Government, drinks industry, health care providers. Break the sexy-alcohol link, helping young people to explore costs and benefits. Address sexual health and alcohol issues together.

24. If only I had listened to my Health Adviser !!!!!!!!!!!!!!!!!