1. Alcohol Problems and Treatment - An Overview Don Shenker Chief Executive

2. Impact of alcohol misuse

3. Impact of alcohol dependency on health services 1 in 4 acute male admissions are alcohol related In 11% of cases, alcohol is the main cause of men’s high blood pressure Alcohol is a factor in 48% of all violent crime At peak times 7 out of 10 people attending A&E have alcohol related problems Alcohol misuse costs the NHS £2.7 billion a year and totals £25Bn pa

4. Daily guidelines for sensible drinking: adults Recommended ‘sensible drinking’ = 2-3 units or less for women 3-4 units or less for men CMO recommends no alcohol for under 15s Department of Health

5. Units of alcohol 1 unit = half pint beer (3.5% alcohol) 1 unit = single spirits (25ml @ 40% alcohol) 1 unit = 1 glass wine (125 ml @ 8% alcohol) But these are now quite rare!

6. Government Categories Lower risk drinkers (who are at a low risk of alcohol-related illness) are defined as: Men who don’t regularly drink more than 3 to 4 units a day Women who don’t regularly drink more than 2 to 3 units a day Increasing risk drinkers (who are at an increasing risk of alcohol-related illness) are defined as: Men who regularly drink more than 3 to 4 units a day but less than the higher risk levels Women who regularly drink more than 2 to 3 units a day but less than the higher risk levels. Higher risk drinkers (who have high risk of alcohol-related illness) are defined as: Men who regularly drink more than 8 units a day or more than 50 units of alcohol per week Women who regularly drink more than 6 units a day or more than 35 units of alcohol per week

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8. Related health conditions Chronic Disorders Gastrointestinal Cardiovascular Neuropsychiatric conditions Cancers Admissions:34,000 -91,000 Acute Disorders Acute Toxic Effects Accidents and assaults Self-inflicted injuries Admissions:40,000- 60,000 Sources: DoH (1995), Gutjahr et al (2001), Britton and McPherson (2001)

9. Alcohol related crime Estimated 1.2m incidents of alcohol related violence 80,000 arrests for drunk and disorderly 19,000 sexual assaults related to alcohol 85,000 cases of drink driving 360,000 victims of alcohol related domestic violence Source: Strategy Unit Interim Analysis (2003)

10. Alcohol and the family Relationship breakdown Domestic violence and aggression Health impacts Poor parenting Unsafe sex Marriages twice as likely to end in divorce 1/3 of divorce petitions (W.H.O.) About 2m children affected by parental alcohol problem Between 30-60% child protection cases

11. FAST 1. MEN: How often do you have EIGHT or more drinks on one occasion? WOMEN: How often do you have SIX or more drinks on one occasion? 2. How often during the last year have you been unable to remember what happened the night before because you had been drinking? 3. How often during the last year have you failed to do what was normally expected of you because of drinking? 4. In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?

12. Cycle of change (Prochaska & DiClemente 1986)

13. Elements of brief advice: FRAMES Feedback about risks of substance use Responsibility placed on client to change Advice to cut down / abstain etc. Menu of options and choices Empathic approach Self-efficacy: using a non- confrontational counselling style which encourages & reinforces client’s strengths

14. Tier 1 Police/CSO A&E/Walk in Centre/Minor injuries Primary Care Housing Tier 2 Outreach Drop in services Assertive Outreach Specific advice & information services Tier 3 Tier 4 a&b Services that work with a wide range of clients Provide accessible alcohol specialist services for a wide range of alcohol misusers Solely for misusers in structured programmes of care Aimed at individuals with a high level of presenting need. Inpatient detox and stabilisation, residential rehab or residential crisis intervention Self-help groups Treatment services Care planned counselling Stepped Care Approach

15. Types of treatment Advice and information (Tier 2) Self-help groups (Tier 2) Care planning counselling (Tier 3) Structured day programmes (Tier 3) Community detoxification (Tier 3) Inpatient treatment (Tier 4) Residential rehabilitation services (Tier 4)

17. Thank You www.alcoholconcern.org.uk dshenker@alcoholconcern.org.uk Tel. 020 7264 0510