Alcohol Problems and Treatment -

An Overview

Don Shenker

Chief Executive

Impact of alcohol misuse

W orkplaceAbsentee ism , accidents

and perform ance

F inancia lexpense,

unem ploym ent e tc

Persona l SafetyR isky behaviour and

situation

H ealthphysica l health

and m enta l health

H ousingtenancy problem s,

com pla in ts e tc

C rim eG reater lik lihood of arrest,

drink driv ing anddom estic v io lence

Fam ily and F riendsR elationship problem s,

parenta l negligence,abusive behaviour

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

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

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!

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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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)

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)

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

FAST1. 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?

Cycle of change (Prochaska & DiClemente 1986)

Elements of brief advice:FRAMES

Feedback about risks of substance useResponsibility placed on client to

changeAdvice to cut down / abstain etc.Menu of options and choicesEmpathic approachSelf-efficacy: using a non-

confrontational counselling style which encourages & reinforces client’s strengths

Tier 1Police/CSO

A&E/Walk in Centre/Minor injuriesPrimary Care

Housing

Tier 2Outreach

Drop in services

Assertive Outreach

Specific advice & information services

Tier 3

Tier 4 a&b

Services that work witha wide range of clients

Provide accessiblealcohol specialist services for

a wide range of alcohol misusers

Solely for misusers instructured programmes

of care

Aimed at individuals with a highlevel of presenting need.

Inpatient detox and stabilisation,

residential rehab or residentialcrisis intervention

Self-help groups

Treatment services

Care planned counselling

Stepped Care Approach

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)

Thank You

www.alcoholconcern.org.uk

dshenker@alcoholconcern.org.uk

Tel. 020 7264 0510