Transcript Improving Health and Wellbeing UK

Reducing the costs from alcohol–related harm
Risk
Men
Women
Lower
Risk
No more than 3-4 units
per day on a regular
basis
No more than 2-3 units
per day on a regular
basis
Increasing
Risk
4 or more units per day
on a regular basis
3 or more units per day
on a regular basis
Higher
Risk
8 or more units per day
on a regular basis or 50+
units per week
6 or more units per day
on a regular basis or 35+
units per week
6.6m
15.8%
15%
26.3m
6.9m
60%
62.5%
16.5%
6.9m
16.5%
1.6m
3.8%
2.2m
5.2%
Source: General Household Survey 2009 & mid-2009 population estimates (ONS) & Adult Psychiatric Morbidity Survey 2007
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7% of all hospital admissions
◦ In 2009/10 there were around 1.1 million alcohol
related hospital admissions
◦ an increase of 12% compared with 2008/9.
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Up to 35% of all A&E attendance and
ambulance costs may be alcohol-related
◦ Up to 70% of A&E attendances at peak times on the
weekends (between midnight and 5am) may be
alcohol-related
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Alcohol misuse is calculated to cost the health
service £2.7bn per annum
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Between 15,000 and 22,000 premature deaths annually in
England and Wales each year
Nearly 5,000 (3.5%) cancer deaths per annum are attributable
to alcohol
◦ Cancers of the oral cavity and pharynx, larynx, oesophagus
and liver
◦ Suggestive but inconclusive data for role in rectal and breast
cancer
A severe risk of cardiovascular disease
◦ 1,200 associated deaths per year due to haemorrhagic
stroke
◦ 10% of deaths due to hypertension
Liver Cirrhosis is now the 5th most common cause of death
and continues to rise
◦ The top 4 conditions – HD, CVD, Chronic Lung Disease and
Cancer deaths are all falling.
◦ Alcohol accounts for 58% of all Liver Disease
◦ 4,500 deaths, a 90% increase over the past decade
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986,000 violent incidents in England and Wales in 2009/10, where the
victim believed the offender to be under the influence of alcohol (50% of
all violent crimes) (Flatley et al., 2010)
Nearly half of all offences of criminal damage are alcohol-related
alcohol is implicated in domestic violence, sexual assaults, burglary, theft
robbery and murder (Prime Minister‘s Strategy Unit, 2003)
In 2008 estimated 13,020 reported road casualties (6% of all road
casualties) occurred when someone was driving whilst over legal limit.
The provisional number of people estimated to have been killed in drinkdrive accidents was 430 in 2008 (17% of all road fatalities) (Department of
Transport, 2009)
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Approximately two thirds of male prisoners and over a third of female
prisoners are hazardous or harmful drinkers and up to 70% of probation
clients are hazardous or harmful drinkers (Singleton, et al., 1998)
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Identify those at risk
Deliver Brief Advice to those drinking at
increasing and higher risk
Refer Dependent Drinkers to Specialist
Services
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Opportunistic alcohol case Identification and
the delivery of Brief Advice (IBA)
is the same as
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Screening and Brief Interventions for alcohol
misuse (SBI)
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Alcohol risk levels can be quickly ascertained
using a simple screening tool
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Developed by WHO
Validated screening tool
High specificity (94%)
High sensitivity (92%)
Adapted version for the UK
Various shortened adaptations for prescreening
More accurate and economical than most
bio-chemical tests
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Feedback - provides feedback on the client’s
risk for alcohol problems
Responsibility - the individual is responsible
for change
Advice - advises reduction or gives explicit
direction to change
Menu - provides a variety of options for change
Empathy - emphasises a warm, reflective and
understanding approach
Self-efficacy - encourages optimism about
changing behaviour
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The recommended brief intervention is 5
minutes of advice developed by the WHO
In the UK, the University of Newcastle had
refined this into a programme called How
Much Is Too Much?
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Content
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Understanding units
Understanding risk levels
Knowing where they sit on the risk scale
Benefits of cutting down
Tips for cutting down
Benefits of cutting down
Physical
 Reduced risk of injury
 Reduced risk of high blood
pressure
 Reduced risk of cancer
 Reduced risks of liver
disease
 Reduced risks of brain
damage
 Sleep better
 More energy
 Lose weight
 No hangovers
 Improved memory
 Better physical shape
Psychological/Social/Financial
 Improved mood
 Improved relationships
 Reduced risks of drink
driving
 Save money
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Have an alcohol-free day once or twice a week
Plan activities and tasks at those times you usually drink
When bored or stressed have a workout instead of
drinking
Explore other interests such as cinema, exercise, etc.
Avoid going to the pub after work
Have your first drink after starting to eat
Quench your thirst with non-alcohol drinks before
alcohol
Avoid drinking in rounds or in large groups
Switch to low alcohol beer/lager
Avoid or limit the time spent with “heavy” drinking
friends
This is one unit...
1 very small
glass of
wine(9%)
Half pint of
regular
beer, lager
or cider
For more detailed information on calculating units see - www.units.nhs.uk/
1 single
measure of
spirits
1 small glass
of sherry
1 single
measure of
aperitifs
How many
units did
you drink
today?
...and each of these is more than one unit
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A pint of
regular
“regular”
beer, lager
or cider
A pint of
“strong”/
”premium”
beer, lager
or cider
Alcopop or a
275ml bottle
of regular
lager
440ml can
of “regular”
lager or
cider
440ml can
of “super
strength”
lager
250ml glass
of wine
(12%)
Bottle of
wine
(12%)
Risk
Men
Women
Common Effects
Lower Risk
No more than
3-4 units per
day on a
regular basis
No more than
2-3 units per
day on a
regular basis
Increased relaxation
Sociability
Reduced risk of heart
disease (for men over 40 and
post menopausal women)
Increasing
Risk
More than 34 units per
day on a
regular basis
More than 2-3
units per day
on a regular
basis
Higher Risk
More than 8
units per day
on a regular
basis or more
than 50 units
per week
More than 6
units per day
on a regular
basis or more
than 35 units
per week
Progressively increasing
risk of:
Low energy
•Memory loss
•Relationship problems
Depression
Insomnia
•Impotence
•Injury
•Alcohol dependence
•High blood pressure
•Liver disease
•Cancer
There are times when
you will be at risk even
after one or two units.
For example, with
strenuous exercise,
operating heavy
machinery, driving or if
you are on certain
medication.
If you are pregnant or
trying to conceive, it is
recommended that you
avoid drinking alcohol.
But if you do drink, it
should be no more than
1-2 units once or twice a
week and avoid getting
drunk.
Your screening score
suggests you are drinking
at a rate that increases
your risk of harm and
you might be at risk of
problems in the future.
What do you think?
The benefits of cutting down
What’s everyone else like?
% of Adult Population
Population by Risk Category
70.0%
60.0%
50.0%
40.0%
Male
Female
30.0%
20.0%
10.0%
What targets should you aim for?
0.0%
Abstaining Low er risk
Making your plan
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Psychological/Social/Financial
•Improved mood
•Improved relationships
•Reduced risks of drink driving
•Save money
Physical
•Sleep better
•More energy
•Lose weight
•No hangovers
•Reduced risk of injury
•Improved memory
•Better physical shape
•Reduced risk of high blood pressure
•Reduced risk of cancer
•Reduced risks of liver disease
•Reduced risks of brain damage
Increasing
risk
Higher risk
When bored or stressed have a
workout instead of drinking
Avoid going to the pub after work
Plan activities and tasks at those times
you would usually drink
When you do drink, set yourself a limit
and stick to it
Have your first drink after starting to
eat
Quench your thirst with non-alcohol
drinks before and in-between alcoholic
drinks
Avoid drinking in rounds or in large
groups
Switch to low alcohol beer/lager
Avoid or limit the time spent with
“heavy” drinking friends
Men
Should not regularly drink more than 3–4
units of alcohol a day.
Women
Should not regularly drink more than 2–3
units a day
‘Regularly’ means drinking every day or
most days of the week.
You should also take a break for 48 hours
after a heavy session to let your body
recover.
What is your personal target?
This brief advice is based on the “How Much Is
Too Much?” Simple Structured Advice
Intervention Tool, developed by Newcastle
University and the Drink Less materials originally
developed at the University of Sydney as part of a
W.H.O. collaborative study.
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There is a very large body of research evidence
56 controlled trials (Moyer et al., 2002) all have
shown the value of IBA
A recent Cochrane Collaboration review (Kaner et
al., 2007) shows substantial evidence for IBA
effectiveness
For every eight people who receive simple alcohol
advice, one will reduce their drinking to within
lower-risk levels (Moyer et al., 2002)
This compares favourably with smoking where only
one in twenty will act on the advice given (Silagy &
Stead, 2003)
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Staffing and staff attitudes
◦ Don’t have time
◦ Not my job
◦ Uncomfortable commenting on patient’s personal
life
◦ To close to home
◦ Don’t feel trained to intervene
◦ Don’t believe it will do any good
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Focus on dependence
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Not my job
◦ ‘Every contact counts’
◦ reduces problems caused by alcohol
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Training
◦ Less is more
◦ E-learning
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The SIPS study recently published findings
of three randomised control trials on IBA
using various screening tools, levels of
intervention and in three different settings.
◦ Primary Care
◦ A&E
◦ Probation
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In probation
 Training crucial
 Alcohol Health Worker support crucial
 Senior management buy in crucial
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But IBA can be equally effective in a nonhealth setting if adequately supported and
delivered by well trained practitioners
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IBA e-Learning module & Alcohol Learning Centre
http://www.alcohollearningcentre.org.uk/
NICE guidance
http://guidance.nice.org.uk/PH24
http://guidance.nice.org.uk/CG115
Primary Care Framework
http://www.pcc.nhs.uk/alcohol
SIPS Research Programme
http://www.sips.iop.kcl.ac.uk/index.php
Materials, Units Calculator and Drink Check
http://www.nhs.uk/LiveWell/Alcohol/Pages/
Alcoholhome.aspx
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