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					Turning The Corner With Alcohol ?


The Scottish Experience with
- Prevention
- Treatment
- Policy

Peter Rice,
Consultant Psychiatrist, NHS Tayside
Vice Chair, Alcohol Focus Scotland
The Scots – A Peaceable People
We Travel Round The World Making Friends
We Have A Noble Tradition in Medicine
Alcohol Related Deaths in Scotland 1980 - 2003




                                                  ISD
                                            ISD 2005 2005
Liver Cirrhosis Death Rates 1950 – 2006 :
An International Comparison
SCOTTISH ALCOHOL HARM or INTOXICATION ADMISSIONS:
            THE AGE and GENDER PROFILE
UK Alcohol Consumption
INTERNATIONAL TRENDS IN ALCOHOL CONSUMPTION
                    1990      2002
Consumption in pure litres of alcohol per head total population

Ireland                                     7.6                   10.8

UK                                          7.7                   9.6

Netherlands                                 8.1                   8.0

Belgium                                     9.9                   7.9

Austria                                     10.4                  9.2
New Zealand                                 8.8                   6.9
Australia                                   8.5                   7.3


                                                                         World Drink Trends 2004
Male Cancer Deaths in Scotland 2007 - 1997
SUICIDE IN SCOTLAND

   THE CONFIDENTIAL ENQUIRY


•Suicides identified from General
Registrar Office of Scotland

•NHS Boards identify those in contact
with services in previous 12 months

•Detailed questionnaire to Consultant
Psychiatrist. (97-100% return rate)

•Data analysed by Confidential Enquiry
team at University of Manchester

•First published analysis of Scotland only
data in June 2008
Suicides in Scotland 1998-2005

Rates of Substance Misuse


Alcohol Dependence 17%
Drug Dependence     9%


Alcohol Misuse      58%
Drug Misuse         39%
•“It is likely that alcohol and
drugs lie behind Scotland’s higher
rates of suicide and
homicide.”


•“Our findings support the view
that alcohol and drugs are the
most pressing mental health
problems in Scotland”
                 Alcohol and Violence
      Drink/drug status of accused persons (where known)
              in homicide cases, Scotland, 2004/05



           Neither drunk
           nor on drugs,
                28%                        Drunk
                                            46%
           Drunk & on
           drugs, 10%
                 On drugs, 15%

                                               Source: Scottish Executive




+ in 60% of violent incidents (2000-04) victims believed
perpetrators under influence of alcohol
                                      Alcohol and Offending

                          Prisoners in Scottish prisons and alcohol, 2005

             45%
                         40%
             40%
                                         34%
             35%
                                                       30%
             30%
                                                                        26%
Percentage




             25%                                                                             23%
                                                                                                              20%
             20%

             15%

             10%

             5%

             0%
                   Drunk at time of   Drinking a     Affected      Affected their   Drunk alcohol in Affected ability
                       offence        problem on   relationships      health          the morning    to hold down a
                                        outside     with family                                            job
                                                                                    Source: Prisoner survey
 Child Protection and Parental Substance Misuse

 Of all 109 children on CP Register in a Scottish Council in 2007.

   -65% with identified parental substance misuse.

          1/3 Drugs only. Mainly paternal use.
          1/3 Alcohol only. Mainly maternal or both parents use.
          1/3 Drugs and Alcohol


Commonly associated with Domestic Violence.
Children registered due to Physical Neglect (60%)
                           Emotional Abuse (35%)
    Fragmenting Scotland’s
   Cohesion – total cost 2.25bn
Healthier                   Safer &
• 11% of A&E                 Stronger
• 1 death every 6           • 45% of prisoners
  hours                     • 65% of homicides



Wealthier                   Smarter
& Fairer                    • >65,000 children
                            • 1 in 3 divorces
• £820m productivity loss
                            • 40% of 15yr olds &
                              15% of 13yr olds
                        ALCOHOL: No Ordinary Commodity

Measure                                   Effect

Pricing                                   High

Availability                              High
- Age limit
- Outlet Density


Safer Drinking                            Mid
- Sever training
- Safer glasses


Treatment                                 Mid
- Brief Interventions


Regulating Ads                            Low
& Promotions

Information                               Low
- Schools
- Product Labelling

                                          WORLD HEALTH ORGANISATION 2003
Relationship between price and alcohol consumption in UK 1960-2002
   THE ARITHMETIC

36 cans Tennents Lager for £ 15

36x440mlx4% = 634 ml alcohol

63 UK units for £15

10mls alcohol for 24 pence


1 Standard NZ drink for $ 0.74
Ban sale of cheap alcohol,
Tesco urges Brown
Britain's biggest supermarket will call on Gordon
Brown today to introduce new laws to ban the sale
of cut-price alcohol amid growing concern over the
level of drink-fuelled crime and disorder.

Tesco said there was now a need for legislation to
"ensure responsible pricing on alcohol", but urged
the Government to take the lead.
Competition laws prevent it from discussing an
industry-wide alcohol price increase with its rivals,
but the supermarket said it would support a
mandatory rise.




                                   February 21st 2008
    Population Approach                       High Risk Approach


- Overall reduction of consumption   - Promotes responsible alcohol use

-Target is whole population          - Targets segments of the population

- National action                    - Local solutions

- Regulation and legislation         - Information on products and harm

- Wider public interest              - Personal choice and responsibility

- Wide range of outcomes             - Specific targets
                                     (Binge drinking, Drink Driving)

- Early interventions                - Treatment for dependence

- Leadership                         - Partnership
    The Licensing Objectives

- Prevention of Crime and Disorder
- Securing Public Safety
- Preventing Public Nuisance
- Protecting and Improving Public Health
- Protecting Children from Harm.
          What do we expect?

•   Reduced consumption and harm
•   More responsible retailing
•   Licensing policies to suit area
•   Public engagement in process
•   Fairness
        HEALTH IMPROVEMENT TARGETS 2008

- Coronary Heart Disease
- Children’s Dental Care
- Childhood Obesity
- Suicide Prevention
- Smoking Cessation
- Breastfeeding and…….

Achieve agreed number of screenings using the
setting-appropriate screening tool and appropriate
alcohol brief intervention, in line with SIGN 74
guidelines by 2010/11
                 A TARGETED SCREENING APPROACH

- 19% of adult population, c 800,000 seen in Primary Care with target
presentations

                                               % pop seen per year
    •Mental health problems (depression)                         4.9%
    •Anxiety related problems                                    5.1%
    •Fatigue/malaise/ dizziness                                  4.6%
    •All injuries                                                7.2%
    •GI presentations (including gastritis, ulcer, pancreatitis) 0.5%
    •Alcohol and/or substance misuse                             1.5%

- 25% of those screened by FAST are positive

- 75% receive Brief Intervention

- Potential number in A&E, general hospital and Ante Natal settings, c
135,000 will compensate for number missed in Primary Care.
            WHERE’S THE MONEY ??
Investment of £125m over 3 years.

First call on the additional funding should be to enable
NHS Boards to meet these targets, and for brief
interventions to become part of the standard services
offered by NHS Scotland.

We anticipate that considerable work will be required in
2008/09 to establish delivery arrangements and build
capacity across the priority settings of

- Primary Care,
- A&E
- Ante natal
- Acute Care
- Deprived populations
Alcohol Problems – A Continuum
Alcohol Interventions – A Continuum




                                Screen
                                & BI
1 UK Drink
is 10 mls
of alcohol

250ml beer
80ml wine
A Stepped Care
Approach:

SBI in a Care
Pathway
SCOTTISH GOVERNMENT PUBLIC HEALTH ALLOCATIONS 08/09



 Increased screening for alcohol misuse will have a knock-on
 effect on the volume of downstream services required. As a
 consequence the overall package delivers a considerable
 uplift in funding for early intervention and treatment
 (including support for newly identified dependent drinkers),
 and for prevention activities.

 Where appropriate, services should comply with guidance
 contained in the Health Technology Assessment Report 3
 on Prevention and Relapse in Alcohol Dependence.
                Cost Effectiveness
Recent studies suggest that alcohol treatment has both short
and long-term economic benefits.

The Review of the effectiveness of treatment for alcohol
problems suggests that provision of alcohol treatment to 10
per cent of the dependent drinking population within the UK
would reduce public sector resource costs by between £109
million and £156 million each year.

Analysis from the United Kingdom Alcohol Treatment Trial
suggests that for every £1 spent on alcohol treatment, the
public sector saves £5.
Scottish Strategy 2008
      SCOTTISH GOVERNMENT PROPOSALS 2009

- A Minimum Price for Alcohol
   (Example of 40p per unit / $1.20 per NZ standard drink)

- No discounts for multiple purchase. (3 for 2, 20 for 12)


- Age limit of 21 in off sales.


- Social responsibility fee from industry for city centre
management.


- More support and treatment.

				
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