The hardest hit: addressing the crisis in alcohol treatment services.

Alcohol Concern & Alcohol Research UK|May 2018 |The hardest hit: Addressing the crisis in alcohol treatment services

The report highlights how severe funding cuts, rapid re-tendering cycles, loss of qualified staff and lack of political support are impacting on some of the most vulnerable people in society. It also highlights the  need for action to ensure that treatment services do not enter a cycle of disinvestment, staff depletion, and reduced capacity.

Image source: alcoholconcern.org

Key findings from the report show:

• Only 12% of respondents felt that resources were sufficient in their area;
• Respondents reported cuts of between 10% and 58%, with one treatment provider saying local areas were ‘paring back to a skeleton service’;
• 59% of respondents felt that aspects of services in their area had worsened in the last three years, with particular threats to community detox and residential rehabilitation facilities;
• 62% of respondents said that in their area appropriate care is not available for people with both a mental health and an alcohol problem, with many told they must resolve their alcohol problems before they can access mental health services;
• Only 7% described the quality of engagement between JobCentre Plus and local alcohol services as ‘good’.

To address the issue, the report sets out several key recommendations, including:

• The Government must develop and implement a National Alcohol Strategy, with treatment at the heart of a broader suite of interventions to reduce alcohol harm.
• The Government must urgently plug the gap in treatment funding and reduce health inequalities arising from local funding structures. The report contains recommendations for how this might work.
• There must be a national review of commissioning of alcohol services, and the balance of staffing in the alcohol field.

  Source: Alcohol Concern 

A press release can be read here

The full report is available from Alcohol Concern 

Labelling drinks as being ‘low alcohol’ may increase alcohol consumption

University of Cambridge | April 2018 |Labelling alcoholic drinks as lower in strength could encourage people to drink more, study suggests

New research conducted as part of a collaboration between the Behaviour and Health Research Unit at the University of Cambridge and the Centre for Addictive Behaviours Research at London South Bank University has looked into the impact of labelling alcoholic drinks as low alcohol (via University of Cambridge)

The study was conducted in a laboratory designed to look like a bar involved over 260 participants who were randomly assigned to  taste-test drinks with different labels.  Those assigned to the first group were given drinks labelled as  ‘Super Low’ and ‘4%ABV’ for wine or ‘1%ABV’ for beer. In a different group the drinks were labelled ‘Low’ and ‘8%ABV’ for wine or ‘3%ABV’ for beer. In the final group participants taste-tested drinks labelled with no verbal descriptors of strength, but displaying the average strength on the market – wine (‘12.9%ABV’) or beer (‘4.2%ABV’).

Those in the sample, selected to represent the UK population, drank more alcohol if the label on the drink indicated lower alcohol strength.  This meant the mean consumption of drinks labelled ‘Super Low’ was 214ml, compared with 177ml for regular (unlabelled) drinks.
Senior author, Professor Theresa Marteau, said: “Labelling lower strength alcohol may sound like a good idea if it encourages people to switch drinks, but our study suggests it may paradoxically encourage people to drink more.”

ABV- alcohol by volume is the standard measure of how much alcohol is contained in a given volume of an alcoholic drink.

The full press release from the University of Cambridge can be read here 

Full reference:

Vasiljevic M, Couturier DL, Frings D, Moss AC, Albery IP, Marteau TM|  ‘Impact of lower strength alcohol labeling on consumption: A randomized controlled trial’| Health Psychology| DOI: 10.1037|hea0000622

Support to help at-risk children living with alcohol-dependent parents

Department of Health and Social Care | April 2018 | New support to help children living with alcohol-dependent parents

Jeremy Hunt has announced new plans to identify at-risk children and provide them with rapid access to support and advice. He said, “the consequences of alcohol abuse are devastating for those in the grip of an addiction- but for too long, the children of alcoholic parents have been the silent victims. This is not right, not fair. These measures will ensure thousands of children affected by their parent’s alcohol dependency have access to the support they need and deserve.”

As part of these plans, a £4.5 million fund has been promised to support at-risk children,  is for local authorities to develop plans that improve outcomes for children of alcohol-dependent parents. Steve Brine MP will have a specific responsibility for children with alcohol-dependent parents.

The measures include:

• fast access to support and mental health services for children and their families where there is a dependent drinker
• quicker identification of at-risk children, including those undertaking inappropriate care responsibilities
• the provision of outreach programmes to get more parents successfully through addiction treatment
• early intervention programmes to reduce the numbers of children needing to go into care

They are designed to help an estimated 200,000 children in England living with alcohol-dependent parents.

Further details are at the Department of Health and Social Care

Drinking 10 drinks a week reduces life expectancy by up to 2 years

Cambridge University | April 2018 | Drinking more than five pints a week could shorten your life, study finds

The latest edition of The Lancet includes research from Cambridge University that has been funded by NIHR, the British Heart Foundation and other partners. Dr  Angela Wood the lead author of the study said: “Alcohol consumption is associated with a slightly lower risk of non-fatal heart attacks but this must be balanced against the higher risk associated with other serious – and potentially fatal – cardiovascular diseases.”
The authors of the study found that an increased intake of alcohol  is associated with a higher risk of stroke, fatal aneurysm, heart failure and death (via Cambridge University).
The researchers found that intake of 10 or more alcoholic drinks per week was linked with one to two years shorter life expectancy.  For those drinking 18 or more drinks per week  life expectancy was around four to five years shorter. For this reason the authors  say their findings challenge the belief that moderate drinking is beneficial to cardiovascular health, and support the UK’s recently lowered guidelines on alcohol consumption. 

Summary

Background

Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

Methods

We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose–response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th–95th percentile 1·04–13·5]) from 71 011 participants from 37 studies.

Findings

In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking  greater than 0–less than or equal to 100 g per week, those who reported drinking more than 100– less than or equal to 200 g per week,  more than 200– less than or equal to 350 g per week, or  greater than 350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.

Interpretation

In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

The full article may be downloaded from The Lancet 

Full reference:
Wood, A, M., M et al. |Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies |The Lancet | Vol. 391| Issue 10129 | P. 1513 – 1523 | DOI: https://doi.org/10.1016/S0140-6736(18)30134-X

Related:

Cambridge University news release Drinking more than five pints a week could shorten your life, study finds

 

In the media:

BBC News  Regular excess drinking can take years off your life, study finds

 

‘Drunk tanks’

 The NHS England Chief Executive has announced that the NHS will decide in the coming year whether ’drunk tanks’ should routinely be used to take pressure off A&E departments and 999 ambulance services.  Supervised areas where revellers who have over-indulged can be checked, rather than being taken to A&E, are already used in some areas such as Newcastle, Bristol, Manchester and Cardiff.

Substance misuse services

This briefing looks at the quality and safety of clinics offering residential services for people withdrawing from drugs or alcohol | Care Quality Commission (CQC)

The Care Quality Commission has published Substance misuse services: the quality and safety of residential detoxification. This briefing examines the quality and safety of clinics offering residential services for people withdrawing from drugs or alcohol.  It outlines concerns identified during CQC inspections and gives an example of good practice, as well as actions and recommendations.

The briefing reported a number of concerns. Many of the clinics were not:

• assessing the risks to the safety of people prior to their admission following recognised national clinical guidance on treating people who are withdrawing from alcohol or drugs
• storing, dispensing and handling medicines
• appropriately carrying out full employment checks or sufficiently training their staff

The CQC also found that nearly three in four providers failed in at least one of the fundamental standards of care that everyone has the right to expect, whilst almost two-thirds of providers were not meeting the requirement for providing safe care and treatment.

Full briefing: Substance misuse services: the quality and safety of residential detoxification

 

Alcohol policy and older people

The International Longevity Centre UK has published Calling Time: addressing ageism and age discrimination in alcohol policy, practice and research.  This report examines ageism and age discrimination in alcohol policy, practice and research.  It also contains research on age discrimination legislation and policy in the UK and includes examples of positive practice.